Cervical Radiculopathy

What is a cervical radiculopathy?

The term cervical relates to your neck and the term radiculopathy refers to irritation of your nerves, in particular what is called your nerve root.

A cervical radiculopathy is a complaint that involves the irritation of one, or more than one, of the nerve roots as it exits your neck. It is often characterised by neck and arm pain with tingling or numbness.

That sounds really complicated. Can you explain it more simply?

The nerves that supply your arms with their ability to work and feel come from your neck. Your nerve’s main job (amongst other things) is to pass information (nerve impulses) down to their target site (muscle or joint or skin) and transport messages back up again to your spinal cord and your brain.

Your nerves pass out of the neck via small holes called foramen on their way down to your arm. They are very good at doing their job and are generally quite resilient (i.e. they can put up with a lot of work without complaining), however, they are sensitive (hitting your funny bone which is actually a nerve is a good example of this). On the nerve’s journey from the neck into your arm, it can get irritated and sometimes this can cause it to become upset and start to cause you issues.

Is it the same as a trapped nerve?

The term ‘trapped nerve’ is misleading and not a useful or accurate way of describing the issue. Worst of all, it can cause people to get the wrong impression of what is causing their symptoms and worry that something is ‘trapped’ and needs ‘releasing’ in their neck.

Nerves don’t get trapped. Nerves are sensitive and they can get irritated just like any other type of body tissue. Certain things such as disc or joint changes or an injury can sometimes cause nerve irritation, but a cervical radiculopathy itself is not a damaging problem and is certainly not because something is trapped in your neck.

Does it matter what you call it?

We really think it does. Words are incredibly important as they help us understand what might be going on in our neck and what we are dealing with. If you have been told that you have neck pain and that it's something you need to be concerned about, then it is only human to find yourself worrying about it. If things are explained correctly and words, phrases and images are used appropriately, you are likely to understand the issue better and be in a better frame of mind to do something about it.

Interestingly, a study by Kim et al. (2017) found that emotional stresses and challenges such as low mood and worry appeared to be more likely to contribute to neck pain than physical factors. In other words, how you feel and what you think about your neck issue does matter!

What are the common symptoms with cervical radiculopathy?

This is a really important question and it is useful for you to know what is normal with a cervical radiculopathy. We’ve broken the answer down into things that are found most commonly:

Cervical radiculopathies can cause pain but equally so, sometimes don’t cause any pain at all. In most cases, you may feel pain in the neck, shoulder blade which will commonly travel down your arm, possibly to your fingers. This is called ‘referred pain’ which in other words means that the pain is travelling away from the neck. Pain when turning your head, looking up or moving your arm is common.

In some cases of cervical radiculopathy, the neck may feel stiff or tight. This is likely to be linked to increased muscular work around the neck as it reacts and tries to help the issue.

Clicks, pops, clunks and grinds are very normal in all joints, including your spine, and in the vast majority of cases are nothing to worry about. People often find themselves worrying that they are ‘wearing their neck out’ because of the noises it makes. This is simply not the case and your neck, along with all of your joints, are strong, robust and designed to last you a lifetime. Noises are often gas bubbles popping in the joint or friction between the moving surfaces. Noises from the neck are normal and not to be worried about, just like rumbles from your tummy are normal and don’t mean anything is wrong, it’s just another noise the body tends to make.

The feeling that the head is ‘too heavy’ for your neck is often reported by people with neck pain. It is not a concerning symptom and is likely to be linked to muscular tiredness, as a painful neck will make the muscles around the neck region work differently, and eventually they can get tired and grumpy.

Are there any other symptoms that can happen with a cervical radiculopathy?

 There a number of other symptoms that are linked with cervical radiculopathy, but these tend to be less common:

Neck pain can typically travel to the shoulder blade and arm, but can sometimes go upwards towards the head causing headaches. Often, this is linked to the increased muscular activity in the neck muscles which acts as a protective response whilst the neck starts its recovery.

The nerves that supply your arms with their ability to work and feel things come from your neck. If you have had an injury to your neck then it is possible to irritate your nerves. Nerve irritation tends to cause pain, tingling (pins & needles) and/ or numbness. Nerves are not easily damaged but are very sensitive and don’t take kindly to being upset. As mentioned before, an interesting example of this is when you hit your funny bone. Your funny bone is actually a nerve, not a bone at all, and when you hit it, it is often sore, tingly and might even burn all the way down to your fingers. Encouragingly, just like funny bone bashes, the symptoms of tingling with a cervical radiculopathy often get better with time.

