Long-Term Effects of Herniated Disc in the Neck

What is a Cervical/Neck Herniated Disc?

Cervical radiculopathy or a “pinched nerve in your neck”  is an injury marked by nerve compression from a herniated disc (bulging disc) or arthritic bone spurs in the joints of the neck. This compression or impingement typically produces neck pain, radiating arm pain in the form of numbness and tingling or muscle weakness in the arm that is affected. Most of the time shooting arm pain happens to one arm, one side, however it is possible for both arms to have symptoms if there are severe bony spurs present in the neck, impinging/irritating the nerve on both sides. 

Relevant Anatomy 

Your Neck is made up of 7 cervical vertebrae (bones) that sit on top of one another. In between each of the vertebra is a gel-like piece of cartilage called the intervertebral disc.

Think of the disc as round gel filled cushions. The outer part of the disc is called the annulus, and the middle is called the nucleus which is filled with gel. When we are younger (30 years of age or younger) the disc is made mostly of gel and water. As we get older, the disc dries up. The disc becomes thinner and less flexible, making it easier to injure. At times, the gel inside can push out through the disc  and lead to a herniation (bulging disc). Which can eventually compress or pinch on the nerves of the neck. 

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Risk factors that may increase your chances of a herniated disc:

• Age – most herniated discs occur in people who are ages 30 to 50 due to age-related disc degeneration. Disc herniations are less common after the age of 50, because with aging the gel dries up and there is less gel to press out onto the nerves. 
• Occupation – Physically demanding jobs that  have repetitive tasks such as lifting, pulling, pushing, or twisting can put more stress on the disc.
• Obesity – increased weight can result in more  pressure placed on the disc

Signs and Symptoms of a Herniated Disc in the Neck

Typical signs of a  herniated disc in the neck (cervical spine) are:

1. Pain in the neck, shoulder blade or arm.
2. Tingling, numbness, weakness or any combination of these symptoms in the arm, shoulder, or neck.

Many times symptoms from herniated discs are made worse by certain activities or positions. If you have a herniated disc in the cervical spine this may include:

• Pain may increase with side bending the neck, and rotating the neck (looking over your shoulder).
• Pain may increase after staying in one position for a long time such as sitting, laying or looking down at a screen/book.
• It may be tough for you to find a comfortable position and you may move your head in a lot of positions or feel your head is just “hanging” on your neck.

How is Shooting Arm Pain Diagnosed?

A physical therapist will complete a thorough evaluation including a review of your:

• Past medical history. 
• Neck range of motion.
• Neck and arm strength. 
• Neck and upper body muscle length. 
• Neural evaluation (evaluation of how the nerves are operating that are associated with the neck and arm).
• Use examination tools backed by research to determine the source of your pain.

How Can a Physical Therapist Help Treat a Herniated Disc in the Neck?

The goal of physical therapy is to help you return to the activities you were doing at home or recreationally before the injury, with the same quality and intensity.

Your treatment program will include a combination of manual therapy where we work on the joints and soft tissue of the neck, shoulders/upper back and exercises that are designed to alleviate pressure on the nerve and help your neck and body return to those previous movements or activities with confidence. 

This can include a combination of:

• Soft tissue massage to the affected areas.
• Joint mobilizations of the affected  joints and neighboring joints.
• Stretching and mobility activities.
• Strengthening/neuromuscular control activities.
• Posture based activities.
• Return to work or sport specific activities. 
• Number of different modalities including cupping and dry needling.

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What the research says about surgery for cervical radiculopathy 

“Persson et al. concluded that there were no long term differences (1 year) between surgery and physical therapy in strength, pain and sensation. Several other studies demonstrated that physical and social functioning and pain significantly improved after surgery, although these improvements remained relatively short termed (max 1 year) and diminished after a longer period (1 to 4 years).”

“Engquist M et al. found that surgery with physical therapy resulted in a more rapid improvement during the first year post operation, with significantly greater improvement in neck pain and the patient's global assessment than physiotherapy alone. The differences between the groups decreased after 2 years. They may suggest that physical therapy should be tried before surgery is chosen.”

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Exercises That May Help With Shooting Arm and Neck Pain

I must preface this by saying that you should consult with a medical professional before trying these exercises as not all exercises are appropriate for everyone even if diagnosed with the same injury. We all have unique bodies, with different demands from our everyday lives and there is no one cookie cutter way to treat a herniated disc in the neck. 

Long Term Side Effects of a Herniated Disc in the Neck 

In very rare cases, a herniated disc in the neck (cervical radiculopathy) may continue to progress with numbness and/or weakness in the neck and arm despite treatments. The longer that numbness or weakness lasts in the shoulder, arm, or hand, the more likely that these deficits will become permanent or lead to disuse of that extremity. When nonsurgical treatments such as physical therapy  fail to treat or  manage the symptoms and nerve compression has been confirmed, surgery may need to be considered.

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