Cervical disc herniation

Cervical Disc Herniation: What Is It and How Is It Treated?

A cervical disc herniation is a localized displacement of the contents of a disc in the neck; treatment generally aims to reduce symptoms and restore normal activities without surgery. The disc acts as a cushion between the bones of the spine, called vertebrae. A herniated disc can irritate a nerve and cause pain in the neck or arm.

Most people with symptoms related to a nerve root in the neck get better without surgery. A nerve root is the part of a nerve near the spine. Physical therapy can help reduce pain, keep the neck mobile, and help you resume your activities. An improvement in symptoms does not necessarily mean that the herniation has disappeared on an imaging test.

What is the cervical intervertebral disc?

Le disque intervertébral cervical est un coussin qui répartit les charges entre les vertèbres du cou et permet leurs mouvements. Le cou comporte sept vertèbres cervicales, nommées C1 à C7. Il n’y a pas de disque entre C1 et C2. Les six disques se trouvent entre C2-C3 et C7-T1; T1 désigne la première vertèbre du haut du dos. Ces six niveaux discaux¹ comprennent donc la jonction entre le cou et le haut du dos.

The disc consists of two distinct parts. The nucleus, located in the center, is the soft, jelly-like part of the disc. The annulus, which surrounds the nucleus, forms a layer of strong fibers that holds the nucleus in place. This structure helps distribute the load when you tilt your head forward or backward and when you turn it.

Cervical herniations often involve the C5-C6 and C6-C7 levels. These levels are near the base of the neck, but the C7-T1 disc is located even lower. Imaging studies of the neck also frequently reveal changes at the C5-C6 level ². Their frequency does not prove that any single force alone explains the formation of a herniation.

What forms can a cervical disc herniation take?

Une Cervical disc herniation peut prendre la forme d’une protrusion, d’une extrusion ou d’un fragment détaché, appelé séquestration. Ces termes décrivent son apparence et son lien avec le disque. Le bombement est une autre modification du contour du disque. La classification des hernies cervicales³ ne décrit pas une progression obligatoire d’une forme vers la suivante.

A bulge, sometimes referred to as a "bulging disc" in English-language reports, refers to a widening of the disc's outline. It does not, by itself, constitute a localized herniation.

A protrusion is a herniation in which the displaced portion is narrower than its base where it attaches to the disc. The term describes the shape of the herniation; it does not mean that the nucleus has necessarily passed through the entire thickness of the annulus.

Extrusion is a herniation in which the displaced portion is wider than its attachment base. It may remain contained by the fibers of the annulus or pass through an opening. Cervical radiculopathy—involvement of a nerve root in the neck— can occur if the herniated disc irritates or compresses that nerve root. Therefore, the shape of the herniated disc alone is not sufficient to determine whether a nerve root is affected.

La séquestration signifie qu’un fragment s’est détaché du disque. Ce fragment peut se trouver dans le canal de la colonne, où passent les structures nerveuses. Il peut diminuer de volume avec le temps. Une synthèse sur les hernies du bas du dos rapporte cette diminution dans 93,0 % des cas avec fragment détaché⁴. Des cas de diminution de hernies du cou⁵ sont aussi publiés, mais le pourcentage mesuré au bas du dos ne donne pas votre probabilité de récupération au cou.

What Causes a Herniated Disc in the Neck?

A cervical disc herniation can occur as a result of age-related changes in the disc or following an injury. A specific triggering event is not always identifiable. Your physical therapist will take into account when your symptoms began and how they have progressed to tailor the evaluation.

As we age, the disc may lose water, and the annulus may develop cracks. These changes can cause the disc’s contents to shift. They do not mean that everyone will develop a painful herniated disc.

An injury can also cause a herniated disc, for example, during an accident or as a result of physical exertion. A tear in the annulus can then allow the contents of the disc to shift. After a sudden movement of the neck during a car accident, the examination is used to identify possible injuries; pain alone does not confirm a herniated disc.

