Cervical Radiculopathy.
What is cervical radiculopathy?
Cervical radiculopathy occurs when a nerve root in the cervical spine — the seven vertebrae and associated structures that make up the neck — is compressed or irritated, producing pain, numbness, tingling or weakness that radiates from the neck into the arm, forearm and hand in a characteristic pattern corresponding to the affected nerve root level.
The cervical nerve roots exit the spinal canal through openings called foramina, and these can be narrowed by disc herniation — where disc material presses directly on the nerve root — or by cervical spondylosis — where age-related bony changes including osteophytes reduce the foraminal dimensions. Both mechanisms produce the same pattern of symptoms, though disc herniation tends to present more acutely and in younger patients, while spondylotic radiculopathy tends to develop more gradually in older adults.
Cervical radiculopathy is estimated to affect approximately 83 per 100,000 people annually, with peak incidence in the fifth and sixth decades of life. It is more common in men than women.
Which nerve root is affected — and how to tell
The level of the affected nerve root determines the distribution of symptoms, and this distribution is clinically important both for diagnosis and for monitoring recovery. The most commonly affected levels are C6 and C7, accounting for the majority of presentations.
What are the symptoms?
Cervical radiculopathy typically presents with neck pain that radiates into the arm following the distribution of the compressed nerve root, along with numbness, tingling, or altered sensation in the corresponding dermatome, and weakness in the muscles supplied by that nerve root. The pain is often described as sharp, shooting, burning or electric. Symptoms are typically worse with positions that narrow the foramen — neck extension and lateral flexion toward the affected side — and better with positions that open it — elevating the arm above the head (the shoulder abduction relief sign) or flexing the neck forward.
What is the prognosis?
The natural history of cervical radiculopathy is generally favourable — the majority of patients with cervical disc herniation-related radiculopathy achieve significant improvement with conservative management within six to twelve weeks, as the herniated disc material gradually resorbs and the nerve root recovers. Spondylotic radiculopathy tends to be more persistent but also responds well to physiotherapy in most cases. Surgery is reserved for patients with progressive neurological deficit, severe pain unresponsive to appropriate conservative management, or those who prefer surgery after an adequate trial of conservative care.
How is it diagnosed?
Clinical assessment by a physiotherapist involves specific neurological examination — dermatomal sensation testing, myotomal strength assessment, reflex testing, and upper limb tension tests (ULTT) that selectively tension the specific nerve roots. The Spurling's test — axial compression of the cervical spine combined with lateral flexion and rotation toward the symptomatic side, which reproduces the arm symptoms — has good specificity for cervical radiculopathy. The shoulder abduction relief sign — where elevating the arm above the head reduces arm symptoms — is highly specific and supports the diagnosis. MRI is the gold standard imaging for identifying the level and cause of nerve root compression.
How can physiotherapy help?
Physiotherapy can play a significant role in the management of cervical radiculopathy by addressing pain, improving mobility, and promoting long-term neck and arm health.
Neural mobilisation — gentle nerve gliding exercises that promote movement of the compressed nerve root and reduce neural mechanosensitivity — is the most distinctive and specific physiotherapy intervention for cervical radiculopathy and has strong evidence for reducing arm symptoms. The technique involves carefully moving the cervical spine, shoulder and arm through positions that progressively tension and unload the affected nerve root, improving its capacity to glide freely through the foramen.
Cervical traction — either manual or mechanical — reduces foraminal compression by separating the vertebrae, providing temporary relief from nerve root pressure. It is particularly effective in the acute phase when symptoms are severe and other interventions are limited by pain.
Manual therapy including joint mobilisation and soft tissue massage relieves muscle tension, improves joint function in the neck and reduces nerve irritation. Deep cervical flexor retraining — rebuilding the strength and coordination of the longus colli and longus capitis — reduces mechanical load on the cervical spine and protects the affected nerve root from further compression during daily activities. Real time ultrasound guides this retraining by providing direct visualisation of these deep muscles.
Posture correction addresses the forward head position and rounded thoracic spine that increase foraminal narrowing and perpetuate nerve root irritation. Strengthening exercises target the neck, shoulder and arm to improve muscular support and reduce nerve compression risk. Clinical Pilates provides structured thoracic and cervical rehabilitation in a controlled environment that progressively builds the postural capacity needed for long-term management. Dry needling assists with cervical and periscapular muscle guarding that limits treatment progress. articulatephysiotherapy
For patients whose cervical radiculopathy arose from a workplace or motor vehicle injury, WorkCover and CTP funded physiotherapy is available.
Our physiotherapists Yulia Khasyanova and Bethany Kippen both have experience in cervical spine conditions and nerve pain management and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Cervical radiculopathy occurs when a nerve root in the cervical spine — the seven vertebrae and associated structures that make up the neck — is compressed or irritated, producing pain, numbness, tingling or weakness that radiates from the neck into the arm, forearm and hand in a characteristic pattern corresponding to the affected nerve root level.
