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Cervical Disc Herniation Topic Overview
What is cervical disc herniation?
The bones (vertebrae) that form the spine in your back are cushioned by round, flat discs. When these discs are healthy, they act as shock absorbers for the spine and keep the spine flexible. If they become damaged, they may bulge abnormally or break open (rupture), in what is called a herniated or slipped disc. Herniated discs can occur in any part of the spine, but they are most common in the neck (cervical) and lower back (lumbar) spine. The seven vertebrae between the head and the chest make up the cervical spine.
- An activity that harms the neck.
- An injury.
- Another medical condition.
Activities that cause neck pain Most neck pain is caused by activities that involve repeated or prolonged movements of the neck. This can result in a strain (an overstretched or overused muscle), a sprain (injury to a ligament), or a spasm of the neck muscles.
These activities include:
- Holding your head in a forward or odd position for long periods of time while working, reading, watching TV, or talking on the telephone.
- Sleeping on a pillow that is too high or too flat or that doesn't support your neck, or sleeping on your stomach with your neck twisted or bent.
- Spending long periods of time resting your head on your upright fist or arm.
- Work or exercise that uses the upper body and arms, such as painting a ceiling or other overhead work.
Stress and focusing intensely on a task can also cause neck pain. Tension may develop in one or more of the muscles that connect the head, neck, and shoulders. They may feel tight and painful.
Injuries that cause neck pain
Minor injuries may occur from tripping or falling a short distance or from excessive motion of the cervical spine.
Severe neck injuries may occur from:
- Whiplash in a car accident.
- Falls from significant heights.
- Direct blows to the face or to the back or top of the head.
- Sports-related accidents.
Medical conditions that cause neck pain
Certain medical problems can cause neck pain. These include:
Problems related to aging, such as:
- Narrowing of the spinal canal (cervical spinal stenosis).
- Arthritis of the neck (cervical spondylosis).
- Meningitis, which causes inflammation around the tissues of the brain and spinal cord.
- Flu, which tends to make the neck and the rest of the body ache all over.
Chronic conditions such as:
- Rheumatoid arthritis.
- Ankylosing spondylitis.
- Torticollis (wryneck). Torticollis is caused by severe muscle tightness or a shortened muscle on one side of the neck, causing the head to be tilted to one side. Torticollis is usually a symptom of another medical problem.
Referred pain. Referred pain occurs when a problem in one place in the body causes pain in another place. For example, a problem with your jaw (temporomandibular disorder) or your heart (such as a heart attack) can cause neck pain.
Infection or a tumor in the neck area.
Some medicines can cause neck pain as a side effect.
Neck pain may:
- Spread to the upper back, shoulders, or arms.
- Be worse with movement.
- Make your neck stiff or tender.
- Cause headaches. These are common and may last for months.
Nerve-related symptoms caused by pressure on the spinal nerve roots or spinal cord include:
- Numbness, tingling, or weakness in your arm or hand.
- A burning feeling when you are touched on the skin of the arm or hand.
- A pain that feels like a shock and extends into your arm or hand.
- Leg numbness or weakness, and loss of the ability to control urination (bladder control) or bowel movements. This can occur when there is pressure on or injury to the spinal cord.
Most neck pain gets better within several weeks with treatment that includes taking steps to relieve pain, modifying activities, and doing exercises or manual therapy. Neck pain caused by an injury such as a severe whiplash may take longer but usually improves in 6 to 12 months.
Chronic neck pain
Neck pain may become long-lasting (chronic) when it occurs in combination with other health conditions, such as conditions associated with increasing age. These include narrowing of the spinal canal (cervical spinal stenosis), arthritis of the neck (cervical spondylosis), or herniated disc. In some cases, chronic neck pain can be caused by repeated and prolonged movements, such as long hours working at a computer.
Chronic neck pain can make it hard to cope with daily life. Common side effects of chronic pain include fatigue, depression, and anxiety.
