Cervical Disc Herniation: Symptoms, Treatment and Exercises

83New cases of a pinched nerve causing arm pain, per 100,000 people each year

4–6 monthsTime to clear improvement for most people

%90Have no symptoms, or only mild ones, in the long term

%87,6Disc bulges on the MRI scans of people with no pain at all

What is it?

Between the vertebrae are discs that act as cushions. When the outer ring of a disc weakens and tears, the gel-like core inside can push out; this is called a herniation. The part that pushes out presses on or irritates a nerve root that runs from the spinal cord to the arm.

A herniated disc is not the only cause of a pinched nerve causing arm pain (cervical radiculopathy). Especially in older people, a more common cause is bony spurs from osteoarthritis narrowing the opening where the nerve leaves the spine. In younger people, a herniated disc is more common.

Symptoms

Pain spreading from the neck to the shoulder, the shoulder blade and the arm, usually on one side
Numbness, tingling or electric-shock sensations in the arm, the hand or certain fingers
Weakness in the arm or hand, difficulty gripping
Tipping your head back or turning it towards the painful side may make the pain worse
Some people notice that their arm pain eases when they rest their hand on top of their head

If the pain is only in your neck and does not spread into your arm: Neck pain page →

Which nerve causes pain where?

Depending on which nerve root is pinched, pain and numbness spread to different areas. The root most often affected is C7, followed by C6.

C5Pain and numbnessOuter shoulder and upper armMovement that may weakenLifting the arm out to the side
C6Pain and numbnessOuter side of the forearm, thumb and index fingerMovement that may weakenBending the elbow, bending the wrist back
C7Pain and numbnessMiddle fingerMovement that may weakenStraightening the elbow, pushing
C8Pain and numbnessRing and little fingers, inner edge of the handMovement that may weakenUsing the fingers, gripping

Diagnosis: MRI is not everything

The diagnosis is made first of all through an examination. A physiotherapist or doctor checks your neck movements, the strength of your arm muscles, your reflexes and your sensation. They also use special tests that load or relieve the nerve root, such as the Spurling test, the nerve tension test and the neck distraction test.

An MRI shows where the herniation is, but it cannot guide the decision on its own. Among 1,211 people with no symptoms at all, 87.6% had disc bulges on MRI; even in people in their 20s, the figure was 73–78%. What matters is whether the MRI findings match your symptoms and the examination.

Course and treatment

Symptoms are usually at their worst in the first few weeks. Most people improve clearly within 4–6 months, and this improvement still holds at 2–3 years of follow-up. In a study that followed 561 patients for about 5 years, 90% of patients had no symptoms or only mild symptoms at the final check-up; a quarter had had surgery.

Staying activeIt is enough to avoid, for a few days, the movements that make the pain much worse. Complete bed rest is not recommended.
ExerciseExercises that strengthen the deep neck muscles and the muscles around the shoulder blades and stabilise the neck, together with nerve gliding exercises, are the cornerstone of treatment.
Manual therapy and tractionGuidelines recommend manual therapy and intermittent neck traction (a controlled pull on the neck), combined with exercise, for long-lasting pain that spreads into the arm.
Neck collarIt can be worn for a short time in the first few days, when the pain is very severe. Long-term use is not recommended.
Medication and injectionsPainkillers recommended by your doctor. For selected patients, injections targeting the nerve root may be given if the doctor decides they are appropriate.
SurgeryIf there is progressive loss of strength, signs of spinal cord compression, or pain that disrupts daily life despite 6–12 weeks of appropriate treatment, an assessment by a neurosurgeon or an orthopaedic surgeon is needed.

Exercises at home

Four exercises for a pinched nerve

If pain, numbness or tingling in your arm gets worse or spreads further down towards your fingers during an exercise, stop that exercise. If the pain draws back up from the arm towards the neck, that is usually a good sign. For strengthening and stretching exercises, see also the neck pain page.

Hand on head

Put your hand on your head

When your arm pain is severe, put the hand on your painful side on top of your head and rest like that. This position reduces the tension on the nerve root. For some people it eases arm pain considerably.

