bulging disc, shaking hand


I have found your website really useful and wondered if you could help me. I have had 3 separate bouts of neck pain in the last 18 months. I am a saxophone player (music teacher) and put these symptoms down to the neck strap/ hand position for prolonged periods of time. The first two bouts were basically a stiff neck and headaches and disappeared quite quickly. This time, however, it has continued and the symptoms are changing.

I have a clicking/grinding neck throughout the day (although once it has clicked, actually feels like a 'fizz' and makes me a bit dizzy but then eases the neck tension.

I also have had a shaky right hand when held in certain positions and shoulder and back pain as well as headache the majority of the time.

I have had these symptoms for over 3 months and have been to the doctors who thought it was a trapped c7 nerve, referred to a physio (5 appointments later and I had just had the same chat and tests but no manipulation).

I was referred to the senior physio who sent me for an MRI scan. The results came back last week and show some minor degenerative changes in my neck and a bulging disc. The physio has asked me to be referred back to my doctors to explore 'other avenues' but they were unable to suggest what these were when I went today.

The physio would like me to go to neurology but I am confused as to what they would be looking for and why anything they would be looking at hadn't showed up on the MRI scan.

I appreciate that this is a bit of a ramble but I would really like some help!

Thanks for your time.

Actually it's not a ramble at all; you've given me a pretty good synopsis compared to the three liners in terrible grammar that I often get.

Two things you have omitted however; your age and what injuries you've had to your neck. Have you had any old whiplash injuries, falls down the stairs, off horses, and so on?

The shaky right hand is probably not directly related; does it occur when your hand is at rest, or only when you are using it? It could be serious, but probably isn't, depending on your age. For that a consultation with a neurologist would be of value. Is it Parkinson's for example, or an "intention" tremor.

What's really good is that you make no mention of radiating pain, or numbness and tingling down your arm. That clicking and grinding in the neck is the sign of wear and tear arthritis in your cervical spine from an old injury.

The nerves to the upper back and shoulder eminate from the lower neck. The headaches are usually from the upper neck, but there are other causes.

Musicians do have a hard time from the neck and upper back; part of the solution is to keep moving when playing. A strap that shares the weight of the instrument on both shoulders would help too.

This the kind of stuff that chiropractors deal with on a daily basis; after eighteen months it won't necessarily be straight forward. However, it's good that you don't have many significant findings on the MRI.

Fixated joints, as we call them, don't show up on MRI; all them should be moving in tandem when you turn you head, flex and extend it. Usually a non movable area is what causes the pain and discomfort, and nerve irritation; it also contributes to the "immobilisation" arthritis that physiologists have done so much research on.

Start hunting for a competent and thorough chiropractor in your area; talk to friends and family, and your GP. This sounds very treatable to me; I'm busy with folk with similar symptoms daily.

Good luck; let me know how you get on.

Dr B

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

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Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

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