Unravelling C6 Radicular Pain: The Definitive Evidence-Based Guide to Cervical Radiculopathy, Neuroanatomy, and Targeted Recovery

If you have ever experienced an agonising, electric shock-like sensation shooting down your neck, travelling through your shoulder blade, and radiating all the way into your thumb and index finger, you know just how disabling and distressing cervical nerve pain can be. In clinical practice, this presentation is one of the most frequent and complex spinal conditions we assess and treat at Destiny Health.

Among all the nerve roots in the human neck, the sixth cervical nerve root (C6) is uniquely vulnerable to mechanical compression, structural irritation, and chemical inflammation. Whether your symptoms began as an insidious, dull ache in the upper back after long hours hunched over a laptop, or escalated suddenly into severe arm pain with numbness and pins and needles following a sporting injury, understanding the precise mechanisms behind your symptoms is the essential first step toward lasting recovery.

In this comprehensive, evidence-based guide, we unpack the latest scientific literature on C6 radicular pain and radiculopathy. We will explore the vital clinical distinctions between nerve pain and nerve dysfunction, delve into the exact myotomes, dermatomes, and reflexes involved, analyse demographic risk profiles, explain why your thoracic spine holds the absolute key to cervical offloading, and outline current best-practice physiotherapy interventions and highly detailed surgical pathways.

1. Defining the Condition: Radicular Pain vs. Radiculopathy

Before diving into complex neuroanatomy, it is absolutely crucial to clarify a common source of confusion in both public understanding and clinical literature: the vital distinction between C6 radicular pain and C6 radiculopathy. 

While these two terms are frequently used interchangeably in everyday medical conversation, they represent completely distinct physiological phenomena that often, but do not always, coexist in the same client.

C6 Radicular Pain

Radicular pain is a symptom. It refers to single-root sharp, shooting, lancinating, or burning pain caused by ectopic action potentials. These abnormal nerve signals originate from an inflamed or mechanically irritated C6 dorsal root ganglion (DRG) or the nerve root itself.

When a disc herniates or a bone spur encroaches on the nerve, it does not just cause physical pressure; it triggers a cascade of inflammatory mediators (such as cytokines, prostaglandins, and substance P). This "inflammatory soup" sensitises the nerve, causing it to misfire. 

The pain travels along the sensory pathway of the nerve, projecting deep into the forearm and hand. Importantly, radicular pain can occur without any detectable neurological deficits (such as numbness or muscle weakness). It is an issue of nerve irritation, not necessarily nerve damage.

C6 Radiculopathy

Radiculopathy, on the other hand, is a neurological state. It refers to an actual conduction block along the spinal nerve or its roots. When axon conduction is physically compromised, due to sustained ischaemia (lack of blood flow to the nerve), severe mechanical compression, or overwhelming neuro-inflammation - observable neurological deficits emerge. These measurable clinical signs include:

• Hypoaesthesia or Anaesthesia: Numbness, blunted sensation, or a complete loss of feeling in the C6 dermatome (the specific patch of skin supplied by the C6 nerve).
  
• Paraesthesia: Abnormal "pins and needles", tingling, or a crawling sensation under the skin.
  
• Motor Deficits: Measurable weakness in the specific muscles supplied by the C6 myotome.
  
• Reflex Hypoactivity: A diminished, sluggish, or entirely absent brachioradialis or biceps deep tendon reflex.
  

Clinical Insight: A client can present to our clinic with severe, unrelenting C6 radicular pain but have entirely normal strength and reflexes. Conversely, an older patient might present with only mild arm pain but demonstrate profound thumb numbness and significant wrist weakness (painless radiculopathy). A thorough clinical assessment at Destiny Health evaluates both the inflammatory pain drivers and the fundamental neurological integrity of the nerve.

2. Demographic Profiles and Risk Factors: Who Is Most Affected?

Cervical radiculopathy is a globally prevalent cause of neck and arm morbidity. Extensive epidemiological data from population-based registries provide incredibly valuable insights into who is most likely to develop this condition, and how the underlying causes shift as we age.

