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Best Exercises for Herniated Cervical Disc

by Jaydee Vykoukal, PT, DPT October 16, 2019 0 Comments

Woman on yoga mat stretching her neck

The seven cervical vertebrae of the spine house all of the nerves that go to (and from) the arms and neck. Thus, a herniated disc can become a big problem. If your symptoms are mild to moderate, or your physical therapist approves, cervical herniated disc exercises are a great place to start. Conservative treatment should always be your first step in the recovery process.

When a herniated, or bulging disc is putting excessive pressure on your spine and surrounding neck tissues, it leads to symptoms such as numbness, tingling, shooting pain, aching and weakness in the neck, shoulders, arms and hands. How far these symptoms go into the arms and what areas it affects depends on which disc is injured and the severity of the bulge.

    How Neck Exercises Help a Herniated Disc

    Disc injuries in the neck respond well to stretching and strengthening exercises. They are of particular importance in the neck because of the high amount of mobility this area allows (so that you can do things like turn your head and look up). Thus, there is a lot of room for tissue imbalances that can quickly lead to chronic pain and leave you feeling stuck. With the right attention to the neck and upper body, restoring the delicate balance of flexibility and strength can yield immediate results.


      NOTE ON CENTRALIZATION:
      When symptoms spread further into the arms and hands, this is a sign of worsening spinal nerve damage, known as peripheralization or cervical radiculopathy. With any type of exercise program, the goal is to avoid peripheralization and promote centralization.  Meaning the symptoms are receding from the hands, arms, and shoulders and into the neck where the actual disc injury is. This may cause your neck to feel more sensitive, this is normal.

        *Consider talking to a medical professional if you’re not sure what you should be doing

        Neck Stretches

        Tension build up and muscle spasms in the neck are extremely common, cervical disc herniation or not. When the neck is tight, it increases pressure on all the tissues of the spine including the nerves, joints, muscles, and maybe even the spinal cord.  This can ultimately lead to the classic sensation of a pinched nerve. Taking the time to loosen these areas up will typically help you feel better quickly. 

        Chin Tuck

        When your neck hurts, chances are you’re holding yourself in a tense hunched posture.  This is bad for your discs and feels terrible on all the muscles in your neck, particularly the small muscles that attach to the base of the skull (a notorious spot for headaches).  To restore balance, try a chin tuck. Start by lying on your back to get the form down, then you can progress to doing it in sitting. With the back of your head touching the floor (or a small pillow if needed for comfort), think about bringing the chin down toward the floor without lifting the head off the floor or bringing tension into our shoulders.  It will feel awkward and it should result in a “double chin” if done correctly!  When progressing to sitting or standing, make sure you are keeping the motion small (more of a pivot motion) and not just bending your entire neck down toward your chest.

        Hold 3-5 seconds 10-15 times, focusing on keeping the shoulders relaxed.  Repeat throughout the day as needed. You can also try a longer hold while lying down (try putting a rolled towel at the base of your head for extra stretch).  Hold it for 2-5 minutes while focusing on deep relaxing breaths.

        Lateral Bend

        This is a great way to stretch the upper trapezius muscles in the neck, the most notoriously overused and tense muscles.  In a relaxed seated position, you will simply bring one ear toward the same shoulder until you feel a stretch in the side of the neck.  Make sure to keep your nose pointing forward (no rotation in the neck) and the shoulders relaxed and low, not letting them hitch up toward your ears.  You can try sitting on your hand, holding onto your chair, or bringing your hand behind your back to help with this. 

        Hold 30-90 seconds 2-3 times on each side.

        Upper Back Joint Mobilization

        The upper back can be left feeling stiff and stuck in a hunched position when dealing with chronic neck pain. Conversely, a tight mid-back can put extra strain on the neck. Alleviate it by lying on the floor (knees bent) with a rolled towel under your upper spine. The towel should be directly under your spine from about the mid-back up to shoulder height. Start with a small roll and build up as you are comfortable. When in this position focus on taking relaxing deep breaths, on your exhale reach your arms overhead as far as is comfortable (increase range as tolerated). Stay slow and controlled as you return them to the starting position. Make sure you aren’t letting the back arch, meaning you may need to gently tighten the abs. If you’re feeling ambitious, you can even try a foam roller under your entire spine (this requires some balance).

