Spurling Test (Cervical Compression): How to Detect Cervical Radiculopathy

When a client reports neck pain that radiates down the arm, sometimes with tingling or loss of strength, the Spurling test (also known as the cervical compression test) is one of the most commonly used tests to assess whether there's compression of a cervical nerve root.

It's a provocation test: unlike the cervical distraction test (which aims to relieve symptoms), this one aims to reproduce the radiating pain through compression.

What does this test measure?

The Spurling test assesses whether axial compression of the cervical spine, combined with extension and lateral rotation/flexion toward the symptomatic side, reproduces the characteristic radiating pain of cervical radiculopathy (compression of a nerve root, for example due to a cervical disc herniation or foraminal narrowing).

By tilting and rotating the neck to one side while compressing, the intervertebral foraminal space on that side is reduced, which can further compress an already irritated nerve root.

Equipment needed

• None required
• The client can be seated or lying supine

Step-by-step protocol

1. The client sits in a relaxed position
2. Ask them to tilt their head laterally toward the side where symptoms are present (or toward the side being assessed)
3. Add a gentle neck extension
4. From this position, apply gentle, progressive downward axial pressure to the top of the client's head (compression)
5. Ask whether the characteristic radiating pain appears or is reproduced down the arm, and along what path
6. Stop the pressure immediately if clear symptoms appear—there's no need to maintain it for long
7. Repeat on the opposite side for comparison, if clinically relevant

Common mistakes

• Applying too much force or doing it abruptly, especially in people with suspected more serious cervical pathology
• Not starting from the tilt/rotation toward the correct (symptomatic) side
• Confusing local muscle tension in the neck/trapezius with the characteristic radiating pain of radiculopathy

How to interpret the result

Result	Interpretation
Positive: compression in flexion/extension reproduces radiating pain down the arm (following a dermatomal pattern)	Suggests cervical radiculopathy—compression of a cervical nerve root
Negative: no radiating pain reproduced, only local neck tension	Reduces the likelihood of significant cervical radiculopathy at this time

A positive Spurling test, especially when accompanied by changes in strength, reflexes, or sensation in the upper limb following a specific dermatome, should be referred for medical evaluation to confirm the affected level and rule out causes requiring different management.

Relationship with other tests

The Spurling test is best interpreted alongside:

• Cervical distraction test — its counterpart: if distraction relieves symptoms and compression reproduces pain, the pattern strongly aligns with radicular involvement
• Lhermitte's sign — if an electric sensation also appears with cervical flexion, special attention should be paid to signs of spinal cord involvement

Documenting the pattern in Movalytics

The pattern "positive Spurling + cervical distraction that relieves symptoms" is a highly informative finding worth documenting clearly, along with the exact path of the radiating pain (which fingers, which part of the arm). In Movalytics you can record these results in each cervical assessment and track how the pattern evolves over time.

Frequently asked questions

Is the Spurling test safe? Yes, when applied with gentle, progressive pressure—but it should be avoided or done with great caution in people with suspected cervical instability, undiagnosed bone pathology, or severe neurological symptoms (where immediate referral takes priority). Does a positive Spurling test always mean a cervical disc herniation? Not necessarily; there can be other causes of foraminal narrowing (degenerative changes, for example), but the pattern points toward radicular compression in general, the specific cause of which requires imaging. What should I do if the test is positive? Document it, avoid positions/loads that reproduce the radiating pain, and refer for medical evaluation, especially if there are associated neurological symptoms (weakness, reflex changes).