Disc bulges in general are sneaky. They don’t necessarily present themselves in any dramatic way at first and often start as a small sensation that persists and gets more dramatic over a few weeks. Often people believe it is a small pain that will ‘go away’. However the persistent nature of the pain often leads them to a therapists door seeking assistance.
When talking about bulging discs, there is often a lot of focus on the lumbar discs as this area is perhaps more common for disc bulges than the cervical spine. Only 8% of disc herniations occur in the cervical spine. However cervical disc herniation is not unusual and does present considerations that are particular to this location. We’ve talked about the anatomy of disc bulges previously - for a refresh click here.
The cervical spine along with the lumbar spine is notably susceptible to disc bulges due to the moveable nature of these vertebral segments and the amount of movement that is required in daily activities. Disc bulges in the neck illicit annoying numbing pain that radiates along the arms and down the shoulders and can possibly even be accompanied by headaches and some migraine like symptoms. Cervical disc bulges can also be disguised as the pain patterns associated with the condition can mimic other issues such as Separated Shoulder, weakness in the Rotator Cuff, Thoracic Outlet Syndrome and Wry Neck.
C6/7 is the most common location for this type of herniation however herniation can occur in the area from C5 – T1. The pain patterns include neck, shoulder and scapula pain, radiating pain down the forearm and into the digits along with weakness in particular muscles of the arm and certain actions such as lateral rotation, wrist flexion and grip strength.
Clients presenting with disc herniations will usually be accompanied with numbing pain and radiating pain in their extremities. Notably the sensation affects broad areas of the legs and arms and even down to the feet and hands due to the nature of neural (nerve) involvement in a disc bulge. This neural involvement is particularly noteworthy in a cervical disc bulge due to the relatively small space between vertebral segments. Any change in the discs here is felt perhaps more acutely than in the lumbar spine as there is just less space for the body to tolerate any changes in this small opening.
Clients can simply wake up with pain without having necessarily been involved in any impact trauma or exuberant movement. The radiating pain can travel down the arm, forearm and hand as well as radiating into the shoulder blade. Rotation is difficult and holding the arm above the head often helps to relieve the pain as it takes the pressure off the nerve that is being affected by the bulge. Often clients present with a minimal pain that is consistent and doesn’t get better in time.
As symptoms can often mimic other conditions, after seeing a client for a session and noting no improvement in the condition and returning pain the very next day usually for me, indicates disc involvement. I’ve managed to make a few calls on this in my time, sending people off for a scan after getting this result and a positive disc herniation is the result.
People at risk are those involved in heavy lifting and the more mature athlete. As we age, the tough fibrous outer wall of an intervertebral disc weakens and the chance of disc herniation increases. Those involved in athletic lifting can suffer from this condition particularly where overhead lifting is involved. The slightest deviation in technique can place excessive load on the cervical spine and athletes as young as 30 have suffered from cervical disc herniation as a result.
Thankfully the recovery rate from this condition is reasonably high with up to 95% of people making a return to activity and reduction in pain after conservative, non-invasive treatment. This prognosis can take as little as 4-6 weeks. As with the lumbar spine, creating space in the spine is paramount so dealing with any issues in the soft tissue around the neck and shoulders is important. Also, working on the neck posture which as I have written about before, always comes down to the thoracic cage and alignment through the whole spine. Working on all aspects of the arm muscles and neck muscles to ensure satisfactory alignment is a great way of helping the body to recover from this condition.
There are more severe cases where surgical intervention is required to correct the bulge. Steroidal injections are often administered where an injection is made into the epidural space of the spine, reducing the inflammation and swelling of the nerves. This is still considered ‘conservative’ treatment but often requires more than one application and can be ongoing for a year or more. 50% of clients will experience relief but often the results are temporary.
More aggressive surgery involves a DISCECTOMY – a surgical incision going in through the neck (either the front or the back depending on which part of the disc is damaged) and removing the damaged portion and inserting plates or bone grafts to create a fusion of the spinal segment and prevent further narrowing of the disc space.
Disc Bulges in the cervical spine aren’t a death sentence to an athlete. However they are a warning. In terms of the spine, the neck is often where pain is felt but the cause of influences on the neck come from lower down. In terms of the ‘pebble in the pond’ the neck is the outer edge, so the ripples are felt more acutely here than in the centre. Addressing postural issues and technicial issues in sporting actions are vital to ensuring that your neck remains long, graceful and elegant - and out of pain.