This information is for reference use only and should not constitute a diagnosis.

**Introduction**

Video on it’s way…

If you go to your family doctor with neck and/or arm pain and ask about seeing a chiropractor for it, they will often say, “Oh, no,” they’ll try to pop it back into place, which will not only be painful but make matters much worse.” Is this true? What is the chiropractic approach to treating a “slipped disc”? Drugs? Surgery? TL;DR: No.

Well, if you’re looking for conservative care (which means non-surgical and drugless), chiropractic is your best bet for this. In treating cervical “slipped discs,” most spine experts agree that conservative care should be tried before surgery is considered, except in severe cases.

Not only that, but chiropractic care has a long history of successfully providing conservative care for disc conditions – and no, chiropractors don’t try to “pop a disc back in place.”

It’s our hope that when you’re done reading this, you will understand the cervical spine discs’:

A: Anatomy

B: Symptoms

C: How doctors diagnose the disc, and

D: What treatment options are available.

**Anatomy**

The human spine is formed by 24 spinal bones, called “vertebrae.” Vertebrae are stacked on top of one another to form the spinal column. The spinal column gives the body its form and is the body’s main upright support.

The section of the spine in the neck is known as the cervical spine.

The cervical spine is made up of the upper seven vertebrae, numbered C1 to C7. These vertebrae are arranged to support the neck and allow for a wide range of head movements.

It’s easiest to think about the disc as a circle of ligament between each vertebra in the spine that acts as both a shock absorber and a shock distributor.

Without discs, the spine simply could not function. A disc is made of two parts. The center, called the “nucleus pulposis” (It means “pulpy center” in Latin) is spongy, a little like crab meat. It provides most of the disc’s ability to absorb shock. The nucleus is held in place by the annular rings… concentric rings (like those of a tree) of fibrous material surrounding the tough, gelatinous center. When cracks or fissures occur in the fibrous rings, the rubbery-like material in the center can begin to push out.

Discs don’t really “slip.” Instead, they bulge, herniate, protrude, or rupture. Saying a disc has “slipped” does, however, suggest that something has “slipped out” and is not where it’s supposed to be, which is what exactly happens in disc injuries.

The cervical disc issue is often the result of a cumulative process rather than a single ‘event’. As is often the case with joint and back injuries, the problem starts small and then builds until it becomes symptomatic.

For example, a patient might experience sudden neck pain while lifting something, turning their head, or even just sleeping in an awkward position. However, the incident itself didn’t cause the disc to “slip,” but represents the final “straw” in a much longer process. The real causes of disc injury include disc dehydration, unusual stress on the disc due to disturbed mechanics, and too much load on the disc.

Healthy discs work like shock absorbers to cushion the spine. They protect the spine against daily stress and during strenuous activities that put strong force on the spine, such as turning the head quickly or lifting heavy objects. Perhaps the most interesting feature about discs is that they have no blood supply. In fact, the discs are the largest avascular structure in the human body.

Instead of a blood supply, the disc ‘sucks up’ water during sleep and squeezes it out when loaded. Discs depend on water to keep their height and perform efficiently. When we’re young, discs have their own circulation that helps keep them hydrated. As we get older, this circulation ends, and the spine must move so that water can be drawn into the discs. If discs become dehydrated and lose their height, they’re vulnerable to cracks and fissures. The loss of water in the discs is one reason why people may experience neck issues as they age.

Although daily activities may cause the nucleus to press against the annulus, the body is normally able to withstand this pressure. However, as the annulus ages, it tends to crack and tear. It is repaired with scar tissue. This process is known as degeneration.

Over time, the annulus weakens, and the nucleus may begin to herniate (squeeze) through the damaged annulus. At first, the pressure bulges the annulus outward. Eventually, the nucleus may herniate completely through the outer ring of the disc.

Chiropractors are especially interested in seeing how injuries in one part of the body relate to the mechanical system of the body as a whole. We look at injuries specifically, but they also try to determine in what way an injury is the outcome of disturbances elsewhere in the body.

The spine functions as a whole, so if we have mechanical disturbances in one part of the spine, even as far away as the lower back, it can influence conditions in another area of the spine. Imbalances in the pelvis, problems in the sacroiliac joints, upper back issues, or even the feet and ankles can contribute to the process of disc degeneration and eventual injury, and can explain why your chiropractor adjusts you, not only at the cervical level but elsewhere as well.

A cervical disc can also become herniated during an acute (sudden) injury. Activities like automobile or motorcycle accidents, or even sneezing with a twisted posture or a heavy impact on the spine can cause a disc herniation.  Damage to the disc is ADDITIVE, meaning every little damage builds on the next, like hearing loss or dental cavities.