Age Distribution and Aetiological Shifts

The overall annual incidence of cervical radiculopathy is estimated at approximately 83 to 107 cases per 100,000 individuals. However, the primary underlying pathophysiology (the aetiology) shifts dramatically across different age brackets:

• Younger Cohorts (Ages 20–39): In younger adults, C6 nerve root compression is predominantly driven by acute posterolateral disc herniations. The nucleus pulposus (the dense gel centre of the disc) breaks through the outer annulus fibrosus. This is typically triggered by high-velocity axial loading, sudden neck flexion-rotation injuries, intense strain during heavy weightlifting, or trauma from contact sports.
  
• Peak Incidence (Ages 40–55): The absolute peak incidence of cervical radiculopathy occurs in the fifth decade of life. At this transitional stage, the aetiology becomes a hybrid. Patients often present with focal disc protrusions combined with early, insidious spondylotic degeneration (wear and tear).
  
• Older Cohorts (Ages 60+): In the older demographic, C6 radiculopathy is overwhelmingly driven by chronic cervical spondylosis. Over decades, intervertebral discs lose their water content and height (desiccation). To stabilise the now-wobbly spine, the body creates osteophytes (bone spurs). The facet joints hypertrophy (enlarge), and the uncovertebral joints develop osteophytosis, leading to profound neural foraminal stenosis (narrowing of the bony tunnel where the nerve exits).

Gender Profiles and the Modern Shift

Historical medical literature suggested a slightly higher prevalence in males (roughly a 1.5:1 male-to-female ratio), which was traditionally attributed to heavy physical labour, construction, and demanding occupational environments. 

However, modern epidemiological data demonstrate a near-equal distribution between men and women. In fact, recent extensive healthcare registry studies show slightly higher healthcare-seeking rates among females aged 45 to 65 for chronic cervical nerve compression.

Key Modifiable and Non-Modifiable Risk Factors

The scientific literature consistently identifies several core risk factors for developing C6 radicular pain:

1. Occupational Posture and Ergonomics: The rise of the digital age has led to "text neck". Sustained forward head posture, prolonged computer work with inadequate lumbar and thoracic support, and repeated exposure to axial vibration (such as long-distance driving or operating heavy machinery) severely overload the lower neck.
   
2. Repetitive Overhead Work: Frequent overhead reaching, painting, or manual handling under load places heightened compressive and shear forces directly across the lower cervical motion segments.
3. Smoking and Vaping: Nicotine induces potent microvascular vasoconstriction, choking off the already fragile blood supply to the intervertebral discs. This dramatically accelerates disc desiccation, degeneration, and structural failure at the C5-C6 level.
   
4. Prior Lumbar Spine Pathology: Interestingly, individuals with a documented history of lumbar disc herniation have a statistically higher likelihood of developing cervical disc pathology. This points toward a shared genetic predisposition to early connective tissue and disc matrix degradation.

3. Neuroanatomy Unpacked: The C6 Segment, Dermatomes, Myotomes, and Reflexes

To fully comprehend why C6 radiculopathy produces such incredibly specific and predictable symptoms, we must thoroughly examine the anatomical pathway of the C6 nerve root as it exits the cervical spine and branches down the brachial plexus into the upper limb.

The Vulnerable C5-C6 Motion Segment

The human spine is a biomechanical marvel, but it has weak points. The C6 spinal nerve exits the neural foramen above the C6 vertebra (specifically, between the C5 and C6 vertebral bodies).

The C5-C6 motion segment is the absolute apex of the cervical lordosis (the natural curve of the neck). It is the most mobile region of the lower cervical spine, accommodating immense degrees of flexion and extension every single day. Consequently, it acts as the fulcrum for the weight of the head and experiences the highest cumulative mechanical stress of any cervical level. Because of this architectural burden, C5-C6 disc herniations and associated foraminal stenosis are responsible for an overwhelming 40–50% of all cervical radiculopathy cases.

