To suffer from a pinched nerve in your neck is an agonizing experience. Sharp, shooting pain down your shoulder and arm, together with irritating tingling in your fingers. Suddenly, your hand feels useless, and you drop things. You’re aware of the pain constantly, and it doesn’t go away even when you stretch. Even when you try to sleep, it simply feels worse. These are common symptoms of nerve compression in the neck (also called cervical radiculopathy).
The good news is that 75 – 90% of patients can recover from these symptoms without the need for surgery. Even though nerve pain is severe and causes a lot of concern, don’t lose hope. If you would like to understand this condition better, this article is for you.
Understanding the anatomy of your neck will help you know where the pinch and the pain are coming from.
Bones
Your cervical spine is made up of seven small vertebrae in your neck, labeled C1 to C7. These bones stack on top of each other to form the structure of your neck. Your neck supports the weight of your head and allows a wide range of motion, like turning, tilting, and nodding.
Discs
Between each vertebra is a spinal disc, which acts like a cushion and shock absorber. These discs have a soft, gel-like center and a tougher outer layer. They help keep your spine flexible and decrease the pressure between the bones.
Nerves
Running through the middle of the vertebrae is your spinal cord. It is a vital communication highway that connects your brain to the rest of your body. From the spinal cord, nerve roots branch out through small openings between the bones, exiting the spine to form a network of nerves that supply your arms, hands, legs, and feet. Each nerve is covered with a sheath, also called a myelin sheath. It speeds up the conduction of the impulses through each nerve. Inside this sheath is a fine network of arteries that provide the nerve with enough blood and oxygen.
Muscles
Surrounding all of this is a complex network of muscles. They play a key role in supporting your head, maintaining your posture, and moving your neck. The neck muscles, including the scalenes, levator scapulae, sternocleidomastoid, and upper trapezius, help control head and neck motion. Further down, shoulder and upper back muscles like the trapezius, rhomboids, and rotator cuff muscles work together to support posture and shoulder movement.
What do nerves do?
Nerves are the body’s electrical wiring system. These power cables are responsible for two-way communication from the brain to the hands and feet.
Some of the things that nerves do for you:
- Voluntary movement: Nerves allow you to control your muscles for different actions like walking, talking, and reaching.
- Senses: Your senses (touch, sight, smell, hearing, and taste) rely on nerves to transmit information to the brain.
- Involuntary actions: Essential functions like breathing, digestion, and a steady heart rate are controlled by nerves.
- Stress Response: The body’s fight-or-flight response to stress is controlled by your nervous system.
When a nerve is pinched or compressed, it affects the ability of the nerve to transmit and receive messages.
I think I have a pinched nerve in my neck. How did it happen?
The slow burn
The pain and discomfort that you become aware of with a pinched nerve in your neck don’t happen instantly. It’s a process that unfolds as the nerve becomes increasingly compressed and irritated.
It all starts when something, such as a herniated disc, bone spur, or tight muscles, puts extra pressure on the nerves in your neck. Nerves are incredibly delicate structures that need two important things to function well. Firstly, they are extremely sensitive to the blood supply and oxygen supplied by the vast network of small blood vessels around them. Secondly, they need to be able to move and glide inside the myelin sheath and between the different layers of tissue in your body. Compression on a nerve causes an immediate change in circulation and nerve movement. Ultimately, this affects the nerve’s ability to send and receive signals.
Inflammation starts a fire
This initial pressure creates inflammation around the nerve. It leads to swelling in the nerve and surrounding joints, and muscles. In response to this, your neck muscles tighten and form incredibly painful spasms. The spasms are there for a reason. To keep you from moving your neck too much and worsening the pinch on the nerve.
It spreads…
With continued pressure and poor blood flow, the pinched nerve starts to send abnormal signals down the arm. Now, you feel shooting pain down your arm, sometimes making your arm more sore than your neck. Together with constant and intense pain, other symptoms arise. It starts with an electric tingling in your fingers or an irritating numbness that doesn’t want to go away, even if you try to ‘shake it off’.
