• Disc Injury


    Discs are anatomical structures that are situated between the spinal vertebrae. They provide a cushioning between the hard bones, as well allowing for movement of one vertebra on top of another. In addition, the discs also create space between the vertebrae that allow for spinal nerves to pass in and out of the spine.

    There are 23 discs in total. They are present between all vertebrae, except between the two top vertebrae of the neck (C1-C2) and between the top vertebrae and the skull (Occiput-C1).

    The disc is made up of an outer tough fibrous ring called the annulus fibrosus and an inner jelly-like portion called the nucleus pulposus. The outer part of the disc has good blood supply, but there is little to no blood supply to the inner disc. Spinal movement is therefore needed to pump nutrients in and waste products out from the middle part of the disc.

    Nerves only penetrate part of the way into the disc, meaning the inner disc is not pain sensitive.

    Disc injuries are common. They are most common in the lower lumbar spine. They are not as common the neck, but can occur in the mid to lower neck regions.


    Most spinal injuries (including disc injuries) are the result of:

    • Repeated micro trauma, such as bending, lifting and poor posture
    • Lack of spinal flexibility
    • De-conditioning of the deep spinal muscles leading to a lack of core stability

    The uneven stressors caused by these problems can eventually lead to a degenerative tearing the outer annulus fibrosus. This tear/s will cause the inner nucleus pulposus to be pushed out and will present as one of the following:

    • DISC BULGE: Here the annulus has only partially torn. The nucleus ‘bulges’ out, but does not push all the way through the outer fibrous ring.
    • DISC HERNIATION/PROLAPSE: A herniation and prolapse describe the same injury. In this case the tear is larger and the nucleus has fully ‘protruded’ out from the fibrous ring.
    • DISC SEQESTRATION: In this case part of the disc that has protruded out has broken free and floats within the spinal canal.
    • DISC DESICCATION: This is a breaking down of the disc due to loss of fluid. It may be considered normal in an older person, but when it occurs in someone under 60yrs it is suspected to be as a result of injury or increased stress on the disc.

    Disc injuries can become serious because of their close proximity to the spinal cord and spinal nerves as they exit the spine. Particularly in the case of a disc prolapse or sequestration, the offending disc can physically compress or chemically irritate the nerves causing pain and other symptoms. This happens most commonly to the spinal nerves as they exit the spine through a small opening called the intervertebral foramen (IVF).


    Many disc injuries produce no symptoms at all and most will heal over time without the need for surgery. If a disc injury is causing symptoms often the pain is felt as a deep ache that may refer down the arm (if the injury is in the neck) or leg (if the injury is in the low back). Pain can vary in intensity and be either sharp or dull.

    Other disc signs may include:

    • Spinal or referred pain when coughing
    • Disc pain when slumping forward
    • Referred pain may be more intense than spinal pain
    • Referred pain when lying on back and raising one or both straight legs (low back disc only)


    If the disc is compressing an exiting spinal nerve, classic radicular signs might be present. These include:

    • Pain and loss of sensation (pins and needles) along the distribution of the nerve
    • Loss of strength to the muscles that receive nerve supply from the damaged nerve
    • Reduced or absent muscle stretch reflex

    The radicular signs will vary depending on which spinal nerve is affected. For example, the Right C5 nerve root at the middle to lower part of the neck can be compressed by a disc prolapse at the C4/5 disc level and give the following signs:

    • Pain and/or tingling felt in the mid to lower neck that refers across the right shoulder
    • Loss of strength in the deltoid muscle. This creates weakness in raising the arm above the head
    • Loss or reduced biceps reflex– when you tap on an biceps tendon with a reflex hammer the elbow should flex, slightly jerking the hand towards the shoulder
    • Decreased sensation over the top of the shoulder – usually tested using a pinwheel


    This is made based on clinical findings and confirmed with either a CT scan or MRI (preferred). X-rays can show disc degeneration based on thinning of the disc space, but cannot show any detail with the disc.


