Has your client been to a neurologist yet? I am assuming yes, because of the specificity of the information you have given.I get a lot of these types of referrals from a neurologist who is manual therapy minded. the referrals come to me, long before they go to the neurosurgeon. So, I do a lot of area-specific deep work, combined with a lot of traction work and a lot of anterior neck work. Generally, a client with a problem of this magnitude gets one hour neck (usually 50 mins face up work) and back work (usually ten mins. into the posterior upper, paraspinals, lower and sacro-ilicas). However, each session can be different. If the next week they come in and need 30 and 30, then that is what they will get -- it all depends on what the body is doing at that time.I feel it is best to ask the client to get a prescription for their care from the neurologist when possible, and keep it on file. Make sure and document what you do on each visit.My worst case scenario, the client has been having pain and radiculopathy for over three years, and refuses surgery. At first he came 2 - 3 times per week. After about 4 months, the pain subsided. It came back and he went into rehab along with coming to me (once per week) for treatment. After three months almost all of the pain went away again. It returned about 5 months later and he started up his exercises again, going in and out of the pain cycle over the next number of months, seeing me intermittently. This last round of pain has been accomanied again by the radiculopathy and we have decreased treatments slowly from weekly to every two weeks beginning in about February. Just yesterday he said the tingling is only intermittent and he was virtually pain free. He is staying on a regular schedule of every two weeks now. At least it keeps him off the operating table.My best case scenario, about one to two months and no more pain, so now the client just comes in for maintenance whenever there is a flare up.I do have people who have severe numbness and tingling of the bilateral hands and they do receive immediate relief as well as warmth and proper feeling right after the treatment. One in particular also has problems with TOS, so you may need to address that too.I have a little information on the "Massage Pearls" thread of how I do some of my neck work. Since each client is built differently, you may have to modify that. I know every single person gets something different, and a lot of it also depends on the depth of pressure they can handle. Also, you may need to start out light for the first few visits, and explain that they may not get much relief at first if they can't handle deeper work. Also, if working deep on the cervical musculature, make sure to switch sides often and give them frequent "breathers" so that they get through the hour. And don't forget to remind them they may be sore for a few days following.Of course, this is just my own info that I have found over the past yea-many years. There may be someone else doesn't agree with this, so I can just say I have helped a lot of people and usually when they don't want surgery, it is the next best bet. If they need surgical intervention though, I do believe we should not discount that need.If there are lighter techniques that also get the client well, I know I'd love to hear about them!
Hope this helps.