What is a cervical disc injury?
Cervical is the medical term for neck. A cervical "disc injury," or neck injury refers to a disruption of annular fibers of the disc and movement of disc material. Annular disruption is accompanied by an inflammatory reaction capable of producing symptoms. Significant annular disruption can lead to disc bulging or herniation, resulting in compression of nerve roots. Most complaints of tingling, numbness, and pain in the arm rare thought to be caused from a combination of mechanical and chemical factors (1). Ensuing symptoms may include pain, paresthesia, numbness, or weakness.
What causes a cervical disc injury?
Disc injuries are rarely the result of a single traumatic event, but rather, a continuum of problems, beginning with repetitive disc sprain, leading to herniation, ending in degeneration. The normal age-related loss of the normal disc height along with with repetitive stressors like compressive loading, sheer stress, and vibration weaken the disc's annular fibers. This process eventually leads to annular disruption (2). Constant neck motion and awkward postures combined with compressive loading allow for herniations to become more prominent. Only the outermost fibers have a nerve supply, so early disruption may not cause any pain at all. In fact, asymptomatic "protrusions" are present in up to 63% of males over the age of 40 (4). Asymptomatic "herniations" are present in 10% of adults under 40, and 5% of adults over 40 (5). Ninety percent of symptomatic disc herniations occur at C5-6 or C6-7. (8,16)
Cervical disc injuries is the second most common cause of cervical radiculopathy (pain into the shoulder, upper back, and arms) behind degenerative stenosis (11,12). Cervical disc herniations are most likely to affect adults below the age of 55, with a peak incidence in the fourth decade (13,62). Cervical disc herniations are slightly more common in males (13,62). Activities that are thought to predispose patients to cervical disc problems include repetitive stressful workstation postures (i.e. maintaining a prolonged forward head posture), repetitive cervical flexion, improper sleep postures, trauma, frequent heavy lifting, cigarette smoking, and driving or operating vibrating equipment- including motor vehicles (13,14,62).
What are the symptoms of a cervical disc injury?
Symptoms may arise from inflammation in the area, mechanical compression of a nerve, or both (15). Cervical (neck) discogenic pain often begins with simply symptoms in the neck and then progresses into pain in the shoulder, arm, and hands (16). Cervical disc injuries without mechanical compression may produce neck pain that can radiate (or move) into the head, neck, shoulders. Neck pain may be worse with prolonged sitting with poor posture or prolonged neck forward bending. Arm pain may be the predominant symptom in cases of a cervical disc injury (12). Patients may note an increase in pain in their arm when coughing or sneezing and find relief by elevating their arm above their head (2).
Do I need x-rays or other imaging?
A radicular complaint in the upper extremity may suggest the need for radiographic workup. Plain film radiographs of cervical disc injuries are often "normal," but may show concurrent degenerative change, particularly in older patients. Joint degenerative changes can cause narrowing of the intervertebral foramen (IVF) and is visualized on the oblique films. Symptoms often arise from a combination of disc bulging and spondylolytic bony encroachment, i.e. “disc/ osteophyte complex” or “hard disc”.
MRI is a sensitive modality for detection of cervical disc injury and provides additional information concerning the hydration status of the dis (25). However, MRI can yields false positives, and the true origin of the patient’s complaints may not always arise from the imaged disc lesion (5). Direct displacement of a nerve root or fluid within the nerve root are generally associated with symptomatology but are not always present.
What are the bet treatment options for a cervical disc injury?
The goal of conservative management should be to reduce pain and inflammation, decrease mechanical compression, and improve functional stability. Conservative management of cervical disc herniation with radiculopathy has been shown to result in regression of herniated material with subsequent reduction in local and radicular complaints (22,30-33). The relatively avascular anatomy (lack of blood flow) of the disc may prolong recovery times.
The judicious application of spinal manipulation has been shown to be safe, appropriate, and effective for the management of cervical disc herniation and/or radiculopathy (35-50,65,66). One study of 50 patients undergoing HVLA manipulation at the level of cervical disc herniation demonstrated significant improvement after two weeks of care with none worsening and 85.7% reporting significant improvement at three months (40). Another study of 104 MRI-confirmed disc herniations demonstrated that patients treated with chiropractic spinal manipulation were significantly more likely to report relevant “improvement” compared to those treated with cervical nerve root injection blocks (65). Alternatives to HVLA manipulation include Grade 3-4 mobilization, instrument-assisted adjusting, and cervical flexion distraction. Cervical spine manual traction is a beneficial modality for cervical disc lesion and has been shown to help decompress, rehydrate, and promote recovery (8,56-60). The use of ice, electrical stimulation, or ultrasound may provide benefit.
Restoration of normal flexibility and mobility allows for a more balanced distribution of forces away from the injured segment. Stretching and myofascial release techniques may be necessary for the paracervical region, including the suboccipital, posterior cervical, SCM, levator, and trapezius muscles. Implementation of IASTM procedures may help release myofascial adhesions in chronic cases. Cautious application of upper extremity nerve flossing may help mobilize and de-sensitize the irritated nerves.
Stabilization programs should focus on coordinating cervical, thoracic, and shoulder girdle movement and correct for biomechanical deficits including weakness in the deep neck flexors, upper crossed syndrome, or paradoxical breathing. Patients should be counseled on proper workstation and sleep postures and should avoid activities that involve axial loading of the cervical spine, like headstands, carrying objects on the head, and diving into water.
NSAIDs may help relieve inflammation. Medical co-management of acute cases with short-term tapering oral steroids is a potent anti-inflammatory adjunct. Recalcitrant cases may require pain management and/or neurosurgical consult. Cervical epidural injections or selective nerve root blocks may be helpful. (64) The addition of spinal manipulation post-epidural injection has been shown to improve outcomes. (61) Surgical alternatives, including discectomy, or discectomy with fusion, should be considered only after a failed trial of conservative therapy, or in the presence of progressive neurologic deficit (22).
At Creekside Chiropractic & Performance Center, we are highly trained to treat each of these conditions. We are the only inter-disciplinary clinic providing services to Sheboygan, Sheboygan Falls, Plymouth, and Oostburg including chiropractic, manual therapy, myofascial release, ART (Active Release Technique), massage therapy, acupuncture, physiotherapy, rehabilitative exercise, nutritional counseling, personal training, and golf performance training under one roof. Utilizing these different services, we can help patients and clients reach the best outcomes and the best versions of themselves. Voted Best Chiropractor in Sheboygan by the Sheboygan Press.
Evidence Based-Patient Centered-Outcome Focused
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