Herniated cervical disc / Prolapsed disc in the neck
Rehab training for herniated cervical disc

Rehab 1 – Rehab 2 – Rehab 3
Description of the herniated cervical disc

The back consists of 24 vertebrae, and in between most of them there is a disc. The disc consists of a hard outer ring of fibers made of connective tissue (anulus fibrosus) wrapped around like yarn in a ball and a soft viscous water-containing core (nucleus pulposus) at its core which creates shock absorption and mobility.

In the event of a prolapsed disc, the material breaks from the inner part of a disc through the outer (peripheral) parts, most often at the back and thinnest part, and thus into the the hole where the nerves run through the spinal cord and peripherally into the body. The inner soft part of a disc is locally irritated and may irritate the spinal nerves’ sheath, which is the film surrounding the nerves inside the spine. A prolapse may also occur inside the vertebra by piercing the endplate, especially if there is a risk of osteoporosis.

Disc herniation in the cervical spine is less common than prolapse in the lower back, however it still occurs quite frequently. About 20% of all prolapses are cervical. This can happen to anyone, but it is most common in people over 40 since aging causes changes in the vertebrae and the surrounding structures.

The different prolapses provide different radiating pain, depending on which nerves are affected, since these affect reflexes, sensibility, and muscle strength. Radiating pain is usually experienced first as prickling, stinging or swirling sensations, as well as strong reflexes. Then the herniated disc can develop, completely squeezing the nerve, which can be a more severe condition, depending on the location of the prolapse. Symptoms of complete nerve impingement are numbness, reduced strength, and discontinued reflexes.

Symptoms of herniated cervical disc
  • Local pain at the site of the prolapse and possible radiating pain into one leg exacerbated by exertion.
  • Prickling sensations the area of nerve intervention (dermatome).
  • Svaghed i armen.
  • Reflexes may be altered.
  • Functional failure due to direct pressure on the nerves.
Examination and diagnosis of herniated cervical disc

For all pain in the the neck, shoulder and arm, the doctor or therapist should do different tests to check for a prolapsed disc. Especially if radiating pain accompanies the local pain. The diagnosis is made by a physician who performs the back exam, measures muscle strength, reflexes, and sensibility. In addition, the doctor may confirm his suspicion by referring the patient to MR or CT scan. Prolapse is best diagnosed with X-ray examination with contrast injection, a so-called myelography or radiculography.

If your therapist; chiropractor, osteopath, physiotherapist or manual therapist suspects that the pain in your back could be a herniated disc, they should do some tests that may prove or disprove the hypothesis.
Typically, a therapist will perform the foramen compression test, Jacksions and Spurling’s test, all of which are compression tests that show whether pain is provoked by compression the nerve roots. They usually also measure the reflexes and check sensibility and muscle strength of the arm.

Treatment for herniated cervical disc

Several studies have shown that patients with prolapsed discs who stay mobile have a shorter duration of illness than if they are bedridden. In other words, you do not get better by sleeping – on the contrary. In addition, it is evident that the mobile patients have fewer co-morbidities, better physical condition and quality of life, and because of this, the rehabilitation period is shortened compared to bedridden patients. Today, the vast majority of patients suffering from prolapse are treated with specific training therapy, and only a very few are being operated. This means that increasing the active stability and strength (muscle control and strength) since the passive is impaired (it irritates the joints) and should therefore be supported by the muscles in the area.

Most people who suffer from a prolapsed disc gradually become symptom-free by reducing load and doing back training. If surgery is required, the patient will usually be able to return to sport or heavier lifting after 4-6 months. The results of herniated disc surgery are good. Of those operated, 95% will be free from the pain in the leg and can return to work.

Acute (0-48 hours)

In case of an acute herniated disc, consult a doctor or therapist. You must rest for the first 48 hours, and only do small moving exercises. A couple of times a day you can do cold / heat treatment (cryo- / thermotherapy). Where you are lying on an ice bag for 9 minutes and then a hot pillow for 15 minutes.

Subacute / chronic disc (from day 2)
  • Specific exercise programs see rehab 1-4.
  • Cryotherapy / thermotherapy (ice for 9 minutes followed by 15 minutes heat pad).
  • TENS.
  • Ultrasound (continuous / pulsating), 3 Mhz, 2 W cm2.
  • Kinesiology tape.
  • K-laser.
  • Rest the back as often as possible.
  • A manual therapist, chiropractor or osteopath can, with special techniques, remedy the protrusion, depending on where it is located.
  • The doctor can provide pain medication and, in addition, operate in cases where all other treatments have had no effect for a long time.
Rehab training for herniated cervical disc

Rehab 1 – Rehab 2 – Rehab 3