Home Exercise Program for Neck Pain and Radiculopathy

What you are treating

Most neck pain comes from the small joints, discs, and muscles of the neck, loaded for years by a head that sits forward of the shoulders. A pinched nerve in the neck (cervical radiculopathy) adds pain, tingling, or weakness down the arm along the path of one nerve, from a herniated disc in younger adults or from bone spurs narrowing a nerve opening in older ones. Both improve without surgery in most people: for a pinched nerve, about three in four are much better within three months.

The program is built on three ideas: positions that take pressure off the nerve, a neck that sits back over the shoulders instead of in front of them, and strong, well-timed muscles between the shoulder blades so the neck is not doing the work of holding the head up. If you want a week-by-week plan with the medicines and the point at which an injection makes sense, see my home program for neck pain and a pinched nerve. This sheet is the exercise detail that goes with it.

The rule for the arm: pain that moves from the hand or forearm up toward the shoulder and neck is improving. Pain that moves farther down the arm is worsening. Judge every exercise by that rule.

Part 1: take the pressure off (first 1 to 2 weeks)

• The relief position. If arm pain is severe, rest the hand of the painful arm on top of your head for a few minutes. It slackens the nerve and often gives quick relief. Use it several times a day; it is also a sign that the nerve is the source.
• Avoid looking up and over the shoulder on the painful side for long, carrying bags on that side, sleeping on the stomach, and long stretches at a screen with the head forward.
• Sleep on your back with a thin pillow that keeps the head level, or on the side with a pillow that fills the gap between the ear and the shoulder.
• Chin tucks. Sitting tall, slide the chin straight back as if making a double chin, without tipping the head up or down. Hold 5 seconds, 10 times, every hour or two. This is the one exercise to do more than any other.
• Scapular retraction. Squeeze the shoulder blades down and together, hold 5 seconds, 10 times, several times a day.
• Gentle range of motion: turn the head slowly toward each side, tilt each ear toward the shoulder, within comfort. 5 each direction, twice a day.
• Ice or heat for 15 minutes, whichever helps. Medicines as we discussed.

Part 2: strengthen the deep neck and the shoulder blades (weeks 2 to 8)

Four days a week.

• Deep neck flexor lift. Lying on your back with the knees bent, tuck the chin and lift the head half an inch, keeping the chin tucked. Hold 5 seconds, 10 times. Progress to 10-second holds.
• Chin tuck against a band or a towel: tuck against light resistance, 3 sets of 10.
• Isometrics. Press the palm against the forehead, then the back of the head, then each side, resisting with the neck without moving. 5 seconds each, 5 times each direction.
• Wall angels. Back and head against a wall, arms in a goalpost shape, slide the arms up and down keeping the forearms on the wall. 2 sets of 10.
• Rows with a band, elbows close, blades down. 3 sets of 15.
• Prone Y, T, and W, no weight at first. 10 each.
• Thoracic extension over a foam roller or the back of a chair, 10 slow repetitions. A stiff upper back pushes the neck forward.
• Doorway chest stretch and upper trapezius and levator stretches, 20 seconds, 3 rounds each side, daily.

Part 3: nerve glides (once arm pain is easing)

These slide the nerve gently through its path and are for a pinched nerve, not for simple neck pain. Do them only when the arm symptoms have started to retreat, and stop if they increase.

• Stand with the shoulder blade down. Straighten the painful arm out to the side at shoulder height, palm up, elbow straight. Bend the wrist back while tilting the ear away from the arm, then release the wrist while tilting the ear toward the arm. Slow, 10 repetitions, twice a day. It should feel like a mild stretch along the arm, never a shooting pain.

Part 4: keep it (week 8 and beyond)

• Chin tucks and scapular retractions as a habit, especially at screens: a set every hour.
• The screen at eye level, the keyboard close, the elbows supported, and a break every 30 minutes.
• Two or three sessions a week of the rows, wall angels, and deep neck flexor work keep the gains.
• Walking, swimming (backstroke rather than freestyle at first), and cycling with an upright position are all good.

Notes for the physical therapist

• Cervical radiculopathy and mechanical neck pain: directional-preference testing (retraction, retraction with extension), with centralization as the guiding outcome; a lateral glide or an opening-pattern bias if retraction-extension peripheralizes.
• Deep cervical flexor and lower trapezius and serratus anterior activation, scapular control, thoracic extension mobility, and upper-quarter postural correction.
• Median nerve mobilization (sliders before tensioners) once symptoms are stable and centralizing.
• Manual therapy to the cervical and thoracic spine as indicated; thoracic manipulation has good support for neck pain.
• Refer back to me for progressive weakness, signs of myelopathy (hand clumsiness, gait change, hyperreflexia), or arm pain that is not centralizing at 6 weeks; a selective nerve root injection or, for persistent radiculopathy, a foraminotomy or disc replacement are the next steps.

When to call

• Arm pain spreading farther down the arm, or new weakness in the arm or hand.
• Clumsy hands, trouble with buttons or handwriting, or a change in balance or walking, which can mean pressure on the spinal cord itself.
• Numbness in both arms or in the legs.
• Severe neck pain after an injury, or neck pain with a fever.

Learn more

OrthoInfo, Cervical Radiculopathy (Pinched Nerve): orthoinfo.aaos.org (opens in a new tab)

My guides to cervical radiculopathy, neck pain, and the home program for neck pain and a pinched nerve.

This program is a starting place and a set of suggestions for your physical therapist, not a prescription. Your therapist will adjust it to your exam. Stop and call us if an exercise sends pain farther down the arm, or if you notice the warning signs at the end.