Although the sound of prolapsed disc creates fear among the most brave, it is in the vast majority of individuals treated conservatively without operation. Prolapse of a disc describes a change in the anatomy of the disc material in a way that there is deformation towards usually the back oblique direction (posterolateral). This may be accompanied with neck or arm pain (known as radiculopathy/nerve root irritation), or can be asymptomatic, which is very commonly the case. The reason someone has pain and/or referred symptoms in the arm is related to mechanical or chemical irritation of the nerve, for which your expert clinician would be able to guide you on the appropriate management. In most cases, the management involves physiotherapy, pharmacotherapy and activity modification. However on specific occasions medical interventions are vital to improve quality of life.
Nerve root irritation
Nerve root irritation causes pain or neurological symptoms to the arm and can be present with or without neck pain. This may be a result of disc prolapse resulting in direct mechanical compression or a result of chemical irritation of the nerve root. Another reason for nerve compression can be a result of osteophytes formed in the vertebrae as part of degeneration. Nerve pain is experienced as an electric shock or a tight narrow band in the arm, or it may cause sensory disturbances and/or muscular weakness. Appropriate management involves physiotherapy, pharmacotherapy and activity modification or in some cases medical intervention.
Facet joint pain
Facet joint pain is a common cause of symptoms related usually from prolonged sustained positions with bad posture, degeneration, but it can also be the result of direct injury or microinjuries. It is very common in the general population due to the increase of sedentary lifestyle. Changes in the muscle length and structure are gradually developing due to prolonged sustained positions. These changes may give initial discomfort but can also progress into disabling pain for some individuals.
An experienced physiotherapist can identify the cause of pain and rule out any other pathologies. Treatment can include manual therapy, soft tissue techniques, exercise prescription and daily adaptations.
It describes the injury resulting from sudden acceleration/ deceleration of the neck and head and most commonly occurs in a driving accident. It may cause a combination of injuries in the soft tissues (muscles, ligaments, discs), the nerves and the vertebrae (bones of the spine). In addition, over left untreated is an injury to the brain (concussion) and/ or the vestibular system causing a combination of other symptoms such as headaches, fatigue, fear of light/sound, dizziness, memory problems, among others. Your expert clinician will guide you on the appropriate management. Specialist treatment is key in order to prevent chronic issues from a mild brain injury, also known as chronic concussion syndrome.
A concussion is a result of mild brain injury that can result from a variety of mechanisms. As described above, whiplash injury is a major cause of missed and untreated concussion, as the focus is placed on other injuries in the neck. Concussion can also occur from a direct injury to the head or an injury to the body such as a sporting tackle (i.e. rugby, hockey, etc). The symptoms include among others, headaches, fatigue, fear of light/sound, dizziness, memory problems, exercise intolerance and impaired cognitive and vestibular function. Specialist treatment for this complex pathology is key in order to prevent chronic issues from a mild brain injury, also known as chronic concussion syndrome. The experienced team of a doctor and a specialist physiotherapist will help you return back to your previous life.
Cervical myelopathy refers to the serious condition of compression of the spinal cord and usually is a result of disc herniation, however several other causes can cause this serious condition. Symptoms can include a combination of neurological symptoms in the arms and legs, gait disturbances, balance issues and weakness, among others. Specialist evaluation from a Spine consultant, neurologist or neurosurgeon is necessary to discuss appropriate management.
The cyclists neck:
Neck pain in cycling is common especially with the use of racing bikes and with long distances. Racing bikes a lot of times cause people to ride with a bad posture, meaning flexed lower and upper spine causing hyper-extension in the neck. The neck as any part of the spine has joints that if they are fixated in a specific position for long time, such as long-distance cycling, can result into mechanical neck pain. However, as the body degenerates in the aging population, these symptoms may come sooner and persist longer.
The symptoms of neck discomfort include pain with prolonged cycling that worsens as you continue your activity. These may be accompanied with stiffness around the neck and shoulder muscles as the body attempt to protect an irritated area. As this worsens, headaches and inability to find comfortable positions in your day are not uncommon. Sleeping is not normally affected, however in the presence of stiff muscles it may be difficult to find a comfortable position for your head. During the morning the feeling of stiffness may be experienced as more severe and a hot shower may give temporary relieve. The pain may range from mild ache to severe discomfort depending on the irritation of the underlying structures and your daily activities. Desk job is associated with the protracted extended position in the neck that will result in pain at work. Feelings of clicking and grinding of the neck or radiating pain in the arm or fingers are due to underlying pathologies such as degenerative changes in the disks or from nerve irritation respectively.
Examination will commonly reveal a protracted neck posture with weakness in the deep stabilizing muscles of the neck as a result of persistent hyper-extension. In addition, there is commonly provocation of symptoms with specific neck positions and total range of movement may be limited, especially in rotation or tilting of your head. Stiffness of the surrounding muscles as explained before is not uncommon and is secondary causing the reduced range of movement. Strength in the shoulders is unlikely to be affected but can result in a case of secondary nerve irritation.
The management of the cyclist’s neck is with conservative management and may include analgesia or heat application in the initial stages of rehabilitation. In addition, instruction of correcting posture in activities of daily life and in cycling will allow for gradual resolution of the underlying irritation. In order to maintain a correct posture, exercises for the neck and upper back muscles will be initiated and will be combined with a variety of manual techniques. These include a combination of soft tissue work on the surrounding stiff muscles and mobilization of the spine to increase mobility of the affected segments in your spine. This will allow you to progress to returning to your previous levels of activity without discomfort.