Neck-Related Arm Pain

  • Cox Technic decompression was part of the treatment resulting in return to work in 27 days.
  • Repeat MRI showed no change
  • Outcome: 20 visits over 50 days with total remission of pain.
  • Lingering Symptom: Absent Achilles’ reflex
  • Other individual studies showing relief of pain caused by disc herniation:

    • Guadagnino (12) reported on Cox Technic's spinal manipulation successfully relieving pain due to a proven disc herniation.
    • Haldeman (13) published a description of Cox Technic as a chiropractic technique in a textbook on the principles of chiropractic.
    • Snow (14) published on the successful Cox Technic system management of a patient with lumbar spinal stenosis.
    • Another study of 30 patients with C6-C7 herniated disc showed immediate increase of grip strength following electrotherapy and exercise. (16)
    • Conservatively treated cervical spine disc herniation patients without myelopathy responded better than surgically treated patients. (17)  This study emphasizes the importance of non-surgical treatment for cervical disc herniation patients: complications.
      • Remember that complications and serious disability are far less with conservative care than surgical care in disc herniation patients.
    • Interestingly, females with bilateral chronic neck pain had a generalized smaller cross sectional area of the cervical multifidus muscles compared to healthy females, contributing to spinal stenosis. (18)
    • Cervical radicular arm pain often results from a herniated cervical disc or degenerative disc disease with spinal stenosis or a combination of the two. (19, 20)
    • Upper-extremity pain, paresthesia or numbness, weakness, scapular pain, or a combination of these signs and symptoms (21), headaches (22), and neck pain may point to arm pain radiculopathy. 

    Let's end this section on the management of neck, shoulder and neck-related arm pain patients with the Cox Technic system of examination, diagnosis and spinal manipulation treatment with a classic example of a cervical disc herniation in Figures 7 and 8 below.

       Figure 7

    Figure 8

    Figure 7 shows a large C5-C6 disc herniation (see arrow) that was successfully managed with Cox Technic Flexion Distraction and Decompression spinal manipulation.

    Figure 8 shows the disc herniation seen in Figure 7 in a view looking down upon the disc. See the herniation at the arrow.

    The chiropractic management system of Cox Technic Flexion Distraction and Decompression protocols for the examination, diagnosis and treatment of neck pain and arm pain (radiculopathy) patients may be a solution for your neck-related arm pain.

    Contact Atiyeh Chiropractic and Functional Neurology for an evaluation and treatment plan for the relief of your arm pain today.

    1. Cleland, JA; Whitman, JM; Fritz, JM; Palmer, JA. Manual physical therapy, cervical traction, and strengthening exercises in patients with cervical radiculopathy: A case series. JOURNAL OF ORTHOPAEDIC & SPORTS PHYSICAL THERAPY 35 (12). DEC 2005. p.802-811
    2. Ahn,Y; Lee, SH; Chung, SE; Park, HS; Shin, SW. Percutaneous endoscopic cervical discectomy for discogenic cervical headache due to soft disc herniation. NEURORADIOLOGY 2005; 47 (12):924-930
    3. Rowland LP: Surgical treatment of cervical spondylotic myelopathy: time for a controlled trial. Neurology 1992; 42(1):5-13
    4. Henderson FC, et al: Stretch associated injury in cervical spondylotic myelopathy: new concept and review. Neurosurgery 56 No 5, May 2005
    5. King, JT: Multimodal assessment after surgery for cervical spondylotic myelopathy. J of Neurosurgery – Spine 2005;2(5):526-34
    6. Kruse RA, Imbarlina F, DeBono VF: Treatment of cervical radiculopathy with flexion distraction. J Manipulative Physiological Therapeutics 2001;24(3):206-209
    7. Gudavalli, S, Kruse, RA. Foraminal stenosis with radiculopathy from a cervical disc herniation in a 33 year old man treated with flexion distraction decompression manipulation.  J Manipulative Physiological Therapeutics 2008;31(5):376-80
    8. Kruse RA, Gregerson D: Cervical Spinal stenosis resulting in radiculopathy treated with flexion-distraction manipulation: A case study. J of  the Neuromusculoskeletal System  2002;10(4):141-7
    9. Kruse RA, Schliesser J, DeBono VF: Klippel-Feil syndrome with radiculopathy. Chiropractic management utilizing flexion-distraction technique: a case report. J of Neuromuscular System 8(4):124
    10. Schliesser JS, Kruse RA, Fleming Fallon L: Cervical radiculopathy treated with chiropractic flexion distraction manipulation: a retrospective study in a private practice setting.  J Manipulative Physiological Therapeutics 26(9)
    11. Morris CED: Chiropractic rehabilitation of a patient with S1 radiculopathy associated with a large lumbar disc herniation.  J Manipulative Physiological Therapeutics 22(1)
    12. Guadagnino MR: Flexion Distraction manipulation of a patient with a proven disc herniation. J of Neuromusculoskeletal System 5(2)
    13. Haldeman S: Traction and distraction techniques. Principles and Practices of Chiropractic 3rd edition, 2005
    14. Snow G: Chiropractic management of a patient with lumbar spinal stenosis. JMPT 2001; 24(4): 300-304
    15. Simotas AC: Non operative treatment for lumbar spinal stenosis: clinical and outcome results and a 3 year survivorship analysis. Spine 2000;25(2)
    16. Joghataei, MT, et al: The effect of cervical traction combined with conventional therapy on grip strength on patients with cervical radiculopathy. Clin Rehabilitation 2004; 18(8):879-87
    17. Heckmann JG: Herniated cervical intervertebral discs with radiculopathy: an outcome study of conservatively or surgically treated patients. J Spinal Disorders 1999; 12(5)
    18. Fernandez-De-Las-Penas, C; Albert-Sanchis, JC; Buil, M; Benitez, JC; Alburquerque-Sendin, F. Cross-sectional area of cervical multifidus muscle in females with chronic bilateral neck pain compared to controls. Journal Of Orthopaedic & Sports Physical Therapy 38 (4). Apr 2008. P.175-180
    19. Radhakrishnan K, Litchy WJ, O'Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy: a population-based study from Rochester, Minnesota, 1976 through 1990. Brain. 1994;117(pt 2):325–335
    20. Tanaka N, Fujimoto Y, An HS, et al. The anatomic relation among the nerve roots, intervertebral foramina, and intervertebral discs of the cervical spine. Spine. 2000;25:286–291.
    21. Cloward RB. Cervical diskography: a contribution to the etiology and mechanism of neck, shoulder and arm pain. Ann Surg. 1959;150:1052–1064.
    22. Persson LC, Carlsson JY. Headache in patients with neck-shoulder-arm pain of cervical radicular origin. Headache. 1999;39:218–224
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