Herniations cause pain from a variety of sources: mechanical pain, inflammation pain, and neurogenic pain. Mechanical pain comes from the parts of the spine that move during activity, such as the discs and ligaments. Inflammatory pain occurs when the nucleus squeezes through the annulus. The nucleus normally does not come in contact with the body’s blood supply. However, a tear in the annulus puts the nucleus at risk for contacting this blood supply.

When the nucleus herniates into the torn annulus, the nucleus and blood supply meet, causing a reaction of the chemicals inside the nucleus. This produces inflammation and pain.

Neurogenic pain occurs when there is direct pressure against a spinal nerve. Pressure on an irritated or damaged nerve can produce pain that radiates along the nerve, often down the arm and into the hand.

It’s interesting to note that disc damage is typically a problem of middle age… Young discs haven’t been subjected to enough stress to herniate, and elderly discs are dried out to the extent that they don’t ‘goop’ anymore.

**Symptoms**

If you are actually reading this because Dr. Carr told you to… you probably already know.

Many cases of cervical disc herniation result from degenerative changes in the spine. The changes that eventually lead to a disc herniation produce symptoms gradually. At first, complaints may only be dull pain centered in the neck, pain that comes and goes over a period of a few years.

Doctors think this is mainly from small tears in the annulus. Larger cracks in the cervical annulus may spread pain into the shoulders or arms.

When the disc herniates completely through the annulus, it generally causes immediate symptoms, with sharp pain that starts in the neck and shoots down part or all of the arm. Commonly, patients no longer feel their usual neck pain, only arm pain. This is likely because painful tension on the annulus releases when the nucleus pushes completely through. This usually occurs in the morning, and often patients will say they woke up and then “X happened” and it was like being hit by lightning.

Disc herniations produce inflammation when the nucleus comes in contact with the body’s blood supply (mentioned earlier). The inflammation can be a source of throbbing pain in the neck and may spread into one or both shoulders and arms.

A herniated disc can press against a spinal nerve, producing symptoms of nerve compression. Nerve pain follows known patterns in the upper limbs. It can be felt on the side of the upper arm, in the forearm, or even in the hand and fingers.

Pressure on the nerve can also cause sensations of pins, needles, and numbness where the nerve travels down the arm. If this happens, a person’s reflexes may slow, the muscles controlled by the nerve may weaken, and sensation in the skin where the nerve travels may be impaired.

Rarely, symptoms involve changes in bowel and bladder function. A large disc herniation that pushes straight back into the spinal canal can put pressure on the nerves that go to the bowels and bladder. The pressure may cause neck pain, pain running down both arms, and numbness or tingling between the shoulder blades. The pressure on the nerves can cause a loss of control in the bowels or bladder. This is an emergency!! If you experience this, DIAL 911 NOW and go to the ER!

**Diagnosis**

How do doctors diagnose the problem?

Diagnosis begins with a complete history and physical exam. Your doctor will ask questions about your symptoms and how your problem is affecting your daily activities.

These will include questions about where you feel pain and whether you have numbness or weakness in your arms. Your doctor will also want to know what positions or activities make your symptoms worse or better. Doctors rely on your report of pain to get an idea which disc is causing problems and if a nerve is being squeezed.

Then the doctor examines you to determine which neck movements cause

pain and whether you have any signs of weakness or sensory loss.

The next step is imaging studies. The X-ray does not show the disc itself, but it can rule out conditions that can cause similar symptoms, such as tumors or fractures. An MRI (magnetic resonance imaging) is usually ordered to examine the soft tissue of the disc. This test can detect the presence of a disc herniation, determine its severity, and reveal if it is pressing on the spinal nerves or spinal cord. Sometimes, a CT scan may be used as a follow-up to the MRI or when an MRI is not available.

**Treatment Options**

So what can be done to fix a herniated cervical disc? When herniation occurs, you will want to start with conservative measures.

Conservative treatment typically involves medication, physical therapy, and/or chiropractic care.

**Medications:** Over-the-counter pain relievers such as acetaminophen or ibuprofen can reduce pain and inflammation. If these are not effective, prescription medications might be considered. However, the goal is to reduce pain and inflammation so that you can progress with other therapies.

**Physical Therapy:** Physical therapists can guide you in exercises designed to reduce pain and strengthen the muscles supporting your neck and spine. Posture correction and learning ergonomic techniques are also important parts of therapy.

**Chiropractic Care:** Chiropractors offer a range of non-surgical treatments, including spinal adjustments, which can help improve spinal alignment, reduce pain, and increase range of motion. Chiropractors may use techniques like cervical mobilization, stretching exercises, and recommendations for proper ergonomics.

**Surgery:** If conservative treatments do not provide relief or if symptoms are severe (such as significant weakness or loss of function), surgery might be considered. Options include discectomy (removal of the damaged part of the disc), fusion surgery (joining two vertebrae), or artificial disc replacement.

Always discuss with your healthcare provider to choose the most appropriate treatment plan based on your individual needs and circumstances.