Cervical Disc Dysfunction
1. Introduction
Intervertebral discs are strong and robust structures that lie between vertebrae. Their function is to absorb shock and allow for effective movement of the spine in all directions while acting as tough structures that allow the spine to tolerate load and compression (1, 3). For this reason, they cannot “slip”. The outer region of the disc (the annulus fibrosis) surrounds the soft inner core of the disc (the nucleus pulposus). Cervical disc dysfunction is an umbrella term that refers to a process where the intervertebral discs lose height and hydration. Cervical spondylosis may also occur, which refers to these discogenic changes, plus changes to the surrounding joints and soft tissues (4, 5). Both are thought to occur with age because as part of the ageing process the discs can dehydrate, lose elasticity and reduce in height, which can lead to pain and decreased function. However, not everyone will have symptoms as a result of these changes (1, 6).
Frequently Asked Questions
- Cervical disc dysfunction refers to pain originating from the intervertebral discs in the neck which can cause pain, weakness and altered sensation in the neck and arm.
- Relatively common.
- It is estimated that >30% of those between the ages of 30 – 50 will have some degree of disc dysfunction.
- Problems associated with disc dysfunction are most common in 40 – 60-year-olds (1, 2).
- No.
- Changes to the discs are generally normal, age-related changes.
- These changes can occur without any symptoms or pain.
- When pain is present it is not an indicator of damage and could be due to a variety of reasons (1, 3).
- It is associated with increasing age and more prominent in those over 40.
- Those with a previous history of neck injury/trauma.
- Those whose job/sport involves repetitive neck movements (3, 4).
- Those with a family history of neck pain.
- 60% of the occurrence of the condition is in females (4).
- Neck pain and reduced range of movement/stiffness of the neck.
- Sometimes associated pain travelling down the arm and even into the hand.
- Altered sensations often described as pins and needles, numbness or tingling in the arm.
- Headaches may also occur (4, 5).
- Remain active within your limitations.
- Resume normal activities inclusive of work as soon as possible.
- Using hot and/or cold (ensuring that the skin is protected) may help relieve pain.
- Use a supportive cushion to help you sleep at night.
- Advice by a qualified physiotherapist will be helpful in most cases (8, 9).
- This will depend upon several factors including, but not limited to, other medical conditions, stage of injury, your ability to follow your rehabilitation plan, etc.
- Between 33% and 65% of people recover from an episode of neck pain within one year, but relapses can be common (7).
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk. Book online with us today to get a programme tailored to your specific needs.
2. Signs and Symptoms
- Neck pain is the most common characteristic. This may be more prevalent when your body is upright/head is moving and may be reduced by lying down/reclining.
- A reduction in the range of movement of the neck may be seen due to pain or the presence of bony spurs (osteophytes).
- The cervical nerve roots may be affected. These innervate the head, neck and arms, meaning tingling, numbness and referred pain to these areas are common.
- Headaches can also present as a result of disc problems (5, 6).
3. Causes
Cervical disc dysfunction is often caused by normal, age-related changes, combined with excessive stress/strain on your neck. As people age, the water content within the discs reduces. This can cause them to become less flexible, begin to shrink or bulge/herniate; however, these changes are often completely normal (1, 2).
Our bodies adapt to what we do on a daily basis and so the more we move, the more our discs are exposed to this and can tolerate these movements. Excessive stress in a particular direction, or a decrease in movement, can increase the strain on the discs leading to pain (1, 2). Disc related pain can also be caused by any traumatic events such as falls, car accidents and sports injuries.
4. Risk Factors
This is not an exhaustive list. These factors could increase the likelihood of someone developing cervical disc dysfunction. It does not mean everyone with these risk factors will develop symptoms.
- Age – disc dysfunction is most common in those over 50.
- Occupational factors – those who frequently perform repetitive activities or spend large portions of time sitting may be at increased risk of disc dysfunction.
- Trauma – such as a road traffic accident.
- Family history (3, 4).
5. Prevalence
- In the general population, the point prevalence of neck pain ranges from 0.4% to 41.5%, the 1-year incidence ranges from 4.8% to 79.5%, and lifetime prevalence may be as high as 86.8%.
- Studies report that although the prevalence is similar between genders (60/40 F:M), symptom severity increases in males (3, 4).
6. Assessment & Diagnosis
Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis. Your clinician may perform a series of tests to examine the range of movement of the neck, test the strength of the muscles in your arm and check your reflexes and sensation.
Your treating clinician will want to know how your condition affects your day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made. Imaging studies like magnetic resonance imaging (MRI) or X-ray are not required to achieve a working diagnosis. However, in persistent cases that have not responded to a period of appropriate conservative management, they may be warranted.
7. Self-Management
As part of the sessions with your physiotherapist, they will help you to understand your condition and what you need to do to help you recover. This may include reducing the amount or type of activity, as well as other advice aimed at reducing your pain. It is important that you try and complete the exercises you are provided as regularly as possible to help with your recovery. Rehabilitation exercises are not always a quick fix, but if done consistently over weeks and months then they will, in most cases, make a significant difference.
