Just like how sciatica/ leg pain is usually caused by a bulging disc in the lower back or by a muscle pinching the nerve, arm pain and/or numbness & tingling is usually caused by a bulging disc in the neck or by a muscle pinching a cervical (neck) nerve root or plexus.
The nerve roots that come out from between your cervical vertebrae converge to form three main nerves that service the arm: the ulnar, median and radial nerves. If any of these nerve roots are pressed by a bulging disc, a bone spur or thickened ligament, it usually causes radiating (traveling) pain from the neck down the arm; usually all the way down to the fingertips.
The specific area of pain/tingling depends on which nerve root is being pinched. In fact, that is how doctors diagnose the precise problem area. For example, numbness down the medial (inner) side of the forearm down to the pinkie and ring finger can be produced by compression of the C8 & T1 nerve roots. Numbness in the outer forearm, thumb and first two fingers is associated with the C6 & C7 nerve roots.
Radiating arm pain can also be caused by thoracic outlet syndrome, where muscles near the neck and upper shoulder pinch the nerve plexus (where the roots converge). This will be next week’s topic.
Self Treatment for Radiating Arm Pain
If you have significant neck pain accompanying your arm symptoms, then it is likely you have a bulging disc in your neck. It feels like a focused, sharp pain deep inside the neck on one side. Massage does not help this kind of pain.
Most mild to moderate cases of cervical disc bulges resolve with exercises and manual therapy. The severe cases usually require surgery to remove the disc portion that is pressing against the nerve. If you have a severe case, get a consultation from a spinal surgeon and a second opinion. If done in time, surgery can resolve the arm pain, but if the entire disc is removed the surgeon will fuse the vertebrae above and below the disc which will reduce your neck range of motion somewhat.
If the disc bulge or offending structure is allowed to compress the nerve root for an extended period it may result in permanent injury to the nerve. This means after surgically removing the bulge, you still may have numbness down the arm. This is why, for nerve compression conditions, time is of the essence.
Non-surgical candidates can do exercises to reduce the bulge size. For typical posterior bulges (bulges that protrude towards the back and one side of the vertebral body) try this: while standing, use your posterior neck muscles to pull your neck straight back, as far as you can; hold for 3 seconds. It may feel uncomfortable if your disc bulge is acute. Keep your chin tucked in so that the top of your head is level. Do eight times, twice a day for a couple of weeks; note changes in your neck pain and arm pain. Discontinue if it aggravates your condition. This movement gently presses the backs of the vertebral bodies together, which pumps the disc bulge back to center.
If the exercises help but you hit a plateau, try side bending your neck towards the side of the pain, very slowly; repeat six times. Again, note changes; discontinue if it aggravates the pain.
Recommended Lifestyle Changes
Forward bending of the neck and anterior weight bearing of the head (forward head posture) tends to make the cervical discs more vulnerable to bulging because in this position the vertebrae press the front part of the discs, pushing the jelly center (nucleus) towards the back.
Axial forces (straight down through the spine) to the neck can also make disc bulges worse. Any activity that involves jumping creates axial forces — running, basketball, gymnastics, mountain bike riding, sky diving, etc. It’s not a concern unless you do it frequently.
If you have a bulging disc in your neck with arm pain, here are some suggested lifestyle changes:
Use a contoured neck pillow and sleep on your back.
Get a standing desk if your job requires a lot of sitting– it’s better for your back and neck.
Use the Cervical PosturePump device to hydrate your cervical discs
Strengthen your neck muscles so they offer more support to your neck.
Avoid excessive jumping. If you like running, consider getting Z-coil or Gravity Defyer shoes (see below).
Treatment Accessories to Reduce Arm Pain from Disc Bulge
PosturePump Disc Rehydrator
This device uses specially designed air bladders, inflated by a hand pump to spread apart and extend neck vertebrae. This expands the discs, drawing in fluids and nutrients and also stretches the neck into its normal, ideal curvature.
Anti-Shock Specialty Shoes
These specially designed shoes have powerful springs in the heel that significantly dampen the forces generated from running. Less shock to your feet, ankles, knees, hips, low back and neck.
