Cervical nerve root compression, also known as cervical radiculopathy, is a condition that occurs when a nerve root in the neck becomes compressed or irritated as it exits the spinal column. This nerve compression leads to symptoms such as radiating neck and arm pain, muscle weakness, altered sensation (like numbness or tingling), and sometimes reduced reflexes. These symptoms typically follow the path of the affected nerve and can vary depending on which level of the cervical spine is involved.
The cervical spine consists of seven vertebrae, labelled C1 through C7, with nerve roots exiting between each level. These nerves travel down the arms, controlling sensation and muscle function. When one of these nerve roots is compressed, by a disc protrusion, bone spur, or narrowing of the spaces in the spine, it can interfere with the nerve’s function, leading to uncomfortable symptoms.
Causes of Cervical Nerve Root Compression
There are different causes of cervical nerve root compression, and they tend to vary depending on a person’s age due to natural changes in spinal anatomy and biomechanics over time.
In Younger Individuals
In people under the age of 40 or so, the cervical discs are typically well-hydrated and have a healthy, gel-like centre called the nucleus pulposus. This inner portion is surrounded by a tougher outer layer known as the annulus fibrosus. With sudden mechanical stress, like heavy lifting, abrupt twisting, or trauma, the inner gel can push out through the outer layer, resulting in a disc herniation. If the herniated disc material presses on a nearby nerve root, this can cause a sudden onset of symptoms like radiating pain, pins and needles, or weakness.
Younger individuals with disc herniation often recall a specific triggering event, like lifting something heavy or a sudden neck movement. The onset of pain can be immediate or develop over the next day or two.
In Older Individuals
For people over the age of 40 or 50, the cervical spine tends to undergo more degenerative (age-related) changes. Discs begin to dehydrate and shrink as part of the natural ageing process, a condition known as disc degeneration. This process reduces the height of the disc space, making it easier for surrounding structures to impinge on nerve roots.
As degeneration progresses, several changes can occur:
- Disc space narrowing, which reduces the room available for the nerves to exit the spinal canal.
- Osteophyte formation (bone spurs), which are bony outgrowths that can form along the edges of the vertebrae and compress nearby nerves.
- Spinal stenosis, or narrowing of the spinal canal or foraminal openings (the side passages where nerves exit), which can crowd the nerves.
- Facet joint arthritis, which affects the small joints at the back of the neck and can reduce spinal mobility while narrowing nerve pathways.
While disc herniations can still happen in older individuals, they’re typically one part of a broader picture involving multiple degenerative changes.
Sometimes, the specific cause of compression can’t be identified, even after imaging. These are called idiopathic cases, meaning the source is unclear or not easily pinpointed.
Risk Factors
Several factors can increase a person’s risk of developing cervical nerve root compression:
- Age: As mentioned, age-related changes in the spine are a major contributor, especially after the age of 40–50.
- Previous Neck Injuries: Traumas such as whiplash or vertebral fractures can weaken the neck structures and make them more prone to future problems, including nerve compression.
- Poor Posture: This is one of the most common contributing factors in today’s world, particularly with people spending long hours at desks or looking down at devices. When the head is tilted forward, the pressure on the cervical spine increases dramatically. For example, a head weighing around 5kg can feel like 12kg to the neck at just a 15-degree forward tilt. Over time, this can place undue stress on the spinal structures.
- Occupational Stress: Jobs or activities that involve repeated neck movements, sustained awkward positions, or heavy lifting can increase the strain on the cervical spine. Over time, this can lead to wear and tear and increase the risk of nerve compression.
Commonly Affected Levels
The C7 nerve root is the most commonly affected level in cases of cervical nerve root compression. When this nerve is compressed, people typically report pain or tingling that travels from the neck down the back of the arm to the middle finger. Muscle weakness often appears in the triceps, and the triceps reflex may be reduced or absent.
