Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine
The cervical hernia is the equivalent of the herniated disc lumbar, but at the level of the neck. Like any discopathy, it can have consequences on daily activities.
What is a cervical hernia and what are the symptoms? When should you operate, or on the contrary try natural treatments? Is that bad ?
This popular article explains everything you need to know about cervical hernia, with an emphasis on scientifically proven treatment strategies.
Definition and anatomy
Before discussing cervical hernia, one should understand the anatomy of the neck region.
There are 7 cervical vertebrae numbered C1 to C7. Between the vertebrae, there are intervertebral discs allowing shock absorption and neck movements.
A disc consists of two basic elements.
- The fibrous ring (Annulus fibrosus) in the periphery.
- The nucleus pulposus (Nucleus pulposus) inside
A cervical disc herniation occurs when part (or all) of its protective outer layer cracks, and part of the nucleus pulposus escapes into the tear. This can occur as a result of trauma, or over time (disc degeneration)
A cervical hernia can theoretically occur at any level of the neck, but the C5-C6 and C6-C7 spaces are the most affected.
To clarify the diagnosis, a doctor may perform a clinical examination where he will observe the movements, the path of pain and numbness, muscle strength, reflexes, etc.
To corroborate this hypothesis, cervical MRI is often used. This medical imaging, unlike CT scans and x-rays, allows soft tissues, affected nerve roots and damaged discs to be observed.
Cervical Hernia Symptoms
As surprising as it may seem, cervical hernia is not always symptomatic. This comes from the fact that the body has an important capacity to adapt.
Thus, if the hernia formed gradually, and it does not cause nerve irritation or inflammation, it is possible that the cervical hernia does not cause any pain. On the other hand, there are situations where it will sometimes have disabling consequences.
Also, the pain may disappear and reappear spontaneously, or be aggravated by provocative activities.
Here is a list of symptoms commonly observed in the presence of a herniated disc:
- Cervicalgia (neck pain)
- Headache (headache)
- Neck and shoulder stiffness
- Radiating pain in the upper limb (cervico brachial neuralgia)
- Burning sensation in the arm
- Tingling and numbness in the arm or hand
- Tinnitus
- Feeling dizzy and dizzy
- nausea
- Pain in the shoulder blade
- Pain at night (especially if the pillow is unsuitable)
It should be noted that all cervical hernias are different, and each patient may experience distinct symptoms depending on their condition.
Cervical hernia C6-C7, occupational disease?
The subject of work in the presence of cervical hernia is very often discussed between patients and doctors. Is it an occupational disease? Is there a disability rate? Can you work with a cervical hernia?
First of all, it is common to prescribe a work stoppage following a pain attack. This stop can last a few days to a few weeks, and will be reassessed regularly.
For the return to work, this will depend on the nature of the job, the physical requirements, as well as the evolution of the condition. For example, sedentary work will be easier to resume than work requiring repeated movements or heavy lifting. All these elements will be taken into consideration by the doctor.
For example, if you have a desk job, here are some recommendations for recovery:
- When you are at the office: try to reorganize your workspace to avoid stress.
- When working on your computer: make sure your computer screen is at the same height as your eyes. Thus, you will not have to constantly lower or raise your head. On the other hand, it must be understood that the frequent change of position is the best way to prevent the appearance of dysfunctions, even more so than adopting a straight posture.
- During your sleep: choose a good pillow (ideally shape memory) to support the cervical spine.
- Avoid carrying loads that are too heavy and repetitive.
- If you have no choice, at least make sure you improve the strength and stability of your neck and upper extremities to meet the physical demands of your job.
- Find ways to manage your stress which is notably responsible for muscle tension and linked to the appearance of neck pain.
Finally, it should be noted that cervical hernia is not currently recognized as an occupational disease (only lumbar disc herniation is recognized). Thus, the person suffering from this disease is not compensated at all.
On the other hand, if it results in a rate of incapacity greater than 25%, it is possible to ask for the finding of the occupational origin of the pathology. This recognition will be made by decision of the Regional Committee for the Recognition of Occupational Diseases.
Cervical hernia: When to operate?
When talking about the treatment of cervical hernia, the last thing you want is to resort to surgery.
However, some situations constitute medical (and sometimes surgical) emergencies. It is essential to consult quickly if you feel:
- Weakness in arms and/or legs
- Sensation of paresthesia in the limbs
- Coordination disorder
- Speech disorder
- Difficulty walking
- Fever associated with pain
- Night sweats
- Weight loss that is not related to diet
- Urinary or fecal incontinence
- Pain that does not respond to conservative treatment and lasts longer than 3 months
If the pain is not associated with serious damage to the spine (such as spinal cord disease) or systemic damage (such as cancer), other treatment strategies are preferred.
How to treat a cervical hernia?
