Can Chiropractic Reverse Cervical Disc Degeneration?
Conservative Treatment and Patient Expectations
Question: The results of my recent MRI showed that I have signs of cervical disc degeneration (bone spurs and a herniated disc at C4-C5). My chiropractor says he can reverse this process through treatment—but it may take five or more years. Can this condition really be reversed through chiropractic treatment?
—P.D., South Valley, NM
Answer: This is an interesting question, but you may not like the initial answer. No, your chiropractor cannot reverse cervical disc degeneration. But don't stop reading just yet. That doesn't mean that conservative treatment can't significantly reduce your pain and improve your quality of life.
First, you should have a well-rounded understanding of your condition. This will put you in the best position to make a well-informed treatment decision.
Cervical disc degeneration results from the normal aging process in the discs between our vertebrae. It often begins in our teen years, but it can start earlier in some people, later in others. This depends on a number of factors, but it is especially sensitive to genetic influences.
If the disc degeneration is confined to a single localized disc location in the neck, it is often a sign of prior injury, and this can accelerate the degenerative process for that disc. Bone spurs are often seen bordering degenerated discs and this means that the degeneration has been present for quite a few years.
Careful scientific studies have clearly demonstrated that degenerated discs do not necessarily produce symptoms. In other words, some people without any neck pain or other related symptoms often have disc degeneration and bone spurs. Studies have shown that many times people with advanced degenerative disc disease, including disc herniations, have little or no neck pain or disability. Even the size of the disc herniation is a poor predictor of how painful it may be. There is simply no reliable correlation between how advanced the degeneration appears on imaging (such as an MRI) and the presence or absence of symptoms.
On the other hand, some people with little or no visible disc degeneration, disc herniations, disc bulges, or bone spurs, can experience significant neck pain and disability. Research has reliably shown that x-ray, MRI, and CT imaging cannot be used to pinpoint any specific disc, or other anatomical abnormality, as the cause of pain.
Because imaging is unreliable in identifying symptomatic spinal discs, history and physical examination findings are much more relevant and should be considered with any imaging findings in order to determine the clinical significance, if any, of those imaging studies. (Invasive studies such as discograms may identify symptomatic discs, but their use for this is controversial and recent evidence suggests that discograms themselves may actually further damage a degenerated disc.)
When you write that you recently found out you had cervical disc degeneration (bone spurs and a herniated disc at C4-C5) based on an MRI, I assume your doctor also took into account your history and physical examination findings. These examination findings should determine whether or not you are a good candidate for conservative treatment.
Conservative treatment may consist of education in effective self-management of your pain, manual therapy (manipulation, mobilization or massage), mechanical therapy (individualized therapeutic exercise, various forms of traction, etc.), passive modalities for short-term acute pain management, and so forth.
While studies have shown that many people with neck pain and disability benefit from some or all the above forms of treatment (often used by chiropractors), each person is unique. If you are having neck pain or associated symptoms and your chiropractor feels you are a good candidate for treatment, you may want to try a limited trial of treatments (for example, 6-8 treatments) to gauge your response to the treatment and determine how effective it is at reducing your pain and helping you reach goals which are important to you in your day to day life.
A positive response (when you notice a reduction in pain and/or an improvement in function) may warrant additional care based on your improvement and preferences. However, there is no credible scientific support for the notion that disc degeneration can be prevented, slowed, or reversed by chiropractic care over any period of time—short or long-term.