Management of Cervical Radiculopathy: Mid-Stage Essentials

Cervical radiculopathy is something physiotherapists see often, but for patients it can feel overwhelming and is commonly associated with significant pain, neurological symptoms, and fears of long-term disability.

As physiotherapists, we know that most cases have a favorable prognosis with conservative management. However, gaining a patient’s trust in conservative care is integral to recovery, and the way we progress rehabilitation plays a key role in maintaining both trust and motivation.

Expert physio Erik Thoomes did this perfectly in his management of a 49 year old office worker with cervical radiculopathy. In this blog, we’ll explore the management of cervical radiculopathy with a focus on how Erik navigated the tricky mid-stage of treatment.

If you want to see exactly how expert physio Erik Thoomes assessed and managed a real patient with cervical radiculopathy, check out his full Case Study HERE. With Case Studies you can step inside the minds of experts and apply their strategies to get better results with your patients. Learn more here.

Screening and imaging

First of all, it’s important to understand our scope in the management of cervical conditions. Screening for red flags is essential when assessing a patient presenting with neck pain. Erik talks us through the initial red flag assessment of his patient in this clip from his Case Study:

Importantly, red flag screening is not a one-off task at the initial assessment, it’s something that should be ongoing throughout the patient’s care. Even if your working diagnosis is clear, new or worsening symptoms should prompt a review of red flag criteria. Some key situations where escalation or referral is warranted include persistent symptoms not responding to an appropriate course of physiotherapy, or sudden and/or worsening muscle weakness, reflex changes or sensory loss, which could indicate neurological deterioration.

Diagnostic imaging is not routinely needed if you’re confident in your diagnosis. It should be reserved for situations such as:

• Uncertain diagnosis.
• Considering injection therapies.
• When surgical management is being considered.

While Erik was confident in his diagnosis, his patient had strong fears of an oncological cause due to a family history of cancer, so his General Practitioner sent him for imaging to allay these fears. By excluding sinister pathology, imaging provided reassurance and allowed rehabilitation to move forward.

Initial management

The early stage of treatment often centers on helping the patient understand what is happening and what they can expect. Clear advice and education about the generally good prognosis of cervical radiculopathy can significantly reduce fear and improve adherence to the plan.

Pain management should also be addressed early. Referral to the patient’s General Practitioner for analgesia may be needed if pain is severe and limiting function. Alongside this, gentle “opening” exercises to reduce neural or joint compression symptoms can help the patient feel more in control and start to restore confidence in movement.

Mid-stage management

Once acute pain is settling, we move from symptom relief into functional restoration. Watch Erik outline the Delphi study consensus recommendations for mid-stage management of cervical radiculopathies in this clip from his Case Study:

With these recommendations in mind, Erik’s real-life mid-stage management of his patient focused on:

Individualised fitness: the patient began walking and using the cross trainer to rebuild cardiovascular fitness. Cycling and swimming were avoided initially, as these were the original aggravating factors.

Manual therapy: cervical mobilisation to address stiffness, thoracic manipulation, and cervical lateral glides to target neural mechanosensitivity and mobility.

Ergonomic and vocational advice: this included a staged return-to-work plan, structured microbreaks (with 1–2 minutes of exercise) every 45 minutes, and the use of a sit-to-stand desk to avoid sustained postures.

Supervised exercise: Erik targeted the patient’s specific deficits, including grip strength exercises, axio-scapular muscle strengthening, and deep neck flexor motor control and endurance training.

Check out the software Erik used to train deep neck flexors and keep his patient engaged in the below video from his Case Study:

This comprehensive approach addressed not only the patient’s impairments but also the broader context of daily function, workplace demands, and set them up for long-term self-management.

Wrapping up

Mid-stage management of cervical radiculopathy is arguably the most challenging stage.
This is where physiotherapists need to move beyond symptom control and start addressing function and underlying contributors (while also avoiding flare ups which could in turn compromise the patient’s trust!).

By applying the right strategies, we can help patients regain independence and confidence. The balance lies in progressing exercise while continuing to educate, reassure, and adapt to the individual’s lifestyle and goals.

To see exactly how Erik Thoomes assessed, diagnosed and managed his patient all the way to full recovery, check out his full Case Study HERE.