Just like how sciatica/ leg pain is usually caused by a bulging disc in the lower back or by a muscle pinching the nerve, arm pain and/or numbness & tingling is usually caused by a bulging disc in the neck or by a muscle pinching a cervical (neck) nerve root or plexus.

The nerve roots that come out from between your cervical vertebrae converge to form three main nerves that service the arm: the ulnar, median and radial nerves. If any of these nerve roots are pressed by a bulging disc, a bone spur or thickened ligament, it usually causes radiating (traveling) pain from the neck down the arm; usually all the way down to the fingertips.

The specific area of pain/tingling depends on which nerve root is being pinched. In fact, that is how doctors diagnose the precise problem area. For example, numbness down the medial (inner) side of the forearm down to the pinkie and ring finger can be produced by compression of the C8 & T1 nerve roots. Numbness in the outer forearm, thumb and first two fingers is associated with the C6 & C7 nerve roots.

Radiating arm pain can also be caused by thoracic outlet syndrome, where muscles near the neck and upper shoulder pinch the nerve plexus (where the roots converge). This will be next week’s topic.

Self Treatment for Radiating Arm Pain

If you have significant neck pain accompanying your arm symptoms, then it is likely you have a bulging disc in your neck. It feels like a focused, sharp pain deep inside the neck on one side. Massage does not help this kind of pain.

Most mild to moderate cases of cervical disc bulges resolve with exercises and manual therapy. The severe cases usually require surgery to remove the disc portion that is pressing against the nerve. If you have a severe case, get a consultation from a spinal surgeon and a second opinion. If done in time, surgery can resolve the arm pain, but if the entire disc is removed the surgeon will fuse the vertebrae above and below the disc which will reduce your neck range of motion somewhat.

If the disc bulge or offending structure is allowed to compress the nerve root for an extended period it may result in permanent injury to the nerve. This means after surgically removing the bulge, you still may have numbness down the arm. This is why, for nerve compression conditions, time is of the essence.

Non-surgical candidates can do exercises to reduce the bulge size. For typical posterior bulges (bulges that protrude towards the back and one side of the vertebral body) try this: while standing, use your posterior neck muscles to pull your neck straight back, as far as you can; hold for 3 seconds. It may feel uncomfortable if your disc bulge is acute. Keep your chin tucked in so that the top of your head is level. Do eight times, twice a day for a couple of weeks; note changes in your neck pain and arm pain. Discontinue if it aggravates your condition. This movement gently presses the backs of the vertebral bodies together, which pumps the disc bulge back to center.

If the exercises help but you hit a plateau, try side bending your neck towards the side of the pain, very slowly; repeat six times. Again, note changes; discontinue if it aggravates the pain.

Recommended Lifestyle Changes

Forward bending of the neck and anterior weight bearing of the head (forward head posture) tends to make the cervical discs more vulnerable to bulging because in this position the vertebrae press the front part of the discs, pushing the jelly center (nucleus) towards the back.

Axial forces (straight down through the spine) to the neck can also make disc bulges worse. Any activity that involves jumping creates axial forces — running, basketball, gymnastics, mountain bike riding, sky diving, etc. It’s not a concern unless you do it frequently.

If you have a bulging disc in your neck with arm pain, here are some suggested lifestyle changes:

• Use a contoured neck pillow and sleep on your back.
• Work on improving your posture: eliminate forward head posture.
• Get a standing desk if your job requires a lot of sitting– it’s better for your back and neck.
• Use the Cervical PosturePump device to hydrate your cervical discs
• Strengthen your neck muscles so they offer more support to your neck.
• Avoid excessive jumping. If you like running, consider getting Z-coil or Gravity Defyer shoes (see below).

Treatment Accessories to Reduce Arm Pain from Disc Bulge

PosturePump Disc Rehydrator

This device uses specially designed air bladders, inflated by a hand pump to spread apart and extend neck vertebrae. This expands the discs, drawing in fluids and nutrients and also stretches the neck into its normal, ideal curvature.

 

 

Anti-Shock Specialty Shoes

These specially designed shoes have powerful springs in the heel that significantly dampen the forces generated from running. Less shock to your feet, ankles, knees, hips, low back and neck.

