Pinched Nerve in the Neck: who to see and what helps

Pinched Nerve in the Neck · Kitchener, Waterloo & Cambridge

A pinched nerve in the neck, or cervical radiculopathy, is a nerve root squeezed or irritated where it leaves the spine, which sends pain, pins and needles or weakness down an arm. Most people improve within weeks without surgery. New arm weakness, numbness or pins and needles calls for an urgent appointment with a physician or nurse practitioner; once that is done, the first visit at CARESPACE is with a physiotherapist or a chiropractor.

What a pinched nerve in the neck is

Nerve roots leave the spinal cord through small openings between the neck bones and run on into the shoulder, arm and hand. When an opening narrows, or the root becomes inflamed, the arm that root supplies is affected. The seventh root (C7) is involved most often, then the sixth. It is most common in people in their early fifties.

Symptoms of a pinched nerve in the neck

• Pain in one arm, or sometimes both, often with neck pain. Arm pain is the most common symptom.
• Pins and needles in part of the arm or hand
• Numbness or changed sensation in part of the arm or hand
• Weakness in particular arm muscles, which only a minority of people notice

Pinched nerve, carpal tunnel or something else?

Several problems send symptoms into the same arm. Carpal tunnel syndrome is a nerve squeezed at the wrist: numbness in the thumb, index, middle and half the ring finger, without weakness higher up the arm. Rotator cuff tendinopathy is shoulder pain that can spread into the arm. Spinal stenosis in the neck matters most: when the spinal cord itself is squeezed, the signs are clumsy hands, trouble walking and urinary urgency. They need an urgent medical appointment, or a 911 call if they come on suddenly (see below). Our Herniated Disc page is about the lower back; in the neck, a herniated disc is one of the causes of a pinched nerve.

What causes a pinched nerve in the neck

• Age-related wear, the usual cause: enlarged joints and bone spurs narrow the opening the nerve root passes through.
• A herniated disc pressing on or inflaming the root.
• An injury, less often. After a collision, see Whiplash.

How a pinched nerve is diagnosed

The history and an examination of strength, reflexes and sensation can be enough, helped by tests that bring on the arm symptoms or relieve them, such as resting the hand of the sore arm on top of the head. A US review for family physicians advises an MRI when the spinal cord may be involved, when weakness persists or progresses, or after four to six weeks without improvement. It cautions that scans show wear in people with no symptoms and that MRI findings can mislead. Nerve conduction tests are not routine; they help when a nerve problem in the arm itself, such as carpal tunnel syndrome, is the likely alternative.

When a pinched nerve is an emergency

Call 911 for new problems walking, loss of bladder or bowel control, a sudden loss of coordination, for example with buttoning a shirt, or the signs of a stroke: a face that droops on one side, not being able to lift both arms and keep them up, or speech that is slurred or garbled. Do not wait for an appointment with us: nobody at CARESPACE can rule these out.

Go to an emergency department for neck or arm pain with a fever.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

Ask for an urgent appointment with a physician or nurse practitioner for severe neck pain that starts suddenly or is getting worse quickly, heaviness or weakness in your arms or legs, pins and needles in an arm together with neck or arm pain, or pain between your shoulder blades. This is the UK NHS’s urgent list, and its third item describes most pinched nerves: new arm symptoms should be assessed medically, and early. Weakness that is getting worse needs the same. So do hands that are slowly getting clumsier, balance that is slowly getting worse or a new, urgent need to pee, which can be signs of pressure on the spinal cord, and neck or arm pain with unexplained weight loss, pain at night or a history of cancer: a US review for family physicians says these require immediate workup. If you cannot get an urgent appointment, go to an emergency department.

What the evidence says about treating a pinched nerve in the neck

• Where this comes from. Ontario’s 2016 traffic-injury guideline, which covers neck pain with nerve signs in the first six months; a 2016 Canadian chiropractic guideline; Denmark’s 2017 national guideline for the first 12 weeks; and a 2016 US review for family physicians. The trial evidence is thin: the Danish authors call it “limited and of very low quality”. “May consider”, “suggest” and “weak” all tell you a panel was unsure, whatever the quality of the studies.
• Most people improve without surgery, usually within four weeks, and whichever non-surgical treatment is used.
• Supervised strengthening exercise is the one treatment Ontario’s guideline says clinicians may consider in the first three months: graded neck strengthening twice a week for six weeks, with home exercise and education. The Canadian chiropractic and Danish guidelines also back supervised exercise, as weak or good-practice recommendations.
• Information and staying active. Care should always include an explanation of how the condition usually runs and advice to stay active. Education should not be offered alone.
• Hands-on treatment. Manual therapy, alone or with exercise, is allowed in Denmark as a weak or good-practice recommendation, with a note that trial evidence for mobilization or manipulation in a pinched nerve is lacking. It is not among Ontario’s recommendations for neck pain with nerve signs.
• Traction, collars and laser: the guidelines differ. In Ontario, clinicians should not offer traction, a collar or low-level laser in the first three months. Denmark gives traction a weak recommendation. A US physiotherapy guideline says clinicians may provide exercises, laser and short-term use of a collar for recent symptoms, and should provide intermittent traction with exercise and manual therapy for chronic ones.
• Massage and acupuncture. Both have weak recommendations against them in Denmark for a recent pinched nerve.
• When it is not improving. Referral to a surgeon, or a steroid injection, is something to consider after four to eight weeks without improvement in the US review and after 8 to 12 weeks in Denmark, and promptly if weakness is progressing. In Ontario, people who still have nerve signs and disability after three months should be referred to a physician.

