cervical disc

What is a cervical disc bulge?

The cervical spine (i.e. neck) comprises of many bones known as vertebrae, each of which is separated by a disc (figure 1). The disc comprises of many layers of strong connective tissue wrapping around the disc. In the middle of the disc lies a soft jelly-like substance which is capable of changing shape. When this jelly-like substance protrudes from the disc due to a tear in several layers of the connective tissue, this is known as a disc bulge.

To understand the mechanism of a cervical disc bulge, it is useful to liken the disc to a vanilla slice. Imagine a vanilla slice wrapped in five layers of sandwich wrap. The top and bottom layers of pastry represent the vertebra (bones), the custard represents the jelly-like substance of the disc and the sandwich wrap represents the connective tissue around the disc. If you were now to pinch the front of that vanilla slice, you could imagine, the custard would squeeze towards the back of the vanilla slice and may tear two or three layers of sandwich wrap at the back of the vanilla slice. As a result the custard is no longer supported as effectively at the back of the vanilla slice and therefore bulges out at this location. In the disc, the situation is the same. Bending the neck forward closes down the front of the disc, pushing the jelly-like substance within the disc towards the back. Overtime or suddenly, this may tear several layers of connective tissue at the back of the disc resulting in a cervical disc bulge.

Causes of a cervical disc bulge

There are four main activities in everyday life which typically cause disc bulges in the neck provided they are forceful, repetitive or prolonged enough. These include: bending the neck forwards, poor posture (slouching) especially during sleep or sitting (figures 2 & 3), activities using your arms in front of the body (e.g. washing dishes, driving etc.) and lifting. Twisting or side bending movements of the neck may also contribute to injury by focusing stress on one side of the disc. Occasionally, cervical disc bulges may occur following a trivial movement involving bending forward such as picking up a small object or sneezing. In these instances, the disc has normally been subject to repetitive or prolonged bending, slouching or lifting forces leading up to the incident. Often a cervical disc bulge will occur upon waking after a long sleep in an awkward position.

Signs and symptoms of a cervical disc bulge

Patients with a cervical disc bulge typically experience one sided neck pain which is most common in the lower neck region. In some cases, symptoms may be felt centrally or on both sides of the neck. The symptoms associated with a cervical disc bulge are sometimes accompanied with pain radiating down the arm (sometimes as far as the hand and fingers) or into the shoulder blade region, or in some cases, headaches. Muscle spasm, pins and needles, numbness or weakness may also be present. Occasionally the neck may be noticeably out of alignment, with pain preventing the patient from straightening the neck. Movements of the neck are generally restricted, particularly to one side.

Patients with a cervical disc bulge may experience a sudden onset of neck pain during the causative activity, however, it is also common for patients to experience pain and stiffness after the provocative activity, particularly the next morning. Symptoms are often worse with sustained postures such as reading, driving, sitting at a computer or watching television. Symptoms may also be exacerbated by activities using the arms in front of the body (such as cooking, ironing, vacuuming etc.), prolonged sitting (especially if slouched), lifting and with certain neck movements involving rotation, side bending, bending forwards or backwards. Sneezing may also aggravate symptoms. Patients with a cervical disc bulge will often experience pain and stiffness that is worse first thing in the morning.

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Herniated Disc and Headaches

herniated disc and headaches are commonly connected although many patients, and their physicians, fail to make the association, leaving them with often debilitating symptoms that remain unaddressed. Headaches are just one possible symptom of a herniated disc in the cervical spine, with arm pain, shoulder pain, altered sensation, numbness, weakness, and muscle wasting also possible ramifications of a herniated disc. Dizziness and nausea may also accompany aherniated disc and headaches. Chronic intermittent pain in the neck that is followed by acutesevere neck pain may indicate a bulging disc that has suddenly herniated.