8. Rehabilitation
Research is very clear that active self-management is key for a timely recovery. This includes advice about remaining active within limitations and resuming normal activities inclusive of work as soon as possible (8).
Below are three rehabilitation programmes created by our specialist physiotherapists targeted at addressing cervical disc dysfunction. In some instances, a one-to-one assessment is appropriate to individually tailor targeted rehabilitation. However, these programmes provide an excellent starting point, as well as clearly highlighting exercise progression.
9. Cervical Disc Dysfunction
Rehabilitation Plans
Our team of expert musculoskeletal physiotherapist have created rehabilitation plans to enable people to manage their condition. If you have any questions or concerns about a condition, we recommend you book an consultation with one of our clinicians.
What Is the Pain Scale?
The pain scale or what some physios would call the Visual Analogue Scale (VAS), is a scale that is used to try and understand the level of pain that someone is in. The scale is intended as something that you would rate yourself on a scale of 0-10 with 0 = no pain, 10 = worst pain imaginable. You can learn more about what is pain and the pain scale here.
This programme focuses on maintaining range of movement within the neck and low-level exercises aimed at the affected nerve(s). It is important not to further irritate the nerve so always work to a point of mild self-perceived tension only. We suggest you carry these exercises out daily prior to progressing onto the next stage of rehabilitation when your pain and function allows. This should not exceed any more than 4/10 on your perceived pain scale.
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This is the next progression. More focus is given to progressive loading of the neck and shoulder regions, with further exercises aimed specifically at the affected nerve. This should not exceed any more than 4/10 on your perceived pain scale.
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This programme is a further progression with challenging progressive loading of the neck, core and shoulder regions and continued exercises targeting the affected nerve(s). This should not exceed any more than 4/10 on your perceived pain scale.
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10. Return to Sport / Normal life
For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.
As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering, you might benefit from a further assessment to ensure you are making progress and to establish the appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.
11. Other Treatment Options
- Medication – you might benefit from specific medication options prescribed by an appropriately trained healthcare professional.
- Surgery may be considered as a last resort if there is severe nerve compression, or where there are persistent symptoms that do not improve with conservative management (8, 9).
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References
- Peng, B. and DePalma, M.J. (2018). Cervical disc degeneration and neck pain. Journal of pain research, 11, 2853.
- APTA. (2017). Neck Pain: clinical practice guidelines linked to the international classification of functioning, disability and health from the orthopaedic section of the American Physical Therapy Association. American Physical Therapy Association. https://www.ncbi.nlm.nih.gov/pubmed/28666405.
- Singh, S., Kumar, D., & Kumar, S. (2014). Risk factors in cervical spondylosis. Journal of clinical orthopaedics and trauma, 5(4), 221–226. https://doi.org/10.1016/j.jcot.2014.07.007.
- Kelly, J.C,, Groarke, P.J,, Butler, J.S,, Poynton, A.R,, O’Byrne JM. (2011). The natural history and clinical syndromes of degenerative cervical spondylosis. Advances in orthopedics. 28,2012.
- Binder, A.I. (2007). Cervical spondylosis and neck pain. British Medical Journal 334(7592), 527-531.
- Kuo, D.T. and Tadi, P. (2020). Cervical Spondylosis. StatPearls [Internet].
- BMJ. (2018). Assessment of neck pain. BMJ Best Practice. http://www.bestpractice.bmj.com.
- Cote, P. et al. (2016). Management of neck pain and associated disorders: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. European Spine Journal. Springer. https://www.ncbi.nlm.nih.gov/pubmed/26984876.
- Kjaer, P et al. (2017). National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy. European Spine Journal. Springer. https://www.ncbi.nlm.nih.gov/pubmed/28523381.
Other Conditions in
Neck, Neurological, Orthopaedics, Pain
Whiplash Disorders
An injury which typically occurs following a road traffic collision, often affecting the soft tissues of the neck.
Thoracic Outlet Syndrome
A condition presenting with pain in the arm as a result of compression of structures around the neck/shoulder.
Neck Pain
Pain or discomfort in the neck and/or shoulder girdle, with or without pain referred to the arms.
Cervical Spinal Stenosis
Narrowing of the spaces through which the neck spinal nerves travel which can result in weakness, pain and reduced function.
Cervical Radiculopathy
Nerve pain originating from the neck and causing pain, altered sensation or weakness in the arm.
Cervical Arterial Dysfunction
An umbrella term for rare vascular (blood vessles) problems of the neck.
Benign Joint Hypermobility Syndrome
Common age related changes to the structure of the knee joint which may be associated with pain, stiffness and loss of function.
Acute Torticollis
Sometimes referred to as “wry neck”, this is a condition causing muscle spasms and associated neck pain.