Anatomy of cervical disc injuries

Chances are you or one of your friends in Ashland, OR has experienced neck pain at some point in their life. Or perhaps you are one of the millions of people who has chronic neck pain. One possible cause of neck pain is cervical disc injuries. These injuries can be one of the scariest types of neck pain in the body. It can show up as an inability to turn your head without pain. Or a searing pain in the shoulder blade. Or pins and needles in the hand.

There are seven cervical vertebrae. When you reach around to the back of your neck you can feel the ends of the long spinous processes. On the sides of the neck are the harder to find transverse processes. There are many ligaments that connect these bones together. Between the bodies of these vertebrae are discs. The discs in the cervical region are thicker than in the rest of the spine in order to provide the extra cushioning that is necessary for the diversity of neck movements you do every day.

The fibrocartilage disc is made of annular fibers and an inner core of nuclear material. The annular fibers do not cause pain, but protrusion of the nuclear material through the annular fibers creates an inflammatory reaction that causes pain in the neck and can put pressure on the nerve root sending pain down the arm. When the disc bulges or protrudes and presses on the nerve it can cause numbness or tingling. Pain down the arm is usually a combination of inflammation and structure. This pain goes from the neck out to the wrist and hand of the side where the disc is compromised. The further down the arm or back that the pain goes the more severe the injury is.

What disc is compromised can be determined by mapping out the specific pathway of pain called a dermatome. See the image below.

Causes of Cervical Disc Injuries in Ashland

Damage to a disc usually shows up after a specific movement, but it is often the result of an accumulation of repetitive stress on the disc. The repetitive strain on the disc results in a loss of its normal viscoelastic properties. Aging, being in poor shape, and postural stress can make the disc less resilient to compressive loading, sheer stress, and vibration. All these forces can weaken the annular fibers resulting in a fissure, bulge, or herniation.

There are two main types of weakening. One weakens an entire side of the disc and the other creates disruption of individual fibers.

The disc is thinner at the back and that is why protrusions and herniation’s are more common there. The nerve root canals are narrower in the lower neck and that’s why most herniation’s in that area cause pain. Over 90% of herniation’s at C5-6 or C6-7 cause pain. Up to 63% of protrusions don’t cause any pain and 10% of individuals will have herniation’s without pain.[1]

These injuries can make life unbearable or least difficult for months or even years. The body will try and protect the area initiating an involuntary muscle spasm that will limit movement in the area.

Trauma is the most likely cause of disc injury. Other causes are postural stress with workstation postures, repetitive looking down, improper sleep postures, frequent heavy lifting, cigarette smoking, and driving or operating vibrating equipment.[2]

Common Symptoms of Cervical Disc Injuries in Ashland

The symptoms you experience are dependent on the location of the disc protrusion. After protrusion the disc can extrude which is basically a herniation. The amount of the disc that is compromised is classified as either “focal,” meaning less than 25% of the disc circumference is displaced, “broad-based”, involving 25-50% of the perimeter, and “circumferential” involving 50-100%.[3] The symptoms that are experienced are primarily from inflammation, but they can also be due to mechanical compression.[4]

These symptoms can start in the neck and then go down the arm as a radicular complaint. Pain that goes down the arm is called radiculopathy and disc injury is the second most common cause after degenerative stenosis.[5] The pain will radiate into the head, neck, shoulders, arm, forearm, hand, or interscapular area. These symptoms can get worse with prolonged workstation use or prolonged flexion. The pain is described as sharp and can be accompanied by numbness or tingling. There can be weakness in the arm or the hand while writing or gripping.

Neurologic findings for radiculopathy from cervical disc injury include upper extremity sensory disorders (88%), reflex abnormalities (61%), and motor weakness (51%).[6] If these symptoms continue to get worse a surgical consultation is needed.

If you are between the age of 40-55 and have neck pain it is more likely that it is from a disc injury especially if there is pain in the arm.[7]

How to Evaluate Cervical Disc Injuries in Ashland

Although the anatomy of the disc and the spine seems straightforward, evaluating and diagnosing disc injuries can be a challenge. If you have the symptoms listed above, then it is time to determine how the disc is compressing on the nerve. As a rule when ligaments are injured, passive tests are painful. When the origin is muscular, resisted tests are painful. When the origin is a nerve, the passive tests are limited in motion and painful. Muscle testing provides the most specific assessment of individual nerve roots.