Le tabagisme fait partie des facteurs possibles. Des recherches chez des jumeaux⁶ montrent aussi une influence de l’hérédité sur les changements des disques du cou. Cette influence ne détermine pas à elle seule l’apparition d’une hernie douloureuse. Le rôle d’un travail avec vibrations ou de positions prolongées de la tête ne permet pas d’identifier avec certitude la cause d’une hernie chez une personne. Votre évaluation peut examiner ces habitudes pour adapter ce qui accentue les symptômes.

Une étude de population rapportait davantage de nouveaux cas de radiculopathie cervicale par année chez les hommes que chez les femmes⁷. Seulement 21,9 % des cas étaient attribués à une protrusion discale; les autres causes comprenaient notamment des changements des os et des articulations du cou⁷. Cette étude ne mesure donc pas la fréquence de toutes les hernies cervicales.

What are the symptoms of a cervical disc herniation?

A cervical herniated disc can cause neck pain, involuntary muscle spasms, difficulty moving the neck, or pain that radiates down the arm. It may also be present without any symptoms. The imaging results should be compared with your symptoms and the physical exam findings ².

Une étude a examiné par imagerie par résonance magnétique, ou IRM, le cou de 1 211 volontaires sans symptôme. Cet examen produit des images détaillées des tissus. Parmi les personnes dans la vingtaine, un bombement discal était présent chez 73,3 % des hommes et 78,0 % des femmes². Un bombement ne correspond pas forcément à une hernie et ne prouve pas, à lui seul, la cause d’une douleur.

Dans l’ensemble de ces 1 211 volontaires âgés de 20 à 70 ans, une compression, c’est-à-dire une pression sur la moelle épinière, était visible chez 5,3 % et un changement de son apparence sur certaines images de l’IRM chez 2,3 %². La moelle épinière est un cordon de tissu nerveux qui transmet des messages entre le cerveau et le corps. Ces chiffres portent sur tous les âges étudiés, pas seulement sur la vingtaine. Ils ne permettent pas d’ignorer une faiblesse ou un autre signe d’alerte.

When symptoms are present, they generally include gradual or sudden neck pain, neck muscle spasms in the form of involuntary contractions, decreased neck mobility due to pain, and sometimes the head remains tilted forward because the person is unable to straighten it due to severe pain.

Pain that radiates from the neck down the arm is called cervicobrachialgia. If a nerve root is affected, the condition is referred to as cervical radiculopathy. The pain may be accompanied by tingling, numbness, or weakness. Nerves transmit the signals necessary for sensation and movement. Some people find relief from their pain by placing their hand on their head; however, this symptom alone does not confirm the diagnosis.

What are the serious symptoms to watch out for?

New or worsening weakness, loss of sensation, balance problems, or changes in bladder or bowel control require urgent medical attention. These signs may indicate significant nerve damage, even if the pain is mild.

Seek medical attention immediately if any of these problems occur or worsen significantly:

• pain, weakness, heaviness, tingling, or other changes in sensation in an arm, hand, or leg;
• difficulty walking, loss of balance, or clumsiness in the hands—for example, when buttoning a garment;
• difficulty urinating, unusual urges, urinary incontinence, or loss of bowel control;
• a change in sensation around the buttocks or genitals, or a new change in sexual function, such as a new difficulty having an erection or an orgasm;
• neck pain accompanied by a severe headache.

Ces signes à faire évaluer rapidement⁸ sont aussi décrits pour une atteinte de la moelle épinière du cou⁹.

Une compression de la moelle dans un canal du cou rétréci peut nécessiter une intervention rapide. Appelez le 911 si une faiblesse ou une paralysie apparaît soudainement dans un bras, si le visage s’affaisse d’un côté ou si la parole devient difficile. Un de ces signes peut correspondre à un accident vasculaire cérébral¹⁰, un problème de circulation du sang dans le cerveau, même s’il disparaît ensuite.