The C6 Dermatome (Sensory Distribution)

A dermatome is a specific area of skin supplied by sensory neurones originating from a single spinal nerve root. When the C6 nerve root is compressed, inflamed, or hypoxic, sensory changes are typically mapped out in a predictable pattern:

• The anterolateral (front and outside) aspect of the upper arm.
• The lateral border of the forearm.
• The anatomical snuffbox (the depression at the base of the thumb).
• The thumb (first digit) and the index finger (second digit).
  

Patients commonly describe these sensory changes to our physiotherapists as a deep burning sensation, an icy coldness, hypersensitivity to light touch (allodynia - where even a shirt sleeve brushing the skin is painful), or profound numbness in the thumb pad.

The C6 Myotome (Motor Distribution)

A myotome is the group of muscles innervated by a single spinal nerve root. While most muscles receive nerve supply from multiple roots, the C6 root provides the primary motor innervation to several critical upper limb muscle groups.

When conducting a neurological examination at Destiny Health, we test the following:

In moderate-to-severe C6 radiculopathy, motor weakness manifests dramatically. Patients often report difficulty lifting a kettle, dropping cups, reduced grip power due to a collapsing, unstable wrist (because the wrist cannot be forcefully extended to provide leverage for the finger flexors), and rapid motor fatigue during repetitive household or workplace tasks.

Deep Tendon Reflexes

A robust neurological examination of C6 nerve root compromise always focuses on testing the integrity of the reflex arc. We focus on two deep tendon reflexes:

1. Brachioradialis Reflex (C6 primary): Tapping the brachioradialis tendon at the distal radius near the wrist normally elicits a sudden, mild elbow flexion and forearm supination. A diminished or absent reflex clearly indicates a lower motor neurone lesion at the C6 level.
   
2. Biceps Reflex (C5/C6 shared): Tapping the biceps tendon in the cubital fossa (the crook of the elbow) tests both the C5 and C6 sensory and motor arcs.
   

4. Clinical Presentation and Diagnostic Testing

Typical Clinical Presentation and Bakody's Sign

A patient presenting to the clinic with an acute, highly irritable C6 radiculopathy often adopts a very classic, almost protective posture.

They will routinely walk into the treatment room holding their affected arm elevated above their head, with their hand resting squarely on top of their skull. Known in medical literature as Bakody’s sign (or the shoulder abduction relief sign), this specific movement physically shortens and slacks the lower trunks of the brachial plexus. 

This reduces the mechanical traction and tension running directly across the inflamed C6 nerve root, providing immediate, albeit temporary, relief.

Conversely, symptoms are typically sharply aggravated by activities that narrow the neural foramen or compress the joint spaces, such as:

• Looking up towards the ceiling (cervical extension).
• Side-bending or rotating the head firmly towards the painful side.
• Coughing, sneezing, or bearing down on the toilet (the Valsalva manoeuvre), which spikes intrathecal (spinal fluid) pressure and pushes a herniated disc harder against the nerve.

Clinical Prediction Rules and Physical Tests

To accurately confirm a diagnosis without relying solely or immediately on expensive and time-consuming medical imaging (like an MRI), we utilise internationally validated Clinical Prediction Rules. High diagnostic accuracy is achieved when a cluster of specific orthopaedic tests is positive:

1. Spurling’s Test A (Cervical Compression Test): The patient's neck is carefully extended and side-bent toward the involved side. The practitioner then applies a gentle, controlled downward axial pressure to the top of the head. A positive test instantly reproduces the patient's exact sharp, radiating pain down the arm.
   
2. Cervical Distraction Test: While the patient is lying comfortably face up (supine), the practitioner applies gentle, continuous manual traction to the base of the skull, lifting the head slightly away from the shoulders. A positive result is indicated by the significant temporary relief or complete abolition of arm pain.
   
3. Cervical Rotation Test: The practitioner assesses active range of motion. An ipsilateral cervical rotation (looking toward the painful side) that is severely limited to less than 60 degrees is a strong indicator of pathology.

