The cervical herniated disc is one of the most common causes of neck pain. The prevalence of cervical disc herniation increases with age and is most common in the third to fifth decade of life, however, most cases are diagnosed between the ages of 51 to 60. It occurs more frequently in females, which account for more than 60% of cases.1
Exercises are surely an important part of strengthening the neck, particularly for rehabilitation after an injury or neck pain. But is it safe to exercise with a cervical herniated disc? What type of neck exercises are advised for cervical herniated disc and what should be avoided? Various queries revolve around exercising with a cervical herniated disc.
Let us understand the cervical herniated disc and some important aspects of exercises.
Cervical Herniated Disc
People often experience an event of sudden impact or jerky movement before the pain begins. Unlike mechanical neck or back pain, cervical herniated disc often causes symptoms of nerve involvement like burning pain, tingling, and numbness. It often causes neck and arm pain with impingement of nerves and associated inflammation.
An intervertebral disc is composed of annulus fibrous, which is a dense collagen ring that encloses the nucleus pulposus. Due to the regular wear and tear or degeneration that occurs with aging, the soft tissue gets weakened. As a result, the nucleus pulposus or a part of it protrudes through the collagen ring. It can happen suddenly owing to a sudden jerk or trauma. It can occur more commonly in people suffering from connective tissue disorders and some congenital disorders.2 While a herniated disc is more common in the lumbar spine, the cervical spine is the next commonly affected region.
Cervical disc herniation commonly occurs between C5-C6 and C6-C7 vertebral bodies, which results in symptoms at the C6 and C7 levels. Common symptoms include neck pain, arm pain, numbness, and tingling in one or both arms. The range of motion of the neck is usually affected and nerve involvement, muscle weakness, and reflexes are evaluated during a clinical examination. Scans may be ordered, as appropriate, to rule out other conditions and to confirm the diagnosis.
Treatment usually includes immobilization of the neck with a neck collar for a short period during the acute phase. Medical management is advised, depending on the condition and severity.
Is It Safe To Exercise With A Cervical Herniated Disc?
After a brief period of rest physical therapy is advised to promote healing. This includes applying various modalities such as ice, heat, ultrasound, electrical stimulation therapy, and exercises.
Now coming to the question of whether it is safe to exercise with a cervical herniated disc.
Exercises during the initial period after a cervical herniated disc, which is rehabilitation, particularly focus on recovery from the injury. With a cervical herniated disc there is a fresh trauma that you need to recover from. So the key is to follow the advice, take small steps and move towards betterment each day. Movement of the muscles and strengthening is essential but gradually, so proceed only once you get better at the first one.
Rehabilitation exercises mainly include those that improve the range of motion, followed by neck strengthening exercises. These are mainly aimed at relieving pain and improving the neck range of motion and flexibility to promote better healing. Beginning with exercises soon after the initial rest period or once acute pain subsides, prevents the formation of scar tissue and helps in better healing. It loosens tight muscles and improves blood circulation.3 It thus promotes natural healing, thus the chances of regaining the functional abilities increase.
However, care should be taken to go slow during the initial exercise period and prevent injuries or sudden jerky movements at other times. Hence, it is advisable to perform those exercises only under the guidance of your physical therapist after getting a nod from the treating doctor.
Once the period of rehabilitation is over and the regular physical therapy is done, you may be given a routine plan to be followed for the next few months along with follow-up. The plan will also include learning the correct ways to do things like proper lifting techniques, practicing good posture, gentle stretching movements, and regular exercises to maintain flexibility and strengthening. It is advisable to follow those instructions and include those exercises to ensure continued healing and strength building.
One of the important things to understand is that healing can occur on its own, with simple measures. But to prevent further injuries exercises and a balance of activity and rest are needed. Medical experts believe that the earlier the exercises begin the better for recovery.
In a 2012 report, a 34-year-old patient presented with signs and symptoms of cervical radiculopathy and disc prolapse, with loss of cervical lordosis. She was treated with mobilization of the upper thoracic spine from C7 to T6 level, while she awaited a surgical opinion. A cervical extension exercise was performed with the prior voluntary extension of the thoracic spine and elevated shoulders. The same was later continued at home along with general postural advice. She showed improvement and her symptoms reduced over the next four sessions and surgical intervention was not required.4
This clearly shows that exercises can surely help in improving the condition but should be done only as advised by a medical expert and a physical therapist. Resuming regular activities, routine workouts, sports, or other physical activities may have certain restrictions depending on the condition and the severity.
Those who have experienced a cervical herniated disc a long time ago need to focus on therapeutic exercises to maintain muscle strengthening and joint flexibility. The exact type and repetitions of exercises may vary depending on the presence of pain or other symptoms.
Usually for chronic pain with a history of cervical herniated disc chin tucks, neck stretches, upward and downward bending, neck side turns, neck side tilts, neck rotations, shoulder shrugs, and arm rotations are advised. Isometric exercises and weight training are further advised to ensure continued strengthening of the soft tissues.
Exercises help in improving joint and muscle strength and keep the soft tissue flexible. However, which exercises to perform during an acute phase after a cervical herniated disc and which to avoid is decided by the physical therapist. With gradual improvement in the condition, the exercises should be stepped up in a graded manner aiming to regain the full potential of the tissues and improve the range of motion. For chronic complaints regular, gentle stretching and range of motion exercises work best along with strength training. Till complete recovery is achieved it is best to avoid other exercises, high-impact exercises, jerky movements, and contact sports.