When your neck is sore, you might feel a bit reluctant to move it. This is an entirely normal reaction to an injury. Most of the time, the worry about moving will settle as your symptoms settle. However, if you find yourself frightened or nervous that movement may hurt or damage your neck, then it is really important for you to know that movement is safe and crucial to helping your neck get better. Pain will often make people feel vulnerable and can be concerning, but as outlined throughout this whole information page, your neck is strong, robust and very resilient. Pain is normal with a cervical radiculopathy and the best medicine is normal, confident movement. Us physios like to say ‘motion is lotion!’, therefore, any movement is better than none and will help you on your road to recovery.

What causes cervical radiculopathy?

The easiest answer to this is that it's not always clear. In the past, it used to be thought that a nerve has to be touched, pinched or pressed on to cause it to become upset. However, recent research suggests that nerves can become irritated without being physically touched. Inflammation (the body’s way of dealing with insult and injury) of some of the structures near the nerve can cause a change in the environment around it, and might be enough to irritate it. With this in mind, nerves can still become irritated if something is creating pressure on or around them, such as disc and joint changes (Barrett & Hilibrand, 2015).

Interestingly, it is worth acknowledging that other factors might play a part in you developing symptoms with a cervical radiculopathy. How you are feeling, how well you sleep,  whether you are dealing with emotional hardship or stress at the time, your physical fitness and the support network you have around you can all play a part in whether you develop symptoms or not.

 

Should I go to Accident and Emergency?

A cervical radiculopathy can potentially be very painful and as such, quite distressing and worrying. For most people, they are able to make a recovery without needing to seek more help than just a GP and their physiotherapist.

 

Is there anything I should look out for?

In most cases, the symptoms associated with a cervical radiculopathy are easily recognised, but occasionally there are things that do not fit and should be highlighted to your doctor, nurse or physio.

  • Generally feeling unwell and/or a temperature alongside your neck pain
  • A history of trauma that started your neck pain
  • Pain or symptoms that travel into your face
  • Shortness of breath, especially if you are a smoker
  • Headaches that are different to your normal headaches
  • Changes in your vision, speech or hearing alongside your neck pain

The following symptoms would be considered rare with cervical radiculopathy and if you develop any of the following you should seek medical attention urgently.

  • Difficulty coordinating your arms or legs
  • Pins and needles or numbness in your both your arms, or both your legs or all limbs
  • Changes in your bladder/ bowel or sexual function since the injury

How is a cervical radiculopathy disorder diagnosed?

In most cases, cervical radiculopathies can be diagnosed through the clinical features (what it looks like and how it behaves), your symptoms (what you tell us about your neck) and the clinical assessment (testing the movements etc.). An X-ray or MRI of the neck is not normally required. 

 

Why are X-rays/scans not always required?

In a lot of cases, the information we as healthcare professionals can get from asking you questions and testing the neck is enough to make a decision. X-rays/scans are very useful tools (and would always be ordered if needed), as they show you what your neck looks like on the inside. However, in some cases what your neck looks like on the inside doesn’t really marry up with what your problem might be.

There is growing evidence (experiments and clinical studies) that demonstrate what you see is not always what you get with X-rays and scans and that a lot of the so-called ‘worn out’ or ‘abnormal’ findings are seen commonly in people with no pain, stiffness or symptoms.

In a large study of over 1200 people, Nakashima et al. (2015) demonstrated that most of the common ‘problems’ found in neck scans, including disk changes, are seen as much and sometimes more, in people WITHOUT any pain, stiffness or symptoms as those with symptoms.

What this means is that what you say about your neck issue, how you move and how you feel etc. are often more important than the results of an X-ray or scan.

What can I do to help myself?

Reassuringly, there are lots of things that you can do to help get your neck going and start your rehabilitation.

Taking time to read and digest the information above will hopefully help you understand that cervical radiculopathies aren’t necessarily something that should be feared, that it’s safe to be sore and that you can do something about it. Understanding the problem is halfway to dealing with it.

It would be lovely we could simply take pain relief or exercise our way out of all of the aches and pains that we face in our lifetimes, wouldn’t it? For a number of issues, that might be all you need to do and you will end up feeling better. However it is often a useful thing to do to take some time to think about some of the reasons why things might be sore.

If you think of your pain as your neck trying to say that it is struggling to do what you want it to do or the way you want to do it, by looking at the things that make it sore, you may be able to consider what you can do to help yourself. For example, if you find that your neck is always worse on the days that you are on the computer for longest or the days you don’t have your breaks, then perhaps your neck is saying it’s struggling, and you might find taking more breaks/ having your lunch away from the desk might help.

