cONCUSSIONS
Disc Injuries & Herniations
Headaches
Radiculopathy
wHIPlASH
DIsc Injuries
Intervertebral discs are structures in between the cervical vertebrae that act as shock absorbers for the spine. They help aid cervical motion and help protect various structures in the neck such as the cervical vertebrae and nerve roots. The intervertebral disc is made up of two parts, the annulus fibrosus and the nucleus pulposus. The nucleus pulposus contains a gel made primarily of water and proteoglycans and acts to resist axial compression and distribute compressive forces. The annulus fibrosus is made primarily of collagen fibers and encloses the nucleus pulposus; which helps withstand tension within the disc.
A cervical disc injury typically involves these two structures. The more common injury involves tearing of the annulus fibrosus with protrusion of the nucleus pulposus (disc herniation). The second type of disc injury is an annular tear without herniation of the nucleus pulposus (internal disc disruption).
A person with a cervical disc injury may present with neck pain, radicular pain, and weakness in their upper extremity due to myelopathy and/or neuropathy. Intervertebral disc injury is most commonly associated with compression of the cervical spine with the neck in flexion or hyperextension. This can lead to a herniation of the nucleus pulposus (HNP) and most commonly occurs at the posterolateral aspect of the disc due to the compromised reinforcement and typical mechanism of injury. Due to the common direction of protrusion, nerve roots are often compressed resulting in radiating symptoms that can include upper extremity numbness, tingling, and muscle weakness.
Degenerative Disc Disease (DJD)
The intervertebral disc is one of the most common sources of neck pain. Intervertebral discs are structures in between the cervical vertebrae that act as shock absorbers for the spine. They help aid neck motion, transmit loads from one vertebral body to the next, and help protect various structures in the neck such as the cervical vertebrae and nerve roots. The intervertebral disc is made up of two parts, the annulus fibrosus and the nucleus pulposus.
The nucleus pulposus contains a gel made primarily of water and proteoglycans and acts to resist axial compression and distribute compressive forces. The annulus fibrosus is made primarily of collagen fibers and encloses the nucleus pulposus; which helps withstand tension within the disc.
The intervertebral disc undergoes the most age-related changes of all connective tissue. Over time and with repeated stresses, the nucleus pulposus becomes replaced with fibrocartilage, and the gel within the disc decreases in water and proteoglycans causing a loss of disc height.
The degenerative changes are seen in three stages. The first stage is the Dysfunction Stage. This stage involves outer annular tearing, cartilage destruction, and joint dysfunction. The symptoms include local neck pain, muscle guarding, and decreased cervical mobility. The second stage is known as the Instability Stage. At this stage disk resorption occurs as well as a loss of disk height. The symptoms include a feeling of the neck “catching” when moving. The last stage is the Re-stabilization Stage. During this stage the progressive degeneration leads to osteophyte formation and stenosis. Symptoms are those of the dysfunction stage
Possible Treatments in Physical Therapy
1. Manual Intervention: to focus on improving cervical ROM, normalize mechanics of the spine and shoulder girdle
2. Soft Tissue Mobilization: as indicated to reduce muscle guarding and soft tissue overload to restore normal resting muscle length and full pain free ROM.
3. Strengthening: to improve neuromuscular control of the injured cervical spine and shoulder girdle. Postural training and reconditioning.
4. Traction: manual and/or mechanical traction of the cervical spine will help reduce compressive forces on the herniated disc by unloading the cervical spine. 5. Modalities: as indicated to reduce pain and inflammation at the cervical spine.
References:
Orthopedic Physical Assessment, 4th Edition. David J. Magee, 2006. Physical Rehabilitation: Assessment and Treatment, 4th Edition. Susan B. O’Sullivan and Thomas J. Schmitz, 2001. www.emedicine.medscape.com/article/93635-overview
Disclaimer:
This website is an information and education resource for health professionals and individuals with injuries. It is not intended to be a service for patients and should not be regarded as a source of medical or diagnostic determination, or used as a substitute for professional medical instruction or advice. Not all conditions and treatment modalities are described on this website. Any liability (in negligence or otherwise) arising from any third party acting, or refraining from acting, on any information contained on this website is hereby excluded.