Cervical Disc Dysfunction

Intervertebral discs are strong and robust structures that lie between vertebrae. Their function is to absorb shock and allow for effective movement of the spine in all directions while acting as tough structures that allow the spine to tolerate load and compression ^{(1, 3)}. For this reason, they cannot “slip”. The outer region of the disc (the annulus fibrosis) surrounds the soft inner core of the disc (the nucleus pulposus). Cervical disc dysfunction is an umbrella term that refers to a process where the intervertebral discs lose height and hydration. Cervical spondylosis may also occur, which refers to these discogenic changes, plus changes to the surrounding joints and soft tissues ^{(4, 5)}. Both are thought to occur with age because as part of the ageing process the discs can dehydrate, lose elasticity and reduce in height, which can lead to pain and decreased function. However, not everyone will have symptoms as a result of these changes ^{(1, 6)}.

Cervical disc dysfunction is often caused by normal, age-related changes, combined with excessive stress/strain on your neck. As people age, the water content within the discs reduces. This can cause them to become less flexible, begin to shrink or bulge/herniate; however, these changes are often completely normal ^{(1, 2)}.

Our bodies adapt to what we do on a daily basis and so the more we move, the more our discs are exposed to this and can tolerate these movements. Excessive stress in a particular direction, or a decrease in movement, can increase the strain on the discs leading to pain ^{(1, 2)}. Disc related pain can also be caused by any traumatic events such as falls, car accidents and sports injuries.

• In the general population, the point prevalence of neck pain ranges from 0.4% to 41.5%, the 1-year incidence ranges from 4.8% to 79.5%, and lifetime prevalence may be as high as 86.8%.
• Studies report that although the prevalence is similar between genders (60/40 F:M), symptom severity increases in males ^{(3, 4)}.

Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis. Your clinician may perform a series of tests to examine the range of movement of the neck, test the strength of the muscles in your arm and check your reflexes and sensation.

Your treating clinician will want to know how your condition affects your day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made. Imaging studies like magnetic resonance imaging (MRI) or X-ray are not required to achieve a working diagnosis. However, in persistent cases that have not responded to a period of appropriate conservative management, they may be warranted.

As part of the sessions with your physiotherapist, they will help you to understand your condition and what you need to do to help you recover. This may include reducing the amount or type of activity, as well as other advice aimed at reducing your pain. It is important that you try and complete the exercises you are provided as regularly as possible to help with your recovery. Rehabilitation exercises are not always a quick fix, but if done consistently over weeks and months then they will, in most cases, make a significant difference.

For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.

As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering, you might benefit from a further assessment to ensure you are making progress and to establish the appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.

• Medication – you might benefit from specific medication options prescribed by an appropriately trained healthcare professional.
• Surgery may be considered as a last resort if there is severe nerve compression, or where there are persistent symptoms that do not improve with conservative management ^{(8, 9)}.