Vari-Desk Height Adjustable Portable Desk
Place this lightweight desk on your traditional sit-down desk and switch its height between standing and sitting in less than five seconds. Choose to stand for as long as you like, then switch back– great for easing into standing while working, if you’ve been a desk sitter for many years.
The cervical spine is the thinnest and most flexible part of the human spine. It is tasked with supporting the weight of the head in the upright position while allowing turning in multiple planes — looking left, right, up, down and behind. It also contains structures directly tied to life sustenance, which is why the neck is a logical target when it comes to martial arts/ self-defense and restraint (and unfortunately, murder).
Given all these vital functions, it is wise to take good care of your cervical spine in a proactive way.
The cervical spine is naturally designed to curve, where the apex is at about the level of the Adam’s apple.
This curve behaves much like a spring in a car’s suspension; or the slight upwards curve you see in any bridge design. Long ago, architects discovered that the load capacity of bridges could be dramatically increased simply by integrating curves or arcs into the design. Like a neck curve, a bridge curve or arc distributes weight over a greater area so that gravity cannot concentrate over one small area and cause structural failure.
If the neck curve helps distribute the weight of the head in the upright position, what do you suppose might happen if the curve straightened out or started to bend in the opposite direction like the one to the left?
If you lose your cervical curve over time, which could happen from years of poor posture or trauma like multiple rear-end car collisions, you will probably not notice it until several years pass. The change in biomechanics shifts a greater burden of support to your cervical discs and vertebral end plates. This promotes disc degeneration. The once thick and healthy discs lose fluid content, lose strength, allow the center material to bulge out (herniate, protrude or rupture) and cause bony protuberances called osteophytes to form all around the edges of the vertebrae and facet joints.
For some unfortunate people, the bony projections narrow the passageways where the nerve roots and spinal cord pass through (a condition called spinal stenosis) and neck surgery is necessary to prevent nerve tissue from permanent damage, paralysis and severe paresthesias (numbness, tingling) in both the arms and legs.
So the bottom line: be conscientious about the importance of the health of your cervical spine. Don’t get blind-sided by an MRI diagnosis of “multiple-level, severe degenerative disc disease with advanced neural encroachment.”
I’ve seen such cases where patients were oblivious to what was developing inside their necks. They dismissed their neck stiffness and aches to “getting older” or simple muscle strain. When massage and chiropractic provided only temporary relief, they had a cervicalMRI done which revealed the formidable origin behind these symptoms, and the next step was neck surgery. Neck surgery of this nature involves removing the damaged disc, shaving off the osteophytes and inserting a bone graft to promote fusion of adjacent vertebrae.
Prevention is the best approach. You don’t have to have neck problems to start preventive measures. In fact, the vast majority of patients who have early to moderate stage degenerative disc disease have no complaints. It’s like a cavity — you don’t feel anything as the pit erodes the tooth enamel, but as soon as it hits a nerve, you will definitely be aware of its presence. But by that time, you’ll need invasive procedures. In the case of a cavity, it means either a filling or tooth extraction; in the case of a cervical disc, it might mean cervical decompression surgery.
Below is a video that summarizes the importance of maintaining a healthy cervical curve (“lordosis”) and exercises to maintain or restore your neck curve so that it can better withstand the physical demands placed on it and hopefully preclude the need to visit an orthopedic surgeon years down the road.
Also, make sure to check out this site’s Self-Care for Neck Pain video, which demonstrates home care procedures for managing musculoskeletal neck pain and/or stiffness.
The underlying theme of this blog is that by making strategic changes in your daily routine, you can save yourself a lot of pain and dysfunction now and later on in your life. And it’s my desire to share with you some of these simple changes.
Isn’t this a simpler and smarter way to live, rather than being indifferent or oblivious to the fact that your body slowly loses its resiliency as you age, and not taking appropriate, protective measures? If you perform regularly scheduled maintenance to your car, it will last a lot longer than if you do not. The same goes for your body, but the stakes are a lot higher.