When these clinical signs are present together, the specificity for correctly diagnosing cervical radiculopathy is exceptionally high, allowing treatment to commence immediately.

5. The Biomechanical Link: Why Thoracic Spine Mobility Protects Your Neck

One of the most frequently overlooked and under-treated factors in the management, rehabilitation, and long-term prevention of C6 radiculopathy is the intricate biomechanical relationship between the thoracic spine (mid-back), the rib cage, and the lower cervical spine. This is known in physiotherapy as the "Regional Interdependence Model".

The Kinematic Chain and Forward Head Posture

The thoracic spine serves as the physical and architectural anchor for the neck. The cervical spine cannot function optimally if its foundation is compromised. In modern society, prolonged sitting, constant mobile phone use, and sedentary habits inevitably lead to an increased thoracic kyphosis (a severely rounded upper back and slumped shoulders).

When the thoracic spine stiffens and locks into this kyphotic state, the body must mechanically compensate to keep the eyes horizontal and looking straight ahead. This postural chain reaction forces the lower cervical spine (C5, C6, C7) to shear forward into a forward head posture, while the upper cervical spine (C1, C2, C3) hyper-extends to lift the chin.

The Physics of Compressive Loading on C5-C6

According to advanced spine biomechanics literature:

• In a perfect, neutral anatomical position, an adult human head weighs approximately 4.5 to 5.5 kg.
  
• Due to the laws of leverage and gravity, for every 2.5 cm (1 inch) the head translates forward from the centre of the shoulders, the effective functional load exerted on the lower cervical spine increases exponentially.
  
• At a 45-degree forward tilt (typical "text neck" posture), the sheer force acting directly on the C5-C6 segment reaches a staggering 22 kg (49 lbs).

This massive, unremitting extra loading creates chronic compressive shear forces across the C5-C6 intervertebral disc. Over years, this triggers the body's defensive mechanism: laying down extra bone to stabilise the excessive movement. This accelerates osteophytic bone spur formation around the uncovertebral joints, which eventually acts like a vice, narrowing the foraminal space where the delicate C6 nerve exits.

By proactively mobilising the thoracic spine back into extension and rotation and rigorously strengthening the thoracic spinal erectors (the muscles running down the spine):

1. The base of the neck shifts backward, realigning directly over the body's centre of gravity.
   
2. The compensatory lower cervical hyperextension is completely eliminated.
   
3. Neural foraminal height and volume at C5-C6 are maximally preserved during daily functional neck movements.
   

6. Evidence-Based Physiotherapy Treatments for C6 Radiculopathy

Current clinical practice guidelines - including stringent recommendations from the Australian Physiotherapy Association (APA) and international spine societies - strongly advocate for conservative multimodal physiotherapy as the absolute first-line treatment for C6 radiculopathy, provided there are no surgical red flags.

Extensive research demonstrates that over 75% to 90% of patients recover successfully without ever requiring surgical intervention when they are meticulously guided through a targeted, structured, and progressive rehabilitation programme.

Treatment Component 1: Deep Neck Flexor Motor Control Training

Patients suffering from C6 radiculopathy almost universally exhibit severe neuromuscular inhibition, weakness, and eventual fatty atrophy of the deep, segmental stabilising muscles of the neck (specifically the Longus Colli and Longus Capitis). This is typically accompanied by the painful overactivity and spasm of large, superficial neck muscles (like the Sternocleidomastoid and Upper Trapezius) that are trying to brace the painful spine.

• Craniocervical Flexion Exercise (CCFE): This is the cornerstone of cervical rehabilitation. The patient lies supine and is taught to gently nod their head as if making a subtle gesture to say "yes" (a micro chin tuck). This movement targets a controlled flattening of the cervical lordosis specifically using the deep neck flexors, without engaging the superficial global muscles. Often, a pressure biofeedback unit (a small inflatable cuff under the neck) is used to ensure precise muscle activation.
  