How to diagnose a cervical disc herniation?

The diagnosis of a cervical disc herniation is based on the onset and progression of symptoms, an examination of the neck and arms, and imaging tests if necessary. Your physical therapist or doctor will ask you questions about when the pain began, how it has progressed, and what factors make it worse or better. He or she will then assess your range of motion, strength, and sensation in your neck and arms.

The clinical examination includes neurological tests to assess how the nerves in your neck are functioning. Your therapist will test your reflexes—the automatic responses of your muscles—your muscle strength in various muscle groups, and your sensitivity to light touch. These tests help identify a nerve root that may be affected. No single test is sufficient on its own to explain all of your symptoms.

Additional tests are useful in certain situations. An MRI shows the intervertebral discs, nerve roots, and spinal cord. An X-ray mainly shows the bones and does not allow for direct visualization of a herniated disc. An electromyogram, or EMG, measures the electrical activity of the muscles. It may be combined with nerve conduction studies, which assess the transmission of signals through the nerves. These tests can help distinguish between a problem near the spine and a nerve problem further up in the arm.

Rest assured, just because a hernia appears on an image doesn't necessarily mean it's the cause of your pain. Imaging results should always be interpreted in light of your clinical symptoms. A visible hernia that causes no symptoms generally does not require specific treatment.

When should you see a physiotherapist for a cervical herniated disc?

A physical therapist can evaluate you if neck or arm pain persists, recurs, or limits your activities. Physical therapy is one of the non-surgical treatment options available. If you experience any of the warning signs described above, seek the appropriate emergency medical care first.

Au Québec, vous pouvez consulter directement un physiothérapeute en clinique privée, sans voir un médecin d’abord. Le physiothérapeute évalue votre situation et vous oriente vers un médecin lorsque c’est nécessaire. L’Ordre professionnel de la physiothérapie du Québec explique cet accès direct¹¹.

Physical therapy can help reduce symptoms, keep your neck mobile, and allow you to resume your activities even if a herniated disc is still visible. You’ll see steady progress in your daily life—for example, in your ability to sleep, work, or turn your head.

What physiotherapy treatments are available for a cervical herniated disc?

Physical therapy may combine tailored exercises, manual therapy, and activity recommendations to reduce symptoms associated with a cervical herniated disc. The specific approach depends on your pain, mobility, strength, and any observed neurological signs.

Your joint mobility will be assessed to understand how your vertebrae move. We will also test how your nerves respond to movement and tension to see if they have become more sensitive. Your posture will be observed to understand how you hold yourself on a daily basis. The quality of your movements will be analyzed to see how you move your neck. Finally, your strength and control over your movements will be assessed to select the appropriate exercises.

Joint mobilizations are movements guided by the hands; manipulations are faster joint movements. The physical therapist assesses their appropriateness before using them. A meta-analysis of eight trials, involving 632 people with cervical radiculopathy, reports generally favorable results for manual therapy in terms of pain and daily functional limitations. However, comparisons with other treatments or a wait-and-see approach remain too uncertain to establish a clear benefit ¹². The techniques and comparison groups differed; these results do not measure the effectiveness of physical therapy as a whole.

Appropriate exercises can help build strength and improve mobility in the neck and shoulders. For persistent neck pain, strengthening the neck, the area around the shoulder blades (the flat bones at the back of the shoulders), and the arms can provide short-term pain relief ¹³. The 2015 Cochrane Review did not identify any trials specifically addressing recent pain limited to the neck. For recent cervical radiculopathy, however, it reported a small short-term benefit in terms of pain relief, with a low level of certainty.

Dans un essai auprès de 205 personnes ayant une radiculopathie depuis moins d’un mois, la physiothérapie avec exercices à domicile a réduit davantage la douleur au cou et au bras pendant six semaines que l’attente avec poursuite des activités¹⁴. Des médicaments contre la douleur étaient permis dans tous les groupes. La réduction supplémentaire était d’environ 12 points sur 100 pour le bras et 14 pour le cou. Les limitations quotidiennes ne s’amélioraient pas clairement davantage sous physiothérapie, et les différences de douleur entre groupes n’étaient plus présentes à six mois.