It quickly feels out of control
If the cause of the nerve compression isn’t found and treated, it can ultimately block the flow of impulses through the nerve completely. This leads to muscle weakness, leaving you with a heavy, weak arm. The longer the nerve remains irritated, the more intense and widespread the pain can become. With time, the pinched nerve becomes more sensitive through a process called sensitization. Now, the smallest movement or pressure leads to a big reaction (overreaction).
Causes of a pinched nerve
Disc herniation or bulge
These gel-like discs between your cervical (neck) vertebrae can bulge outward, impinging on the space where the nerve exits from the spine. It typically happens due to swelling or increased compression on the disc.
Facet joint sprain (Locked neck)
That sudden pinching pain that makes your neck ‘lock up’ in place. The facet joints form part of each neck joint and help with movements like turning your head. A facet joint sprain or pinch can often happen with a sudden movement like looking over your shoulder in the car.
Degenerative changes in your neck
These ‘wear and tear’ type changes happen in joints as we age. It is also called cervical spondylosis. The spaces between the vertebrae narrow, leading to increased pressure between the joints and nerve openings. And, sometimes osteophytes (also called bone spurs) form and can easily irritate a nerve that runs from the spine.
Poor posture and repetitive strain
Sitting hunched over a desk or computer for many hours puts immense strain on your neck muscles and joints. They have to work hard to support the weight of your head, and a position like that is not optimal. The more hours you spend like that, the more it adds to strain, pain, and muscle spasms. In turn, it increases the pressure and traction on sensitive nerve tissue in your neck.
Traumatic accidents or falls
Accidents that cause a whiplash effect on your neck can easily overstretch nerve tissue and lead to injuries of your neck joints or discs. It leads to inflammation and irritation of nerves in your neck.
How severe is the compression on my nerve?
In medical terms, nerve injuries are often classified into three levels of severity:
Neuropraxia is the mildest form, where the nerve is compressed but not permanently damaged. The outer covering (myelin sheath) surrounding the nerve is damaged, and this affects the conduction of signals through the nerve. Signals are slower than usual, but the nerve can recover completely.
Axonotmesis is more serious. The inner part of the nerve (the axon) is damaged, although the outer covering remains intact. That means almost no signals can run through this nerve. This type of injury can heal, but it takes much longer.
Neurotmesis is the most severe form, where the nerve is completely cut or torn.
While this classification is useful, we use other key areas to determine the severity of your pinched nerve:
Sensation changes
Changes in feeling are one of the first signs of nerve compression. You might notice numbness and tingling (pins and needles) in specific patterns along your arm and hand. The more pronounced and widespread these abnormal sensations become, the more significant the nerve irritation.
Muscle strength
Nerves control muscle movement, so when a nerve is compressed, muscle weakness develops in the areas it supplies. Initially, your arm feels heavy, and you find your grip strength isn’t what it used to be. But, with worse compression, your arm and hand feel weak and ‘dumb’, like you’ve forgotten how to use them. Testing the muscle strength and reflexes of specific muscle groups in your arm gives us an accurate idea of how severely your nerves are compressed.
Irritability
How easily and severely are your symptoms triggered? If small movements, light touch, or certain postures quickly bring on strong symptoms (like sharp pain or numbness), it suggests that the nerve is highly sensitive and possibly under significant stress. It is typical for nerve pain to have a latent effect (feel worse a few minutes after a movement or posture). A highly irritated nerve typically causes worse pain in your arm than in your neck.
Limitation of movement
Stiffness and loss of normal movement in the neck, shoulder, or arm are a given when you have a pinched nerve. This is due to pain, muscle guarding, or the nerve losing its ability to glide and move freely. If your neck feels locked in place and you can’t even lift your arm to put on a shirt, it often points to a more irritated or compressed nerve.
Diagnosis
Physiotherapy diagnosis
Our experienced physiotherapists are highly trained to assess and diagnose a pinched nerve in the neck (cervical radiculopathy). We don’t just treat symptoms, we start by carefully identifying the underlying cause.
The process begins with a detailed conversation about your symptoms. We’ll ask about your daily activities, posture, work habits, exercise routine, and any recent injuries that could be contributing factors. It is important to get a clear idea about how your nerve pain responds to different movements and what makes it worse or better.
Next, we perform a physical assessment. This includes range of motion tests of your neck and arm, and neurological screening to assess your sensation, reflexes, and muscle strength. Another important way to identify nerve irritation is neurodynamic testing, an effective way to check how well the nerves are gliding and moving between the different layers of tissue.
