Disc Herniations

Spinal pain which is caused by a disc herniation is responsible for between 3-5% of all cervical pain. This is caused where the nucleus pulposus, the inner most part of the disc, is displaced from the intervertebral space and in some instances may cause irritation to the nerve that exits as the same level and causes what is known as a cervical radiculopathy.

Symptoms can either be progressive or as a result if an illiciting evident however more often than not that can occur without an exact cause. Like spondylosis, it is important to recognise that a large percentage of the population have disc herniations without symptoms and can be attributed to the normal part of the aging process – it is therefore important to link the clinical presentation to any imaging.

If a nerve is affected, people usually report symptoms on one side and usually into the arm or shoulder blade which can include pins and needles, numbness, burning or weakness. These symptoms can be exacerbated by neck movements, certain positions such as neck flexion or extension or coughing / sneezing.

People with signs and symptoms that can be associated with a disc herniation which can lead to nerve irritation may report:

• Progressive or sudden onset of neck pain

• Reduced range of movement

• Symptoms such as pins and needles, numbness and weakness which radiates down one arm however in rare symptoms it may affect both. The part of the arm that has symptoms can tell us what nerve has been affected

• Pain into the arm which may be exacerbated with neck movements

• Sleep disturbances

A thorough subjective history while help identify a possible diagnosis or a disc herniation, whilst a thorough examination may identify:

• Reduced range of movement which may cause a change in arm symptoms

• Positive Spurlings test

• Positive upper limb tension test

• Positive distraction test.

• Tenderness and pain at the level of the disc herniation when palpated.

• If a nerve root has been affected, there may be reduced sensation or strength or the muscles supplied by these nerves.

• Possible loss of reflexes.

Physiotherapy can help by providing:

• Soft Tissue Massage

• Advice and education around symptom and pain management

• Joint mobilisations and manipulations

• Traction

• Home exercise programme – range of movement, strength and postural exercises

While disc herniations may be painful and arm symptoms worrying, the progrnosis is good and discs can typically heal withing 8-12 weeks and seldom need any further form of investigation. MRI’s are usually requested if symptoms continue to worsen such as symptoms in both arms, worsening weakness etc.