The McKenzie Method focuses, in particular, on identifying a direction of movement that alleviates symptoms. We refer to “centralization” when the pain moves away from the arm and closer to the neck ¹⁵. A follow-up study, involving only 19 complete case records of cervical radiculopathy, observed an improvement in daily functional limitations following this approach, without a significant improvement in pain intensity. It does not demonstrate that centralization yields better results than any other method.

Your physical therapist can help you pace your activities to minimize pain flare-ups and gradually resume the activities that matter to you. They can also suggest adapted movements as part of treatment for motion-sensitive nerves. These movements are designed to make everyday activities more manageable.

Dans un essai auprès de 88 adultes ayant des symptômes de radiculopathie cervicale depuis deux à six mois, l’ajout de mouvements guidés du bras visant le nerf médian, un nerf qui se rend jusqu’à la main, à des exercices du cou réduisait davantage la douleur et les limitations après quatre semaines que les exercices seuls¹⁶. Les deux groupes recevaient aussi de la chaleur. Aucune différence nette n’était observée pour l’étendue des mouvements du cou. Ces résultats ne prouvent pas que le nerf a retrouvé un glissement normal ou que la hernie s’est résorbée.

What can you do at home for a cervical herniated disc?

Home care involves adapting activities that cause pain, moving within tolerable limits, and finding comfortable positions. Temporarily limit movements that significantly worsen your symptoms, then gradually resume them as your condition improves.

There are several strategies that can help relieve your symptoms at home. Gently move your neck within a comfortable range. Limit movement and adjust it if it significantly increases pain in your arm, tingling, or weakness. Support your arm in a comfortable position by using a pillow under your armpit, the armrests of a chair or sofa, or by putting your hand in your pants pocket when you’re standing.

Une revue sur le mal de dos n’a pas trouvé d’association claire avec le fait de rester assis au travail dans la plupart des études, bien qu’une étude ait observé une association¹⁷. Ce résultat ne démontre pas que la position assise cause une hernie au cou ni qu’une position ne puisse accentuer vos symptômes. Adaptez surtout les positions qui vous incommodent.

Limit the amount of time you spend in the same position, whether you're at the computer, watching TV, or reading. Get up regularly to move your neck and shoulders a little.

Choose a pillow that comfortably supports your neck. No single pillow is ideal for everyone. If sleeping on your stomach makes the pain worse during the night or when you wake up, try a different position.

If your symptoms persist or limit your activities despite these adjustments, consult a physical therapist for a comprehensive evaluation and a personalized treatment plan. The warning signs described above require appropriate medical care; do not wait to see if these tips are effective.

How do cervical herniated discs heal naturally?

The body can reduce a cervical disc herniation through water loss from the herniated disc and the removal of some of its contents by immune cells, which play a role in the body’s defenses. Symptoms may also improve even if the herniation remains visible. These two processes do not necessarily occur at the same rate. Non-surgical treatment focuses primarily on your comfort and ability to function.

La résorption désigne la diminution du matériel déplacé hors du disque. Elle est bien documentée pour les hernies du bas du dos¹⁸. Des cellules du système immunitaire peuvent éliminer une partie du fragment; des changements de ses tissus et la formation de petits vaisseaux participent aussi au processus¹⁹. Au cou, une publication regroupe 76 cas dont la hernie avait diminué sur des IRM successives⁵. Cette sélection de cas ne permet pas d’estimer la fréquence du phénomène chez toutes les personnes ayant une hernie cervicale.

Even a hernia with a displaced or detached fragment can shrink in size. Therefore, its size alone does not determine how your symptoms will progress. However, the onset or worsening of weakness should be evaluated promptly, even if the hernia may still resolve on its own.