    Almost all mechanical spinal injuries, with the exception of fractures and dislocations, do better in the long run if you return to gentle movement, rather than prolonged bed rest.

    While it might be beneficial to wear a soft cervical collar during the acute phase initially, it is important to get it moving gently as soon as is practical.

    Other self-management includes:

    • Soft cervical collar (neck brace) if severe pain
    • Rest in positions of comfort – lying on back with neck supported (this is not always comfortable)
    • Gentle movement – especially slow turning of the head side to side in the pain free (or pain limited) range
    • Ice 10min x3/day
    • Very gentle flexibility exercises.
    • Low force chiropractic techniques, light cervical traction and soft tissue techniques


    • Lifestyle changes – become more active if sedentary lifestyle
    • Improve ergonomics at work and home
    • Improve posture
    • Up date your pillow if no longer supportive
    • Avoid sleeping on stomach – the turning of the head for prolonged periods will damage the neck
    • Improve core stability and flexibility of the neck.
    • Chiropractic care, cervical traction and soft tissue techniques
  • Facet Joint Disorders


    Facets are the small, paired joints situated at the back of the spine, behind the spinal cord. They are weight-bearing joints that guide spinal movement.

    Facet joints are covered with smooth cartilage that allow for the joints to slide on one another. Each joints in covered by a joint capsule, which is rich in nerve endings to detect movement and pain.

    Pain emanating from facets is sometimes called facet syndrome. It is one of the most common of spinal complaints and typically responds very well to chiropractic care. Facet disorders do not usually involve the spinal nerves, but rather the smaller branch off the spinal nerve called the dorsal rami.

    Referred pain can still be a feature of facet syndrome, but it does not follow a radicular pattern as is often seen with a disc prolapse. Disc injuries are more likely to refer all the way into the hand (from the neck) and foot (from the low back). Facet disorders tend not to refer past the elbow or knee.


    • Intermittent pain of varying intensity
    • Tenderness to pressure over the inflamed facet joint/s
    • Pain that is worse when bending neck backwards – this compresses the facets


    This is based on clinical findings and X-ray, which may show degenerative or other changes in the facets. Injecting the facet joint with a pain-blocking anesthetic is the most definitive form of diagnosis. Relief with this technique is diagnostic, but only performed in severe cases.



    • Avoid activity that aggravates pain
    • Gently move and stretch neck often – especially rotating side to side
    • Ice 10min x3/day
    • Very gentle flexibility exercises.
    • Chiropractic care and soft tissue techniques


    • Lifestyle changes – become more active if sedentary
    • Improve ergonomics at work and home
    • Improve posture
    • Up date your pillow if no longer supportive
    • Avoid sleeping on stomach – the turning of the head for prolonged periods will damage the neck
    • Improve core stability and flexibility of neck.
    • Chiropractic care and soft tissue techniques
  • Torticollis


    Torticollis is a condition in which the neck is twisted with the ear pulled to one side and the chin rotated to the other side. Torticollis presents itself in several ways, based on age and underlying cause. There is a wide range of severity and outcomes.


    The most common form of torticollis seen in a chiropractor’s office is Acute Torticollis (also known as wry neck). This occurs mostly in older children and young adults. The pain and muscle spasm usually lasts 1-2 weeks. The trigger factor may be some minor trauma such as twisting the neck while drying your hair or jarring the neck while hitting a tennis ball. Often the affected person will wake up with some mild stiffness that increases to sharp pain and torsion in the neck.

    Chiropractic care can be useful in reducing muscle spasm, relieving pain and ensuring a quicker and more complete return to function. In addition to gentle and specific spinal adjustments, slow holding adjustments on the cranial (skull) bones and soft tissue techniques for muscle spasm at the front and back of the neck may also be used.

    Home advice will usually involve recommendations for rest, together with gentle mobilising exercises of the neck and shoulders. These should be within the comfortable range of motion. Alternating heat/ice might be useful initially. Often supporting the neck with a scarf or, if needed, a soft cervical collar is helpful – but only for a short period of time.