This might seem surprising, but the treatment objective for cervical hernia does not necessarily aim to eliminate the presence of the hernia.
Indeed, the focus will be on symptoms and quality of life. Thus, a cervical hernia will be considered "resolved" if the patient has managed to resume his activities without pain, even if the hernia remains present on the MRI.
But why?
As mentioned previously, it is not the cervical hernia that causes the problem, but above all the inflammation generated and the nerve irritation potentially associated. Here is what causes the symptoms that compel many patients to consult!
Here is a list of treatments available today to treat and relieve cervical hernia:
Rest and medication
As much to tell you right away, prolonged rest is not recommended in the presence of cervical hernia.
This is because prolonged inactivity has harmful consequences such as muscle atrophy, muscle and joint stiffness, non-optimal blood circulation, etc.
On the other hand, if the symptoms are incapacitating, it is allowed to take a temporary and relative rest. This involves temporarily avoiding painful movements (such as sudden movements or taking heavy loads).
It is also at these times that the doctor prescribes medications aimed at controlling pain, reducing inflammation and soothing muscles. Medications to relieve nerve pain in the upper limbs are also available.
As soon as possible, it will be necessary to resume tolerable activities to stimulate blood circulation, oxygenate the tissues and optimize healing. This balance between gradual recovery and avoidance of worsening pain will be a key factor in rehabilitation.
Ice or heat
Ice is often used following an acute pain attack to calm inflammation and relieve pain.
Heat, on the other hand, is used once the crisis has passed, to relax tense muscles and create a relaxing environment.
To learn more about using heat and ice (as well as which modality to choose), see next article.
Pillow and sleeping positions
When cervical hernia symptoms affect sleep quality, you should adjust your sleeping position to try to improve your nights.
On the one hand, the prone position is generally contraindicated in times of pain, because it induces an often painful cervical rotation. The position on the back or on the side is often preferred.
Using the right pillow can make a huge difference. An orthopedic memory foam pillow is often recommended for the many benefits it provides.
To learn more about orthopedic memory foam pillows, as well as which one to choose, read a healthcare professional's review here.
Natural treatment
Sometimes so-called “scientific” approaches provide limited relief. Many people then decide to use natural treatments or alternative therapies.
Although they are not supported by robust scientific evidence, natural treatments such as these are often used in the treatment of cervical hernia:
- Acupuncture
- Cupping (suction cups)
- Essential oils
- Natural products
- Homeopathy
- Sophrology
- Yoga
Physiotherapy and osteopathy
The physiotherapist (physiotherapist) is a therapist who can help treat and relieve the symptoms of cervical hernia. Among the many modalities that are part of its therapeutic arsenal, we include:
- Electrotherapy (TENS)
- Massage, mobilizations and tractions
- Mckenzie method
- Therapeutic exercises
In addition, the osteopath uses a holistic approach aimed at restoring functional abilities. Osteopathic manipulations of the skull, neck and surrounding areas often relieve symptoms.
Psychological work
No, the cervical hernia is not fictitious, and is not “in the head”.
On the other hand, stress and catastrophic thoughts can increase cervical tension, cause headaches, and worsen existing symptoms.
To this extent, work aimed at relieving stress and anxiety can help not to correct the cause of the hernia, but to relieve its consequences.
Techniques of breathing or meditation (like mindfulness) can help. In some cases, consult a psychologist can also be useful.
Infiltration
Infiltration is usually the last option before surgery. Cortisone is often used to calm inflammation.
To learn more about infiltration (and the different types), see the next item.
Cervical hernia and sport
Can you play sports with a cervical hernia? This is a question frequently asked by active people struggling with a neck problem.
Everything will depend on the physical activity practiced, and the severity of the pain. In the acute phase, it will often be necessary to take a break until the inflammation calms down. This is all the more true if the sport practiced involves physical contact, repeated movements (such as jogging) or heavy loads (bodybuilding, Crossfit, etc.).
Once the inflammation is under control, it is possible to resume some gentle activities that do not put stress on the cervical region. Swimming on your back, cycling or walking are examples of activities that are often tolerated in the presence of cervical hernia.
If the activity practiced causes too much pain, it will be important to use a gradual and safe approach so as not to make the pain worse. A physiotherapist is best able to support you in your return to sport.
Conclusion
The cervical hernia occurs at the level of the neck, and is caused by the migration of the gelatinous nucleus through the fibers of its envelope, the fibrous annulus.
Sometimes asymptomatic, it can still cause significant symptoms in the neck, arm and shoulder blade that limits everyday life and sports activities.
Appropriate treatment can relieve symptoms, and promote the return to work and daily activities.
Good recovery !
To learn more about herniated disc in general, see the following article:
Herniated disc from A to Z: Better understand your condition (symptoms and diagnosis)