Physical therapy can help you manage pain and resume your activities as the condition progresses. Exercises for the muscles that control neck movement may be part of the program. They do not guarantee that the disc will resorb or prevent any new problems from occurring.

In the population-based study on cervical radiculopathy, 90% of participants were asymptomatic or experienced only mild discomfort at the last follow-up, after a median follow-up period of 4.9 years—meaning that half had a shorter follow-up period and the other half a longer one. Symptoms had recurred at least once in 31.7% of participants, and 26% had undergone surgery ⁷. These findings apply to several causes of nerve damage, not just herniated discs. The guide on physical therapy for neck pain outlines possible treatment options.

When is surgery necessary?

Surgery may be necessary if spinal cord compression causes symptoms that are getting worse or if muscle weakness worsens. These signs require prompt medical evaluation; you should not wait until a physical therapy program has failed.

Surgery may also be considered if pain or difficulties with daily activities remain significant despite appropriate and regularly reviewed non-surgical treatment. The decision takes into account the physical examination, imaging results, potential benefits, risks, and your preferences.

Dans un essai de 63 personnes ayant une radiculopathie cervicale, la chirurgie suivie d’une physiothérapie structurée apportait une amélioration plus rapide que la même physiothérapie seule pendant la première année. Les deux groupes s’amélioraient. La chirurgie suivie de physiothérapie réduisait davantage la douleur au cou sur les deux années de suivi, sans avantage net pour la douleur au bras ni pour les limitations mesurées globalement. La différence d’amélioration ressentie entre les groupes diminuait à deux ans²⁰. Un programme sans chirurgie peut être essayé quand aucun signe ne nécessite une intervention rapide.

Two studies published in 2025 distinguished between people with herniated discs and those with spondylosis—changes in the discs and joints often referred to as neck osteoarthritis. Among the 89 people in the herniated disc group, surgery reduced functional limitations more significantly at one year than non-surgical care, which included sessions with physicians specializing in functional recovery and physical therapists to support a return to activities and symptom management. The average difference was 7.4 points out of 100, which was below the 15-point threshold the study used to define a significant change. Among the 91 people in the osteoarthritis group, no clear difference was observed ²¹. The potential benefit therefore also depends on the clinical situation.

Why isn't an image of the disc enough to explain the pain?

Une image du disque ne suffit pas à expliquer la douleur parce que certains changements sont aussi présents chez des personnes sans symptôme. Dans l’étude des volontaires en bonne santé, le bombement discal était déjà fréquent dans la vingtaine². L’examen et votre évolution permettent de juger si une image correspond au problème actuel.

The C5-C6 and C6-C7 levels are often affected, but their names alone do not indicate the severity of the problem. The C7-T1 disc is located even lower. A report should be interpreted in light of your symptoms and the examination findings.

The presence of a hernia on imaging does not necessarily predict pain or disability. The healthcare professional focuses primarily on determining whether the visible changes correspond to the painful area, the neurological signs, and their progression. A holistic approach to pain helps to understand all the factors that contribute to your experience of pain.

How can you get help for your cervical herniated disc?

Our physical therapists can assess your neck or arm pain and recommend treatment tailored to your activities. The assessment identifies possible causes, symptoms that require medical evaluation, and movements that can help you.

The program may include identifying movements that alleviate symptoms, movements tailored to sensitive nerves, and strengthening exercises. Your physical therapist will tailor the exercises to your strength, your ability to control your movements, and your response to treatment.

Your physical therapist will also explain how to adjust your activities and what to do if your symptoms return. Understanding how a hernia might progress and recognizing the warning signs will help you be an active participant in decisions about your care.

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Nos physiothérapeutes ont défini la stratégie de recherche, le plan et le contenu clinique de cet article. Un outil d’IA a soutenu la recherche documentaire et la révision du texte pour assurer une cohérence du contenu et du style d’écriture.