One Popular Reason Why People Develop Pain
The problem I see is that most people forget that when you are in your 20s and 30s you can get away with things like prolonged sitting, staying out late and eating unhealthy things like burgers and fries frequently. At that age your human growth hormone is still giving you that fountain of youth energy and your musculoskeletal system, especially your joints, is still in good working order.
However, through your 40s-60s, your job and/or family responsibilities increase and you have less time for yourself, and you think you can take the same abuse that you took in your earlier years. This is where problems start to manifest.
You see, health problems such as degenerative disc disease take years to develop. Take an x-ray or MRI of your neck or low back, and all those nasty osteophytes, thinning discs and crooked spines you see didn’t start yesterday. They started perhaps ten or more years prior.
So, you are either in a situation where you can do lifestyle modifications to reduce the chances of disorders like this from affecting your health and quality of life; or, you already have the disorder, but need to find ways to stop it from progressing and/or reduce its impact on your health and quality of life.
You see, as long as you are alive, your cells have the capacity to regenerate or transform. Depending on the current state of your health and therefore your body’s recuperative capacity, it could take a long time or a relatively shorter time to see results.
For example, if you are overweight; a smoker and drinker and have a negative impression of life, those serve as extra barriers to healing. Get rid of them, and you’ve got a better chance.
A Simple Exercise to Do Daily if You Sit a Lot
Back to those “lifestyle modification” tips that can help you avoid a life of pain.
Here is today’s example, an exercise called Wall Angels. If you find yourself having a slouched upper back, rounded lower back and forward lunging neck, you’ve got to try these. When done regularly, they can help restore and maintain good posture.
Posture affects your spine, joints, muscles, breathing, energy levels and sometimes even mindset. It is critical to have good posture if you expect to achieve optimal health in your life.
Give it a try; all you need is an empty wall with no obstructions:
Do you experience neck pain or stiffness? Tension headaches?
Do your upper shoulders feel like bricks and have tight, sensitive knots as big as golf balls?
Any pain, strain or weakness in your upper back between your shoulder blades?
If so, you likely have Anterior Weight Bearing of the head, or Forward Head Posture.
Appearance is the least of your worries when it comes to poor posture.
Yes, people tend to look much better when standing up straight and confident as opposed to looking like Quasimodo in his advanced years. But looks are not the main problem with a slouched posture.
You see, posture has a direct impact on your breathing quality. If your rib cage and spine are hindering your diaphragm movement and lung expansion, then your breaths will be more shallow. You’ll be getting less oxygen to your muscles and organs; you’ll expend more effort breathing, and you will likely feel fatigued more often than not.
On average, a person at rest takes about 16 breaths per minute. This means we breathe about 960 breaths an hour and 23,040 breaths a day! That’s a lot of energy expenditure, which is hindered by poor posture.
Anterior weight bearing of the head, unfortunately, is very hard to avoid. Because your eyes are in front of your body and not in the back of your head, you naturally flex your neck forward to focus your eyes on what you are doing. This means bending your neck forward as you look at a computer monitor, when reading a book, or when doing just about every activity of daily living: brushing your teeth in front of the mirror, working on a hobby, playing with your children and so on. All these activities will cause you to bend your neck forward.
Bad posture can lead to advanced arthritis and spine decay.
Your spine, when viewed from the side, has curvatures that work like springs on a car’s suspension system. They dampen shock to the spine. Do you know that the simple act of walking puts significant forces into your spine, thanks to gravity? If you are a runner, those forces are multiplied exponentially.
In a strong, healthy spine, these forces are adequately absorbed by the curves, discs and supporting soft tissues. If you have lost some of your spinal curvatures, then the forces generated from walking, running, jumping, and yes, sitting are not going to be dispersed as well and your delicate joint surfaces will have to bear more of this burden. Over time, this can make your spinal segments look like the one below (left spinal segment):
Spinal degeneration occurs mostly in the neck and lumbar spine.
Your neck and lumbar spine are where the nerves that go to your arms and legs branch out from, so adverse alterations to these areas can lead to symptoms in your extremities: pain, numbness, tingling or weakness.
