Cervical radiculopathy is a pain syndrome involving one of the cervical nerve roots, with the C7 root (60%) and the C6 root (25%) being the most commonly involved. In younger persons this is due a direct injury which compromises the nerve exit or due to an acute disc prolapse. In older age groups this syndrome can also occur, but in this case is due to narrowing of the nerve exit by arthritic joints and ligament enlargement, disc bulging and bony outgrowths. Cervical nerve root pain referred to physiotherapists for the management of neck pain and arm pain.

Factors making nerve root pain more likely are routine lifting of weights above 25 pounds (12 kilograms), driving or operating vibrating machinery and smoking. Cervical radiculopathy is not common and occurs much less frequently than lumbar root lesions such as sciatica.

Cervical radiculopathy can occur for a variety of reasons while sometimes there is no obvious precipitating factor that can be found. A sudden extension, side bending and rotation, e.g. in sport or trauma, could close down the exit gap quickly and squeeze the nerve, injuring it. Sudden flexion or extension with a side bend away from the affected side could pull the nerve strongly, again injuring it and causing symptoms. Disc prolapses can occur with a sudden load on the neck in any position, and in older people sustained or repetitive extension and rotation may cause the osteophytes to contact the nerve, with similar results to the previous events but with a slower onset.

To ensure the problem is radiculopathy the physio will take a history including the area and type of pain, muscle weakness or numbness, factors making the pain worse or better, how the injury happened, any current treatment and any lower limb or bowel or bladder problems. Commonly the pain has not come on quickly but insidiously and over time, initially presenting with a dull achy pain to a very severe burning pain in the neck and over the shoulder. This can worsen to the upper arm, then the forearm and the hand as the root irritation increases. Rarely there may be no real pain but loss of muscle power and sensibility.

People with root pain look tired due to poor sleep, don’t find anything funny and guard their arm in a protective posture against the abdomen or hold it out to the side with their hand on the back of their neck or the other side of the head. This may reduce the forces through the inflamed nerve root and so reduce pain.

Patients typically present to the physiotherapist in a distressed state, looking tired, having no sense of humour and holding their arm protectively. The arm may be held in front of the body or with the shoulder out to the side and the hand over the top of the head or behind the neck in an attempt to reduce the pain by relieving traction stress on the nerve root.

Initial management is to reduce the inflammation and pain and physiotherapists use cold therapy, anti-inflammatories, manual traction, mechanical traction and instruction to avoid activities or postures which are worsening. The physio reduces the forces applied to the nerve root area with a collar for day or night use to support the neck and limit the available neck movements and with careful manual tractioning to relax muscle spasm and allow the pain to settle.

In the sub-acute phase restoration of neck range of movements and strength is encouraged with isometric neck exercises with a progression to isotonic and multiple muscle groups. To prevent further problems, a long term exercise regime of aerobic fitness, stretching and strengthening may be helpful.

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