• Progression and Proprioception: The training is systematically progressed from holding gentle isometric contractions for 10 seconds in a lying position, to seated, standing, and eventually highly functional, load-bearing positions to permanently restore dynamic cervical stability.

Treatment Component 2: Manual Therapy and Cervical Traction

Clinical trials overwhelmingly and consistently demonstrate that combining hands-on manual therapy with targeted exercise yields vastly superior long-term outcomes compared to exercise alone.

• Manual Joint Mobilisations: Physiotherapists utilise precise, graded passive accessory intervertebral movements (PAIVMs) applied strictly to the thoracic spine and the non-provoking adjacent cervical segments. These techniques (often based on the Maitland or Mulligan concepts) help rapidly restore segmental joint mobility and powerfully decrease local pain signalling to the brain via spinal gating mechanisms.
  
• Manual or Mechanical Traction: Applying a slow, sustained longitudinal axial pull to the neck acts to physically increase the intervertebral space height. This effectively widens the neural foramina, reduces the internal intradiscal pressure (creating a vacuum effect), and can structurally facilitate the regression or reabsorption of herniated disc material away from the entrapped C6 root.
  

Treatment Component 3: Scapulothoracic Strengthening and Postural Re-conditioning

Restoring absolute motor control in the large muscles that anchor the shoulder girdle to the rib cage is paramount to unweighting the cervical spine. Rehabilitation rigorously targets:

• Lower and Middle Trapezius: To forcefully counteract upper trapezius dominance and prevent constant shoulder shrugging/elevation.
  
• Serratus Anterior: To ensure smooth, stable scapular upward rotation during overhead reaching, preventing the neck from compensating.
  
• Rhomboids and Thoracic Erectors: To build endurance strength that maintains an upright, proud thoracic posture against the relentless pull of gravity during an 8-hour workday.
  

7. Advanced Surgical Interventions: When Conservative Care Fails

While conservative management is exceptionally successful, clear, non-negotiable criteria exist for medical or surgical escalation. Surgery is generally reserved for a small minority of cervical radiculopathy cases (roughly 10–15%).

Immediate neurosurgical or orthopaedic spine referral is mandatory if a patient displays red flags. These include rapidly progressive motor weakness (for example, losing the physical ability to extend the wrist against gravity over a period of just a few days) or unmistakable signs of spinal cord compression (cervical myelopathy, indicated by heavy legs, bowel/bladder changes, or profound clumsiness in both hands).

If a patient experiences intractable, excruciating radicular pain that severely compromises their quality of life, prevents sleep, and completely fails to improve after 6 to 12 weeks of 

high-quality, structured conservative therapy, surgical options are thoroughly and carefully explored with a specialist.

When surgical intervention is indicated, spine surgeons typically employ one of three main, highly sophisticated procedures. Each carries distinct mechanisms, biomechanical advantages, and postoperative recovery profiles.

1. Anterior Cervical Discectomy and Fusion (ACDF)

ACDF remains the most widely performed and historically established "gold standard" surgical procedure for C6 radiculopathy caused by severe disc herniation or advanced spondylosis.

 

• The Procedure: Performed under general anaesthesia, the surgeon approaches the spine from the front (anterior) of the neck through a small, cosmetic horizontal incision, usually hidden in a natural skin crease. The delicate structures of the neck, including the trachea and oesophagus, are gently retracted to expose the front of the spinal column. 

The surgeon meticulously and completely removes the damaged C5-C6 intervertebral disc (discectomy). This creates direct, open access to the spinal canal, allowing the surgeon to carefully drill away any bone spurs (osteophytes) and remove any stray disc fragments that are aggressively pinching the C6 nerve root or the spinal cord.

• The Fusion: Once the nerve is definitively decompressed, the empty disc space cannot simply be left hollow. It must be structurally stabilised to prevent the spine from collapsing. A rigid spacer (made of either donor bone graft or a synthetic polyetheretherketone (PEEK) cage) is tapped into the empty space to precisely restore the normal disc height. Finally, a small titanium plate and tiny screws are affixed to the front of the C5 and C6 vertebral bodies to rigidly lock them together.

