“I’m really worried that I might have slipped a disc….”
“The patient is a 35-year old male physiotherapist presenting with severe, worsening right-sided neck and arm pain, and neck stiffness… He reports no previous injuries and has no medical conditions and is generally fit and well.”
This patient is me. I treat acute neck pain most days in practice – it’s one of the commonest spinal conditions. I never dreamt that I would become one of these patients. My learning curve has been massive and I’d like to share it with you, so first a little more background.
My main physical activity growing up was horse riding or, more precisely, showjumping. I rode most days and competed many, if not most, weekends. Most musculoskeletal clinicians would immediately assume this pursuit predisposed to my current neck problem – believing I must have fallen off my horse and created an injury pattern, but in fact, I never fell off that much.
Sure, there was the occasional fall over the course of 20 years but never anything that I’d consider clinically relevant or predisposing to serious musculoskeletal damage. (For that, I’d probably have had to have fallen badly onto my head/neck at some point.)
I stopped riding regularly about 10 years ago. To maintain my fitness, I got into gym training, using free weights and machine weights as well as some cardio. I’ve been pretty committed to it for the past six years and in the past year or two shifted to more functional, gymnastics training. I’ve been lucky enough to have had no injuries of note over this time.
My neck injury, or rather, the precipitating trigger for it, took place around 12 weeks ago. There wasn’t a single event but two or three small injuries that led to my severely deteriorating symptom picture. I can divide my injury journey into four phases.
Phase 1: The innocuous injury
I was at the gym training to do muscle-ups on the rings. This is a muscle up:
I had been training to do this for some weeks, but around 12 weeks ago I lost control of my right arm which jolted sideways.
I felt an intense sharp pain at the base of my neck. I didn’t pay it much attention and changed exercise. By the end of the training session, my neck felt very stiff and uncomfortable when I turned my head both ways, but mainly to the right. I have always had a bit of a stiff neck – and is the only part of my body that has ever given me any pain so I trusted that it would improve on its own as it usually did and decided to give the gym a miss. And it did improve! The pain and stiffness reduced over the following two days so I went back to the gym but took a break from muscle up training and stuck with my usual weights and cardio routine.
The following week I decided to give muscle-ups another go. I managed two, but as soon as I pulled myself up for the third one, I felt the same sharp pain at the base of my neck, more intensely than the first time.
This time I stopped and left the gym with the idea of going back to my clinic to ask one of my colleagues to treat me. A couple of days later, after one osteopathic treatment, which massively helped with the pain, I went back to the gym.
However, something had changed in the strength of my right arm. The pain at this stage was fairly minimal and I didn’t feel much else amiss apart from weakness when using my shoulder. I managed a few push-ups and a low-key shoulder workout but didn’t feel comfortable carrying on.
I didn’t know that this was to be my last workout for some time….
Three days later, my symptoms began in earnest. I developed severe shoulder and arm pain that extended to my triceps and forearm and felt like a strong gripping ache very deep within my arm.
I began to suspect this was the dreaded ‘slipped’ disc. Which my inner physiotherapist knew would get better, but first, it got worse….
Phase 2: It got much worse
Two weeks after the first painful episode, the gipping arm pain reached a peak that lasted about 10 days, which is a long time to be in constant pain (particularly for someone who has been lucky enough never to experience much significant pain). Night-time was worst as finding a comfortable position was impossible and I woke every hour*.
By now the neck pain had also come back so I was woken up by either sharp pain at the base of my neck or constant gripping arm pain. Codeine was useful at this stage and for a few days, it helped me to initially fall asleep. I didn’t want to rely on it too much so after about a week of taking it before bed I decided to stop and see what happened.
Throughout this period I was having osteopathic treatments at my practice once or twice a week. I found that the main benefits of treatment were as much psychological as physical, as I was able to completely relax and let somebody else look after my body for a little while.