The C6 nerve root is the next most commonly affected. Symptoms here usually include pain or paraesthesia (pins and needles) that radiates into the thumb and lateral forearm. There may be biceps weakness and a reduction in the biceps reflex.
These lower cervical levels (C6–C7) are more commonly affected because they experience more motion than the upper cervical spine, and they’re more susceptible to degenerative changes due to their load-bearing position.
Diagnosis
Diagnosing cervical nerve root compression involves a combination of a thorough history, physical examination, and sometimes imaging.
When you visit a physiotherapist or healthcare provider, they will begin by asking detailed questions about your symptoms, such as when they started, how they feel, what makes them better or worse, and whether there’s any history of injury or relevant occupational stress. Your medical history, activity levels, and goals will also be discussed.
The physical exam includes neurological testing, where the therapist assesses muscle power, sensation, and reflexes in the upper limbs to identify which nerve root might be compromised. The spine may also be palpated for stiffness or tenderness, and special orthopaedic tests may be performed.
If nerve root compression is suspected and symptoms are persistent or worsening, your physiotherapist or doctor may refer you for an MRI, which provides clear imaging of the discs, nerves, and surrounding structures to confirm the diagnosis.
Symptoms
The hallmark symptoms of cervical nerve root compression vary depending on which nerve is affected, but typically include:
- Radiating pain from the neck into the shoulder, arm, or hand
- Numbness or tingling in a specific distribution (dermatome) of the arm
- Muscle weakness in the affected limb
- Reduced or absent reflexes
- Neck stiffness or discomfort
Symptoms can worsen with certain neck movements or prolonged positions, especially those that reduce the space available for the nerve root.
Prognosis
Most cases of cervical nerve root compression have a favourable prognosis, especially when diagnosed early and managed conservatively. Acute cases often improve significantly within 8 to 12 weeks with physiotherapy and appropriate medications.
Several factors can influence recovery time:
- Severity of compression
- Duration of symptoms before treatment began
- The underlying cause (e.g., isolated disc herniation vs. complex degenerative changes)
- Compliance with treatment, including exercise and ergonomic changes
While most people recover well, some may experience residual symptoms or require further intervention if conservative management is ineffective.
Treatment Options
Conservative Management
For the majority of people, conservative treatment is the first line of management. This often includes:
- Manual therapy: Gentle joint mobilisations or manipulations to create more space for the nerve and relieve pressure such as traction and opening techniques.
- Soft tissue release: Targeting the neck and shoulder muscles to reduce tension and secondary discomfort.
- Education and activity modification: Learning positions that relieve pressure on the nerve (such as cervical unloading postures) and avoiding aggravating movements.
- Medications: You may be referred to your GP for anti-inflammatory drugs or nerve-specific medications to help manage symptoms.
- Home exercises: These are prescribed to maintain movement, reduce stiffness, and improve mobility.
As symptoms improve and become more stable, your physio will guide you through a strengthening program. This usually includes deep neck flexor activation and postural strengthening to support the spine and reduce the risk of recurrence. They’ll also work with you to gradually return to physical activity and ensure long-term spinal health.
Further Intervention
If symptoms are severe, persistent, or progressive despite conservative treatment, further medical intervention may be necessary.
- Corticosteroid injections: These can be used to reduce inflammation and swelling around the compressed nerve root, offering temporary but often significant relief.
- Surgical options: In rare cases where symptoms are disabling or worsening (e.g., progressive weakness or muscle wasting), surgery may be required. This might involve removing part of the disc (discectomy), bone spurs, or even spinal fusion in more complex cases.
Cervical nerve root compression is a relatively common condition, especially as we age or subject our necks to repeated strain. The key is early recognition, proper assessment, and a structured treatment approach. For most people, conservative management through physiotherapy, activity modification, and supportive care will lead to a full recovery, allowing them to return to normal activities without ongoing issues.
If you’re experiencing symptoms that suggest a nerve issue in your neck, such as arm pain, tingling, or weakness, it’s important to seek assessment early to get the right guidance and avoid long-term complications.
