Your Guide to Neck (Cervical ) Disc Injuries
This information has been prepared to help you fully understand your condition so you will be in the best position possible to work with your physio & follow the steps to your full recovery. Understanding the goals of your treatment & having complete confidence in your physio are vital elements of your recovery plan, so if you have any questions then please feel free to ask your physio.
There are three common terms used in disc injuries – disc bulge, protrusion & herniation. Although people often refer to a disc bulge as a slipped disc, the disc doesn’t actually slip out of place. Rather, the terms bulge, protrusion or herniation means that the material at the centre of the disc has squeezed out of its normal space. This condition usually affects people between the ages of 30 & 40.
Intervertebral discs separate your spinal bones – the vertebrae. They are made of connective tissue which is the material that holds the living cells of the body together, & are made of 2 parts. The centre, called the nucleus, is a spongy gel-like substance which can move. It provides most of the disc’s ability to absorb shock. The nucleus is held in place by the annulus, a series of strong ligament rings surrounding it. Healthy discs work like shock absorbers to cushion the spine. They protect the spine against the daily pull of gravity, & also during strenuous activities that put strong forces on the spine such as jumping, running & lifting.
Bulges occur when the nucleus pushes backwards & puts pressure at the back of the disc, causing it to bulge backward. Usually the bulge will cause pain as it stresses the back of the disc & the surrounding layer of ligament. If the bulge is large it may put pressure on the nerves. Protrusion occurs when the nucleus puts more pressure backwards & tears some fibres of the annulus. The nucleus moves further backwards but not fully through the annulus. Herniation occurs when part of the nucleus squeezes out through the damaged annulus. This produces significant pain & often causes pressure on the nerve.
At first you may only experience a dull pain centred in the neck. This is mainly due to pressure on the annulus. Throbbing pain in the neck may be felt due to inflammation produced by the body in response to the disc bulge. A disc bulge can press against a spinal nerve, producing symptoms of nerve compression. This can include pain, pins-and-needles & numbness. Symptoms follow known patterns through the body & may be felt in the shoulder, arm, or even the fingers. More significant nerve pressure can cause a reduction in your reflexes, & the muscles that are supplied by that nerve may become weak.
What Happens If I Don`t Fully Fix My Neck?
If a disc bulge is left untreated, symptoms will continue to persist. If the disc is pressing on a nerve & treatment is delayed then more significant (& in some cases permanent) nerve damage can result. Early treatment is vital in these cases otherwise permanent damage is much more likely. In severe cases surgery may be required.
People with disc bulges also commonly alter their posture to help with the pain. These changes increase the likelihood of other structures being damaged as the change in posture causes changes in pressure to other areas of the body not used to handling such pressure.
How Long Does It Take To Get Fully Better?
Depending on the severity of the disc bulge recovery can range from 4 weeks to several months. Receiving treatment promptly when symptoms appear will reduce the recovery period.
Your journey to peak performance with Central Physio
Your physio has been extensively trained to thoroughly assess & diagnose your injury. They will give you a step-by-step recovery plan to make your treatment easier for you to understand. The most common phases, or steps, that you will go through during your recovery plan are outlined below. The order & timing of the phases are tailored individually for you & so may vary form this list. Please feel free to ask your physio if you have any questions about your recovery plan.
Phase 1: Optimise & Control Inflammation
Inflammation is the redness & swelling that occurs whenever you injure yourself. Our bodies need inflammation to start the normal healing process but we also need to control it. Reducing the inflammation associated with a disc bulge can help to take away that initial ‘throbbing’ pain patients describe. By reducing inflammation your physiotherapist is able to work a lot more intensively on your neck to restore any lost movement you may have developed or continued discomfort you are having.
Techniques your physio may use to manage your inflammation include specific local massage & soft-tissue releases, joint mobilisations, postural correction techniques & occasionally traction. Taping can be used to help support muscles, & we may also suggest that you see your GP to receive a prescription for some antiinflammatory medication. We will also talk to you about activities to modify or avoid to help your pain settle as quickly as possible.
Phase 2: Restore Range of Motion
Cervical disc bulges result in the joints & vertebrae in your neck becoming less mobile leading to stiffness & restricted movement. Without correcting this joint stiffness you will not regain your full range of movement & a return to your normal lifestyle will be difficult. Without treating the less mobile joints, the risk of re-injuring your neck is increased as the body will have to compensate in other areas to avoid the stiff segments.
Techniques your physio may use to correct the joint stiffness & restricted range of motion include deeper joint mobilisations, stretching & soft tissue massage. You will also be guided through exercises for home & work to help you recover as fast as possible.
Phase 3: Re-educate movement patterns
Your body often changes the way it moves to compensate for the pain produced by the disc bulge. Although this can be helpful in the short term, in the long term it can be very detrimental. It can lead to loading of other weaker structures not normally used to handling stress. This increases the risk of injury to other areas of your neck & to other parts of your body.
Techniques your physio may use to help re-educate your movement patterns include core stability exercises, stretching & postural control exercises. Your physio will often use video feedback or a mirror for these exercises to allow you to see how you should be performing the exercise & help you consistently perform them correctly. Hands-on treatment to fully restore your joint movement & muscle length will continue.
Phase 4: Restabilise
This is one of the most important steps to ensuring full recovery from a cervical disc bulge. Restabilising means re-training the muscles in your body that help to keep your spine strong & stable. Research has shown that your stabiliser muscles are the first muscles to switch off when you get neck pain. If these muscles switch off & are not properly re-trained they lose their conditioning, become smaller & weaker, & your chance of a full recovery is limited. By re-stabilising your spine you are able to move more efficiently & the risk of re-injury is greatly reduced.
Techniques your physio may use to help re-stabilise your spine include Clinical Pilates, Exercise Physiology, light functional strengthening, swiss-ball exercises, deep neck flexor muscle retraining & exercise to build you core strength.
Phase 5: Sports/Ballistics & Advanced Strengthening
Once you are familiar with the exercises required to restabilise your spine your physio will then progress you to more advanced exercises specifically aimed at your activity or sport of interest. For muscle strengthening to be effective the muscles need to be strengthened in the specific way to how they will be used during your daily activities. This phase involves building your spinal strength to comfortably handle the heavier loading & fatiguing demands of sport & exercise.
Many clients find that seeing one of our Exercise Physiologists, Strength & Conditioning coaches or Personal Trainers is a great way to build strength, ability & confidence for a smooth return to full sporting activity. If Pilates is more your style then our great Sports Pilates program is an ideal way for you to continue to build your spinal strength. As well as being an important part of your rehab program these services can help you lift your sports performance whilst staying safer & reducing your risk of future injury.