Pressure on the neck is often tender and the muscles will feel ropey and tense. Pressure on the head can create some pain that shoots down the arm. Pain may also increase when you reach your arm across your body. Symptoms can also increase with coughing or sneezing.

It is also important to look at the facet joints and palpate them for proper motion. If those joints aren’t moving well that is a common reason for extra stress on the disc.[8] Radiographs and MRI are also useful in evaluating disc injuries and should be correlated with history and physical findings to determine relevance.[9]

Upper Cervical Chiropractic for Cervical Disc Injuries in Ashland

The goal of upper cervical chiropractic is to reduce pain and inflammation, decrease mechanical compression, and improve functional stability. Research shows treatment can heal the disc injury and reduce symptoms.[10] There will be significant improvement after two weeks and 85% reporting additional improvement at three months.[11] In addition to gentle adjustments, exercises based on directional preference are employed if they help with symptom centralization. Traction can also be helpful for disc injury because it decompresses, rehydrates, and promotes recovery.[12]

Gentle myofascial release techniques (massage) of the following muscles: suboccipital, posterior cervical, SCM, levator, and trapezius can be really helpful. This will improve mobility and re-distribute the forces away from the injured segment.

Intelligent stretching, strengthening, and nerve flossing can also assist in a speedy recovery. This can include a focus on deep neck flexors, upper crossed syndrome, or paradoxical breathing. Medical co-management can be necessary is difficult cases.

Exercises to help heal cervical disc injuries

Conclusion

Disc injuries can be healed and this article gives you some suggestions on what to look for to determine you have a disc injury and what to do about it. I hope that this information helps you. If you have any additional questions please leave a comment. In addition to this article you can also read the Guide to Chronic Neck Pain eBook.

References

[1] . Kramer J, Rivera CA, Kleefield J. Degenerative disorders of the cervical spine. Rheum Dis Clin North Am. Aug 1991;17(3):741-55.

[2] Harms-Ringdahl K. On assessment of shoulder exercise and load-elicited pain in the cervical spine. Biomechanical analysis of load–EMG–methodological studies of pain provoked by extreme position. Scand J Rehabil Med Suppl. 1986;14:1-40.

[3] David F. Fardon, MD Nomenclature and Classification of Lumbar Disc Pathology SPINE Volume 26, Number 5, pp E93–E113

[4] Wainner RS, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, Allison S. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine 2003;28:52-62

[5] Murphy DR. Herniated disc with radiculopathy following cervical manipulation: nonsurgical management. Spine J 2006; 6:459-63.

[6] Saal JS, Saal JA, Yurth EF. Nonoperative management of herniated cervical intervertebral disc with radiculopathy. Spine (Phila Pa 1976). 1996 Aug 15;21(16):1877-83.

[7] Kelsey JL, Githens PB, Walter SD, Southwick WO, Weil U, Holford TR, Ostfeld AM, Calogero JA, O’Connor T, White AA 3rd. An epidemiological study of acute prolapsed cervical intervertebral disc. J Bone Joint Surg Am. 1984 Jul;66(6):907-14.

[8] Craig Liebenson DC, Functional reactivation for neck pain patients. Journal of Bodywork and MovementTherapies (2002) 6(1), 59^66

[9] Yu SW, Sether LA, Ho PS, Wagner M, Haughton VM. Tears of the anulus fibrosus: correlation between MR and pathologic findings in cadavers. AJNR Am J Neuroradiol. Mar-Apr 1988;9(2):367-70.

[10] . Manchikanti L, Abdi S, Atluri S, Benyamin RM, Boswell MV, Buenaventura RM, et al. An Update of Comprehensive Evidence-Based Guidelines for Interventional Techniques in Chronic Spinal Pain. Part II: Guidance and Recommendations. Pain Physician. Apr 2013;16(2 Suppl):S49-S283.

[11] Cynthia K. Peterson, Christof Schmid, Serafin Leemann, Bernard Anklin, B. Kim Humphreys. Outcomes From Magnetic Resonance Imaging–Confirmed Symptomatic Cervical Disc Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulative Therapy: A Prospective Cohort Study With 3-Month Follow-Up. JMPT Volume 36, Issue 8 , Pages 461-467, October 2013

[12] Browder DA, Erhard RE, Piva SR: Intermittent cervical traction and thoracic manipulation for management of mild cervical compressive myelopathy attributed to cervical herniated disc: a case series. J Orthop Sports Phys Ther. 2004, 34(11):701-12.