Contributing factors to the development of a cervical disc bulge

Several factors may contribute to the development of a cervical disc bulge. These need to be assessed and corrected with direction from the treating physiotherapist and may include:

  • poor posture
  • poor core stability
  • a sedentary lifestyle
  • muscle tightness
  • muscle weakness
  • joint stiffness
  • poor lifting technique
  • a lifestyle involving large amounts of bending, slouching, shoulders forward or lifting activities

diagnosis
Good treatment is always based on an accurate diagnosis. The comprehensive diagnostic process includes:

  • Medical history. You doctor will talk to you about your symptoms, how severe they are, and what treatments you have already tried.
  • Physical examination. You will be carefully examined for limitations of movement, problems with balance, and pain. During this exam, the doctor will also look for loss of reflexes in the extremities, muscle weakness, loss of sensation or other signs of spinal cord damage.
  • Diagnostic tests. Generally, doctors start with plain x-ray films, which enable them to rule out other problems such as infections. CT scans and MRIs are often used to give three-dimensional views of the lumbar spine and can help detect herniated discs.

Treatment

Conservative Treatment

A bulging disc does not necessarily mean that you will need to undergo surgery. The treatment of a bulging disc depends on your symptoms. Most patients with a bulging disc do not need surgery. Your symptoms can usually be managed with conservative treatment such as watching and waiting to see whether your symptoms go away, pain medications, and physical therapy. Many patients who initially have problems due to a bulging disc find their symptoms completely resolve over several weeks or months.

Hot and Cold Therapy: 

Both hot and cold therapies offer their own set of benefits, and your physical therapist may alternate between them to get the best results.

Your physical therapist may use heat to increase blood flow to the target area. Blood helps heal the area by delivering extra oxygen and nutrients. Blood also removes waste byproducts from muscle spasms.

Conversely, cold therapy (also called cryotherapy) slows circulation. This reduces inflammation, muscle spasms and pain. Your physical therapist may place an ice pack on the target area, give you an ice massage, or even use a spray known as fluoromethane to cool inflamed tissues.

 

Prescription Pill Bottles

                                                                         Prescription Pill Bottles

Medication

  • Medication and pain management Medications used to control pain are called analgesics. Most pain can be treated with nonprescription medications such as aspirin, ibuprofen (Motrin, Nuprin, Advil), naproxen (Aleve) or acetaminophen (Tylenol). If you have severe persistent pain, your doctor might prescribe narcotics for a short time. Sometimes your doctor will prescribe muscle relaxants. However, you want to take only the medication you need because taking more doesn't help you recover faster, might cause unwanted side effects (such as constipation and drowsiness) and can result in dependency. All medication should be taken only as directed. Make sure you tell your doctor about any kind of medication you are taking---even over-the-counter drugs or supplements --- and if he/she prescribes pain medication, let him/her know how it is working for you. Also, be sure to notify your doctor of any allergic reactions to medication you have ever experienced.
  • Nonsteroidal anti-inflammatory medications (NSAIDs) are analgesics and are also used to reduce swelling and inflammation that occur as a result of disc herniation. These include aspirin, ibuprofen, naproxen and a variety of prescription drugs. If your doctor gives you anti-inflammatory medications, you should watch for side effects like stomach upset or bleeding. Chronic use of prescription or over-the-counter NSAIDs should be monitored by your physician for the development of any potential problems.

injection

  • Corticosteroid medications, either orally or by injection, are sometimes prescribed for more severe arm and neck pain because of their very powerful anti-inflammatory effect. Corticosteroids, like NSAIDs, can have side effects. Risks and benefits of this medication should be discussed with your physician.
  • Epidural injections or "blocks" may be recommended if you have severe arm pain. These are injections of corticosteroid into the epidural space (the area around the spinal nerves), performed by a doctor with special training in this technique. The initial injection may be followed by one or two more injections at a later date. This should be done as part of a comprehensive rehabilitation and treatment program. The purpose of the injection is to reduce inflammation of the nerve and the disc.
  • Trigger point injections are injections of local anesthetics (sometimes combined with corticosteroids) directly into painful soft tissue or muscles along the spine. While occasionally useful for pain control, trigger point injections do not help heal a herniated cervical disc.

Physiotherapy

Your physical therapist's overall purpose is to help you continue to participate in your daily activities and life roles. The therapist will design a treatment program based on both the findings of the evaluation and your personal goals. Your treatment program most likely will include a combination of exercises.