A few minutes, if it brings relief

Chin tuck

Sit up straight, looking straight ahead. Without tilting your head, draw your chin straight back, as if making a double chin. Feel the back of your neck lengthen; hold for 5 seconds, then relax.

10 reps, 2–3 times a day

Nerve glide

Raise your arms out to the sides at shoulder height, with your elbows bent to 90 degrees and your palms facing forwards. As you tilt your head to the right, straighten your right elbow and lower your forearm out to the side, so that your right arm is completely straight. Come back to the middle. Then tilt your head to the left and do the same with your left arm. The nerve is tightened at one end while it is slackened at the other, so it glides without being stretched.

10 slow reps to each side. Stop if the numbness increases

Shoulder blade squeeze

Stand or sit up straight. Without lifting your shoulders towards your ears, draw your shoulder blades back and slightly down towards each other. Hold for 5 seconds, then relax.

10–15 reps, twice a day

Video

Videos for a pinched nerve in the neck

From the YouTube channel of US physical therapists Bob Schrupp and Brad Heineck.

Coping with a pinched nerve in the neck

A general roadmap of what can be done for pain that spreads into the arm.

The most important exercises for a pinched nerve

Key exercises for a pinched nerve and neck pain.

Videos belong to the Bob & Brad channel.

Frequently asked questions

Does a cervical disc herniation go away on its own?

For most people, yes. Symptoms are usually at their worst in the first few weeks, and most people improve clearly within 4–6 months. During this time, exercise and physiotherapy both reduce pain and make it easier to get back to daily life.

When is surgery needed?

A surgical assessment is needed if there is increasing weakness in the arm, signs of spinal cord compression such as clumsy hands and difficulty walking, or pain that disrupts daily life despite 6–12 weeks of appropriate treatment. In the long term, about a quarter of patients have surgery.

My MRI shows a herniated disc but I have no pain. What should I do?

Try not to worry. Most people with no pain have disc bulges on their MRI. If you have no symptoms, you do not need treatment; you can keep your neck healthy with regular exercise.

Is massage or neck "cracking" OK with a cervical disc herniation?

Soft tissue work and gentle mobilisation are generally safe. Fast, forceful neck manipulation ("cracking"), however, should only be considered when you have nerve symptoms spreading into your arm after a detailed examination, and by a trained practitioner.

How should I sleep?

Most people find it more comfortable to lie on their back or on their pain-free side. Your pillow should keep your neck in line with your spine. Avoid sleeping on your front.

Is a cervical disc herniation the same as a straightened neck?

No. A straightened neck means that the gentle natural curve of the neck looks reduced on an X-ray, and it is common in people with no pain too. A herniation, on the other hand, is a disc bulging out. About a straightened neck →

When to seek help right away

The following signs may mean that the spinal cord or nerves are seriously affected. See a doctor without delay:

Numbness or weakness in both arms at once
Clumsy hands: difficulty doing up buttons or writing, dropping things
Unsteadiness when walking, weakness or numbness in the legs
A change in bladder or bowel control (emergency)
Rapidly increasing weakness in the arm
Fever, unexplained weight loss, a history of cancer, or pain that started after an accident
Arm pain that comes with chest pain, shortness of breath or sweating (it may be your heart; call 112)

Sources

Australian Physiotherapy Association. Cervical radiculopathy. InMotion.
Blanpied PR, Gross AR, Elliott JM, et al. Neck pain: revision 2017. Clinical practice guidelines linked to the International Classification of Functioning, Disability and Health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2017;47(7):A1-A83.
Nakashima H, Yukawa Y, Suda K, Yamagata M, Ueta T, Kato F. Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects. Spine. 2015;40(6):392-398.
Physiopedia. Cervical Radiculopathy.
Radhakrishnan K, Litchy WJ, O'Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain. 1994;117(Pt 2):325-335.
Wainner RS, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, Allison S. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine. 2003;28(1):52-62.
Wong JJ, Côté P, Quesnele JJ, Stern PJ, Mior SA. The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review of the literature. Spine J. 2014;14(8):1781-1789.