 

 

 

Vari-Desk Height Adjustable Portable Desk

Place this lightweight desk on your traditional sit-down desk and switch its height between standing and sitting in less than five seconds. Choose to stand for as long as you like, then switch back– great for easing into standing while working, if you’ve been a desk sitter for many years.

The cervical spine is the thinnest and most flexible part of the human spine.  It is tasked with supporting the weight of the head in the upright position while allowing turning in multiple planes — looking left, right, up, down and behind.  It also contains structures directly tied to life sustenance, which is why the neck is a logical target when it comes to martial arts/ self-defense and restraint (and unfortunately, murder).

Given all these vital functions, it is wise to take good care of your cervical spine in a proactive way.

The cervical spine is naturally designed to curve, where the apex is at about the level of the Adam’s apple.

This curve behaves much like a spring in a car’s suspension; or the slight upwards curve you see in any bridge design.  Long ago, architects discovered that the load capacity of bridges could be dramatically increased simply by integrating curves or arcs into the design.  Like a neck curve, a bridge curve or arc distributes weight over a greater area so that gravity cannot concentrate over one small area and cause structural failure.

If the neck curve helps distribute the weight of the head in the upright position, what do you suppose might happen if the curve straightened out or started to bend in the opposite direction like the one to the left?

If you lose your cervical curve over time, which could happen from years of poor posture or trauma like multiple rear-end car collisions, you will probably not notice it until several years pass.  The change in biomechanics shifts a greater burden of support to your cervical discs and vertebral end plates.   This promotes disc degeneration.   The once thick and healthy discs lose fluid content, lose strength, allow the center material to bulge out (herniate, protrude or rupture) and cause bony protuberances called osteophytes to form all around the edges of the vertebrae and facet joints.

For some unfortunate people, the bony projections narrow the passageways where the nerve roots and spinal cord pass through (a condition called spinal stenosis) and neck surgery is necessary to prevent nerve tissue from permanent damage, paralysis and severe paresthesias (numbness, tingling) in both the arms and legs.

So the bottom line:  be conscientious about the importance of the health of your cervical spine.  Don’t get blind-sided by an MRI diagnosis of “multiple-level, severe degenerative disc disease with advanced neural encroachment.”

I’ve seen such cases where patients were oblivious to what was developing inside their necks.  They dismissed their neck stiffness and aches to “getting older” or simple muscle strain.  When massage and chiropractic provided only temporary relief, they had a cervical MRI done which revealed the formidable origin behind these symptoms, and the next step was neck surgery.  Neck surgery of this nature involves removing the damaged disc, shaving off the osteophytes and inserting a bone graft to promote fusion of adjacent vertebrae.

Prevention is the best approach.  You don’t have to have neck problems to start preventive measures.  In fact, the vast majority of patients who have early to moderate stage degenerative disc disease have no complaints.  It’s like a cavity — you don’t feel anything as the pit erodes the tooth enamel, but as soon as it hits a nerve, you will definitely be aware of its presence.  But by that time, you’ll need invasive procedures.  In the case of a cavity, it means either a filling or tooth extraction; in the case of a cervical disc, it might mean cervical decompression surgery.

Below is a video that summarizes the importance of maintaining a healthy cervical curve (“lordosis”) and exercises to maintain or restore your neck curve so that it can better withstand the physical demands placed on it and hopefully preclude the need to visit an orthopedic surgeon years down the road.

The underlying theme of this blog is that by making strategic changes in your daily routine, you can save yourself a lot of pain and dysfunction now and later on in your life.  And it’s my desire to share with you some of these simple changes.

Isn’t this a simpler and smarter way to live, rather than being indifferent or oblivious to the fact that your body slowly loses its resiliency as you age, and not taking appropriate, protective measures?  If you perform regularly scheduled maintenance to your car, it will last a lot longer than if you do not.  The same goes for your body, but the stakes are a lot higher.

One Popular Reason Why People Develop Pain

The problem I see is that most people forget that when you are in your 20s and 30s you can get away with things like prolonged sitting, staying out late and eating unhealthy things like burgers and fries frequently.   At that age your human growth hormone is still giving you that fountain of youth energy and your musculoskeletal system, especially your joints, is still in good working order.

However, through your 40s-60s, your job and/or family responsibilities increase and you have less time for yourself, and you think you can take the same abuse that you took in your earlier years.  This is where problems start to manifest.