What Increases Your Risk Risk factors for neck pain that you cannot control include:
- Age. People who are middle-aged or older are more likely to have breakdown (degeneration) of discs or joints, as well as bone spurs in the vertebrae of the neck (cervical spondylosis).
- Recent injury or history of injury. A common injury to the neck is whiplash caused by a car accident.
- Conditions that affect the bones and soft tissues of the neck and back, such as rheumatoid arthritis, a narrowing of the spinal canal (cervical spinal stenosis), or a severely curved spine (scoliosis).
- A history of headaches.
Risk factors that you can control include:
- Awkward positions that put stress on the neck, or poor posture at home or at work.
- Stress or depression, or boredom at or unhappiness with work.
- Heavy physical work.
- Smoking or drug abuse.
- Poor physical condition and lack of exercise.
When To Call a Doctor
Call 911 or other emergency services immediately if:
- Neck pain occurs with chest pain or other symptoms of a heart attack, such as shortness of breath and nausea.
- A person has signs of damage to the spine after an injury (such as a car accident, fall, or direct blow to the spine). Signs may include:
- Being unable to move part of the body.
- Severe back or neck pain.
- Weakness, tingling, or numbness in the arms or legs.
Call your doctor now or seek immediate medical care if:
- You have new or worsening numbness in your arms, buttocks or legs.
- You have new or worsening weakness in your arms or legs. (This could make it hard to stand up.)
- You lose control of your bladder or bowels.
- You have long-term neck pain that suddenly gets much worse, and you did not cause it by being more active.
- You have a history of cancer or HIV infection, and you have new or increased neck pain.
- Pain wakes you from sleep.
Most neck pain doesn't require a visit to a doctor.
If the pain doesn't get better after 1 or 2 days and you can't do your normal daily activities, call your doctor.
If you still have mild to moderate pain after at least 2 weeks of home treatment, talk with your doctor. He or she may want to check for problems that may be causing your neck pain.
Who to see Health care professionals who often diagnose the cause of neck pain include:
Primary care providers. This includes:
- Family doctors.
- Osteopathic doctors.
- Physical therapists.
- Nurse practitioners.
- Physician assistants.
- Emergency doctors.
If your neck pain is severe or long-lasting, health professionals who can treat you include:
You can also get care from:
- Certified massage therapists.
Exams and Tests
Initial testing Neck pain is usually evaluated with a medical history and physical exam. Your doctor will ask about your symptoms, injuries or illnesses, any previous treatment, and habits and activities that may be causing your neck pain. During the physical exam, your doctor will check your neck's range of motion and check for pain caused by movement. He or she will look for areas of tenderness and any nerve-related changes, such as numbness, tingling, or weakness in the arm or hand.
Blood tests may be done to check for an illness or infection.
Imaging, electromyogram, and nerve conduction tests You may not need X-rays or other imaging tests. But tests may help if your neck pain doesn't get better, especially when:
- You have signs of nerve damage.
- Another serious problem is suspected.
- The cause of your condition cannot be clearly identified.
- Nonsurgical treatment has not improved your condition and you are considering surgery.
- Your doctor is asked to provide documentation of your condition, such as when a lawsuit or an insurance issue is involved.
Besides X-rays, tests may include:
- MRI, which can help identify problems such as a herniated disc or a pinched nerve.
- CT scan, which looks at the bone and spinal canal.
- Myelogram, which looks at the spinal canal and nerve roots.
- Electromyogram and nerve conduction studies or nerve blocks, which can help find a nerve problem that is causing pain, numbness, or weakness in the arm or hand.
Most neck pain is caused by activities that involve repeated or prolonged movements of the neck. Nonsurgical treatment works well on this type of pain. Most cases of neck pain caused by activities get better in 4 to 6 weeks.1
Acute (short-term) neck pain Home treatment includes applying heat or ice, taking it easy but staying as active as you can, and using over-the-counter pain relievers.
For severe pain or muscle spasm, your doctor may prescribe stronger medicines.
