Cervical hernia

General info

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Summary

Data about the condition

A herniated disc occurs when the inner portion of a disc in the cervical spine breaks through the outer wall of the disc.

In the cervical spine, there are six discs that are in front of the spine and connect each of the 7 cervical vertebrae. Each disc is made of a soft, gel-like material called the nucleus pulposus, which is encapsulated by a series of hard outer fibrous bands, called the annulus fibrosus.

The discs provide cushioning between the vertebrae at each level, while allowing a wide range of motion in all directions.

In the back of the spine, at each level, a nerve root exits the spinal canal and moves down the neck to the shoulder, arm, forearm, hand, and fingers.

When a cervical disc herniates, it can affect or cause inflammation near one of these cervical nerves, causing pain and other symptoms such as nerve irradiation. In the cervical spine, the discs tend to herniate laterally, causing irritation to a nerve root on one side. The two most common levels of the cervical spine in hernia are the C5-C6 level and the C6-C7 level.

Symptoms

On physical examination, special attention should be paid to weaknesses, sensory disturbances of their dermatomal distribution.

Typical findings of solitary nerve injury due to herniated disc compression in the cervical spine

–C5 Pain in the neck, shoulders and scapula, lateral numbness of the arm and weakness during shoulder abduction, external rotation, elbow flexion and supination of the forearm. The affected reflexes are the biceps and brachioradialis.

–C6 Nerve – neck, shoulder, scapula and lateral arm, forearm and hand pain, along with lateral forearm, thumb and numbness of the index finger. Weakness during shoulder abduction, external rotation, elbow flexion, and supination and pronation of the forearm are common. The affected reflexes are the biceps and brachioradialis.

–C7 Nerve pain – neck, shoulder, middle finger are common, along with the index finger, middle finger and numbness of the palm. Elbow and wrist weakness are common, along with weakness during radial extension, forearm pronation, and wrist flexion. The affected reflex is the triceps.

C8 Nerve pain – neck, shoulder and medial forearm, numbness on the medial forearm and medial hand. Weakness is common during finger extension, wrist (ulnar) extension, distal finger flexion, extension, abduction, and adduction, along with distal thumb flexion. Reflexes are not affected.

T1 – Pain is common in the neck, medial arm and forearm, while numbness is common in the forearm and medial forearm. Weakness can occur during thumb abduction, distal finger flexion, and finger abduction and adduction. Reflexes are not affected.

Causes

Common causes of cervical disc herniation include:

Disc degeneration over time. As a disc grows older, it naturally loses hydration and becomes less flexible and durable. Cracks and drops are more likely to develop in a disc that has a lower water content.

Trauma. A direct impact on the spine can cause a disc to rupture or herniate.

Other less common causes of herniated discs are possible, such as connective tissue disorders or other abnormalities in the spine.

Treatment

The treatment of disc herniation has as objectives:

• Elimination of pain.

• Fight against muscle contraction.

• Cessation of the sensitive disorder in the limbs through which the affected nerve passes (paresthesias, numbness).

• The patient’s return to daily activities.

The objectives of the Recovery Program

The content of the Recovery Program

Most neck pain can be treated with non-surgical methods, such as personal care at home and / or with the guidance of a physiotherapist.

• Passive physiotherapy, which involves the effortless treatment of the patient. Numerous treatment methods are available, such as the application of ice packs, heat therapy, massage therapy and others. The purpose of passive physical therapy is to help reduce pain and swelling.

• Active physiotherapy, which involves the patient, who moves his own body through exercises and stretches. To improve the strength and flexibility of the neck, these muscles may become less painful and able to maintain a good posture, which reduces the stress on the cervical spine.

Self-care for cervical disc herniation

• Have you ever wondered why your mother told you to put ice on that ugly swelling you had as a child? How about a hot tub or a heat application relieves pain? Despite the simplicity of heat and cold therapies, the two (in the right combination) can help relieve low back pain, muscle strain and even arthritis. But first you need to find out how and when to use them correctly.

Short rest period. While intense pain-relieving activities and movements should be avoided for a few days, some movements are usually encouraged to prevent the neck from becoming weaker and / or stiffer.

Ice and / or heat. Applying ice can help reduce inflammation and pain. Applying heat can help relax muscles and bring in more blood flow and heal nutrients in the injured area. For ice or heat therapy, applications are limited to 15 or 20 minutes, with a break of at least 2 hours between them, to give the skin recovery time.

5 steps of ice massage

For best results, ice therapy should be applied lightly to the lower back, as described below:

1. Gently apply ice and massage in a circular motion;
2. Concentrate the ice movements on the 15cm ^ 2 area of ​​the back, with the epicenter where the pain is felt;
3. Avoid applying ice massage directly to the bone portion of the spine (bones protruding along the spine);
4. Limit ice massage therapy to about 5 minutes to start (to avoid an ice burn);
5. Repeat the ice massage 2-3 times a day for 3 hours between sessions.

In general, ice should never be applied directly to the skin to avoid burning the skin. However, with ice massage therapy it is acceptable to apply ice to the skin, because the ice does not stay in one place for long.

