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?

The cervical intervertebral disc is a cushion that distributes the load between the vertebrae of the neck and allows them to move. The neck consists of seven cervical vertebrae, labeled C1 through C7. There is no disc between C1 and C2. The six discs are located between C2-C3 and C7-T1; T1 refers to the first vertebra of the upper back. These six disc levels therefore span the junction between the neck and the upper back.

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 affect 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 level¹. Their frequency does not prove that any single specific force alone accounts for the formation of a herniation.

What forms can a cervical disc herniation take?

A cervical disc herniation can take the form of a protrusion, an extrusion, or a detached fragment, known as sequestration. These terms describe its appearance and its relationship to the disc. Bulging is another change in the disc’s contour. The classification of cervical herniations does not describe a mandatory progression from one form to the next.

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.

Sequestration means that a fragment has broken off from the disc. This fragment may be located in the spinal canal, through which the nerves pass. It may shrink over time. A review of lower back herniations reports this shrinkage in 93.0% of cases involving a detached fragment². Cases of hernia shrinkage in the neck have also been published, but the percentage observed in the lower back does not indicate your likelihood of recovery in the neck.

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.

Smoking is one of the possible risk factors. Research on twins also shows that heredity plays a role in changes to the cervical discs. However, this factor alone does not determine the onset of a painful herniated disc. The role of work involving vibrations or prolonged head positions does not allow for the definitive identification of the cause of a herniated disc in an individual. Your evaluation can examine these habits to address factors that exacerbate symptoms.

A population-based study reported more new cases of cervical radiculopathy per year among men than among women³. Only 21.9% of cases were attributed to a disc protrusion; other causes included, among others, changes in the bones and joints of the neck³. This study therefore does not measure the prevalence of all cervical disc herniations.

What are the symptoms of a cervical disc herniation?

A cervical disc herniation can cause neck pain, involuntary muscle spasms, difficulty moving the neck, or pain that radiates down the arm. It can also be present without any symptoms. The imaging results should be compared with your symptoms and the physical exam findings¹.

A study used magnetic resonance imaging (MRI) to examine the necks of 1,211 asymptomatic volunteers. This test produces detailed images of the tissues. Among people in their 20s, disc bulging was present in 73.3% of men and 78.0% of women¹. A bulge does not necessarily correspond to a herniation and does not, on its own, prove the cause of pain.

Among all 1,211 volunteers aged 20 to 70, compression—that is, pressure on the spinal cord—was evident in 5.3 percent, and a change in its appearance on certain MRI images was seen in 2.3 percent¹. The spinal cord is a cord of nervous tissue that transmits messages between the brain and the body. These figures apply to all age groups studied, not just those in their 20s. They do not mean that weakness or other warning signs should be ignored.

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.

These symptoms, which require prompt evaluation, are also described in cases of cervical spinal cord injury.

Compression of the spinal cord in a narrowed spinal canal may require immediate medical attention. Call 911 if you suddenly experience weakness or paralysis in an arm, if one side of your face droops, or if you have difficulty speaking. Any of these signs may indicate a stroke—a problem with blood flow to the brain—even if the symptoms later disappear.

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.

In Quebec, you can see a physical therapist directly at a private clinic without first seeing a doctor. The physical therapist will assess your condition and refer you to a doctor when necessary.The Quebec Professional Order of Physical Therapy explains this direct access.

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 overall 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 benefit⁴. 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 shoulder blade area (the flat bones at the back of the shoulders), and the arms can provide short-term pain relief⁵. 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.

In a trial involving 205 people with radiculopathy lasting less than one month, physical therapy combined with home exercises reduced neck and arm pain more significantly over six weeks than a wait-and-see approach with continued daily activities. Pain medication was permitted in all groups. The additional reduction was approximately 12 points out of 100 for the arm and 14 for the neck. Daily functional limitations did not improve significantly more with physical therapy, and differences in pain between groups were no longer present at six months.

The McKenzie Method focuses, in particular, on identifying a direction of movement that alleviates symptoms. We refer to this as “centralization” when the pain moves away from the arm and closer to the neck⁶. 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.

In a trial involving 88 adults who had been experiencing symptoms of cervical radiculopathy for two to six months, adding guided arm movements targeting the median nerve—a nerve that extends to the hand—to neck exercises reduced pain and functional limitations more significantly after four weeks than the neck exercises alone. Both groups also received heat therapy. No clear difference was observed in the range of motion of the neck. These results do not prove that the nerve has regained normal gliding or that the herniation has resolved.

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.

A review of back pain found no clear association with sitting at work in most studies, although one study did observe an association⁷. This result does not prove that sitting causes a neck herniation or that a particular posture cannot worsen your symptoms. Above all, adjust any positions that cause you discomfort.

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.

Resorption refers to the reduction in the amount of material displaced from the disc. It is well documented for herniated discs in the lower back⁸. Immune system cells can remove part of the herniated fragment; changes in the disc’s tissues and the formation of small blood vessels also contribute to the process⁹. In the neck, one study reported 76 cases in which the herniation had decreased on successive MRI scans. This case series does not allow for an estimate of the frequency of this phenomenon among all individuals with a cervical herniation.

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 surgery³. 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.

In a trial of 63 people with cervical radiculopathy, surgery followed by structured physical therapy led to faster improvement than the same physical therapy alone during the first year. Both groups showed improvement. Surgery followed by physical therapy reduced neck pain more significantly over the two-year follow-up period, with no net benefit for arm pain or for overall functional limitations. The difference in perceived improvement between the groups decreased at two years¹⁰. A non-surgical program may be considered when there are no signs requiring immediate intervention.

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 appointments 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 observed¹¹. The potential benefit therefore also depends on the clinical situation.

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

A disc image alone is not enough to explain the pain because some changes are also present in people without symptoms. In the study of healthy volunteers, disc bulging was already common in people in their 20s¹. A physical exam and your medical history help determine whether an imaging result corresponds to your current problem.

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.

Sources

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2. Rashed S, Vassiliou A, Starup-Hansen J, Tsang K. Systematic review and meta-analysis of predictive factors for spontaneous regression in lumbar disc herniation. Journal of Neurosurgery: Spine. 2023;39(4):471-478. (Back to section: 1)
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