With forward head posture, your head, which weighs 10-12 pounds translates several inches in front of the spinal axis. This creates a “moment force” that is placed mostly on the back neck muscles, upper shoulder muscles and cervical discs.
To get an appreciation of this, imagine balancing an eight pound shot put in your hand, with your wrist bent and your elbow resting on a table; forearm pointing straight up supporting the shot put. It takes little effort to keep that shot put steady.
Now, while still holding the shot put, straighten your wrist and flex it forward so that the shot put is no longer in line with your wrist and forearm (analogous to forward head posture).
All of a sudden, this shift in weight changes everything: your forearm muscles tense up (analogous to your spinal muscles) and your wrist will soon experience strain (analogous to your neck muscles).
This is what happens when the center of gravity of your head moves even just a few inches forward of your spine (reference point at the base of your neck).
Here I illustrate this using a therapy weight pad:
Normal neck curve = strong biomechanics and support, while…
Flattened or reversed neck curve = poor biomechanics and tissue strain
If you have persistently bad posture; especially forward head posture, you are setting the stage for problems. Abnormal stresses to the spine weakens discs, ligaments and cartilaginous surfaces. This is the recipe for spinal decay and increased chance of spinal cord or nerve root impingement.
So if you have forward head posture, start doing exercises that strengthen the back of your neck muscles; stretch shortened, anterior (front) neck muscles, and strengthen your lower back muscles and core. It also helps to stretch shortened muscles in your legs and pelvis that might be restricting your lumbar spine of proper movement. More on this later.
So what do you think? Do you do any exercises and stretches to improve your posture? Let me know!
Recently, Carrie Ann Inaba, one of the judges of the show Dancing With the Stars publicly announced that she has been suffering for quite some time from cervical spinal stenosis– a condition in which the canal that encases the spinal cord in the neck narrows and obstructs nerve tissue. She explained how her condition impacts her life, limiting her from doing the things she loves to do. To Carrie Ann’s dismay, she no longer dances with a partner for fear of getting whiplash and paralysis. That’s quite unfortunate for someone whose entire career revolved around dancing.
Although spinal stenosis is a generalized term for narrowing of the spinal canal by any cause, the most common type, which will be discussed here, is the type caused by osteophytes— growth of bony projections that narrow the openings where nerves pass through. Advanced osteophytic activity is also referred to as spondylosis. When it is severe enough to narrow the spinal canal (foramen) it then creates the condition known as spinal stenosis. For your information, other forms of spinal stenosis are those caused by herniated discs, spondylolisthesis, tumors or any mass that encroaches into the spinal canal.
In her article, Carrie Ann mentioned that spinal stenosis is a form of arthritis and that she is anxious to find a cure for it. Unfortunately spinal stenosis is not one of those conditions that can resolve on its own with rest, exercise and time and other non- invasive measures. And since the inflammation from spinal stenosis is secondary to irritation of nerves, it is technically not a type of arthritis. That is why anti-inflammatory medications have minimal effect on the pain associated with spinal stenosis, which is typically deep, sharp and radiating in nature.
Spinal stenosis occurs when vertebrae, the bones that comprise the spinal column gradually morph in a way that constricts the spinal foramen (canal), or space where the spinal cord resides. When there is less space for the spinal cord to move, it is subject to more abrasion with spinal movement; i.e. bending and turning your neck. The cord (actually, meninges or covering of the cord) rubs against sharp edges of the bony projections into the foramen with movement causing inflammation and injury to the nerve tissue, sometimes causing sclerosis (hardening). In advanced cases, especially cases of lumbar spinal stenosis (due to the more significant weight burden) the narrowing gets so advanced that there is constant pressure on the nerve roots. At this point, it is an emergency situation as renal function and sensation to the legs are affected.
Signs of advanced spinal stenosis include paresthesias, sharp pain with movement, weakness in the extremities, and muscle atrophy in legs and/or arms. Symptoms can be permanent if not treated early.
