Cervical Disc Herniation
Cervical Disc Herniation
One of the most important aspects of assessment in massage is to determine if it's appropriate to work on a specific condition. While massage is safe in most cases, there are some instances where harm can be done if inappropriate treatment is applied. A cervical disc herniation is just such a condition. It's important to identify this condition, as it also should be evaluated by another health professional to make sure massage is appropriate. However, if performed appropriately, there are some beneficial massage approaches.
A herniated disc (also called herniated nucleus pulposus or HNP) results from sudden or long-term compression loads on the spine. Herniations are more common in the lumbar region than in the cervical, but can still produce significant pain or disability when they occur. Cervical disc herniations produce pain or neurological dysfunction in the neck or upper extremities. They are relatively common and frequently occur in asymptomatic individuals, so presence of a herniated disc does not necessarily imply a pathological problem.1
The intervertebral disc is designed to absorb shock and cushion compressive forces transmitted through the skeletal structures of the body. The center of the disc is composed of an inner gel-like substance called the nucleus pulposus. The nucleus is surrounded by concentric layers of collagen that make up the outer disc boundary, called the annulus fibrosus (Figure 1). When compressive loads are placed on the disc, the nucleus presses against the walls of the annulus. As the pressure increases, annulus fibers begin to tear and the disc changes shape (Figure 2). The disc usually is pushed in a posterior-lateral direction. Unfortunately, the cervical nerve roots are very close to where the disc herniation occurs, so the herniation frequently presses on the nerve roots producing sensory or motor nerve dysfunction.
Cervical disc herniations are most common in the lower cervical spine. The nerve roots in this region make up the brachial plexus. The nerves of the brachial plexus eventually course down through the length of the upper extremity, so nerve compression symptoms commonly are felt down all or part of the upper extremity.
In some cases, the disc herniation is an acute injury with a sudden load on the cervical spine. For example, herniations develop when an individual hits their head on the bottom of a shallow swimming pool after diving in. In other situations, a disc herniation may develop from significant compressive loads over time, such as those that occur from chronic forward head posture.
The primary symptoms from cervical disc herniation include pain, paresthesia or weakness in the neck or upper extremities. Pain or paresthesia can occur throughout the entire upper extremity or only in part of it. Muscle weakness may be evident in any of the upper - extremity muscles innervated by fibers of the affected nerves. Because symptoms may occur in any region of the upper extremity, it can be challenging to distinguish a cervical disc herniation from other nerve compression pathologies that occur in the upper extremity, such as thoracic outlet or carpal tunnel syndromes.
Suggestions for Treatment
While surgery was once considered almost essential for this condition, it's not as common now. Research shows that disc herniation problems may heal spontaneously without surgery or other invasive procedures.2 Some rehabilitative exercises are suggested to encourage the disc to return to a normal position away from affected nerve roots.3 It's important to consult with a physician or other health professional for recommendations on treatment.
While massage is not absolutely contraindicated for disc herniations, treatment methods should be used cautiously. The transverse processes protect the nerve roots from further compression during most massage techniques, but symptoms could be aggravated by minor vertebral movements that occur from pressure applied to the region. Massage is helpful to decrease muscle tension in the area and may reduce compressive loading on the disc. However, this massage also should be performed carefully and only once the extent of the disorder has been clarified.
- Boden SD, McCowin PR, Davis DO, et al. Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am, Sept 1990;72(8):1178-84.
- Benoist M. The natural history of lumbar disc herniation and radiculopathy. Joint Bone Spine, 2002;69(2):155-160.
- McKenzie R. Understanding centralisation. J Orthop Sports Phys Ther, Aug 1999;29(8):487-489.