Cervical Disc Injury

In the previous posts, I wrote about disc injuries and why Mckenzie extension exercise is important. This post will be about management of cervical disc injuries and cervical Mckenzie exercise.

Disc Healing time when there is no re-injury or compensation

Discs generally fully re-generate in 6~18 months. The pain goes away before that, but that’s because the inflammation is gone and the outer annulus of the disc is healed, the inner 2/3 of the disc does not have nerve innervation so we don’t feel pain even if they are still not fully recovered.

Why some peoples’ cervical disc injuries doesn’t get better even after 2 years or more?

I wrote that the healing time is 6~18 months IF THERE IS NO RE-INJURY OR COMPENSATION. The main reason why the disc injuries don’t heal is because either the patient is doing something that is re-tearing the annulus of the disc (which is usually protruding their head forward for a long time), or they are doing the Mckenzie exercise wrong.

In my personal experience, I’ve seen so many cases where the patient protrudes their head forward during the consultation and experience sudden pain, and they don’t realize that they had their head forward. Many people think forward head carriage is not a big deal as so many people nowadays have forward head carriage. As mentioned in here, the head can put up to 27kg(60lbs) of force on the neck which would be pressuring the disc nucleus to move backward. Our head doesn’t weigh 27kg but the back muscles add downward force on the neck in order to hold the head up. 27kg is about the weight of a 6~8 year old boy or a 50 inch TV. Considering our disc diameter is about 1.5~2cm and 0.7~1cm thick, this is a significant stress on the spinal discs. Also with office workers, we hold this position for 8~11 hours in front of the monitor.

In order to preserve our disc as long as possible without disc pain, we must reduce the activation of neck muscles by bringing our head back to neutral position.

Cervical Mckenzie Exercise

How to

To bring the protruded nucleus forward, we have to tilt our head back like so in the photo, but we also need to squeeze the shoulder blades together to push the upper thoracic spine forward. Without the shoulder movements, the lower cervical spine will not move into flexion too much. I recommend doing 5 second holds 20~30 times everyday.

If this exercise causes pain, it means you are tilting your head back too much. Because in severe cases, the inflammation is big, it will cause inflammation when the head tilts back too much. Stop the head tilt right before the angle where the pain kicks in, and repeat the movement in that pain-free range.

Some people get pain even if they are tilting their head back slightly, this is because they are lifting their chin only. This will create extension in the upper neck, but more flexion in the lower neck. Considering most of the cervical disc injuries are at the lower cervical spine, this is a very bad thing to do. You must make sure you are tilting the whole neck back, rather than just lifting the chin.

Additional notes

But as mentioned in my previous post, the key about disc rehabilitation is to hold the head tilted back as long as possible THROUGHOUT THE DAY, rather than doing the Mckenzie exercise. The exercise is only a part of the treatment, of course it is important, but if you keep looking down after doing this exercise, there won’t be any improvement.

The most common thing that I noticed in patients who doesn’t improve is they don’t take this exercise seriously, and also don’t fix any of their daily habits nor environments. They tend to believe the chiropractors hands will automatically fix their posture and pain. These people also tend to buy a lot of exercise equipments or massage balls, in the subconscious belief that buying the exercise equipments or massage balls will automatically fix their issue. Unfortunately, we cannot do the exercise for someone else. There is only one way to strengthen a bicep which is to lift heavier weights, same goes with rehabilitating the disc, there is only one way to push the disc forward which is to do the Mckenzie extension exercises.

The efficay of Mckenzie exercises can be seen here, and here.

Chin Tuck exercise is NOT RECOMMENDED

You will notice that the mid cervical disc, in this case C5/6 disc is being pushed backward with chin tuck. This is because of the muscle vectors are forcing downward on the anterior aspect of the vertebral bodies. Therefore chin tuck exercises are not recommended.

Also note that although this patient did not bring his shoulders back (may be because this is an MRI), we can see that the upper cervical disc is being pushed forward in terms of its nucleus which is what we want. This is why I recommend doing cervical Mckenzie exercise.

Monitor Position

Recent ergonomic guideline states that the top of the monitor should be at eye level, but I think this is wrong. Guidelines are for people without any disc injuries, I think the bottom of the monitor should be at eye level. It would be uncomfortable because you can’t see the keyboard, but if you try it, you will see the difference.

Phones

It might look a bit funny, but also have the phone above your eye level so that you don’t look down. You might think people are looking at you weird but they won’t remember you when they go home, just pretend your searching for connection.

Focus

It’s embedded in our DNA to protrude our head forward when we focus on something. But these positions were held no longer than few seconds to few minutes. If we hold the forward head posture for hours everyday for years, its inevitable that we will get cervical disc injuries. The reason why I’m mentioning this is because I know it’s not an easy thing to resist something that’s embedded in our DNA. What I want to preach out is that if we act like we are in primitive era in the modern world, we will start to get pain and become unfit for work. So to use our body wisely, we must adapt to the modern world by having our head back.

Conclusion

To sum up, do the Mckenzie exercise and have you head tilted back all the time.

Change your work environment, and also your home environment. Your computer, TV, chair, desk and everything.

It’s very tempting to bring your head forward but don’t.