Your therapist will design:

  • Exercises that involve specific movements to relieve nerve pressure and decrease pain and other symptoms, especially during the early stages of treatment
  • Stretching and flexibility exercises to improve mobility in the joints and the muscles of your spine, arms, and legs—improving motion in a joint can be key to pain relief
  • Strengthening exercises—strong trunk muscles provide support for your spinal joints, and strong arm and leg muscles help take some of the workload off those joints
  • Aerobic exercise, which has been proven to be helpful in relieving pain, promoting a healthy body weight, and improving overall strength and mobility—all important factors in managing a herniated disk

This might sound like a lot of exercise, but don't worry: research shows that the more exercise you can handle, the quicker you'll get rid of your pain and other symptoms.

Your physical therapist also might decide to use a combination of other treatments:

  • Manual therapy to improve the mobility of stiff joints and tight muscles that may be contributing to your symptoms
  • Posture and movement education to show you how to make small changes in how you sit, stand, bend, and lift—even in how you sleep—to help relieve your pain and help you manage your condition on your own
  • Special pain treatments—such as ice, traction, and electrical stimulation—to reduce pain that is severe and not relieved by exercise or manual therapy

Once your pain is gone, it will be important for you to continue your new posture and movement habits to keep your back healthy.

Acupuncture

Acupuncture: This ancient Chinese practice is rooted in the belief that everyone has an energy force called the Chi (sometimes spelled Qi, but both are pronounced "chee"). When the Chi is blocked or unbalanced, your body may respond with pain and illness. Traditional acupuncturists aim to free up Chi channels, known as meridians, by inserting extremely thin needles into specific points in your body's meridians.

Based on your specific diagnosis, the practitioner will likely insert multiple needles that are left in for about 20-40 minutes.

It has also been suggested that acupuncture triggers the release of endorphins into the blood stream. Simply put, endorphins are your body's natural pain relievers. As such, their release decreases your perception of pain.

Similarly, the Gate Control Theory may play a role in acupuncture's effectiveness at reducing pain. This theory asserts that pain signals travel slowly from the area of injury to the spinal cord into the brain because the nerves can only handle a limited number of signals at once. Acupuncture is thought to generate faster signals to crowd out the slow-moving pain signals, thus blocking out the pain.

 

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Massage Terapy

Massage: When received regularly, massage may offer chronic low back pain relief. A massage involves the stroking, kneading, and manipulation of your back tissues. These movements increase blood flow, which delivers more oxygen and nutrients to the muscles. Extra blood also carries away waste byproducts that may accumulate over time.

While massage is not a proven treatment for herniated discs, it's generally safe and free of side effects. However, massage may not be right for you if you suffer from osteoporosis, deep vein thrombosis, skin infections, open wounds, or arthritis in or near the area to be massaged.

There are more than 100 types of massage techniques. A Swedish massage, for instance, uses long strokes to impact the superficial layers of your muscles. In contrast, a deep tissue massage uses direct pressure and slow strokes to soothe your deep layers of muscle and relieve chronic muscular tension. Your massage therapist will work with you to determine what specific massage will best reduce your pain.

Sports and Corrective Exercises

Exercise is a common component of herniated disc treatment. Taking a proactive approach to your recovery with physical activity will reduce your pain and help ensure the long-term health of your back.

Exercising is an effective way to strengthen and stabilize your low back muscles and prevent further injury and pain. Strong muscles support your body weight and bones—taking unnecessary pressure off your spine.

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Tilt From Front To Back

  • Tilt your head slowly back, far enough so you can look up.
  • Hold posture for a moment.
  • Return slowly to front position.
  • Do 5-10 repetitions of this exercise 3 times a day.
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Tilt From Side To Side

  • Keep your head straight as you slowly tilt it over to the side.
  • Don't go so far that you touch your ear with your shoulder.
  • Hold posture for a moment.
  • Return your head to center position.
  • Move your head to your opposite shoulder.
  • Do 5-10 repetitions of this exercise three times a day.
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Rotate Head From Side To Side

