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Dr. Mark
Dr. Mark, Neurologist (MD)
Category: Neurology
Satisfied Customers: 11946
Experience:  Neurosurgeon - Brain, spine, and peripheral nerve surgery
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Two and a half months ago, I was diagnosed with a C5/C6 disc

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Two and a half months ago, I was diagnosed with a C5/C6 disc bulge and associated nerve root irritation and a small amount of muscle wasting in the area. On the MRI scan, the disc bulge is quite small, with no compression of the spinal cord. After the diagnosis, I was told to stop swimming and running, and I took time off work (which involves sitting at a computer a lot). Two months on, I am trying to return to more normal activity, but I am continuing to suffer with a variety of symptoms: neck pain around the scalenes felt while breathing, pain along the levator scapulae, pain all round the left shoulder (subscapularis?) radiating to the arm, stiff back (trapezius, right subscapularis, and other nearby areas), occasional difficulty swallowing (e.g. pills, or chewy foods), pain in the lats and intercostals. Normally, I have only one or two of these at a time (e.g., three of the most common are left shoulder pain, lat pain and neck pain, but I never seem to have more than one of these at once), and I do have days when I am almost pain-free. Sometimes I have pain when lying down, especially in the scalenes: ice often helps with that. Ibuprofen hasn't helped me at any stage. These pains seem to be much lessened since I was diagnosed, but they are impairing my quality of life, particularly when I try to do more (work on the computer, read, or carry a backpack), but also when there is no obvious trigger.

I first started suffering related symptoms in October last year, and have had several subsequent flare-ups. Physiotherapy initially helped to make me pain-free for a while. The latest flare-up started in May, and as usual physiotherapists were my first port of call: unfortunately, this time physiotherapy did not help, and after some time it became clear that both the manual work and the exercises were actively making things worse; in particular, I was advised to keep swimming and running. Perhaps partly because my symptoms are not exactly typical of a disc bulge, some physios and GPs described my problem as "psychobehavioural", but in fact my symptoms don't seem to be associated with stress. When I started having swallowing problems following the physio exercises, I went to a sports doctor, and received the diagnosis of a disc bulge, and the advice to rest. The doctor does not think I would benefit from an injection, or from further physiotherapy, or surgery.

I have several questions.
(1) Given the information above, would you expect the pain to go away eventually, allowing me to lead my normal lifestyle (possibly with some adjustments)?
(2) The last time I fell was 6 years ago, when I injured my shoulder. Could this disc bulge come from that time, and only become obvious now, or is it more likely to be caused by my lifestyle, which includes: carrying heavy backpacks, swimming intensely front crawl 4-5 hours per week with a somewhat improper stroke, running on pavements, sitting on the sofa working with a laptop on my lap (I don't do this any more)?
(3) Do you think that bad management initially has made my condition chronic?
(4) Should I seek any further medical evaluation for my problem? If so, who might I consult?
Submitted: 2 years ago.
Category: Neurology
Expert:  Dr. Mark replied 2 years ago.



1) It is a bit difficult to say without actually being able to see your MRI images, but if it is minor changes at C5-6, then yes, I would expect the pain to get much better.


2) It is impossible to know when in the past you may have developed that disc bulge, since many people have them without any symptoms. So it is possible that this occurred 6 years ago, but there is no way to prove this. It is similarly impossible to put the blame on lifestyle issues.


3) No, this does not sound like bad management, and no, that would not make a condition chronic.


4) I would have a neurosurgeon review the actual images of the cervical spine MRI, to ensure that there is no significant "foraminal stenosis", which could be pinching a nerve to the side. In addition, a test called a EMG, performed by a neurologist or physiatrist, can help to determine if there is nerve root irritation as the cause for your pains in the neck and down the arms.

Customer: replied 2 years ago.

Thanks for the answer. Number (4) sounds useful advice; do you have any suggestions on how to choose the right neurosurgeon/neurologist? I live in London, so there are many to choose from.


With regard to (3), in that case, why would my condition have worsened after starting the programme of physio exercises? I went to the physio complaining of tightness of the neck causing difficulty swallowing, the physio worked on it for half an hour and it seemed much better, but at the end of the session she told me to pull my shoulder blades together so that she could tape them up to improve my posture, and immediately the neck tightness came back worse. A lot of their exercises involved pulling my shoulder blades together. On the other hand, my condition started improving as soon as I stopped the exercises, as well as swimming and running. It is really important to me that I understand what has been making my condition worse, as I don't want to keep suffering relapses.


Others have also told me they expect the pain to get much better, but I am not convinced that it is improving at the moment. Do you have any comments on how rapidly things might improve, and what I might expect along the way?

Customer: replied 2 years ago.

Relist: Incomplete answer. I am keen to get a more detailed answer to some parts of my question, which is why I asked the follow-up and opened it up to other experts. I was pleased to get the initial reply so quickly, and disappointed that no-one answered my follow-up.


Expert:  Dr. Mark replied 2 years ago.
Hello.Sorry for the delay, but I had surgery yesterday, and thus did not see your reply.To answer the questions: the "right" neurosurgeon is probably best found from another physician's recommendation in the area, as we get the general sense of who in the area is good in their particular field of interest. I would ask your GP or a family friend that has dealt with a neurosurgeon for your best referral.The condition can worsen (or get better) with any activity, as it is fairly "random" in the sense that I can't predict which activities will make you feel better, and what will make you feel worse. Hence, you should listen to your body and avoid activities that make you feel worse, while continuing activities that make it feel better.The issues you describe on your MRI will not get significantly worse with activity so do what makes you feel better.
Customer: replied 2 years ago.

Dear Dr Mark,


Thanks for getting back to me.


I've been advised to "listen to my body" before, and I've been trying to do this for two and a half months already. When I get stiffness in my back or neck, I usually first notice it when I wake up in the morning. When the "nerve" pain flares up, it is always just after some motion of my neck or shoulders, such as a turn of my neck, or lifting an arm, but this might happen while I'm lying in bed, or walking, or eating, and it's surely not these things that are the cause, so it must be something I've done earlier, but I often can't figure out what.


If I knew more about what causes the pain, in particular why it is that sometimes I feel one thing and sometimes another, then it would be easier to know what I should be changing. I don't think I'm getting better, and I don't know why doctors are so confident about my recovery when they can't explain my symptoms. I fear there may be something else wrong with me as well as the disc bulge (e.g., overtraining, chronic fatigue, or some more serious condition): do you think this is likely (I understand you can't possibly rule it out) or is my pattern of symptoms consistent with other patients you've seen?

Expert:  Dr. Mark replied 2 years ago.
Well, your pattern of symptoms doesn't quite fit "neatly" into one specific diagnosis. While some of the symptoms could be related to a nerve irritation due to a cervical spine bulging disc, some of the other symptoms (the ones that don't involve the neck or arm) may not be related at all.Perhaps a test called the EMG can help with the diagnosis, as this test looks for abnormal electrical activity which can occur in nerve-related conditions, and would help to determine if the issue is eminating from the cervical spine.
Dr. Mark, Neurologist (MD)
Category: Neurology
Satisfied Customers: 11946
Experience: Neurosurgeon - Brain, spine, and peripheral nerve surgery
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