What Is Radiculopathy?

Two of the most common complaints in primary care are neck and back pain. In fact, up to 20% of adults have either neck or back pain at any given time. Sometimes these symptoms are due to radiculopathy. 

Radiculopathy is more common in the back, but it can also occur in the neck — both of which can affect your daily life. Many people cannot enjoy their usual activities due to the pain and weakness it can cause. Fortunately, for most people the pain and discomfort is temporary. If you have radiculopathy, understanding the symptoms, causes, and treatments can help you know what to expect. 

What is the definition of radiculopathy?

Radiculopathy is an irritation or compression of a nerve root in the spine. People often call it a “pinched nerve.” But inflammation can cause irritation to the nerve even if the nerve isn’t pinched or compressed. 

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Types of radiculopathy

The type of radiculopathy depends on where the affected nerve is along the spine. The nerve roots exit the spinal cord and run near the discs of the spine down to the rest of your body. The nerves then reach the limbs and send signals for movement and sensation to your arms and legs.

If the affected nerve root is in the neck or cervical spine, it’s a cervical radiculopathy. A thoracic radiculopathy occurs in the middle of the back or thoracic spine. A lumbar radiculopathy affects the low back or lumbar spine. Sometimes radiculopathy affects nerve roots below the hips. This is lumbosacral radiculopathy.

What causes radiculopathy?

One cause of radiculopathy is a herniated disc that compresses a nerve root. This is when the cushion between the bones of your spine slips out of place and pushes on the nerve. It may also be due to degenerative changes — degenerative disc disease — or changes due to wear and tear. This is when the cushion of the disc has age-related thinning and damage.

The most common cause of cervical radiculopathy in younger adults is disc herniation. But in older adults it’s more often due to degenerative changes of the spine. With age, arthritis can narrow the canal where the nerve root runs and compress it. 

Certain activities can increase your risk for cervical radiculopathy. These include:

• Heavy lifting 

• Handling vibrating equipment

• Smoking

• Having neck trauma

The most common causes of thoracic radiculopathy are disc disease and diabetes. In rare cases, it may also be due to thoracic surgery.

Degenerative changes and disc injuries are common causes for lumbar radiculopathy. But other causes may include fractures, tumors, or infections.

Symptoms of radiculopathy

The symptoms of radiculopathy vary depending on the nerve root it affects. It typically involves pain, numbness, or weakness. 

Symptoms of cervical radiculopathy include:

• Neck pain that goes down the arm, upper back, or shoulder 

• Numbness and tingling, or an electrical sensation down the arm

• Muscle weakness of the arm or hand

Symptoms of lumbar radiculopathy include:

• Low back pain that goes down the leg and foot 

• Numbness and tingling or a shooting pain down the leg 

• Leg or foot weakness (it may cause trouble walking or falls in severe cases)

Sciatica refers to pain that starts at the buttock and shoots down the leg. Sciatica pain can arise from radiculopathy or irritation of the nerve root. But it may come from irritation of the sciatic nerve itself, which starts near the buttock. 

Thoracic radiculopathies aren’t as common. Symptoms include a burning or shooting pain in these areas:

• Upper to middle back

• Torso

• Chest wall

• Abdomen 

• Inner aspect of the arm 

Radiculopathy diagnosis

Your healthcare provider may have different ways to check your symptoms. These can include: 

• Physical exam: Your healthcare provider will likely check your muscle strength, reflexes, and sensation.

• Imaging studies: If your symptoms began after an injury, your healthcare provider could order X-rays of the spine or a CT scan. If the pain doesn’t improve, MRI is the preferred imaging. It checks for herniated discs and nerve compression. Providers may also use MRI before certain treatments, like injection or surgery. 

• Electromyography and nerve conduction studies: These check the function of the nerves and can help find the irritated nerve.

Treatments for radiculopathy

Treatment is conservative for most cases. Most of the time cervical radiculopathy responds well. Similarly, most cases of low back pain with radiculopathy improve spontaneously, or on their own.

