the Risks of Manual Therapy for C6-C7 Disc Herniation

C6-C7 intervertebral disc herniation worsened with manual therapy?

Hello, doctor.
I previously had an MRI that confirmed a herniation at cervical vertebrae C6 and C7.
The doctor indicated that the condition is moderate, about 60% severity, but surgery is not necessarily required.
Therefore, I opted for conservative treatment, including rehabilitation and out-of-pocket manual therapy.
However, after a session of manual therapy last week, I experienced severe pain in my neck and back during the night, which lasted for three consecutive days, preventing me from sleeping.
When I returned to see the rehabilitation doctor, she mentioned that this is a normal inflammatory response to manual therapy and prescribed me five days' worth of anti-inflammatory, pain-relieving, and muscle relaxant medications.
Initially, I only had numbness in my fingers at certain angles due to my work, but after the manual therapy, I have been experiencing persistent pain in my neck, along with continuous numbness in my thumb, index finger, middle finger, and ring finger.
My arms also feel sore and numb, and there is significant pain in my neck at certain angles.
Overall, my symptoms have worsened.
I would like to ask if this is normal, or could the manual therapy have potentially exacerbated my condition? Should I consider going to a larger hospital for further examination and possibly another MRI? Thank you, doctor.

Mr. You, 30~39 year old female. Ask Date: 2023/02/27

Dr. Wang Zhaomin reply Rehabilitation

Manual therapy may lead to an inflammatory response, and symptoms may alleviate after the inflammation subsides.
However, improper manual therapy can also worsen symptoms.
It is advisable to consult an orthopedic specialist, a neurosurgeon, or a rehabilitation physician for a thorough examination and diagnosis, and to arrange for subsequent treatment.

Reply Date: 2023/02/27

More Info

When it comes to understanding the risks associated with manual therapy for a C6-C7 disc herniation, it's essential to recognize that while manual therapy can be beneficial for many patients, it also carries certain risks, especially in cases of disc herniation.
Firstly, let's clarify what a disc herniation is. A herniated disc occurs when the soft inner gel of the disc protrudes through a tear in the tougher exterior. This can lead to pressure on nearby nerves, causing pain, numbness, or weakness in the arms or hands, depending on the location of the herniation. In your case, the C6-C7 region is particularly significant as it can affect the nerves that control the arms and hands.

In your situation, you mentioned experiencing increased pain and numbness in your fingers and arms following manual therapy. This is concerning and may not be a typical response to treatment. While some discomfort can be expected after manual therapy due to inflammation or muscle soreness, the severity and persistence of your symptoms suggest that the treatment may have aggravated your condition rather than alleviating it.

Manual therapy, including techniques such as spinal manipulation or mobilization, can sometimes lead to complications, particularly if not performed correctly or if the therapist is unaware of the specific nuances of your condition. In cases of disc herniation, there is a risk that manipulation could exacerbate the herniation or lead to further nerve compression, resulting in increased pain and neurological symptoms like numbness or weakness.

Given that your symptoms have worsened, it is advisable to seek further evaluation. An MRI can provide valuable insight into the current state of your cervical spine and help determine if there has been any progression of the herniation or any new issues that may have arisen since your last imaging. It is crucial to rule out any serious complications, such as increased nerve compression or other structural changes.

In terms of treatment, it is essential to communicate openly with your healthcare providers about your symptoms. If manual therapy is causing significant discomfort or worsening your condition, it may be necessary to explore alternative treatment options. These could include physical therapy focused on gentle exercises, pain management strategies, or even considering a referral to a specialist, such as a neurosurgeon or orthopedic surgeon, for further evaluation.

Additionally, it is vital to consider preventive measures to avoid exacerbating your condition. This includes avoiding activities that strain your neck, maintaining good posture, and engaging in exercises that strengthen the neck and upper back muscles without putting undue stress on the cervical spine.

In summary, while manual therapy can be beneficial for some patients with disc herniation, it is not without risks, especially if symptoms worsen following treatment. Given your current symptoms, it is prudent to seek further evaluation with imaging and discuss your treatment options with a qualified healthcare provider. Always prioritize your health and well-being, and do not hesitate to advocate for the care you need.

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