In most cases, this thorough exam provides a clear picture of what’s going on, but if we do spot anything concerning or outside our scope, we’ll guide you toward appropriate further investigations.
The goal is not just to name the problem, but to fully understand why it’s happening. That way, we can create a treatment plan that is specific, safe, and effective for you.
X-rays
Soft tissue, like discs and nerves, can not be seen on X-rays. However, X-rays will show us the integrity and alignment of the cervical vertebrae. This enables us to see if there is any pathology of the vertebrae or loss of space between them. This points to increased pressure on the nerves that exit the spine.
Your physiotherapist can refer you to get X-rays taken if necessary.
Nerve conduction test
A nerve conduction test makes use of impulses sent through certain nerves to elicit a response (like a muscle twitch). It is a very effective way to see how quickly and strongly a nerve’s response is to such an impulse, especially when it is compared to a healthy nerve. Unfortunately, a test like this needs to be done by a specialist doctor. You do not need a test like this from the start.
Your physiotherapist can guide you and refer you if a nerve conduction test is deemed necessary.
MRI
An MRI scan can image all structures, including soft tissue, fluid (like swelling), discs, nerves, muscles, and bones. However, it is a very expensive test, and you need to be referred by a specialist doctor. It isn’t necessary to go for such a scan from the start.
Your physiotherapist can guide you and refer you to the right specialist if needed.
Why is my nerve pain not going away?
If you hoped your nerve pain would settle on its own, but it’s still hanging around or even getting worse, you’re not alone. Nerves don’t just “bounce back” once they’re irritated. The nerve stays sensitive and inflamed if the underlying pressure or inflammation isn’t addressed. What may start as mild tingling or occasional discomfort can progress to constant pain, numbness, or weakness. Over time, your symptoms become more intense and harder to manage.
Muscle wasting (atrophy)
If a nerve that controls certain muscles stays compressed, those muscles weaken and shrink over time. This is known as atrophy. It affects muscle mass, strength, coordination, and everyday arm movements.
Decreased fine motor skills
A chronic pinched nerve starts to impact your muscles’ ability to control small, precise movements. You will notice that simple tasks become increasingly difficult, like buttoning clothes, writing, typing, and gripping small things.
Compensatory pain or strain
Our bodies are amazing at adapting when we are in pain. Unconsciously, you change your posture and how you move your neck and arm to avoid irritating a pinched nerve. However, with time, this leads to compensatory strain on other areas, such as the opposite shoulder or upper back.
Permanent nerve damage
Nerves need healthy blood flow and movement to function properly. Ongoing compression leads to reduced oxygen and nutrient supply, which, in severe cases, may result in irreversible nerve damage. This means permanent numbness or muscle weakness.
Early treatment helps prevent these complications. With the right care, most pinched nerves can be managed effectively before they become long-term problems.
Problems we encounter when patients come to us with a pinched nerve
Fear of movement
After hearing terms like “disc bulge, nerve damage,” or “bone on bone arthritis,” most people fear movement. This leads to extreme neck and shoulder stiffness and slower recovery. If you suffer from a pinched nerve, there is a fine balance between moving too little or too much. But, if it is done safely and progresses with time, movement is an important part of your recovery.
Over-reliance on passive treatments
Most people try other treatments like massages, manipulations, foam rolling, or a neck brace. The problem with this is that it doesn’t involve an active effort from you. In the acute phase of an injury like this, there is a need for rest and pain-relieving treatments. But, in the long run, they only give short-term relief and don’t solve the root problem.
Conflicting information
You will get different opinions from doctors, scans, or online sources. This will only leave you feeling confused and more anxious about what you should and shouldn’t do. You need someone to guide you through the recovery process, which takes time and effort. Our physiotherapists can help you with this.
Medication alone won’t fix the problem
Strong painkillers can dull nerve pain and have a place in your recovery process. But medication alone doesn’t fix the root cause or prevent it from coming back. To rely solely on medication for weeks or months on end can affect your overall health and make you dependent on the effect that it gives.
