Home Program for Neck Pain and a Pinched Nerve

What you are treating

Most neck pain comes from the muscles, joints, and discs of the neck and settles in a few weeks with movement and good posture. A pinched nerve in the neck (cervical radiculopathy) adds pain, tingling, or weakness that travels into the shoulder, arm, or hand. It comes from a bulging disc or a bone spur pressing on the nerve where it leaves the spine. About three in four people with a pinched nerve in the neck get better without surgery, usually within six to twelve weeks. This plan is built to get you there.

As with the low back, pain that moves toward the neck and away from the hand is improving. Pain moving down the arm is worsening.

Week 1 to 2: calm it down

• Find the relief position. For many people, resting the forearm of the painful arm on top of the head takes pressure off the nerve. Use it when the arm pain flares.
• Avoid what loads the nerve: looking up for long periods, sleeping on your stomach, holding the phone between ear and shoulder, carrying heavy bags on that side, and long stretches of looking down at a screen.
• Set up your screen at eye level and your chair so your elbows are supported.
• Sleep on your back or side with one pillow that keeps the neck level, not propped forward. A rolled towel inside the pillowcase under the neck helps some people.
• A soft collar for a few hours a day during the worst week is fine; more than that weakens the muscles.
• Medicines: acetaminophen on a schedule; an anti-inflammatory with food for one to two weeks if your stomach and kidneys allow; a short oral steroid course or a nerve-calming medicine if I prescribe one. A muscle relaxant at night if spasm keeps you up.
• Gentle movement: chin tucks (slide the chin straight back as if making a double chin, hold 5 seconds, 10 times, every two hours), and slow rotation left and right within comfort.

Week 2 to 6: get moving

• Add shoulder-blade work, which takes load off the neck: squeeze the shoulder blades back and down, hold 5 seconds, 10 times, several times a day; rows with a band; and wall slides.
• Deep neck muscle strengthening: lying on your back, do a chin tuck and lift the head a half inch off the pillow, hold 5 to 10 seconds, build to 10 repeats.
• Nerve glides, once arm pain is easing: standing, drop the shoulder, straighten the arm out to the side with the palm up, and gently tilt the head away, then back. 10 slow repeats twice a day. Stop if it increases arm symptoms.
• Physical therapy if you are not improving on your own, with a therapist who treats the neck with exercise and manual therapy. Forceful neck manipulation is best avoided with a pinched nerve.
• Walking daily. Aerobic exercise reduces neck pain in its own right.

Week 6 and beyond: build it back

• Keep the chin tucks, shoulder-blade squeezes, and rows as a daily habit, especially if you work at a screen.
• Add upper-back and posture strengthening three times a week.
• Take a break from screens every 30 minutes: look up, roll the shoulders, walk for a minute.

When an injection makes sense

A cervical epidural steroid injection can calm a pinched nerve when arm pain remains severe after two to three weeks. It is done by a pain specialist with X-ray guidance. It does not fix the disc; it buys the time the body needs.

When surgery makes sense

• The arm or hand is getting weaker.
• Arm pain is still disabling after six to twelve weeks of a real effort with this plan and, when appropriate, an injection.
• Any sign of pressure on the spinal cord itself: clumsy hands, trouble with buttons or handwriting, unsteady walking, or changes in the legs. These are not treated with waiting.

The options are an endoscopic foraminotomy from the back, a disc replacement from the front, or a fusion from the front. My guides explain each, and which one fits depends on where the nerve is pinched and how the neck is aligned.

Call the office promptly if you have

• Clumsiness in the hands, trouble walking, or a change in balance.
• New weakness in the arm or hand.
• Fever with neck pain, or neck pain after an injury.

Learn more

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

My guides to cervical radiculopathy, posterior cervical endoscopic foraminotomy, and cervical disc replacement.

This plan is general guidance for Dr. Wey's patients and does not replace the advice we discuss in clinic. Stop and call us if any exercise makes arm pain spread farther down the arm, or if you notice the warning signs at the end.