Manual therapy, including massage, mobilization, and manipulation, can help some neck pain. See a physical therapist, chiropractor, or osteopathic doctor for this type of care and to learn stretching and strengthening exercises that you can do at home.
Your doctor may recommend that you wear a cervical collar to support your neck. Cervical collars may reduce neck pain, but they should only be used for a day or two.
Chronic (long-term) neck pain For long-lasting neck pain, you can use the same pain-relief measures used for acute pain. For more information, see Home Treatment.
Your doctor may also prescribe antidepressants.
People who have chronic pain syndrome and its associated problems, such as depression or drug dependence, may respond to treatment more slowly. Counseling along with medical treatment may help in recovery.
Surgery is rarely required for neck pain. It may be an option when neck pain is caused by certain conditions.
For neck pain caused by posture or body mechanics
- Avoid slouching or a head-forward posture. Sit straight in your chair with your lower back supported, feet flat on the floor, and shoulders relaxed. Don't sit for long periods without getting up or changing positions. Take short breaks several times an hour to stretch your neck muscles.
- If you work at a computer, adjust the monitor so the top of the screen is at eye level. Use a document holder that puts your work at the same level as the screen.
- If you use the telephone a lot, use a headset or speaker phone. Don't cradle the phone on your shoulder.
- Adjust the seat of your car to a more upright position that supports your head and lower back. Make sure that you are not reaching for the steering wheel while driving. Your arms should be in a slightly flexed, comfortable position.
- Use proper lifting techniques. Lift with your knees, not your back.
For neck pain caused by sleep habits
- Use a pillow that keeps your neck straight. Special neck support pillows called cervical pillows or rolls may relieve neck stress. You can also fold a towel lengthwise into a pad that is 4 in. (10 cm) wide, wrap it around your neck, and pin it in position for good support.
- Don't sleep on your stomach with your neck twisted or bent.
- If you read in bed, prop up the book so you aren't using your arms to hold it up and bending your neck forward. Consider using a wedge-shaped pillow to support your arms and keep your neck in a neutral position.
Other prevention tips
- If stress is adding to your neck pain, practice relaxation exercises. Consider getting a massage.
- Strengthen and protect your neck by doing neck exercises once a day.
- Stay at a healthy body weight.
Even if you need medical treatment such as prescription medicines for your neck pain, the following home treatment measures will help speed your recovery.
Heat or ice There is not strong evidence that either heat or ice will help. But it won't hurt to try them.
- Use a heating pad on a low or medium setting for 15 to 20 minutes every 2 or 3 hours.
- Take a warm shower in place of one session with the heating pad.
- You can buy single-use heat wraps that last up to 8 hours.
- Try an ice pack for 10 to 15 minutes every 2 to 3 hours.
Get moving, but carefully
- Ease back into your normal daily activities as soon as you can. Movement helps your muscles stay strong.
- Avoid activities such as lifting and sports that make pain and stiffness worse.
- Do stretching and strengthening exercises to keep your neck flexible and strong and prevent stiffness.
- Avoid or change any activities that may be causing your neck pain, such as sitting for a long time at the computer or doing too much overhead work at a time.
- Gently massage or rub the area to relieve pain and encourage blood flow. Don't massage the injured area if it causes pain. Nonprescription creams or gels, such as Bengay, may provide pain relief.
- Acetaminophen (such as Tylenol) can help relieve pain.
- Nonsteroidal anti-inflammatory drugs, ibuprofen (such as Advil) and naproxen (such as Aleve), can help relieve pain and reduce inflammation.
Practice good health habits
- Try to reduce stress and tension at work and home.
- Practice relaxation exercises.
- Consider getting a massage.
- Stop smoking. Smoking slows healing because it decreases blood supply and delays tissue repair.
- Exercise regularly, including aerobic exercise such as walking.
An important part of home treatment is learning how to keep from hurting your neck again..
Medicines can relieve neck pain and reduce inflammation of the soft tissues. Pain relief will allow you to move your neck gently, so you can begin easy exercises and start the healing process.
