Why is it ridiculous? First, we’re not talking about cervical radiculopathy (aka pinched nerves). We’re talking about your pain. Often times, people associate their pain with simple diagnoses. They use these diagnoses to label themselves into specific physical disability. “I can no longer do ‘X’ because I have a pinched nerve.” “I used to lift weights, but I bulged the disc in my neck 5 years ago.” Finally, they convince themselves they will not be able to perform activities they love until they have these specific diagnoses structurally fixed, typically through surgery.
We will begin by re-working why ‘pinched nerves’ and other neck ‘degeneration’ shouldn’t scare you into neck surgery.
Let’s take this further into the cervical spine (aka the neck):
-Neck pain does not always equal damage in the neck.
-Structures in the neck (like discs, nerves and joints of the spine) do not often correlate with pain. Therefore, treatments that focus specifically on improving structure (fusions) may not be effective in reducing pain.
In most cases, surgery should be a last resort, and with good reason. Here are three reasons why you should keep neck fusion surgery on the back-burner:
Number one: Neck surgery does not guarantee pain free movement.
You will be restricted to lifting the weight of a milk container for your morning Cheerios, at least for the first 6 weeks. What people don’t realize are the risks that accompany surgery. As Shao and colleagues write in Medicine, a cervical fusion surgery is considered the gold standard technique in the treatment of degenerative disc disease (the normal “wear and tear” process of shock absorbers of the spine).
What scares us the most is what follows:
“…causes motion loss of the indexed level, increases the intradiscal pressure and motion of the adjacent levels, and may accelerate the degeneration of the adjacent levels.”
Yikes. It pays to read the fine print.
Number two: The surgery designed to fix one level of wear and tear causes accelerated breakdown of additional areas of the spine surrounding the fusion site.
This idea is further supported by Hilibrand: “adjacent degeneration can affect more than 25% of patients within ten years.” If patients have pre-existing degeneration, as we know most people do, the risks increase.
Number three: “Wear and tear” is poorly linked to pain.
We see this time and time again in the research. Patients ignore this so often that we need to remind our readers every blog.
Physical therapists know it. Childs and colleagues write in the clinical practice guidelines that “…although the cause of neck pain may be associated with degenerative processes or pathology identified during imaging, the tissue that is causing a patient’s neck pain is most often unknown.”
Researchers know it. Boden and others write there are countless people with pinched nerves and bulged discs with no pain whatsoever. Brinjikji and colleagues state that, in those with no pain, the likelihood of having disc degeneration increases from 37% of 20-year-old individuals to 96% of 80-year olds.
And of course, the Rehab Renegade guys know it. “Dr. Brendan and Dr. Mike, although incredibly good-looking, spend way too much time studying pain science and not enough time playing with me.” -Mike’s dog
So now what?
The process towards A Pain-free Neck Begins.
Exercise is key. Why? It’s less damaging and can be just as effective. Studies show that although surgery was more effective in reducing pain short-term, pain relief was the same between a group that only exercised and the group that had surgery after a two-year follow-up. Exercise can be equally effective with less future consequences than surgery.
Another reason is that anyone can benefit. Childs and all state that 70-90% of individuals can experience improvement in neck disability without surgery. That is a lot of people. It is important to state that simply avoiding surgery isn’t enough. Chiu and colleagues found that those with chronic pain who exercised their neck see significant improvements in pain and overall satisfaction at a six month follow-up than those who did not.
There are times where surgery is appropriate. Typically, these cases involve severe neurological dysfunction. Surgery may also be appropriate when patients exhaust all other non-surgical measures. Non-surgical measures, however, should be supplemented with pain education. Understanding why your body is in pain is the first step in reducing it. Participating in an exercise regimen designed to improve mobility and strength is the second step. It also has potential to be as effective as surgery, without the long-term risks of future tissue breakdown.
Take back your body. You’re more than just a pinched nerve.
Brendan Glackin, DPT, CSCS
Glackin Physiotherapy, LLC
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