  • Slowly turn your head as far as you can.
  • Hold posture for a moment.
  • Return your head to the center.
  • Move your head in the opposite direction.
  • Do 5-10 repetitions of this exercise 3 times a day.
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Side Resistance

  • Hold one hand against the side of your head.
  • Use your hand to resist the movement as you try to touch your shoulder with your ear.
  • Hold this posture for a count of 5.
  • Relax and repeat on opposite side.
  • Do 5-10 reps of this exercise 3 times a day.
Hand Resistant Exercises
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Forward Resistance

  • Hold both hands against your forehead.
  • Try to move head forward, but resist the movement with your hands.
  • Hold this posture for a count of 5.
  • Relax.
  • Do 5-10 Repetitions of this exercise 3 times a day.
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Backward Resistance

  • Place both hands behind your head.
  • Try to move head backwards, but resist the movement with your hands. Don't tip chin.
  • Hold this posture for a count of 5.
  • Relax.
  • Do 5-10 reps 3 times a day.

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Eat Right for Your Spine

Nutrition plays a very important and direct role in spinal health, and in healing the discs and surfaces of the spinal joints from an internal biological perspective. Regarding the spine, a calcium rich diet is a bone-healthy diet. Keep your bones strong with such foods as:

  • milk
  • low-fat yoghurt
  • cheeses like Edam, Cheddar and Parmesan
  • vegetables like curly kale, okra, red kidney beans, baked beans
  • nuts like almonds, hazelnuts, walnuts, and sesame seeds and tahini paste
  • fish like whitebait, sardines (in oil, tinned) and salmon
  • figs and apricots
  • tofu, soy bean, eggs

Boost healing of your spine at the cellular level with such super foods as:

  • Shellfish: crab, shrimp, prawns and oysters
  • Dark green vegetables: kale ( a type of a cabbage), spinach, collards (relative to Kale), asparagus
  • Red Fruits and Vegetables: red peppers, beets, stewed or fresh tomatoes, dark berries like blueberries and blackberries
  • Soy Products: soy milk, soy cheese and tofu
  • Black olives
  • Red onions and apples (naturally high in a substance called quercitin which has natural anti-inflammatory properties)
  • Flaxseeds, chia seeds
  • Beans: navy beans, kidney beans, soy beans etc.
  • Cold Water oily Fishes: anchovies, herring, sardines, salmon and mackerel
  • Winter Squash
  • Olive oil
  • Fruits, nuts, vegetables and grains
  • Clear Water: Keep yourself super-hydrated. It’s always important to give your body water necessary for the re-hydration process in the healing of degenerated discs. Ideally, drink 8 10-ounce cups of clear water per day.

Laser Therapy

Laser Therapy is a medical procedure that uses highly focused laser light energy to treat pain and inflammation. It works at the cellular level by stimulating the body’s natural healing processes. This highly advanced technology is successful in treating both, acute and chronic conditions, which have failed to be remedied by traditional treatment approaches. This includes, but is not limited to: arthritis; back pain; disc herniations; headaches; knee and hip pain; neck pain; peripheral nerve disorders; neuropathy; sciatica; shingles; spinal stenosis; .Since its FDA clearance, more than a million patients have received the non-invasive treatment — and there has never been a reported side effect.

A variety of low level lasers are proven to be effective in reducing and eliminating acute and chronic pain in the neck  .Many patients find that this solution is a much more effective and immediate alternative to traditional pain medications. Combined with forms of chiropractics and therapy, the Erchonia lasers can help patients lead a normal, active, and healthy life without debilitating pain.

Chiropractic Care

Chiropractic care and treatment methods are highly effective for different musculoskeletal disorders and spinal disc injuries, experienced by individuals because of over exertion and engagement in strenuous activities. Chiropractors provide services for joint and muscle adjustment and pain relief.

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Herbal Treatment and Traditional Medicine 

  • Willow Bark
  • Reduce the inflammation with a treatment of willow bark. This herb can be taken in three different forms and can be found at any health food store. To take willow bark as a tea, boil 1 to 2 teaspoons of the dried herb in 8 ounces of water. Allow the liquid to steep for 30 minutes. Drain out all of the leaves, and sip it like you would regular tea. Drink three to four cups a day for best results.
  • Topical Cayenne Pepper

Rub topical cayenne pepper on the affected area of your back. Cayenne pepper rubs can help ease the pain at the site of the herniation.. Use the cream several times a day or as needed for pain. Wash your hands thoroughly after handling the cream, and be sure to keep it away from your eyes.