Although pain relievers, muscle relaxants, and antidepressants are commonly used for neck pain, none are well-proven treatments.
Nonprescription pain relievers include:
- Creams or gels, such as Bengay, that are rubbed into the neck.
- Acetaminophen, such as Tylenol, which reduces pain.
- Nonsteroidal anti-inflammatory drugs, including ibuprofen (such as Advil) or naproxen (such as Aleve), that can help relieve pain and reduce inflammation.
Prescription pain relievers include:
- Muscle relaxants, which are used to treat severe neck pain and spasms when neck pain begins (acute neck pain).
- Narcotic pain relievers, which are used to treat severe short-term (acute) neck pain.
- Antidepressants, which are used to treat long-lasting (chronic) pain.
- Corticosteroid injections. These are rarely used for neck pain. But they may be tried if you also have symptoms such as pain or numbness in your arm that suggests a nerve root is pinched or irritated (radiculopathy).
Surgery is rarely needed for neck pain. It may be an option when:
- A neck injury causes a fracture or abnormal motion (instability). Surgery may be done to stabilize the spine and prevent a bone fracture from causing instability and possible paralysis.
- Pressure on the nerve roots or spinal cord causes numbness or arm, hand, or leg weakness; severe pain that lasts for months; or loss of bladder or bowel control. Pressure on the nerve roots or spinal cord may be caused by problems such as a narrowing of the spinal canal (cervical spinal stenosis), arthritis of the neck (cervical spondylosis), or a herniated disc in the neck.
- Discectomy (with or without fusion). The surgeon removes herniated disc material that is pressing on a nerve root or the spinal cord.
- Cervical spinal fusion. Selected bones in the neck are joined (fused) together.
- Spinal decompression. Pressure is reduced on the spinal cord or spinal nerve roots by removing part of a bone or disc.
Some people can consider artificial disc replacement instead of spinal fusion. This surgery is currently just for carefully selected patients, and it is done by specially trained surgeons. Doctors have not yet done long-term studies to know how well this works over time.
Other types of treatment for neck pain may help relieve your symptoms, restore movement, and strengthen the muscles around your spine to help prevent further injury.
Other types of treatment include:
- Cervical (neck) collars. These may be used for short periods of time to help reduce pain by restricting neck movement.
- Traction. This is a technique used to stretch the neck and relax thespinal nerve root openings. It may be used if there is no risk of instability in the neck. There is not strong evidence that traction helps.
- Low-level laser therapy. This uses targeted light energy to decrease pain and promote healing. A review of studies suggests that it can help both sudden (acute) and long-term (chronic) neck pain
- Radiofrequency ablation (or percutaneous radiofrequency neurotomy). The purpose of this procedure is to interrupt the pain signal as it travels through the nerve. There is not strong evidence that this helps.
Complementary and alternative treatments
Complementary and alternative treatments are sometimes used to relieve pain and restore neck mobility. They include:
- Massage, to help with relaxation, decreased pain, and increased flexibility.
- Yoga or qi gong, which are programs of exercises to help improve flexibility and breathing, decrease stress, and maintain health.
- Acupuncture, which is done by inserting very thin needles into the skin. Acupuncture is used to relieve pain and to treat many health conditions.
Other Places To Get Help Organizations
American Academy of Orthopaedic Surgeons (AAOS)
6300 North River Road
Rosemont, IL 60018-4262
Phone: (847) 823-7186
Fax: (847) 823-8125
Web Address: www.orthoinfo.aaos.org
The American Academy of Orthopaedic Surgeons (AAOS) provides information and education to raise the public's awareness of musculoskeletal conditions, with an emphasis on preventive measures. The AAOS website contains information on orthopedic conditions and treatments, injury prevention, and wellness and exercise.
American Academy of Physical Medicine and Rehabilitation
Web Address: www.aapmr.org
WebMD Medical Reference from Healthwise
Last Updated: March 12, 2012
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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