You see, health problems such as degenerative disc disease take years to develop.  Take an x-ray or MRI of your neck or low back, and all those nasty osteophytes, thinning discs and crooked spines you see didn’t start yesterday.  They started perhaps ten or more years prior.

So, you are either in a situation where you can do lifestyle modifications to reduce the chances of disorders like this from affecting your health and quality of life; or, you already have the disorder, but need to find ways to stop it from progressing and/or reduce its impact on your health and quality of life.

You see, as long as you are alive, your cells have the capacity to regenerate or transform.  Depending on the current state of your health and therefore your body’s recuperative capacity, it could take a long time or a relatively shorter time to see results.

For example, if you are overweight; a smoker and drinker and have a negative impression of life, those serve as extra barriers to healing.  Get rid of them, and you’ve got a better chance.

A Simple Exercise to Do Daily if You Sit a Lot

Back to those “lifestyle modification” tips that can help you avoid a life of pain.

Here is today’s example, an exercise called Wall Angels.  If you find yourself having a slouched upper back, rounded lower back and forward lunging neck, you’ve got to try these.  When done regularly, they can help restore and maintain good posture.

Posture affects your spine, joints, muscles, breathing, energy levels and sometimes even mindset.  It is critical to have good posture if you expect to achieve optimal health in your life.

Give it a try; all you need is an empty wall with no obstructions:

Recently, Carrie Ann Inaba, one of the judges of the show Dancing With the Stars publicly announced that she has been suffering for quite some time from cervical spinal stenosis– a condition in which the canal that encases the spinal cord in the neck narrows and obstructs nerve tissue.  She explained how her condition impacts her life, limiting her from doing the things she loves to do.  To Carrie Ann’s dismay, she no longer dances with a partner for fear of getting whiplash and paralysis.  That’s quite unfortunate for someone whose entire career revolved around dancing.

Although spinal stenosis is a generalized term for narrowing of the spinal canal by any cause, the most common type, which will be discussed here, is the type caused by osteophytes— growth of bony projections that narrow the openings where nerves pass through.  Advanced osteophytic activity is also referred to as spondylosis.  When it is severe enough to narrow the spinal canal (foramen) it then creates the condition known as spinal stenosis.  For your information, other forms of spinal stenosis are those caused by herniated discs, spondylolisthesis, tumors or any mass that encroaches into the spinal canal.

In her article, Carrie Ann mentioned that spinal stenosis is a form of arthritis and that she is anxious to find a cure for it.  Unfortunately spinal stenosis is not one of those conditions that can resolve on its own with rest, exercise and time and other non- invasive measures.  And since the inflammation from spinal stenosis is secondary to irritation of nerves, it is technically not a type of arthritis.  That is why anti-inflammatory medications have minimal effect on the pain associated with spinal stenosis, which is typically deep, sharp and radiating in nature.

Spinal stenosis occurs when vertebrae, the bones that comprise the spinal column gradually morph in a way that constricts the spinal foramen (canal), or space where the spinal cord resides.  When there is less space for the spinal cord to move, it is subject to more abrasion with spinal movement; i.e. bending and turning your neck.  The cord (actually, meninges or covering of the cord) rubs against sharp edges of the bony projections into the foramen with movement causing inflammation and injury to the nerve tissue, sometimes causing sclerosis (hardening).   In advanced cases, especially  cases of lumbar spinal stenosis (due to the more significant weight burden) the narrowing gets so advanced that there is constant pressure on the nerve roots.  At this point, it is an emergency situation as renal function and sensation to the legs are affected.

Signs of advanced spinal stenosis include paresthesias, sharp pain with movement, weakness in the extremities, and muscle atrophy in legs and/or arms.  Symptoms can be permanent if not treated early.

And what is the treatment for spinal stenosis?  First of all, doctors will usually order MRI and x-ray to determine extent of narrowing.  If it is caught early, physical therapy and lifestyle modification is recommended.   The goal is to slow down or stop the progression of the narrowing.

Surgery is the only option for advanced cases.  Since spinal stenosis involves physical structures compressing nerve tissue, there are surgical procedures that can enlarge the spinal canal by scraping off the encroaching bone material and buy the patient more time.  Since bone is comprised of live cells, the movement of bony projections (called osteophytes) into the spinal canal is still likely after surgery and many who have had such spinal decompression surgeries develop the same problem several years later.