What a doctor may offer

CARESPACE does not provide these, but it helps to know where they fit.

• Medicines. Anti-inflammatories and muscle relaxants are commonly prescribed, on limited evidence, and Danish advice is that pain medicines should come only after careful consideration. A small trial found a short course of steroid tablets eased pain in the short term.
• An epidural steroid injection, whose risks include puncture of the spinal lining, infection and nerve root injury.
• Scans and a surgical opinion, on the timing above.

How each CARESPACE service treats a pinched nerve in the neck

Physiotherapy

A physiotherapist can test the strength, reflexes and sensation that each nerve root supplies, then supervise graded neck strengthening with a home program. Strength can be retested at each visit, because weakness that is progressing is the signal for a scan and a surgical opinion.

See our physiotherapy team →

Chiropractic

A chiropractor can do the same nerve examination and supervise the same strengthening program. For neck pain with nerve signs, the profession’s own Canadian guideline suggests graded strengthening exercise over advice alone and makes no recommendation on manipulation. Mobilization or manipulation has only weak support and little trial evidence here. On risk, that guideline did not review side effects itself; it cites research that about half of people treated with manual therapy can expect minor to moderate side effects and that the risk of major ones is small. So ask which technique is planned and what it is for.

See our chiropractic team →

Other services people ask about

Massage therapy and acupuncture. Both are recommended against, weakly, for a recent pinched nerve, and for massage there is only low-quality evidence in neck pain generally. Neither has support we can point to for this condition.

Where most people start

If arm weakness, numbness or pins and needles is new and nobody has examined it, ask for an urgent appointment with a physician or nurse practitioner first. After that, book with a physiotherapist or a chiropractor; both assess and treat at the first visit.

How your team works together

This is mainly one practitioner’s work: your physiotherapist or chiropractor sets and supervises the exercise. A physician or nurse practitioner comes in for scans, medicines, an injection or a surgical referral.

Browse by service: physiotherapists and chiropractors.

What to expect at your first visit

1. Where the symptoms run: which part of the arm and which fingers, and when it started.
2. Safety questions about walking, hand clumsiness, bladder control, fever, weight loss and any history of cancer. A yes to any of these means medical care comes first.
3. An examination of neck movement, arm strength, reflexes and sensation, with tests that bring on or ease the arm symptoms.
4. What it points to: a nerve root in the neck, a nerve at the wrist or elbow, or the shoulder.
5. Treatment that day, and a plan with strengthening exercises.

What you can do at home

• Stay active, and keep your neck moving.
• Do not wear a neck collar unless a doctor tells you to.
• Use a low, firm pillow, and put heat or cold packs on your neck.
• While your neck will not turn properly, do not drive or cycle.
• A pharmacist can advise on pain relief.
• Watch your grip and arm strength. Weakness that is getting worse needs an urgent medical appointment.

Outlook

Most people improve within about four weeks of non-surgical care. Four to six weeks without improvement is the usual point for a scan, and one to three months without improvement the point for a surgical opinion. How often it comes back is not a figure our sources give.

Pinched nerve treatment in Kitchener, Waterloo and Cambridge

Kitchener. Physiotherapy in Kitchener and Chiropractor in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Physiotherapy in Waterloo and Chiropractor in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Physiotherapy in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

Is it a pinched nerve or carpal tunnel syndrome?

Carpal tunnel syndrome numbs the thumb, index, middle and half the ring finger and does not weaken muscles higher up the arm. A pinched nerve in the neck often comes with neck pain. An examination usually tells them apart, and a nerve conduction test can help when it does not.

Do I need an MRI for a pinched nerve in my neck?

Not at first, in most cases. MRI is for possible spinal cord involvement, weakness that persists or progresses, or four to six weeks without improvement, and scans can show changes that are not the cause.

Should I wear a neck collar?

Ontario’s guideline says clinicians should not offer one for neck pain with nerve signs, and studies found collars made little difference to pain. A US physiotherapy guideline allows short-term use for recent symptoms. If one is suggested, ask for how long.

Will I need surgery?

Most people improve without it. Referral to a surgeon is considered when there is no improvement after one to three months, and promptly when weakness is progressing.

Can I see a physiotherapist for a pinched nerve in Cambridge?

Yes. Physiotherapy is offered in Cambridge, Kitchener and Waterloo. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• Côté P, Wong JJ, Sutton D, et al. Management of neck pain and associated disorders: a clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. European Spine Journal, 2016;25(7):2000–2022. (The abstract is free to read; the full text needs a subscription.)
• Bussières AE, Stewart G, Al-Zoubi F, et al. The treatment of neck pain-associated disorders and whiplash-associated disorders: a clinical practice guideline. Journal of Manipulative and Physiological Therapeutics, 2016;39(8):523–564. (Canadian Chiropractic Guideline Initiative.)
• Kjaer P, Kongsted A, Hartvigsen J, et al. National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy. European Spine Journal, 2017;26(9):2242–2257. (Denmark. The abstract is free to read; the full text needs a subscription.)
• Childress MA, Becker BA. Nonoperative management of cervical radiculopathy. American Family Physician, 2016;93(9):746–754.
• Blanpied PR, Gross AR, Elliott JM, et al. Neck pain: revision 2017. Clinical practice guidelines from the Orthopaedic Section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy, 2017;47(7):A1–A83. (Abstract only.)
• NHS (UK). Cervical spondylosis (urgent and emergency signs), reviewed August 2023, and Neck pain (home care), reviewed April 2023. Both were due for review in 2026.

Related conditions

Neck Pain · Spinal Stenosis · Carpal Tunnel Syndrome · Whiplash · Herniated Disc

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