What is a cervical disc herniation?
A herniated disc is also known as a prolapsed disc but you will probably have heard most people use the term “slipped disc”. This is slightly misleading as your discs physically can’t slip out of place. What has actually happened is that the tough fibers called the annulus fibrosus around the outside of the disc have split causing a weakness and allowing the soft material called the nucleus pulposus from inside the disc to start bulging out. If you like, imagine that your discs are shock absorbers and act like your spines suspension system very much like a car. When you lift a weight the disc compresses, absorbs the weight and disperses it evenly down your spine. Now think of a strong car tyre, that’s what the outside fibres of the disc act like and the soft substance inside is similar to the consistency of toothpaste. Any wear, tear or splits in the tyre surface would allow the soft toothpaste to start bulging out. Once the soft substance starts to protrude your body reacts by gathering Inflammation around the bulge. This creates quite severe pain around the disc itself and causes the sudden intense neck pain that sufferer’s first experience.
What does a cervical disc herniation feel like?
Your cervical spine surrounds the spinal cord to protect it from damage. Your nerves branch off from the spinal cord and pass out at the level of each disc and then continue to travel down into the arm. The nerve passes very close to the edge of the disc and can be adversely affected by a disc herniation in two ways. Firstly, if the disc bulge is significant enough it will touch and compress the nerve causing pain from the neck to travel down into the arm. Secondly, the arm pain symptoms can be caused by the high levels of inflammation around the disc bulge, irritating the near-by nerve. In many cases the neck pain experienced is overshadowed by severe arm symptoms; as the nerve irritation and pressure can also cause additional symptoms like pins & needles, numbness and weakness down the arm and into the hand.
It is quite possible to have a disc herniation with purely neck pain or no neck pain and only arm symptoms. Rarely, the disc herniation may occur in a slightly different position and put pressure on the spinal cord, this causes problems to occur in the legs as well. There have been cases where only minor symptoms or in-fact no symptoms at all have been reported, however due to the fact that the space between the disc and nerve is the smallest in the neck even a mild cervical disc herniation can cause severe symptoms.
The pain is characterised as being an intense ache whilst resting to a sharp, shooting and stabbing pain on movement. The extent of the arm pain and symptoms can lead to sufferers feeling an incredibly heavy arm sensation. Lifting with the affected arm, tilting your head down and to the side will increase your pain levels. Any sudden coughing and sneezing will be extremely painful.
Why & when a cervical disc herniation happens
There is not one specific reason for the onset of a disc herniation but there are many risk factors that may make you more susceptible. The main factor to consider is disc degeneration. As you get older, the soft nucleus pulposus in the center of the disc starts to dehydrate, retaining less and less water. This decreases the discs ability to act as a shock absorber. The deterioration of the disc in this manner can increase the likelihood of the outer annulus fibrosus layer tearing. Poor posture, previous trauma and a lack of exercise leading to poor core body strength can also leave the spine weakened. These risk factors can lead to early degeneration of the discs especially when combined with obesity and increasing age. Activities which increase the pressure within the disc such as carrying uneven weights, bending in an incorrect manner (back bent and knees straight), holding a prolonged poor seated posture (desk work, driving), direct contact sports and even sneezing can cause the already weakened structure of the disc to give.
A Cervical disc herniation occurs most commonly in the mid-levels of the neck between C4-C5 vertebrae and C6-C7. Men are twice as likely to be affected as women and it usually develops within the 25-50 year old age range with the highest incidence between 35-45 years.
How long does a cervical disc herniation take to heal?
The pain levels are normally most severe to begin with, particularly when the nerve is initially compressed or irritated. Over the first six weeks the herniated bulge should naturally start to shrink and reabsorb back into the disc. Due to this, most cases see a 50% improvement in symptoms with pain levels being dramatically reduced and the additional symptoms like pins and needles, weakness and numbness taking slightly longer to resolve.
How will a cervical disc herniation be diagnosed?
Your GP will be able to diagnose you by both listening to your history and examining you. If symptoms persist longer than six weeks an x-ray or an MRI scan may be advised to confirm diagnosis and assess the size and state of the herniated disc.
What treatments are there for a cervical disc herniation?
In more severe cases of cervical disc herniation, surgery may be necessary however this only represents a minority group as only 1 in 10 cases are considered for surgery. Most will improve without surgical intervention. Many find that manipulative therapies like osteopathy, chiropractic and physiotherapy speed up the recovery process and help to alleviate the high pain levels. Your GP may advise a short period of rest after the initial onset when pain levels are high, however it is very important that after two or three days you begin moving again to prevent your neck joints from stiffening and your neck muscles from weakening.
Your GP may prescribe you with anti-inflammatory medications to reduce the swelling around the bulge and analgesic medication for pain relief. You can help yourself by using ice packs on your neck to control the inflammation levels. Make sure the ice pack is covered to prevent ice burn and restrict the time you apply it to 10-15 minutes with at least 30 minutes intervals. Once you start to recover it is very important that you get rehabilitation exercises to strengthen your neck. This can be done through the relative therapist or trainer. In most cases the neck is left weak after a herniated disc, strengthening your neck will ensure you make a better recovery and dramatically decrease future occurrences. It is advisable to seek medical advice from your GP before commencing your rehabilitation exercises.