Cervical Degenerative Disc Disease

• Aging is the most common cause of disc degeneration. As the body ages the discs start to lose fluid and dehydrate. The discs start to narrow and lose their height, compromising their ability to absorb shock and stress.
• The outer fibrous annular rings may begin to crack and tear, weakening the disc walls.
• Individuals who smoke, are obese, and are involved in activities that require heavy labor are more likely to develop disc degeneration.
• Sudden fall or trauma to the spine or disc may begin the degenerative process.
• A disc herniation may initiate the stages of disc degeneration.
• Unlike muscles, there is minimal blood supply to the discs, so they lack reparative ability.

Conditions of the intervertebral disc that can develop as a result of disc degeneration include bulging disc, herniated disc, prolapsed disc, degenerative disc disease, annular tear of the disc, ruptured disc and slipped disc.

The symptoms associated with degenerative disc disease of the neck or cervical spine will depend on the location and structures that are affected. Cervical disc degeneration can affect the back of the head, neck, arm, shoulder blade, and may extend into the hand.

• Many patients with DDD (degenerative disc disease) do not exhibit symptoms.
• Chronic pain in the neck, extending into the shoulders with or without radiation to the arm and down to the hand if the disc presses on the nerve root.
• Sensory changes such as numbness, tingling, or parasthesia if the nerve is compromised.
• If the portion of the nerve responsible for motor function is effected by disc disease, muscle weakness, atrophy or wasting in the arm or hand may occur. In severe cases paralysis may occur.
• Diminished reflexes in the upper extremity.
• Muscle spasm and changes in posture in the neck and shoulder area.
• Loss of motion, with decreased ability to move the head and neck when turning, looking overhead, and side bending.
• Sitting for extended periods of time may produce neck and arm pain
• Difficulty with lifting and over the head activities
• In later stages spinal Stenosis may develop requiring surgical intervention if symptoms are bad enough. Weakness, loss of coordination and abnormal reflex response may occur if the spinal cord is affected.

Treatment of cervical degenerative disc disease or injury will depend on the severity of the condition. When treating acute back problems:

• Rest: avoid the activities that produce the pain (bending, lifting, twisting, turning or bending backwards).
• Medication to reduce inflammation (anti-inflammatory drugs and pain medication).
• Ice in acute cases: apply ice to the cervical spine to help reduce pain and associated muscle spasm. Apply it right away and then at intervals for about 20 minutes at a time. Do not apply directly to the skin.
• Moist heat may be helpful to reduce pain and improve any feelings of stiffness.
• An exercise regiment designed specifically to address the cause of the symptoms associated with the degenerative disc disease and improve joint mobility, spinal alignment, posture, and range of motion.
• A cervical collar or the use of supports may be necessary to reduce stress on the facet joints, muscles and head and neck.
• Steroidal medication to reduce inflammation in moderate to severe conditions.
• Epidural injections directly to the involved disc may be indicated.
• Physical therapy to reduce inflammation, restore joint function, improve motion, and help the return of full function.

Mild

In mild cases rest, ice and medication may be enough to reduce the pain. Many patients will do well with this regiment. Once the pain is reduced, physical therapy is recommended to develop a series of postural correction, stretching and stabilization exercises to prevent reoccurrence of the injury. Return to activity should be gradual to prevent a flare up of symptoms.

Moderate to Severe

If the problem persists, consulting with your health care provider should be the next step. Your physician will perform a thorough evaluation to determine the possible cause of your symptoms, the structures involved, the severity of the condition, and the best course of treatment.

In addition to performing a thorough examination your physician may order the following tests to make a more concise diagnosis:

• X-ray to determine if there is any joint degeneration, fractures, bony malformations, arthritis, tumors or infection present.
• MRI to determine any soft tissue involvement including visualization of the discs, spinal cord and nerve roots.
• CT scans, which can give a cross section view of the spinal structures.
• EMG, which is used to determine nerve involvement or damage.

Your physician may recommend several medication options individually or in combination to reduce the pain, inflammation and muscle spasm that may be associated with disc injuries.

• Over the counter medications for mild to moderate pain.
• Narcotics, if over the counter medications are not effective your physician may prescribe stronger pain medication.
• Anti-inflammatory drugs or prescription NSAIDS to reduce inflammation following acute injury.
• Muscle relaxers to reduce acute muscle spasm.
• Nerve pain medication by prescription, designed specifically to reduce pain from nerve damage.
• Injections like facet injections, nerve blocks or an epidural. These may involve the injection of corticosteroids to a specific structure to reduce local inflammation.

Severe or Non-responsive Degenerative Disc Condition

In the case of conditions that do not respond to conservative care after 8-12 weeks, surgery may be indicated. If you continue to experience some of the following symptoms:

• Increase in radiating or radicular pain from the neck to the arm.
• Pain or nerve damage that gets worse.
• The development of, or an increase in weakness in the upper extremity or hand.
• Increase in numbness or parasthesia in the arm.

The most common disc related surgery is a discectomy in which the disc is removed through an incision. In the cervical spine a discectomy can be performed either anteriorly (front) or posteriorly (back). However there are several other surgical interventions that may be indicated in the case of degenerative disc disease. Which procedure will be performed depends on the cause of the symptoms. Some examples include foraminotomy, laminotomy, spinal laminectomy, spinal decompression, and spinal fusion. Spinal surgery is not usually performed when the only symptom is neck pain.

Physical Therapists are professionals, educated and trained to administer interventions. As defined by The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and the patient or client’s goals.

Your physical therapist will perform a thorough evaluation to assess and determine the following:

• Spinal Examination where the patient is put through a series of movements and tests to determine the most probable cause of the condition.
• Strength: resisted testing is performed to determine if there is associated weakness or strength imbalances.
• Flexibility: tight muscles can contribute to poor mechanics and weakness, thus creating imbalances and making one more susceptible to disc and back injuries.
• Posture Analysis, ADL’s and technique: discuss and observe the activity that may have started the problem. Examination of dynamic and static postures that may have cause or contributed to your current back problem. A review of your current activities at home and work that may or may not be causing or prolonging your present condition.

Physical therapy for back and disc problems must remain conservative at the onset to avoid aggravating the condition. Emphasis will be on rest, reducing the inflammation and increasing the blood circulation for healing. Once the initial inflammation has been reduced, a program of postural reeducation, stretching and strengthening will be initiated to restore flexibility to the joints and muscles involved while improving stability to the neck and spine. Your program design will be based on the structure precipitating your complaints and symptoms. A program not tailored to your problem could aggravate your symptoms.

Common Physical Therapy interventions in the treatment of degenerative disc disease include:

• Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, stretching and joint mobilization by a physical therapist to improve alignment, mobility and range of motion of the cervical spine. Use of mobilization techniques also helps to modulate pain.
• Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen muscles of the cervical spine and shoulder girdle to support, stabilize and decrease the stresses placed on the disc and neck.
• Neuromuscular Re-education (NMR) to improve posture, restore stability, retrain the patient in proper sleeping, sitting and body mechanics to protect the injured disc and spine.
• Modalities including the use of ultrasound, electrical stimulation, ice, cold laser, traction and others to decrease pain and inflammation of spinal structures.
• Home programs including strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.