    Congenital means ‘present at birth’. This form of torticollis is usually the result of birth trauma, commonly seen in breech births or where intervention such as forceps is used. The muscle at the front and side of the neck (called the sternocleidomastoid or SCM) is damaged causing bleeding inside the muscle (haematoma) and shortening of the muscle.

    As these babies have often had a traumatic birth, they have higher risk for a congenital hip dislocation. An x-ray of the neck and the hips may be required in some cases.

    Treatment is very important for these infants to prevent permanent shortening of the neck muscles involved. Facial and skull asymmetry is also common with congenital torticollis.

    Chiropractic care may involve gentle massage and stretching of the SCM. Very light finger-tip adjustments to the neck are often useful, as are craniosacral adjustments to balance dural tension (the dura is the sac-like sheath that surrounds the brain and spinal cord). In some cases it may take weeks or even months for neck posture and movement to return to normal.


    This is a more severe form of torticollis and is also known as cervical dystonia. This typically affects adults between the ages of 30-50 years and is related to nervous system dysfunction at the brain level.This is a particularly difficult condition to treat and can be associated with chronic pain and muscle tremors. Spasmodic torticollis can last for very long periods and in some cases is permanent.

    Chiropractic care offers relief in some cases, allowing the condition to be managed and pain levels kept at a minimum. In some cases medical co-management may also be required.

  • Whiplash


    ‘Whiplash’ is the term used commonly to describe a soft tissue injury to the neck, whereby the head has been forced into a sudden forward and backward movement. Your chiropractor or medical practitioner may also use the term ‘Acceleration flexion-extension neck injury’ or ‘Hyper-extension neck injury.’

    The most common cause of a whiplash is from a motor vehicle accident, but it can also be a result of a sporting injury or other trauma. Child abuse, particularly the shaking of a child, can also result in this injury as well as in more serious injuries to the child’s brain or spinal cord, known as ‘Shaken baby syndrome’.

    In addition to neck pain, a whiplash may also cause headaches, pain in the shoulders and arms, dizziness, numbness and tingling, and weakness in the arms. When these additional symptoms are present it is called a Whiplash-Associated Disorder (WAD). The symptoms of WAD may come on immediately or may be delayed by a few days or even weeks.

    WAD injury is graded from 0-4.

    • 0 = no pain or other symptoms
    • 1 = minor pain, but no evidence of physical injury
    • 2 = signs of physical injury such as trouble turning your head
    • 3 = neurological signs such as a loss of reflexes or arm weakness
    • 4 = neck fracture or dislocation

    If you have a Grade 1 or 2 WAD then chiropractic care is recommended to relieve symptoms, improve spinal function and prevent the WAD becoming a chronic condition. Grade 3 WAD is also likely to respond well to gentle chiropractic care, but will require CT scan or MRI to confirm level of damage. Grade 3 may also require co-management with other professionals, especially in the early stages. Obviously a grade 4 WAD requires urgent medical care.

    In the case of serious trauma it is important that the patient be placed in a cervical collar to prevent neck and spinal movement that may further damage the spinal cord. Plain film x-rays may be required to determine if there is damage to the bones, while a CT or MRI can check for soft tissue injury, such as disc prolapse.

    Fortunately most people with WAD will make a good to full recovery, but the healing time will vary with each individual case. You can improve your prognosis of WAD by adhering to the following recommendations:

    • Gently exercise your neck to restore movement and flexibility and to ensure that the muscles are acting to support your neck. Your chiropractor can develop a program of exercises that are most suitable for you.
    • Try to stay active. Do as many of your normal activities as possible.
    • Relaxing both body and mind will help you manage any pain more easily.
    • Stay at work if you can. People who stay at work after an accident recover more quickly than those who take time off.
    • Don’t use a cervical collar for more than a few days without advice from your chiropractor or health professional. Most people don’t need to use collars, and using one may unnecessarily slow your recovery.
    • Consult with your chiropractor to get the right care and advice.