• Recovery and Biomechanics: Over subsequent months, the body's natural healing process grows new bone across the spacer, permanently fusing the two vertebrae into one solid piece of bone. ACDF has an exceptionally high success rate for eliminating arm pain (often greater than 90%). 

However, because the C5-C6 segment is permanently immobilised and can no longer move, the adjacent segments (C4-C5 above and C6-C7 below) must inevitably absorb extra mechanical stress during daily head movements. Over a timeline of 10 to 15 years, this altered biomechanics can lead to "adjacent segment disease," potentially requiring further surgery.

2. Cervical Disc Arthroplasty (CDA) / Artificial Disc Replacement

CDA is a modern, increasingly preferred alternative to ACDF. It is particularly indicated for younger, active patients or those who have healthy, disease-free facet joints on the back of their spine.

• The Procedure: The surgical approach, the retraction of the anterior neck structures, and the initial meticulous nerve decompression are virtually identical to an ACDF. The surgeon accesses the front of the neck, completely removes the offending C5-C6 disc, and thoroughly frees the pinched C6 nerve from all entrapment.
  
• The Replacement: The critical difference lies in the reconstruction. Instead of inserting a rigid bone graft and locking the bones together with a titanium plate, the surgeon implants a highly sophisticated, specialised artificial disc device. 

These modern implants are typically constructed of titanium or cobalt-chromium endplates with a medical-grade, ultra-high-molecular-weight polyethylene core. They are masterfully engineered to perfectly mimic the natural ball-and-socket or gliding kinematic motion of a healthy human disc.

• Pros & Cons: The absolute primary advantage of CDA is motion preservation. By allowing the C5 and C6 vertebrae to continue moving naturally in flexion, extension, and rotation, it drastically reduces the altered biomechanical stress placed on the adjacent spinal levels. 

This theoretically lowers the long-term risk of adjacent segment disease. Furthermore, it typically allows for a much faster return to normal activities and sports, as the patient does not need to wait 3 to 6 months for a bone fusion to solidify. However, CDA is strictly contraindicated for patients with severe bone degeneration, osteoporosis, spinal instability, or significant facet joint arthritis.

3. Posterior Cervical Foraminotomy

Unlike ACDF and CDA, this procedure is performed entirely from the back (posterior) of the neck. It is highly specific and is designed to widen the neural foramen where the C6 nerve exits, without needing to remove the entire intervertebral disc or fuse the spine.

• The Procedure: The surgeon makes a small incision on the back of the neck directly over the affected C5-C6 level. The thick posterior neck muscles are carefully separated. 

Using a high-speed surgical burr, a small, precise portion of the lamina (the bony roof of the spinal canal) and the inner edge of the overgrown facet joint are drilled away. This creates a much larger, unobstructed "window" (foraminotomy) for the C6 nerve to pass through freely, instantly relieving the compression. Any loose disc fragments pressing backward into the nerve root can also be delicately plucked out.

• Pros & Cons: This is a highly effective, motion-preserving surgery that completely avoids the need for structural implants, plates, or fusions. It is an excellent option for patients whose primary anatomical issue is purely foraminal stenosis (bone spurs pinching the exiting nerve laterally) rather than massive, central disc herniations. 

Because it entirely avoids the anterior structures of the neck, there is zero risk of swallowing difficulties (dysphagia) or vocal cord irritation, which are common temporary side effects of ACDF. However, it can result in more immediate, intense post-operative neck muscle pain and stiffness due to the necessary dissection and retraction of the dense posterior cervical musculature.

8. What to Expect at Destiny Health: Your Recovery Roadmap

At Destiny Health, we unequivocally reject one-size-fits-all treatments, generic exercise handouts, or passive, temporary quick fixes. If you consult our elite clinical physiotherapy team with suspected C6 radicular pain or radiculopathy, here is exactly how we partner with you on your recovery journey:

1. Comprehensive Neurological Assessment: We conduct an exhaustive physical examination. We meticulously map your reflexes, myotome strength, dermatomal sensation, and utilise specialised orthopaedic cervical screening tests to pinpoint the exact level and severity of your nerve compromise.
   