By looking at what’s making your neck sore and asking yourself ‘how can I do that differently’, you can find that the answers come more easily than you would have thought. Making small changes or adapting things can have big results and this is often the best way to start your recovery.

You can find some guidance about ‘calming it down’ here: Calm it down

You will also find some positions for your arm/ head that might be useful at the bottom of the page.

As mentioned before, pain regardless of where it is and where it has come from, can make you feel vulnerable, drained and sometimes a bit lost. There is always potential to be ‘better’, however, what better might mean to you might be different to the next person. Your body is amazing and can sort most issues out by itself, but sometimes it needs some help. Taking time to look after yourself is important. Relaxation, meditation or simply taking ‘you time’ can be really useful in helping get yourself ready to start your rehabilitation or make your rehabilitation more effective.

Relaxing will mean different things to different people, therefore it is worth thinking what works best for you. You can find some ideas and useful app suggestions here: Wellbeing

Exercise, including strengthening exercise (working against something like a weight, gravity or exercise bands) is considered one of the key treatments for most aches and pains.

Exercise comes in many shapes and forms and there is no ‘best’ exercise. Often it is best to think of the most effective exercise as the one you enjoy and will actually do. Current recommendations on exercise and how often we should be looking to do it can be found here: Understanding Exercise

Exercise, even lifting weights or attending a gym, is safe for your neck and encouragingly, in a large review of the research on people with neck pain, de Zoete et al. (2019) found that exercise (of any type) helped to lower pain levels and improve disability.

We have included a series of exercises at the bottom of the page that will be able to help you move forwards with managing your neck complaint.

Some people will choose to manage their pain with pain relief, whilst some may choose to avoid medication. Applying something warm around your neck may also be useful in helping with some of the pain (do remember to wrap your hot water bottle in a towel before applying it to your skin to avoid burns).

What can physiotherapy do for me?

Physiotherapy for neck complaints including cervical radiculopathies can be very effective. We offer a range of options to help you manage your complaint with exercise, education and lifestyle advice/ coaching forming the main part of what we can offer you. We are able to offer other treatments including manual therapy and acupuncture if deemed appropriate, however these would only likely be offered alongside the exercise, education and lifestyle advice.

 

Will it get better?

In a lot of cases, it is very much possible for you to improve the symptoms you have with your neck and most people will improve within 6-12 weeks, however this is very variable. Obviously, it is impossible to predict the timescale or the path that your recovery will take, but encouragingly, with normal confident movement, increased physical and emotional fitness and resilience (if needed), most people will find that their symptoms can change for the better.

 

How long will it take before I feel something?

This is a very difficult question but it is best think about how much time and effort you are going to throw at the challenge, and how confident and motivated you are to do something about it. If you work hard and are consistent with what you do, often people will notice signs of positive response within weeks to months. If you are not committed to the challenge, it will take longer or may not respond at all.

 

What happens if I do all of this and it doesn’t get better?

It is worth reminding yourself that most people’s symptoms do improve over time. It might be difficult to believe this when your neck/ arm is really sore and you can’t see any progress, however, often progress will come in small amounts and is most likely to take weeks rather than days.

If you have really committed yourself to your rehabilitation and things simply are not improving, do speak with your physiotherapist as they will be able to discuss what other options may be available to you.

If your symptoms at any stage get worse, you should speak to your GP or physiotherapist who will again be able to discuss what options might be suitable for you.

Frequently asked questions

Below are some of the common questions that are asked when talking about neck issues that haven’t been covered in the information above.

A: Collars and supports for neck pain are no longer recommended. It used to be that collars were issued by physios for neck issues, however, we now understand that these can actually make things worse as keeping your neck still will not support normal movement. It will cause strength loss and may make you feel worried about moving your neck when the support comes off.

A: Acupuncture is something that can help some people, however not everyone benefits from it. Acupuncture is best thought of as a type of pain relief and as such, it might help ease the pain temporarily but will probably do very little to address the reason why your neck is sore in the first place. Working on normal, confident movement and the strength of your neck is likely to help most people.

A: Interestingly, this is not as clear as some people might have you believe. In a study by Gamkhar & Kahlaee (2018), no significant link between head and neck posture in pain could be found in people with and without neck pain, however muscle size was significantly smaller in people with neck pain. In other words, it doesn’t really matter what your posture is like, but things like your strength, fitness and confidence in your neck and how well you manage things like stress seem to matter.

A: This doesn’t matter. Most, if not all, of the exercises below can be modified or adapted using heavy bags, bottles of water or even books.