Colchicine

  • Take colchicine in place of aspirin for pain. Colchicine comes from the dried corns and seeds in the center of the autumn crocus flower. These are crushed to make a pale, yellow powder, which is an excellent anti-inflammatory treatment. Take two 0.6-milligram tablets every two hours as needed for pain.
  • Turmeric

Take 400 to 600 milligrams of turmeric three times a day to help ease the inflammation of a herniated disk. This treatment will increase circulation and help to ease lower back pain. Turmeric powder is often used as a tea by boiling 1 teaspoon of turmeric in 8 ounces of water

 

Neck brace

A neck brace is will support, align and hold the neck in position. It will limit movement around the nerve and allow it to recover. Additionally, it helps relieve the pressure that is being placed on that particular nerve.

When braced the neck will be immobile and the discs will be held in position. It also acts as a way to hold back any deformed disc so that it adapts back to its position. For this reason a neck collar will be used by medics to treat victims who develop the pinched nerve from an accident.

A neck collar will hold your neck such that chances of poor neck postures will not be present. It may however not be possible to have a neck collar at home but you can always improvise. Try bracing your neck with any hard material that will support and most importantly align it.

 

Surgical Treatment
If non-operative measures do not work, surgery may be recommended. An anterior (from the front) cervical discectomy is the most common surgical procedure to treat damaged cervical discs. The goal of this procedure is to relieve pressure on the nerve roots or on the spinal cord by removing all or part of the damaged disc.

During the surgery, the soft tissues of the neck are separated to expose the offending disc. The disc is removed, to decompress the spinal cord or nerve roots. If necessary, the space left by the removed disc will be filled with a bone graft – a small piece of bone usually taken from the patient’s hip. The bone graft is used to join or fuse the vertebrae together. This is called a fusion. In some cases, some instrumentation (such as plates or screws) may be used to help promote fusion and to add stability to the spine.

During posterior cervical surgery, a portion of the bone covering the nerve may also need to be removed. This procedure is called a laminotomy.

Fortunately, these procedures can often be done utilizing minimally invasive techniques. Minimally invasive surgery uses smaller incisions and tiny specialized instruments such as microscopes and endoscopes.

Recovery
Most patients can begin getting out of bed on the same day surgery is performed! Activity is gradually increased and patients are typically able to go home within 1 - 2 days after their procedure, depending on the extent of the surgery. As with most surgeries, there will be some pain after the procedure. However, doctors these days have considerable expertise at minimizing pain and discomfort. Pain medications will be available to keep you comfortable.

At home, you will need to continue to rest. You will be instructed on how to gradually increase your activity. You may still need to take the pain medications for a while. However, pain and discomfort should begin to reduce within a week or two after surgery. Other techniques for reducing pain and increasing flexibility will be discussed with you before you leave for home. When you can return to work and other activities such as sports and driving will also be discussed with you before you leave.

 

Prevention

. Some simple changes in your daily routine may help. Consider trying to:

  • Take frequent breaksif you drive long distances or work long hours at your computer. Keep your head back, over your spine, to reduce neck strain. Try to avoid gritting your teeth.
  • Adjust your desk, chair and computerso the monitor is at eye level. Knees should be slightly lower than hips. Use your chair's armrests.
  • Avoidtucking the phone between your ear and shoulder when you talk. If you use the phone a lot, get a headset.
  • Stretch frequentlyif you work at a desk. Shrug your shoulders up and down. Pull your shoulder blades together and then relax. Pull your shoulders down while leaning your head to each side to stretch your neck muscles.
  • Balance your base.Stretching the front chest wall muscles and strengthening the muscles around the shoulder blade and back of the shoulder can promote a balanced base of support for the neck.
  • Avoid sleeping on your stomach.This position puts stress on your neck. Choose a pillow that supports the natural curve of your neck.