        Repeat 10 times, repeat throughout the day when you notice back stiffness or poor posture settling in.

        Neck Rotation Stretch

        This is a simple motion that can help you regain lost mobility in the neck. Make sure to keep it comfortable and in good posture (no forward head or slouching). Simply turn your head to one side as far as you can and hold for 5 seconds. Relax and turn to the other side when ready.

        Repeat 5 times to each side as needed.

        Chest Stretch

        Chest tension may not seem related to a herniated cervical disc, however the pectoral muscles are the place where all the nerves from the neck branch into the arms. Thus, tension here can exacerbate any nerve symptoms you are already experiencing. Finding a wall or doorway, bring your arm (elbow bent at a right angle) up until it is in line with your shoulder while resting on the wall. Then, gently lean forward with your body until you feel a stretch in the chest. You can play with your arm position (a little higher will target different muscle fibers). Make sure to keep good posture throughout. You can try stretching the entire chest at once if you can find a doorway to prop both arms at once.

        Hold 30-90 seconds 2-3 times. Onset of tingling is normal, adjust and rest as needed to minimize this.

        Chin Tuck Side Bend

        This is a great combination movement that can release tension in the neck. Bring your neck to one side (as explained in “lateral bend” above). Then, add a tuck of the chin (see “chin tuck” above). Playing with the exact position can help release any stubborn tension that won’t go away with any of the other techniques listed above.

        There are two ways to complete this stretch depending on what feels good to you:  Hold 30-90 seconds 2-3 times. OR gently move in and out of the position 10 times.

        Neck Exercises

        Wherever there is a lot of movement and mobility (such as the neck), sufficient spine stability via good muscle control is so important.  This stability typically needs to be restored after a neck injury by focusing on good posture and strength.

        Thoracic Extension Mobilization

        Lie on a towel roll with your knees bent, this time putting it parallel to your spine (adjust size to your tolerance). You are specifically targeting upper back pain so you should adjust and move the towel to different problem areas as needed. Support your head with your hands as you extend your upper back into the towel. Imagine you’re creating an arc around the towel with your spine, while avoiding arching the low back. This movement helps to increase mid-back movement and decrease strain on the entire spine. You may even experience some relieving cracks in the spine.

        Repeat 10-15 times, moving slow and controlled. You can progress to using a foam roller if comfortable, this is significantly more aggressive!

        Scapular Squeeze

        Squeezing the shoulder blades together helps restore balance to the entire trapezius muscle, relieving tension from the upper shoulders. This facilitates better use of the scapular muscles by promoting proper engagement all the way down the thoracic spine. To start, imagine there is a quarter between your shoulder blades that you want to pin there by squeezing your shoulder blades. As you bring the blades together, keep the neck relaxed and gently push your chest forward. If your shoulders rise toward your ears, stop and try again with a smaller range. If done correctly, you should feel a slight stretch in the chest.

        Hold 3-5 seconds, 10-15 times.  Repeat a few times throughout the day. 

        Neck Extensions

        Be cautious with this movement, as it can easily exacerbate symptoms if completed too soon or aggressively. Sitting in a supportive chair with optimal posture, lift the chin up to look toward the ceiling, Keep a comfortable range and move back and forth slowly. Pay attention to your symptoms, as they should be centralizing rather than progressing into the arms further.

        Repeat 10-30 times periodically throughout the day if tolerated.

        Prone Shoulder Blade Retraction

        This is a great progression from shoulder blade squeezes that further promotes better balance between the neck and thoracic muscles.  Start by lying on your stomach, your head needs to face forward (into the floor) so you may want to put a small towel roll under your forehead for comfort.  Stretch your arms out in a “T” so that they are in line with your shoulders. You will then lift your arms a few inches off the ground while squeezing the shoulder blades together. Focus on using the muscles in the mid-back while avoiding neck use and tension.