The cervical nerve roots exit the spinal canal through openings called foramina, and these can be narrowed by disc herniation — where disc material presses directly on the nerve root — or by cervical spondylosis — where age-related bony changes including osteophytes reduce the foraminal dimensions. Both mechanisms produce the same pattern of symptoms, though disc herniation tends to present more acutely and in younger patients, while spondylotic radiculopathy tends to develop more gradually in older adults.
Cervical radiculopathy is estimated to affect approximately 83 per 100,000 people annually, with peak incidence in the fifth and sixth decades of life. It is more common in men than women.
Which nerve root is affected — and how to tell
The level of the affected nerve root determines the distribution of symptoms, and this distribution is clinically important both for diagnosis and for monitoring recovery. The most commonly affected levels are C6 and C7, accounting for the majority of presentations.
- C5 radiculopathy produces pain and weakness at the shoulder and upper arm, with weakness of the deltoid and biceps and loss of the biceps reflex. Sensory symptoms are felt over the outer shoulder and upper arm.
- C6 radiculopathy — the most common single level — produces pain, numbness and tingling into the thumb and index finger, with weakness of biceps and wrist extension and loss of the brachioradialis reflex. The distribution into the thumb is the most characteristic feature.
- C7 radiculopathy — the second most common level — produces pain and numbness into the middle finger and sometimes the ring finger, with weakness of triceps and wrist flexors and loss of the triceps reflex. Triceps weakness affecting elbow extension is a characteristic functional finding.
- C8 radiculopathy produces numbness and tingling into the ring and little fingers with intrinsic hand muscle weakness and loss of finger flexion strength. It is less common than C6 and C7 radiculopathy.
What are the symptoms?
Cervical radiculopathy typically presents with neck pain that radiates into the arm following the distribution of the compressed nerve root, along with numbness, tingling, or altered sensation in the corresponding dermatome, and weakness in the muscles supplied by that nerve root. The pain is often described as sharp, shooting, burning or electric. Symptoms are typically worse with positions that narrow the foramen — neck extension and lateral flexion toward the affected side — and better with positions that open it — elevating the arm above the head (the shoulder abduction relief sign) or flexing the neck forward.
What is the prognosis?
The natural history of cervical radiculopathy is generally favourable — the majority of patients with cervical disc herniation-related radiculopathy achieve significant improvement with conservative management within six to twelve weeks, as the herniated disc material gradually resorbs and the nerve root recovers. Spondylotic radiculopathy tends to be more persistent but also responds well to physiotherapy in most cases. Surgery is reserved for patients with progressive neurological deficit, severe pain unresponsive to appropriate conservative management, or those who prefer surgery after an adequate trial of conservative care.
How is it diagnosed?
Clinical assessment by a physiotherapist involves specific neurological examination — dermatomal sensation testing, myotomal strength assessment, reflex testing, and upper limb tension tests (ULTT) that selectively tension the specific nerve roots. The Spurling's test — axial compression of the cervical spine combined with lateral flexion and rotation toward the symptomatic side, which reproduces the arm symptoms — has good specificity for cervical radiculopathy. The shoulder abduction relief sign — where elevating the arm above the head reduces arm symptoms — is highly specific and supports the diagnosis. MRI is the gold standard imaging for identifying the level and cause of nerve root compression.
How can physiotherapy help?
Physiotherapy can play a significant role in the management of cervical radiculopathy by addressing pain, improving mobility, and promoting long-term neck and arm health.
Neural mobilisation — gentle nerve gliding exercises that promote movement of the compressed nerve root and reduce neural mechanosensitivity — is the most distinctive and specific physiotherapy intervention for cervical radiculopathy and has strong evidence for reducing arm symptoms. The technique involves carefully moving the cervical spine, shoulder and arm through positions that progressively tension and unload the affected nerve root, improving its capacity to glide freely through the foramen.
Cervical traction — either manual or mechanical — reduces foraminal compression by separating the vertebrae, providing temporary relief from nerve root pressure. It is particularly effective in the acute phase when symptoms are severe and other interventions are limited by pain.
Manual therapy including joint mobilisation and soft tissue massage relieves muscle tension, improves joint function in the neck and reduces nerve irritation. Deep cervical flexor retraining — rebuilding the strength and coordination of the longus colli and longus capitis — reduces mechanical load on the cervical spine and protects the affected nerve root from further compression during daily activities. Real time ultrasound guides this retraining by providing direct visualisation of these deep muscles.
Posture correction addresses the forward head position and rounded thoracic spine that increase foraminal narrowing and perpetuate nerve root irritation. Strengthening exercises target the neck, shoulder and arm to improve muscular support and reduce nerve compression risk. Clinical Pilates provides structured thoracic and cervical rehabilitation in a controlled environment that progressively builds the postural capacity needed for long-term management. Dry needling assists with cervical and periscapular muscle guarding that limits treatment progress. articulatephysiotherapy
For patients whose cervical radiculopathy arose from a workplace or motor vehicle injury, WorkCover and CTP funded physiotherapy is available.
Our physiotherapists Yulia Khasyanova and Bethany Kippen both have experience in cervical spine conditions and nerve pain management and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
