Cervical disc herniation
This occurs when part of the disc's nucleus shifts, putting pressure on its ring. This pressure causes the ring to crack, and part of the nucleus may end up outside the ring.
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What is the intervertebral disc?
The intervertebral disc is like a cushion between the vertebrae in your neck. Its main function is to absorb shock and allow the vertebrae to move properly. The disc is made up of two parts:
- The nucleus (in the center)
- The annulus (which surrounds the nucleus)
What is a cervical disc herniation?
This occurs when part of the disc's nucleus shifts, putting pressure on its ring. This pressure causes the ring to crack, and part of the nucleus may end up outside the ring.
The stages of cervical disc herniation formation
A bulging disc is the beginning of a disc herniation. The nucleus pushes on the annulus of the disc, slightly deforming it.
A protrusion occurs when the nucleus extends beyond the annulus to the outside of the disc. This overflow of the nucleus is the herniation.
Extrusion occurs when there is a tear in the annulus of the disc and the herniation protrudes further outwards.
Sequestration is when a fragment of the herniated disc breaks off and moves independently.
What are the causes of a cervical disc herniation?
A cervical disc herniation can develop gradually over several years or suddenly due to trauma.
Disc herniation that develops gradually is caused by the wear and tear process of the disc, which happens progressively over the years. The annulus of the disc becomes less strong over time, and small tears can develop in it. The nucleus of the disc can then press on this tear and eventually cause a herniation.
A so-called "traumatic" disc herniation is caused by a specific event such as trauma or a sudden movement involving a load. At that precise moment, a tear of the annulus can occur, and the nucleus will protrude through this tear.
What are the symptoms of a cervical disc herniation?
It is important to know that you can have a disc herniation without any symptoms. In fact, when healthy adults undergo an MRI, it is found that 98% of people have degenerative changes in their discs and have no pain.
However, when symptoms are present, here's what you may experience:
- Gradual or sudden neck pain
- Spasms in the neck muscles
- Decreased neck mobility due to pain
- Often the head remains tilted forward, and you are unable to straighten it because the pain is too intense.
If you also experience pain, numbness, or tingling that radiates into your arms, it is possible that the disc herniation is irritating one or more nerves. This is called a radiculopathy (see this section).
People sometimes hold their hand on their head because it is the only position they have found to relieve the pain that radiates into their arm.
What are the serious symptoms of a cervical disc herniation to watch out for?
The presence of certain signs and symptoms should prompt you to seek immediate medical attention at the emergency room or from a doctor. These include:
- Severe weakness or paralysis in one or both arms
- Significant or even complete loss of sensation in one or both arms
- Recent loss of balance when walking
- New incoordination of the arms or hands
- New difficulties with bladder or bowel control
- Loss of sensation in the genital area or when wiping after a bowel movement
Serious symptoms are only present in less than 1% of cases. Most of the time, although the pain can be very unpleasant, the condition resolves well.
How to diagnose a cervical disc herniation?
Diagnosis is made based on a review of your symptoms and a clinical examination.
In some rarer cases, radiological examinations (X-ray, MRI, EMG) are necessary to determine the severity of the disc herniation or to see if it is compressing a nerve in the neck.
It's important to know that what we see on X-rays or other types of imaging is not always relevant. Did you know that up to 78% of young adults in their twenties without neck pain have signs of early disc herniation on MRI (magnetic resonance imaging). Yet, they have absolutely no pain!
Please note that a herniated disc cannot be seen on an X-ray.
When should you see a physiotherapist for a cervical herniated disc?
You should consult a physiotherapist if you have symptoms as described above or if your doctor has already ruled out any other cause that may be responsible for your pain.
You do not need to see a doctor before consulting a physiotherapist. If your condition requires you to see a doctor, your physiotherapist will be able to tell you.
What physiotherapy treatments are available for a cervical herniated disc?
Your physiotherapist will conduct an assessment to determine the cause of your herniated disc pain. To do this, they will evaluate the following:
- Your joint mobility
- The gliding of your nerves
- Your postural habits
- The quality of your movements
- Your strength and stability
Based on the assessment results, your physiotherapist will:
- Mobilize the joints, muscles, and nerves in your neck to reduce pain and improve movement
- Give you specific exercises to do at home to address the cause of the problem and relieve pain
- Teach you how to properly manage your daily activities and hobbies to optimize healing
- Give you advice for your postural habits and movements
What can you do at home for a cervical herniated disc?
Temporarily stop doing movements that cause too much pain, and then gradually start doing them again.
Here are some other tips that may help at home:
- Move your neck in the movements that don't cause any pain at all
- Support your shoulders and shoulder blades
- With a cushion under your armpit
- With the armrests of a chair or sofa
- By putting your hand in your pants pocket
- Limit the time spent in the same position (computer, television, reading). Get up often for a few minutes to move your neck and shoulders a little.
- Ensure your neck is well supported while sleeping with a pillow that fills the curve of your neck. Avoid sleeping on your stomach, especially if you experience stiffness or pain in the morning or during the night.
If you don't see any improvement after 10 days, you should consult a physiotherapist.
Did you know?
- The most common cervical disc herniations occur at levels C5-C6 and C6-C7.
- Women are more likely to experience cervical herniations than men.
Sources
Sharrak S, Al Khalili Y. Cervical Disc Herniation. StatPearls [Internet]. 2020 Aug 10.
Okada E, Matsumoto M, Fujiwara H, Toyama Y. Disc degeneration of cervical spine on MRI in patients with lumbar disc herniation: comparison study with asymptomatic volunteers. European Spine Journal. 2011 Apr 1;20(4):585-91.
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