The intervertebral discs acts as shock absorbers, interposed between two vertebrae. They consist of a central stiff nucleus full of water, held in place by an external fibrous coating. The movement of the rachis modifies the position of the nucleus within the intervertebral disc: a forward flexion causes the nucleus to retract; whereas an extension of the rachis causes a forward displacement.
These physiological movements may become more marked by adopting poor postures or repeating particularly burdensome gestures for the rachis. In these cases, the nucleus may also protrude (bulge), or be pushed posteriorly, without tearing the fibrous ring that keeps it within the intervertebral disc. In more severe injuries, the fibrous ring can be torn and the material contained within the disc comes out (a hernia), pushing sideways, downwards, or more rarely, upwards.
Pain is severe and can pulsate, paraesthesia often accompanies this pain located around the area of the compromised root. Rachis’ movement in both flexion and extension is reduced and extremely painful.
Clinical diagnosis stems from reports of pain shooting down the upper arm from the neck as a result of the compressed nerve root (known as cervicobrachialgia). X-rays, MRI or CT scans can all be used to support the diagnosis.
In most cases, a conservative treatment can be used. During early stages, a neck brace may be required, accompanied by a course of drugs to help the patient manage their pain. Manual therapies form the start of the rehabilitation process (massage, joint manipulation and muscular stretching are all useful here), before physical therapy and exercises to restore full range of motion begin. Maintenance programmes are also important to help patients maintain their strength, but also to avoid seemingly mundane activities which may worsen symptoms (watching TV laid on the sofa, or sleeping with two pillows for example).
Surgical treatment is reserved for selected cases here where conservative treatment was ineffective or where things are more complicated due to potential neurological damage.
Today it is preferable to use less aggressive techniques such as microsurgery, or endoscopic surgery.
Potential problems following surgery can arise due to the recurrence, or formation of fibrous tissue which can compress nerve roots.
Rehabilitation is essential after surgery; the program is similar to that of conservative treatments, but the time taken to recover from the surgery itself must be accounted for.
The symptoms of this complaint may include pain on the inner boader of the scapula and radiation of pain down the arm(cervical brachialgia). This can affect the ability to perform daily acitvities. An upright position can sometimes be more comfortable and sleep may be an issue.
The main objective of the rehabilitation program is the control of pain through physical therapy (laser, TENS) and manual therapies (massage therapy to reduce tone of the overactive muscles).
The highly trained osteopath may work on joint position and perform manipulations of misaligned joints to improve joint alignment.
The goal of rehabilitation is to improve joint mobility and improve postural pattern corrections of the cervical-thoracic spine and shoulders.
Once pain has reduced and mobility improved head and neck muscle strengthening can occur. This initially is with isometric holds and then progression to resisted exercises.
The rehabilitation protocol ends with on field rehabilitation to re-educate and restore vestibular function and spatial perception of the head position.