Cervical Disc Herniation Treatment in Tel Aviv

6-12 weeks to substantial improvement; full recovery up to 12 months

Which Techniques Work Best for Cervical Radiculopathy?

For arm symptoms with centralization on repeated cervical movement testing, see McKenzie / MDT. For mobilization-with-movement and SNAGs targeting the cervical spine, see Mulligan Concept / MWM.

Equal outcomes physio vs surgery at 1 year

C7 60% · C6 25% of radiculopathy

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Which Cervical Level Is Causing My Symptoms?

Disc herniation location determines clinical presentation. C6 and C7 nerve roots account for 85% of symptomatic cases (Radhakrishnan et al., Brain 1994). The foraminal diameter narrows by 20-30% during extension and ipsilateral lateral flexion — which is why these movements are typically provocative.

How Do I Know If My Neck Symptoms Are a Serious Emergency?

Myelopathy (spinal cord compression) is a surgical emergency. Identify and refer immediately if any of these signs are present.

What Actually Happens Inside a Herniated Cervical Disc?

A cervical disc consists of two components: the nucleus pulposus — a gel-like inner core rich in proteoglycans and water (80% water in a healthy disc) — and the annulus fibrosus, a series of 12-20 concentric fibrocartilaginous rings surrounding it. The nucleus acts as a hydraulic shock absorber, distributing compressive forces evenly across the disc. With age, repeated loading, or acute trauma, the annulus develops fissures, allowing the nucleus to migrate outward (prolapse) or fully breach the annular wall (extrusion).

A herniation does not necessarily mean nerve compression: the degree of inflammatory mediators released (PLA2, IL-1β, TNF-α) around the herniated material is a stronger predictor of radicular symptoms than size alone. This is why some large herniations on MRI are asymptomatic, while smaller ones can produce severe pain.

Spurling Test & Clinical Assessment

The Spurling test (specificity 93%, sensitivity 30-50%) reproduces radicular pain and confirms nerve root irritation. Manoeuvre: ipsilateral rotation + extension + gentle axial compression. A positive test = arm pain in dermatomal pattern.

• Distraction test: relieves arm pain with axial unloading (sensitivity 40-50%, specificity 80-100%)
• ULTT (Upper Limb Tension Test): assesses neural mobility — pain reproduction = positive
• Neurological screen: reflexes (biceps C5-6, brachioradialis C6, triceps C7), myotomes, dermatomes
• Imaging (MRI): indicated for progressive deficit, myelopathy signs, or failure of 6-12 weeks conservative care

Can I Avoid Surgery for a Cervical Disc Herniation?

Wong et al. 2014 (Spine J, systematic review): in symptomatic cervical disc herniation with radiculopathy, substantial improvement occurs in the months following onset and most patients recover without surgery. Persson et al. 1997 (Spine, RCT, n=81): at 12 months, surgery, physiotherapy and a cervical collar were equally effective for long-lasting cervical radicular pain; surgery gave faster early pain relief. Conservative care is the recommended first-line approach.

• Phase 1 (Weeks 1-2): gentle cervical traction (intermittent, 5-10 min), isometric neck stabilisation, scapular stabilisation, pain modulation
• Phase 2 (Weeks 3-4): neural mobilisation (ULTT progression), cervical ROM exercises, postural correction, McKenzie directional preference
• Phase 3 (Weeks 5-8): progressive strengthening (isometric → isotonic), deep neck flexor retraining (Jull protocol), functional training
• Phase 4 (Weeks 9-12): sport-specific drills, cervical stability load progression, return-to-activity, recurrence prevention

Neural Mobilisation Techniques

Neural mobilisation addresses mechanosensitivity of brachial plexus and peripheral nerves. Sliders move the nerve without increasing tension, for the acute or subacute phase when it is highly irritable. Tensioners increase tension along the entire neural pathway, reserved for chronic or less irritable presentations. Nee and Butler (2013) found mean arm pain fell 2.3/10 (moderate effect size).

Neural mobilisation addresses mechanosensitivity of the brachial plexus and peripheral nerves. Two approaches:

Slider techniques move the nerve bed in opposite directions simultaneously (e.g., elbow flexion while depressing the shoulder), creating a sliding motion through surrounding tissues without increasing tension. Used in the acute/subacute phase when the nerve is highly irritable. Tensioner techniques increase tension throughout the entire neural pathway and are reserved for chronic or less irritable presentations. Nee & Butler (Man Ther 2013) found neural mobilisation reduces arm pain by a mean of 2.3/10 VAS with moderate effect size.

• ULTT1 (median nerve): shoulder abduction + external rotation → elbow extension → forearm supination → wrist extension
• ULTT2 (radial nerve): similar but with wrist flexion and thumb adduction
• ULTT3 (ulnar nerve): elbow flexion with wrist extension and ulnar deviation

A positive ULTT1 shows the median nerve is mechanosensitive, but not where. The same nerve can be irritated at the root and again at the wrist, so a positive test is followed by wrist-specific examination to rule carpal tunnel syndrome in or out before a plan is built around the neck alone.

Cervical Traction Protocols

Mechanical traction enlarges the intervertebral foramen by 1-2 mm and decompresses the nerve root; it is indicated in radiculopathy with a positive Distraction test. A Cochrane review (Graham et al., 2008) found moderate evidence for short-term pain relief when combined with manual therapy and exercise. Contraindications: myelopathy, vertebral instability, or rheumatoid arthritis affecting the cervical spine.

Mechanical traction enlarges the intervertebral foramen by 1-2mm and decompresses the nerve root. Indicated in radiculopathy with positive Distraction test. A Cochrane review (Graham et al., 2008) found moderate evidence for short-term pain relief when combined with manual therapy and exercise.

• Intermittent traction: 7-12 kg, 25-35° flexion, 15-30 sec hold, 2-3× per session
• Sustained traction: 10-15 lbs, 10-20 min holds, once weekly after acute phase
• Contraindicated if myelopathy, vertebral instability, or rheumatoid arthritis affecting C-spine
• Combine with postural correction, deep neck flexor training, and ROM exercises

When Can I Return to Work and Normal Activity?

Continued activity with ergonomic modification (monitor at eye level, document holder beside the screen, position changes every 30-45 minutes) leads to better outcomes than sick leave. Most patients improve substantially within 6-12 weeks of conservative treatment and return to pre-injury activity over the following months; with radiculopathy, full recovery can take up to 12 months.

Continued activity (with ergonomic modification) leads to better outcomes than sick leave for cervical disc herniation. Key workplace adjustments include: monitor height at eye level to reduce cervical extension loading, document holders adjacent to the screen to avoid sustained neck rotation, and positional changes every 30-45 minutes. With conservative treatment, most patients improve substantially within 6-12 weeks and return to pre-injury activity over the following months; full recovery can take up to 12 months when radiculopathy is present (Wong et al., Spine J 2014).