Unrealistic expectations
To expect immediate results from any treatment will set you up for disappointment. Nerve pain takes time to improve, and your body needs to work through the healing process. Make sure that you are treating the underlying cause of your nerve compression and have patience with the process, with its ups and downs.
Physiotherapy treatment
Our physiotherapists are uniquely equipped to guide your recovery from start to finish. We don’t just focus on relieving the symptoms of a pinched nerve in your neck, we aim to find and treat the underlying cause. Through a combination of hands-on techniques, targeted exercises, and education, we help reduce irritation on the nerve, restore normal movement, and get you back to doing the things you love.
With a deep understanding of anatomy, biomechanics, and nerve function, we can safely guide you through each stage of healing. We always include the surrounding areas, like your shoulder and middle back, to clear compensatory patterns. It is normal for nerve pain to feel better on certain days and worse on other days. A small movement can have a big reaction that takes days to settle. Your physiotherapist can help you understand your pain and walk the road of recovery.
Phases of rehabilitation
1st Phase: Settle the irritation (Week 1 – 2)
In the acute phase, the goal is to reduce nerve sensitivity and inflammation. To calm symptoms, we use pain-relieving modalities such as laser, taping, massage, dry needling, and gentle nerve mobilisation.
Your pain intensity, frequency, and irritability should be low at the end of this phase. Then, we can focus on restoring your movement.
2nd Phase: What you want to achieve in Week 1 – 2
What needs to happen in the tissue/ pathology to fix it
This is the thing you should be able to do by now
3rd Phase: What you want to achieve in Week 2 -3
Treatment elaborated
This is what you need to be able to do with ease so we can progress to the next phase of treatment.
4th Phase: What you want to achieve in Week 3 – 4
Re-inforce, strengthen, guide,
What you should be able to do by this stage is ….
5th Phase: Test return to normal life Week 4 – 6
To makes sure you’re safe to turn to
- Driving you should be able to
- Jogging you should be able to
- Run you should be able to
- Work
6th Phase: Final medical clearance tests (Week
By now, you should be able to jump and throw, but there are some specific stress tests you should be able to do.
By now, you should be able to return to your routine. During the final week of your …….. treatment, we want you to be able to train at your full capacity. ………….. should be able to handle stretch stress, max load, and compressive forces.
So we can sign off on your recovery, knowing you’re safe.
Healing time
Physio protocol time frame for healing (weeks/months)
- A full recovery and return to sport will take longer and should not be confused with the healing period.
- It takes about 3 to 4 months to return to exercise and sports.
- You will need physiotherapy treatment twice a week for the first two weeks.
- After this, your treatment sessions can be …
- Remember: “Non-operative Treatment” or Non- Surgical Not
conservative
Other forms of treatment
This section is about other treatments that can help the process services that can help – but we don’t provide.
- Your doctor (GP) will probably
- Pain meds, injections,
- Getting your back or neck ‘aligned’ or ‘clicked’ in the hopes of improving the … will not improve the state of the muscle or change your pain. It could even worsen or trigger a muscle spasm. You need to look at the bigger picture.
- A biokineticist will be able to help you in the final stages of your rehabilitation and get you back to training for your sport.
- Wearing a back brace won’t be the solution to your problem.
- Stretching or foam-rolling might ease your pain temporarily, but
Is surgery an option?
Surgery for pinched nerves in the neck
Surgery will only be considered if the nerve is in danger. That is you have no sensation and a lot of weakness. If not most specialists prefer their patients trying physiotherapy first.
If you do need surgery a decompression fusion is usually done from the front of the neck. Rods and screws and inserted to relieve the compression. There may be side effects to the procedure, neck rotation is sometimes limited because of the hardware.
Surgery is necessary when …
- These are the surgical checkboxes that must be ticked before surgery is even considered.
- Surgery is only Halfway mark for a successful surgery, the rest is the reintegration, strengthening and adapting your body to the change.
- Types of surgeries that can be done.
- Why is rehab important after surgery?
What else could it be?
- Whiplash
- Thoracic outlet syndrome
- Only mention a few (up to 5) differential Diagnosis
- Describe one symptom or difference between the two that sets them apart
- This section is for very similar Conditions but one or 2 differentiating factors.
Also known as
- Synonyms
- List key phrases (careful – start each bullet with different word)