And what is the treatment for spinal stenosis? First of all, doctors will usually order MRI and x-ray to determine extent of narrowing. If it is caught early, physical therapy and lifestyle modification is recommended. The goal is to slow down or stop the progression of the narrowing.
Surgery is the only option for advanced cases. Since spinal stenosis involves physical structures compressing nerve tissue, there are surgical procedures that can enlarge the spinal canal by scraping off the encroaching bone material and buy the patient more time. Since bone is comprised of live cells, the movement of bony projections (called osteophytes) into the spinal canal is still likely after surgery and many who have had such spinal decompression surgeries develop the same problem several years later.
It’s not quite evident why some people suffer from spinal stenos more than others. But those who have a history of physical trauma to the spine like car accidents, sports injuries and falls are at a higher risk. The theory is that the injury event disrupts the normal alignment of the spinal segments resulting in accelerated wear and tear over time; much like how a loose screw in a machine accelerates mechanical failure. Some orthopedists hypothesize that the appearance of bony projections is the body’s attempt to fuse and stabilize adjacent vertebrae so they can no longer move separately; thus reducing the probability of injury. However, the nerves that share the space with the vertebrae get damaged in the process. If this theory holds true, then it is an inherent design flaw of the body’s self-healing mechanisms.
Also, heavy smoking and obesity, and general poor health can increase your chances of developing spinal stenosis.
I’m sure more than one doctor broke the news to Ms. Inaba that there basically is no “cure” for spinal stenosis once it is in its advanced stages, which appears to be her case based on her own description of her symptoms. It is a mechanical condition that mandates mechanical intervention. No amount of drugs will cure spinal stenosis from advanced osteophyte formatioin. Her only option at this point is spinal decompression surgery to widen the spinal canal and hope that the nerve tissue did not sustain permanent damage.
The best strategy for dealing with spinal stenosis is prevention. If you sustained injury to your spine from a car accident (even a low impact one that did not require medical treatment), a sports injury (including repetitious trauma like that related to gymnastics and football) or slip and fall, realize that “the seed” for spinal stenosis may have been planted in you already. If your injury event was over five years ago, get an x-ray to identify any levels where osteophytes are present; these are the sentinels of potential areas of spinal stenosis as they identify areas of biomechanical weakness. If there are some, the first course of action is to not worsen things. Avoid or reduce activities that regularly place trauma to your spine. Engage in specific exercises that strengthen the neck and lower back to offer more stability. Stretch often (yoga is a great choice) and take care of the insides of your body as well with proper diet, nutrition, hydration and adequate rest.
Lastly, theCervical and Lumbar Posture Pump is a home rehabilitation device that tractions and separates vertebrae to hydrate the discs and increase nutrient absorption which can slow down the progression of spinal stenosis if done diligently on a regular basis. I have personally used them in my practice, and patients reported positive results.
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PosturePump Disc Rehydrator
Anti-Shock Specialty Shoes
Vari-Desk Height Adjustable Portable Desk
If the neck curve helps distribute the weight of the head in the upright position, what do you suppose might happen if the curve straightened out or started to bend in the opposite direction like the one to the left?
and all those nasty osteophytes, thinning discs and crooked spines you see didn’t start yesterday. They started perhaps ten or more years prior.
foramen (canal), or space where the spinal cord resides. When there is less space for the spinal cord to move, it is subject to more abrasion with spinal movement; i.e. bending and turning your neck. The cord (actually, meninges or covering of the cord) rubs against sharp edges of the bony projections into the foramen with movement causing inflammation and injury to the nerve tissue, sometimes causing sclerosis (hardening). In advanced cases, especially cases of lumbar spinal stenosis (due to the more significant weight burden) the narrowing gets so advanced that there is constant pressure on the nerve roots. At this point, it is an emergency situation as renal function and sensation to the legs are affected.
is a home rehabilitation device that tractions and separates vertebrae to hydrate the discs and increase nutrient absorption which can slow down the progression of spinal stenosis if done diligently on a regular basis. I have personally used them in my practice, and patients reported positive results.