        Complete 10-15 times for 2-3 sets. Repeat as needed throughout the day.

        How to Stay Safe While Exercising the Neck

        The biggest issue that you might run into when starting an exercise program is trouble with keeping the neck relaxed.  If the neck feels tense it can make your symptoms worse. Combat this tension with attention to your form, decreasing the range and intensity of exercises, and taking deep cleansing breaths.

        Maintain Good Posture

        Make sure you stay aware of your posture since posture also plays a big role in the dynamics of the spine. Check in with yourself periodically throughout your day, particularly with exercise, to make sure you’re posture is good. If you’re not sure what good posture is, try using a mirror for visual feedback and talk to your physical therapist about your posture. When your form is optimized, you can safely complete exercises without irritating the neck.

        Avoid Certain Activities

        When completing your exercise program for a herniated cervical disc, avoid activities that increase disc, nerve root and spinal cord pressure to allow proper healing. This means no breath holding, heavy lifting, poor posture, extreme ranges of neck motion, or long periods of time with your arms over your head. As your symptoms improve and the neck heals, you can slowly start incorporating some of the more functional movements back into your routine.

          Tips for Maximizing Results:

          If you’re struggling to keep your neck relaxed or can’t seem to keep a good posture. You may need to take some time to address some of the underlying tension in your body first. Here are some great tools to address those problem areas:

          • Foam roller. A great way to progress your thoracic extension and upper back mobilization exercises (see above explanations). If tolerated, simply rolling up and down the spine can help release tension as well.
          • Massage ball or cane. Target more specific knots in the neck muscles and upper back with these.  A massage ball works great against a wall or on the floor to address shoulder blade and mid-back tension.  For those hard to reach spots in the back or top of the shoulders, try a cane.
          • Neck stretcher. Getting your head and cervical spine in a “weightless” position with this type of tool can instantly erase tension in your neck that has built up. 
          • TENs unit. Promote temporary pain relief, relaxation, and blood flow by targeting sore areas with electrical stimulation.  (Talk to your health care provider for guidance.)
          • Heat, ice,and pain cream. All great ways to take the edge off to allow you to comfortably get on track with proper stretching and strengthening. 
          • Posture tools. Sometimes you need a little extra help to initially establish good posture.  Posture braces , shirts, feedback buzzers and tape are all great ways to make progress.
          • Stress management. Too much stress leads to tension that is hard to control. Practicing good time management, exercising, socializing with loved ones, meditation, and deep breathing are all great options.
          • Hot and Cold Therapy. Using ice and heat can help to reduce swelling prior to performing exercises and loosen tight muscles. Click below to learn about how to properly use ice and heat for lower back pain.

          Taking the Right Steps


          Reminder:
          Make sure you seek medical advice throughout the recovery process. Options include physical therapy and orthopedic surgeons. Always start with nonsurgical treatment first if possible.

            As you start an exercise program and treat your disc injury, you will learn to be more in tune with your body and understand what it needs.  Gaining awareness as you increase flexibility and muscle balance will maximize healing and guarantee more long term results.

            Sources:

            https://www.spine-health.com/conditions/neck-pain/what-cervical-radiculopathy

            https://journals.lww.com/spinejournal/Abstract/1996/08150/Nonoperative_Management_of_Herniated_Cervical.8.aspx

            https://www.spine.org/KnowYourBack/Prevention/Exercise/Cervical-Exercise

            SHOP CERVICAL HERNIATED DISC PRODUCTS
            Jaydee Vykoukal, PT, DPT
            Jaydee Vykoukal, PT, DPT

            JayDee Vykoukal is a Doctor of Physical Therapy, owner of the healthy habit platform Health Means Wealth, and freelance medical writer. She loves traveling and spending time with her family in nature. Her passion is helping others continue to participate in the activities they love through education and proper exercise.



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