Last but not least, therapeutic exercises with the intent of downregulating the nervous system, decreasing inflammation, opening the intervertebral foramen, and postural re-education are effective in the management of cervical radiculopathy. From a mobility standpoint, start first with neural mobilization. The rationale behind neural mobilizations are to increase the circulation of the nerve and disperse intraneural edema or inflammation. When nerves are stretched, there is an accompanying increase in tension and intraneural pressure on the nerve - which nerves do not like! We know from animal experiments that when a nerve is inflamed and pissed off, a minimal stretch less than 3% is enough to trigger ectopic impulse generation, which may lead to the provocation of pain! So, we combat this inflammation with specific exercises called nerve glides or nerve tensioners. By increasing the mobility of the nerve/dura itself, or the structures that surround the nerve such as neighboring muscles and joints (called the nerve bed), we can facilitate an optimal environment to disperse inflammation and desensitize the nervous system. Nerve glides are best used when your pain is extremely acute or severe. Nerve glides produce a high level of nerve movement with minimal tension, and can help facilitate dispersing inflammation around the nerve. A nerve gliding technique entails elongating the nerve bed at one joint, while simultaneously reducing the length of the nerve bed at an adjacent joint. On the other hand, nerve tensioners entail elongating the nerve bed at two joints at the same time. While this may seem harmful at first glance, your nerves are meant to move and be elongated! The goal of nerve tensioners are to downregulate the nervous system and get is accustomed to nerve tension. However, in the acute stage when your pain levels are high, it is best to avoid nerve tensioners and stick to nerve glides. As the pain dissipates, then you can progress to nerve tensioners. While you can move any joint along the nerve bed to perform nerve glides and tensioners, we recommend moving your wrist and neck - as the nerves run from your neck all the way down to your wrist! You should also focus your exercises on working on cervical and thoracic spine mobility. You can perform SNAGs or lateral cervical slides for your neck with a towel. Or hop on a foam roller for your thoracic spine. From a strength standpoint, you'll want to work on your deep neck flexors and extensors as well as your scapular stabilizers. From a motor control/postural re-education standpoint, you'll want to work on maintaining a neutral cervical spine - again, avoiding those positions that aggravate your symptoms!
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