Slipped disc in neck

Slipped disc in neck is one of the most painful and difficult conditions seen; the ache in the arm is especially disturbing at night.

This is one of the most stubborn problems seen at the Chiropractic Coalface; I have finally decided that less treatment, rather than more is the solution. Winning the patient's confidence in the midst of such pain is vital, and stems from a thorough examination, a candid approach about the seriousness of the condition and an acceptance that Rome wasn't built in a day. Nor in a night when a slipped disc in neck is often at its worst. 

The nerve roots in the cervical spine find themselves precariously placed between three types of joints:

  1. The intervertebral disc joint
  2. The facet joints
  3. The joints of Luschka
  • Whiplash and the Joints of Luschka ...

    Any one of the three, or several in combination can affect the nerve root. See how the nerve root (illustrated by the red arrow) lies between the IVD, the facet joint and the joint of Luschka?

    • Chiropractic Conditions is a central page at Chiropractic Help. It provides you simply and easily with the sorts of conditions that the average chiropractor would be treating.
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    Slipped disc in neck casefile

    Mr G, a fifty year old body builder consulted me with bad neck pain and headache radiating vaguely, but severely in the right shoulder and lower arm. The arm felt weak and there was frequent pain and tingling in the arms and hands. Bench press in particular was difficult.

    The pain had begun some five weeks previously, with no known cause. He recalled no injuries to the neck.

    He had consulted a physical therapist and another chiropractor, neither of whom could find the cause of the pain or the weakness in his arm. Nevertheless there had been some improvement in the slipped disc symptoms in his neck with their treatment, but not his arm.

    Mr G was an extremely well built man, with enormous muscles associated with body building. He wasn't carrying an ounce of fat.

    Right rotation of his head and neck, right lateral flexion, and extension, all produced pain in his neck and upper right arm.

    On observation, it was obvious that there was severe wasting of the right pectoralis major muscle and the right triceps. Both were very weak for such a strong man. I could overpower both, difficult even in a normal person.

    Kemp's test and the Upper Limb Tension Test were extremely positive, with pain in the lower cervical spine (C7 in particular) radiating radiating tingling in the arm and hand.


    A slipped disc in a human neck.

    Tingling in arms and hands

    Tingling in arms and hands absolutely must be taken seriously if there is a suspected slipped disc in neck.

    The triceps reflex was absent and there were sensory changes in the middle finger; on pinwheel testing there was numbness.

    In short, there were so called hard neurological findings, affecting both the sensory and motor nerves. Slipped disc symptoms in the neck can be very severe, and unresponsive to medication.

    Depending on the severity of the bulge you may have a variety of symptoms; if it affects just the sensory nerve causing pain, tingling and numbness in the arm.

    If the motor fibre is pinched then there will be loss of reflex and weakness and wasting of muscles.

    You may experience several of these symptoms.

    • Severe neck pain
    • Severe trapezius muscle pain
    • A deep ache in the upper midback
    • Pain and tingling in the arms and hands, usually in one arm only
    • Initially, increased sensitivity in the arm known as hyperaesthesia. Later numbness develops, usually in a single dermatome; that's an area of skin supplied by just one nerve root.

    C6 dermatome.
  • Weakness in one or more muscles in the arm. The triceps is most commonly affected, next the small muscles in the hand. The Pec muscles in the chest may also be affected
  • Wasting of the muscles affected then occurs.

  • Triceps in the human arm.

    Extending the elbow, straightening it against resistance, is commonly weak.

    Shoulder abduction relief

    The shoulder abduction relief sign is a strong confirmation of slipped disc in neck. Conversely, relief of pain and tingling in arms and hands points to a tethered nerve and positive artery in a thoracic outlet syndrome.

    There is increased pain in the arm when stretching out the limb. Carrying a briefcase or a heavy package of groceries places increased stress on the injured nerve root.

    Conversely, placing your hand on your head, or sleeping with it under your pillow takes the tension off the nerve.

    The result is relief when raising your arm. Periodically a patient walks into the clinic with his or her hand on their head; the diagnosis is often already made. It's known as the Shoulder Abduction Relief sign.

    The deep ache in the arm is often worst at night.

    A slipped disc in neck is certainly one of the most difficult conditions to manage in any practice. It frequently leads to surgery, which in itself is complex and not without danger. Approximately one in a thousand patients die during or soon after the operation.

    Others either receive no relief or have increased pain. The same of course could be said about chiropractic patients. All professions find this a challenging condition to treat.

    Spurlings test

    A positive Spurling's test is a strong indicator of a slipped disc in neck; however advanced degenerative changes in the uncovertebral joint Luschka can provoke it as well.