2. Symptom Calming & Nerve Offloading: During the highly irritable acute phase, our sole primary goal is aggressive pain reduction. We utilise highly specific, position-based mechanical offloading strategies, gentle hands-on manual therapy, and clinical cervical traction to rapidly calm hyper-reactive nerves and reduce neuro-inflammation.
   
3. Targeted Re-building: As your acute pain settles and the nerve regains its blood supply, we transition you into an active, highly structured conditioning program. This focuses relentlessly on deep neck flexor motor control, thoracic spine mobility restoration, and bulletproofing your scapular stabilisation.
   
4. Long-Term Ergonomic and Lifestyle Resilience: We thoroughly analyse your workspace setup, sleeping posture, lifting mechanics, and gym training routines. We provide you with the education and physical resilience necessary to ensure your cervical spine remains strong, stable, and most comfortable for decades to come.

Medical Disclaimer

The detailed clinical information provided in this comprehensive article is intended strictly for educational and informational purposes only. It does not constitute, and should not be construed as, professional medical advice, medical diagnosis, or a specific treatment plan. Always seek the direct, personalised advice of a qualified healthcare professional, registered physiotherapist, or medical practitioner with any specific questions you may have regarding a medical condition, symptoms, or treatment options. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Academic References & Scientific Literature

1. Bono, C. M., Ghiselli, G., TJ, G., et al. (2011). An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders. The Spine Journal, 11(1), 64–72.
2. Childress, M. A., & Becker, B. A. (2016). Nonoperative management of cervical radiculopathy. American Family Physician, 93(9), 746–754.
3. Engquist, M., Löfgren, H., Öberg, B., et al. (2013). Surgery versus nonsurgical treatment of cervical radiculopathy: a prospective, randomized study comparing surgery plus physiotherapy with physiotherapy alone with a 2-year follow-up. Spine, 38(20), 1715–1722.
4. Hansraj, K. K. (2014). Assessment of stresses in the cervical spine caused by posture and position of the head. Surgical Technology International, 25, 277–279.
5. Joghataei, M. T., Arab, A. M., & Khalleghi, H. (2004). The effect of cervical traction combined with conventional physiotherapy on pain and disability in cervical radiculopathy. Clinical Rehabilitation, 18(8), 879–887.
6. Kuijper, B., Tans, J. T., Schimsheimer, R. J., et al. (2010). Degenerative cervical radiculopathy: diagnosis and conservative treatment. A review. European Journal of Neurology, 17(1), 15–21.
7. Liang, L., Feng, M., Cui, X., et al. (2019). The effect of exercise therapy on cervical radiculopathy: A systematic review and meta-analysis. Medicine (Baltimore), 98(45), e17733.
8. Radhakrishnan, K., Litchy, W. J., O'Fallon, W. M., & Kurland, L. T. (1994). Epidemiology of cervical radiculopathy: A population-based study from Rochester, Minnesota, 1976 through 1990. Brain, 117(2), 325–335.
9. Rhee, J. M., Yoon, T., & Riew, K. D. (2007). Cervical radiculopathy. Journal of the American Academy of Orthopaedic Surgeons, 15(8), 486–494.
10. Wainner, R. S., Fritz, J. M., Irrgang, J. J., et al. (2003). Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine, 28(1), 52–62.
11. Woods, B. I., & Hilibrand, A. S. (2015). Cervical radiculopathy: epidemiology, etiology, diagnosis, and treatment. Journal of Spinal Disorders & Techniques, 28(5), E251–E259.
12. Young, I. A., Michener, L. A., Cleland, J. A., et al. (2009). Manual therapy, exercise, and traction for patients with cervical radiculopathy: a randomized clinical trial. Physical Therapy, 89(7), 632–642.