Recommended Exercises for Cervical Radiculopathy
For cervical radiculopathy, implement a multimodal exercise program consisting of deep neck flexor strengthening, scapulothoracic muscle strengthening, and general stretching exercises, which achieves 90% success rates in conservative management and demonstrates comparable outcomes to surgery at 12 months. 1
Initial Conservative Management Framework
Non-operative treatment including physical therapy is the mainstay approach in the acute phase, with success rates averaging 90% 1. Physical therapy demonstrates statistically significant clinical improvement and can achieve comparable results to surgical interventions at 12 months, though surgery provides more rapid relief within 3-4 months 1.
Core Exercise Components
The evidence supports specific exercise types rather than generic "physical therapy":
Strengthening Exercises:
- Deep neck flexor strengthening - targets the stabilizing muscles of the cervical spine 2
- Scapulothoracic muscle strengthening - addresses shoulder girdle stability and posture 2
- Neck muscle activation exercises show promise for chronic cases (>3 months duration) 3
Stretching and Mobility:
- General stretching exercises form a fundamental component 4
- McKenzie cervical retraction exercises can be added to the multimodal approach, though not supported in isolation 5
Additional Modalities to Combine:
- Manual physical therapy techniques 2
- Cervical traction 2
- Thoracic manipulation and rib mobilizations 5
- Peripheral nerve mobilization 5
- Postural correction exercises with scapular retraction 5
Treatment Duration and Expectations
Expect 7 visits on average over 5-7 weeks 2, 5. The evidence shows:
- 91% of patients improved to "quite a bit better" or more with this multimodal approach 2
- Improvements are maintained at 6-month follow-up 2
- At 12 months, exercise therapy outcomes are comparable to surgical interventions 1
Quality of Evidence
The exercise literature for cervical radiculopathy consists of Level I and II evidence with PEDro Scale scores ranging from 5 to 8, indicating high-quality studies 4. Based on the International Classification of Functioning, Disability and Health (ICF) model, exercise training improves both body function and activity participation 4.
Critical Clinical Decision Point
If symptoms persist despite 6+ weeks of structured conservative therapy including these exercises, surgical intervention should be considered 1. Surgery (anterior cervical decompression) provides more rapid relief within 3-4 months compared to continued physical therapy, with 80-90% success rates for arm pain relief 1.
Common Pitfalls to Avoid
- Do not use McKenzie exercises in isolation - they must be part of a multimodal approach 5
- Do not delay surgical referral beyond 6 weeks if there is progressive neurological deficit - surgical candidates with significant functional deficits impacting quality of life should not continue indefinitely with conservative care 1
- Ensure proper documentation of conservative therapy duration and response - at least 6 weeks of structured therapy with specific dates, frequency, and treatment response is required before considering surgery 1