It’s not quite evident why some people suffer from spinal stenos more than others.  But those who have a history of physical trauma to the spine like car accidents, sports injuries and falls are at a higher risk.  The theory is that the injury event disrupts the normal alignment of the spinal segments resulting in accelerated wear and tear over time;  much like how a loose screw in a machine accelerates mechanical failure.  Some orthopedists hypothesize that the appearance of bony projections is the body’s attempt to fuse and stabilize adjacent vertebrae so they can no longer move separately; thus reducing the probability of injury.  However, the nerves that share the space with the vertebrae get damaged in the process.    If this theory holds true, then it is an inherent design flaw of the body’s self-healing mechanisms.

Also, heavy smoking and obesity, and general poor health can increase your chances of developing spinal stenosis.

I’m sure more than one doctor broke the news to Ms. Inaba that there basically is no “cure” for spinal stenosis once it is in its advanced stages, which appears to be her case based on her own description of her symptoms.  It is a mechanical condition that mandates mechanical intervention.  No amount of drugs will cure spinal stenosis from advanced osteophyte formatioin.   Her only option at this point is spinal decompression surgery to widen the spinal canal and hope that the nerve tissue did not sustain permanent damage.

The best strategy for dealing with spinal stenosis is prevention.  If you sustained injury to your spine from a car accident (even a low impact one that did not require medical treatment), a sports injury (including repetitious trauma like that related to gymnastics and football) or slip and fall, realize that “the seed” for spinal stenosis may have been planted in you already.  If your injury event was over five years ago, get an x-ray to identify any levels where osteophytes are present; these are the sentinels of potential areas of spinal stenosis as they identify areas of biomechanical weakness.  If there are some, the first course of action is to not worsen things.  Avoid or reduce activities that regularly place trauma to your spine.  Engage in specific exercises that strengthen the neck and lower back to offer more stability.  Stretch often (yoga is a great choice) and take care of the insides of your body as well with proper diet, nutrition, hydration and adequate rest.

Lastly, the Cervical and Lumbar Posture Pump is a home rehabilitation device that tractions and separates vertebrae to hydrate the discs and increase nutrient absorption which can slow down the progression of spinal stenosis if done diligently on a regular basis.  I have personally used them in my practice, and patients reported positive results.

A recent study in the Annals of Internal Medicine compared the effectiveness of chiropractic spinal manipulation, pain medications, and home exercise and advice in treating biomechanical neck pain.

The study participants were 272 people between the ages of 18 and 65 who complained of non-specific neck pain for 2-12 weeks.   They were divided into three groups, one of which took medicine only; one which received spinal manipulation to the neck only, and a third group that was just given home exercises and self-care advice.   Participants were asked to rate their pain at 2 weeks, 1 month, 2 months, 3 months, 6 months, and one year.    The method the study used to grade the pain was subjective rating (probably using a visual pain scale between 0 to 10, with 0 being no pain and 10 being the worst pain) and a Health Status questionnaire asking them their level of ability to engage in certain activities.

The patients treated by a chiropractor experienced the highest rate of success with 32 percent saying they were pain free, compared to 30 percent of those who exercised. Only 13 percent of patients treated with medication said they no longer experienced pain.

The conclusion of the study was that for participants with acute (recent onset) and subacute (usually meaning lasting more than two weeks) neck pain, chiropractic spinal adjustments were more effective than medication in both the short and long term. However, a few instructional sessions of home exercises and advice resulted in similar outcomes at most time points.

My comments:

Biomechanical neck pain can lower the quality of life significantly.  Imagine having to struggle to turn your neck all the time, and having to avoid exercise, sports and many recreational activities due to neck pain.  According to the researchers, neck pain affects 70% of adults at one point in their lives.

From my experience, biomechanical neck pain typically arises from some type of past trauma, and it doesn’t have to be major.   Examples include car accidents, sports injuries/impacts, horseplaying as kids; and hard impact generating activities such as running, horseback riding, parachuting, gymnastics, boxing, martial arts, and cheer leading.

A second, possible cause of biomechanical neck pain is ergonomic in nature; meaning, related to positioning of the body.  Long hours of desk work keeps the head relatively stationary (static) in a single position, allowing gravity to pull down on the head, over time altering the weight distribution on the joint surfaces of the bones that make up the neck.  Such an “activity” also promotes muscle deconditioning around the neck.  The term “deconditioned” means that the muscle is slower to respond to nerve commands, so it loses some ability to support,  guard and protect the cervical spine (neck).