    Spurling's test is done by turning your head to the painful side and then looking up; do you get pain and tingling in your arm?

    A letter received at Chiropractic Help

    My right neck, arm, leg and foot are experiencing tingling and burning sensations. Sometimes my foot will feel like it has fallen asleep as well. Also, occasionally, the right side of my face feels numb. I have previously had L2-L4 interbody fusions, Disk repair, somewhere around L2/3 and C4-C6 interbody fusions.

    The pain is unbearable at times. Sitting, standing and walking are the worst. Please help!!

    Chiropractic treatment of slipped disc in neck

    Chiropractic treatment of slipped disc in neck would probably include some or all of the following:

    • Cervical spine manipulation
    • Axial traction
    • Home traction
    • Ice, perhaps with alternating heat
    • Soft tissue massage, including the Scalene muscles
    • Various electical modalities
    • Acupuncture
    • Exercises
    • Avoidance of carrying anything heavy in the affected arm
    • Avoidance of looking up, particular with rotation.

    More about Mr G

    I was insistent that he ceased with body building for a period, certainly his upper body, something he was only partly compliant with, to his detriment. Eventually he learned: "Those who will not hear, must feel."


    20-6-2011: T6 adjustment, cervical spine mobilisation and axial traction.


    23-6-2011: Some improvement, but a very weak feeling remains in the right arm. Tingling in the shoulder region with Kemp's Test. ULTT test R ++ still very positive. Tric R weak. Chiropractic rotatory adjustment C7R (no release), L (release), Half nelson adjustment of upper thoracic spine.

    Advice: Cervical spine X-rays. (Better and safer would be an MRI, but very expensive).

    A chiropractor making a demonstration of a chiropractic technique.


    28-6-2011: Definitely some improvement, but Upper Limb Tension Test (ULTT) and Kemp's test still positive. Same treatment.


    30-6-2011: Further improvement. Same treatment. Oblique X-rays show mild foraminal encroachment at C5-C6 and C6-C7.


    5-7-2011: Continuing improvement. ULTT is negative for the first time, and strength appears to be returning to the triceps and pec major muscles. Kemp's test does not radiate to the arm today.

    Add first exercises: Neaderthal.


    7-7-2011: Continuing improvement. Same treatment.


    14-7-2011: Set back after trying to do some light weights, and pull downs. Forbidden to do any upper extremity gym.


    21-7-2011: Again pain in arm after forbidden training! C7 Left with release. Half Nelson. Deep soft tissue in right trapezius muscles, and rotator cuff muscles, triceps.


    23-7-2011: Still very sore, especially at T3. Kemp's test pain bilaterally, but only in neck.


    26-7-2011: Improving again. Same treatment.


    23-8-2011: After a month's holiday, almost no neck or arm pain. Range of motion is good, Kemp's test is negative and ULTT is negative. Strength has returned to the triceps but wasting of triceps and Pec Major is still evident. Occasional tingling, now in thumb and forefinger (C6 dermatome).

    No manipulation today. Axial traction, cervical mobililisation and soft tissue work.

    The future 

    Whether Mr G can return to body building or not remains uncertain. Certainly a month away from his weights has done him a power of good.

    He's happy. I'm optimistic, but clearly it's the weak link in his chain... and another slipped disc in neck is quite possible.


    › Slipped disc in neck

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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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    Brachial plexus

    The brachial plexus of nerves that supply the arm.

    Chiropractic first poster.
    The inter scalene triangle through which the nerves to the arm must pass.
    Diagram showing how the thoracic outlet can cause arm pain.
    Thoracic outlet surgery is a very delicate business.

    Arm pain

    1. Shoulder

    Shoulder pain.

    Frozen Shoulder

    A man with a frozen shoulder.

    Rotator cuff

    The muscles involved in a rotator cuff strain.

    "My thumb, forefinger and middle finger went weak after cuff surgery."

    "Hello John, I take it you've been back to the surgeon.

    It's probably temporary inflammation of the median nerve, but of course could be worse... I'm afraid I don't think chiropractic has anything to offer at this stage.

    Once everything has healed up, if you don't get the strength back, or your fingers remain numb and tingly, then I'd consult a local chiro to see if there is also a problem in your neck or the first rib.

    Dr B"

    Letter from reader looking for advice.

    Rotator cuff surgery.

    2. Elbow

    Path of the radial nerve.

    Elbow pain

    The tennis elbow muscles.

    3. Wrist

    The median nerve entrapment sites.
    Diagram showing how the pronator teres muscle can cause carpal tunnel syndrome.

    How bad is your arm shoulder hand pain?

    More letters from readers