A: If your neck is sore to begin with, then it is normal to expect that starting some exercises might be a bit sore to start with. As you get better and start to tolerate the exercises better, you should find that they are more comfortable. However, it is worth knowing that strengthening exercises are meant to be hard work (and a bit sore), so if they’ve become too easy, perhaps you need to increase the challenge.

A: The pain in your neck is not an indication of damage, therefore it is safe to move your neck normally. If something is really sore, it makes sense not to force it and work within a range that is comfortable, but it is safe to be sore.

A: Quite simply, no! The exercises will help get you moving and hopefully help with your strength, which are both important for helping neck pain. However, often looking at the things that your neck doesn’t like such as sitting for long periods/carrying shopping and making some changes/adaptations to those things will help the exercises be more effective.

A: If you are not having issues with your sleep, then changing your pillow isn’t likely to help. If you are having issues, first think about what changes/ effort you're putting into controlling your neck during the day as this is likely to be most effective. If you want to change your pillow and think it will help, then choose the one that is most comfortable. There isn’t a ‘best’ pillow as we all have different needs and preferences.

A: Firstly, ask yourself if you have really done everything you can to try and move your neck issue forwards. If the answer is no, consider re-reading the information above and seeking some guidance from your physio.

If you have really committed to your rehabilitation and still don’t find any benefit, then please bring this up with your physio who will be able to discuss your options.

Exercise tips:

 

For positional exercises, consider this as a position that you can try to get into whenever you can, as often as you can.

For movement exercises, aim to complete the exercises little and often throughout the day within what is comfortable.

For ‘nerve’ exercises, try to complete these exercises little and often throughout the day. Try to complete the movements for 30 seconds and complete 2-3 times. Feel free to adapt or change the exercise if you need to.

For strengthening, you may choose to start by simply completing the exercises until your neck gets tired for 3-4 sets with about a minute’s rest in between sets. If you want more structure, try completing 8-12 repetitions for 3-4 sets with about a minute’s rest in between sets. Complete these exercises every other day.

Movement Exercises

Exercise 1
Exercise 2
Exercise 3
Exercise 4
Exercise 5
Exercise 6
Exercise 7
Exercise 8
Exercise 10

'Nerve' Exercises

For pain or tingling into that might go into your palm or thumb, index and middle fingers:
Exercise 1
Exercise 2
Exercise 3
Exercise 4
For pain or tingling that might go into the back of your hand/ fingers:
Exercise 1
Exercise 2
Exercise 3
For pain or tingling that might go into your little and ring finger:
Exercise 1
Exercise 2

Strengthening Exercises

Exercise 1
Exercise 2
Exercise 3
Exercise 4
Exercise 5
Exercise 6
Exercise 7
Exercise 8
Exercise 9
Exercise 10
Exercise 11
Exercise 12
Exercise 13

References:

Barrett, I. and Hilibrand, A.S. (2015). Cervical Radiculopathy Epidemiology, Etiology, Diagnosis, and Treatment. Journal of Spinal Disorders & Techniques, 28(5), 251-9 PMID: 25985461 doi: 10.1097/BSD.0000000000000284 (accessed 28/01/2021)

de Zoete R, M, J. ,  Armfield N, R.,  McAuley J, H., Chen, K. and  Sterling, M. (2019). Comparative effectiveness of physical exercise interventions for chronic non-specific neck pain: a systematic review with network meta-analysis of 40 randomised controlled trials. European Journal of Physiotherapy http://dx.doi.org/10.1136/bjsports-2020-102664 (accessed 26/01/2021).

Gamkhar, L. and Kahlaee. (2018). Is forward head posture relevant to cervical muscles and performance and neck pain? A case-control study. Brazilian Journal of Physical Therapy, 23(4) 346-354 doi: 10.1016/j.bjpt.2018.08.007. Epub 2018 Aug 22 (accessed 29/01/2021).

 Kim, R., Wiest, C., Clark, K. and Cook, C.   (2017). Identifying risk factors for first-episode neck pain: A systematic review. Musculoskeletal Science and Practice, Volume 33, 77-83 https://doi.org/10.1016/j.msksp.2017.11.007 (accessed 26/01/2021).

Nakashima, H.,   Yasutsugu, Y.,  Suda, K., Yamagata, M., Ueta, T. and Kato, F. (2015). Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects. Spine, 40(6):392-8. doi: 10.1097/BRS.0000000000000775 (accessed 26/01/2021).

Sterling, M. (2004). A proposed new classification system for Whiplash associated disorders – implications for assessment and management. Musculoskeletal Science and Practice, 9(2) 60-70.