The worst combination is someone who has a history of impact trauma to the neck who later gets a job that involves working at a desk for long hours at a time.  The trauma history sets the stage for neck pain, and the static positioning of the head accelerates the process over time.

The pain in biomechanical neck pain frequently originates in the joint surfaces of one or several cervical vertebrae, commonly the posterior facet joints (also called the zygapophyseal joints).  This is where most of the movement occurs when turning and bending the neck.    Orthopedic surgeons sometimes prescribe a facet block for neck pain, which is an injection of pain medications directly into the joint, usually guided by video fluoroscopy.  If the patient has degenerative disc disease, pain can emanate from the intervertebral discs, either as a disc herniation or internal tear of the disc.   If this is the case, neck surgery is typically the last hope.  The disc herniation may be able to be reduced by surgery, but if the surgeon feels that the  disc is beyond repair, discectomy (total disc removal) with surgical fusion is usually performed.  However, this is like trading one evil for another.  Surgeons know that when you fuse two vertebrae together, the vertebrae above and below the fusion bear an increased burden of providing the movement lost by the two fused vertebrae.  This will lead to accelerated degenerative changes to those areas as well, over time.

Neck pain can also emanate from the surrounding muscles and fascia.  Myofascial trigger points are focal, tender spots along a muscle that are believed to develop from trauma or microtrauma.  They may actually be a concentration of nerve endings on the muscle that developed following an injury.  These are best handled through manual therapies such as chiropractic, massage, exercises and stretches.

Some people get inexplicable muscle spasms of the neck.  This is usually accompanied with a migraine or tension headache.  A muscle spasm occurs when the nerves that control the muscle misfire, causing the muscle to maintain a constant state of hypertonus (involuntary contraction).  This results in muscle pain, fatigue and low grade inflammation.   Sometimes the spasm can be so intense that anti-spasmodic medications, ice, heat, and rest have no effect.  In cases like this, botox injections are sometimes used.  Botox injections are comprised of a weakened strain of the Botox bacteria, which has the effect of muscle paralysis.

Lastly, it should be mentioned that a poor, nutrient-deficient diet and smoking can make neck pain worse by denying the body critical nutrients needed for repair and maintenance of muscles, ligaments, tendons, nerves and bones.

The study, while emphasizing that chiropractic manipulation was superior to medications in reducing neck pain among participants, also mentions that home exercises and advice were just as effective.    It therefore seems natural that a combination of spinal manipulation and home exercises would be a good strategy to reduce or eliminate biomechanical neck pain.

If you are experiencing non-specific neck pain (don’t really know what caused it) for over two weeks and desire to try chiropractic, it’s important to choose a good,  qualified chiropractor.   Some of the signs of a good, reputable chiropractor are:

1.   Doesn’t try to convince you to purchase a long-term treatment program involving multiple adjustments per week.

2.  Asks you about your complaint:  the nature of your symptoms, how they started, how long you’ve had these symptoms,  how they affect your ability to do certain things; and questions regarding your general health.

3.  Gives you his/her diagnosis and uses standard orthopedic terminology that is consistent with what you are coming in for (doesn’t go off subject).   It meshes with the information you provided in #2 above.  You feel that the chiropractor listened to you, and responded with a meaningful solution that is clear to you.

4.  Gives you a treatment recommendation the same day:  the type of treatment and a brief description of it (spinal adjustments, modalities, supports); what to expect from the treatment, and approximately how long it will take.   The chiropractor should also disclose potential  risks and side effects of the treatment.   In my opinion, six treatments followed by a re-evaluation is a sensible treatment approach for most cases of subacute, musculoskeletal pain.

A chiropractor like this may or may not have a lot of reviews on the internet.  Use your judgement, ask friends and co-workers for referrals, and by all means, don’t be afraid to change chiropractors if your first choice turned out to be bad.

Regarding home exercises and advice for treating biomechanical neck pain, stay tuned!  I will be putting up an information-packed neck pain relief video on this topic shortly.

 

Related articles

• Questions to Ask Your Doctor About Neck Pain (everydayhealth.com)
• Why Do I Have Neck Pain? (everydayhealth.com)