The most effective heat therapy products are those that can keep their heat at a constant temperature. “Warm” is the right temperature. Patients should not have a hot heat source until their skin burns. The desired effect is for the heat to penetrate deep into the muscles.

In many cases, the more heat is applied, the better. However, the duration required to apply heat is based on the type and / or intensity of the lesion. For a very low back tension, short amounts of heat therapy may be sufficient (such as 15-20 minutes). For more intense injuries, longer heat sessions may be more beneficial (such as 30 minutes to 2 hours or more).

A specific type of heat therapy may be perceived as more beneficial than another from one person to another and this requires some experimentation to find out which one works best. There are many different ways to apply heat. Some common options include:

1. A bottle of hot water – tends to stay warm for 20 to 30 minutes;
2. Heated gel packs – keep warm for about 30 minutes. Certain types of gel packs provide moist heat, which some people prefer. 3. Heat wraps – wraps around the back and waist and can be worn on the skin under clothing;
3. Heat wraps – wraps around the back and waist and can be worn on the skin under clothing;
4. Hot bath, hot tub, sauna, steam bath – tend to stimulate the general sensations of comfort and relaxation that can help reduce muscle spasm and pain. A hydromassage jet directed to the epicenter of pain can provide the added benefit of a light massage.

Physical therapy is one of the most common treatments for chronic pain in cervical disc herniation. Most physical therapy programs for neck pain involve applying treatments to reduce the pain and / or stiffness enough to start a neck strengthening and stretching exercise program. The specific methods and exercises used in physical therapy, as well as the duration of the treatment plan, may vary from person to person. Many treatment plans for pain caused by a herniated disc at the cervical level include some form of physical therapy to improve the strength and flexibility of the neck. The structure and length of the physical therapy program may vary depending on the specific diagnosis and situation. Several sessions per week are recommended.

An important component of any exercise program is aerobic exercise, which raises the heart rate and improves circulation. Aerobic exercise can help relieve back pain by decreasing stiffness and improving blood flow to the structures of the spine, increasing the amount of nutrients that reach the spine.

The benefits of aerobic exercise

A regular aerobic exercise routine can help relieve back pain by:

• Reducing the probability and / or severity of potential pain;
• Maintaining functional and mobile spine, limiting disability caused by chronic pain. Failure to exercise with chronic back pain will usually aggravate mobility and functionality;
• Burning calories to help achieve and maintain optimal weight, which can eliminate excess pressure on the spine;
• Increase the production of endorphins, which act as a natural sedative and can lift the mood to relieve the symptoms of depression.

Typical recommendations for aerobic exercise include at least 20 to 30 minutes of training between 3 and 5 times a week to effectively improve circulation. In case of severe pain, it may be helpful to start with shorter exercise intervals, such as 5 to 10 minutes of walking, and gradually increase to a longer routine.

Methodical Indications

Try a new pillow

Keep your spine in natural alignment while you sleep. Some may prefer smaller or flat pillows while sleeping on their backs, or a larger pillow when sleeping on their side to keep their head between their shoulders.

Sleep on your back

This is usually considered the best way to keep your spine in the most natural alignment. Sleeping on your stomach puts the most stress on your cervical spine. If falling asleep on your back is difficult, try an inclined position, an adjustable bed or side sleeping to maintain your spine.

Set the computer monitor to eye level

When you look straight ahead, your gaze should be directly on the top third of your computer screen. If you tilt your head too far up or down to see the top third of the screen, adjust the height of the monitor. People who use laptops usually look at or look down at the screen. Try connecting the laptop to a separate monitor or giving it a boost.

Avoid straining your neck while typing the phone

If you look at your mobile phone to send text or other tasks, you are putting stress in your throat over time. Try to limit cell phone use by taking frequent breaks. And when you need to use it, keep it closer to eye level to reduce stress on your neck.

Wear a helmet

Your throat may become sore if you regularly bend your head to one side. Use a headset with your hands free to help you maintain a better neck posture.

Exercise and stretching

Keep your neck strong and flexible by doing short sets of strengthening and stretching exercises throughout the day. One of the best neck exercises is the chin joint, which helps to strengthen and stretch the muscles in the neck and upper back for better posture.

Stay hydrated

Your body needs water to be the best. This includes your intervertebral discs, which are made up mostly of water and act as spongy pillows between the vertebrae. Try sipping a bottle of water throughout the day or setting reminders to drink a glass of water every few hours.

Wear the weight evenly

For example, a backpack should be worn on both shoulders, not on one. For items that are not easily transported evenly, such as a briefcase or purse, try to travel lightly and carry only essential items.

Maintain a good posture

The further the head goes in a weak position, the harder the head becomes for the neck to hold. Maintain a good posture by keeping your ears directly above your shoulders. If you get caught using a weak posture, correct it immediately.

Did you know?

On average, each of us uses the phone daily for 2 hours and 20 minutes. That means 35 days a year, more than a month, which is a lot.