For cases of radiculopathy that don’t improve, there are many treatments available. Treatments vary based on your symptoms and the severity. Treatments often include:

• Medications

• Injections

• Surgery

• Spinal cord stimulation

• Physical therapy

Medications 

There are several medications that can treat nerve root pain. Your healthcare provider may prescribe a combination of two or more medications. Some medications that can treat radiculopathy are:

• Acetaminophen (Tylenol): This is safe and inexpensive. But be careful not to take more than 4 grams per day.

• Nonsteroidal anti-inflammatories (NSAIDs): These are only for short-term use, in order to avoid gastric ulcers or cardiovascular complications.

• Oral steroids: Some people improve with a tapered dose of oral steroids. Prednisone is a common one.

• Muscle relaxants: These are an option for pain relief, although they may make you drowsy.

• Antiepileptics: These are medications that prevent seizures. But they also help to treat nerve pain. Gabapentin and pregabalin are among the most common. 

• Antidepressants: Cymbalta (duloxetine) can help treat nerve pain.

• Opioids: These have a potential for abuse and addiction, so they are only for severe pain and require careful use.

Injections 

Epidural steroid injections help decrease inflammation around the nerve root. These work by injecting the medication into the fluid around the spinal cord. Your healthcare provider will use X-rays to make sure you get the injection in the right location. They inject a mixture of a steroid and local anesthesia to relieve pain and inflammation. 

Epidural injections are a common type of injection. While you may get immediate relief of your symptoms, it may not provide long-term relief. Some people may benefit from injections in other locations of the spine as well. These can include injections in the joints of the spine.

Surgery

Surgery may be an option for people who don’t improve with less invasive treatment. Those who have severe symptoms or symptoms that started after an injury may need surgery. Examples of severe symptoms that may need surgery include: 

• Severe weakness 

• Loss of bowel or bladder control

• Debilitating pain 

The specific type of surgery depends on the cause of the radiculopathy and the location. Surgery for cervical radiculopathy may be done from the front or the back of the neck. Surgeons also use several techniques for lumbar radiculopathy. Over the years, less invasive procedures have become more common.

Spinal cord stimulator

A spinal cord stimulator is a device that a provider implants under the skin. It transmits electrical pulses to the spinal cord to block pain signals. It may help people who don’t improve with other measures and aren’t able to have surgery. It may even help people who continue to have pain after surgery.

Physical therapy

Physical therapy for cervical radiculopathy may include a combination of treatments, such as:

• Electrical stimulation

• Massage

• Ultrasound 

People with cervical radiculopathy may get relief with exercise. This can be in the form of a physical therapy or home exercise program. Exercise usually includes gentle range of motion exercises as well as strengthening and conditioning exercises. 

Therapies for lumbar radiculopathy may include:

• Lumbar spinal manipulation (a well-trained professional does this)

• Massage

• Exercise

• Heating pads

• Ice packs

• Electrical stimulation 

There are many benefits of exercise for lumbar radiculopathy. Stabilizing the trunk and improving posture are some of the most helpful exercises. Upper and lower extremity strengthening as well as flexibility exercises can also help. 

What happens if you don’t treat radiculopathy?

An untreated radiculopathy may lead to permanent weakness and chronic pain. But most people with cervical and lumbar radiculopathy get better over time. 

Who should I see if I’m feeling symptoms of radiculopathy?

Your healthcare provider can work with a team of providers to help manage your symptoms. This team may include a physiatrist and a neurologist. An interventional pain management specialist may be helpful if you need injections. If your treatment includes surgery, a spine specialist will be part of the team. A physical therapist and, in some cases, a psychotherapist, may also be helpful — especially if you have issues with chronic pain and disability.

Why trust our experts?

Written by:

Itza Rivera, MD

Dr. Rivera is a board-certified physical medicine and rehabilitation specialist. She completed her medical degree and residency training at the University of Puerto Rico School of Medicine, and her neuromuscular disorders subspecialty training at Northwestern University.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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