The osteopathic treatments had to be very gentle but I would definitely get up from the plinth in much less discomfort. This could last for an hour or two before the pain returned, and gradually with less intensity. I was relying on manual treatment and codeine to sleep as these were the only two things that reduced my pain in this phase.
Phase 3: But then it got better
For the following three weeks the pain gradually reduced, and although I was still waking up at night it was only every three or four hours. My neck was still very stiff and rotation still triggered the sharp pain.
I decided to have an MRI scan (on my 35th birthday!) and the result was much worse than I had anticipated. Three moderate to severe disc protrusions (slipped discs), two of which compressed both nerves exiting the spine there, one of which was pronounced enough to intrude on the space where the spinal fluid is. On top of this, a considerable amount of degeneration was found throughout my neck – osteoarthritis – not a great birthday present!
And what could I do about it? The answer is basically nothing! If you are a young individual whose symptoms are improving, all you have to do is wait and let your body heal. Being able to access regular osteopathic and physiotherapy treatment was a godsend as it really helped with pain management.
Luckily, I was improving and woke less and less at night, as well as feeling less gripping pain in my arm, which eventually disappeared about six weeks after the very first gym injury.
Phase 4: Rehabilitation
A disc protrusion can compress the nerve roots at their spinal exits, which reduces transmission of the nerve’s signal down to the muscles it supplies. In my case, this involved mainly my pectoral and triceps muscles. The pain had disappeared, but after six weeks of nerve compression, the muscles were so weak that to my surprise I couldn’t do a push-up.
The feeling wasn’t just deconditioning (which you feel after weeks without training), it was muscle wastage (shrinking) and an inability to get those muscle fibres to contract. Scary!
I am now twelve weeks post-injury and have been focussing on rehab and retraining of the affected muscles on a daily basis, alongside manual treatment every two weeks. I feel much better and my muscles have started firing again.
However, I am still a long way from my level of fitness before the injury and I estimate it will take about three months to regain my full strength. My neck is still stiff at times and I have accepted that this might not improve given the level of degeneration (bony outgrowths from the spine) on the MRI. I am not in pain and I can do anything I want (or getting there) which I am very happy about indeed!
As a physiotherapist and osteopath myself, this experience has really helped me understand what so many of my patients go through. I was lucky as, even though my scan wasn’t great, I never developed more serious neurological symptoms, such as pins and needles down my arm, which a lot of patients report this type of neck disc injury.
It really made me appreciate that everyone is different and although an MRI scan can shed some light on the prognosis (how long it will take you to improve) the recovery process isn’t set in stone and can vary considerably depending on the individual.
A few points about spinal disc problems:
Disc injuries most commonly affect people in their mid-30s as the result of an acute trauma or underlying degenerative changes, usually affecting the cervical spine (neck) or the low back (lumbar spine).
Acute disc injuries like mine can lead to severe pain for six to 12 weeks (and in severe cases even longer).
Pain is usually a combination of neck/lower back pain and some degree of peripheral pain (arm or leg). Severe cases might experience neurological symptoms such as pins and needles or tingling and loss of muscle activation.
Disc injuries heal. Once the acute phase passes and the inflammation around the disc reduces the pain also improves.
Osteopathy and physiotherapy treatment is really beneficial! it alleviates the pain and provides the patient with a rehabilitation program to retrain the affected muscles.
If your pain didn’t get better with manual treatment and rehab you should seek the advice of a spinal consultant who will be able to assess the need for other treatment options such as a steroid injection or in the most severe cases surgery (although this is becoming rarer as we understand more about this injury)
*If I’d had the same sort of pain in my left arm, I would definitely have done some clinical tests to rule out a heart problem – as ‘gripping’ left arm pain is a classic symptom of a heart attack.*
Written by Pietro Susini
If you would like to know more about disc injuries or you think you have suffered one, call our reception team on 02077356813 to understand how we can help you with our physiotherapy and osteopathy services.”