Cervical Disc Herniation – A Comprehensive Guide For Healthcare Professionals

Table of Contents


Cervical disc herniation is the most common cause of neck pain. It occurs when the jelly-like material inside the disc acts as a shock absorber called the nucleus pulposus herniates through the outer fibrous layer (annulus fibrosus). This herniation causes compression of the adjacent spinal nerves passing through the cervical canal. It produces symptoms like neck pain, weakness of the muscles of the neck, shoulder and arm, numbness, Paresthesia and tingling sensation. [1]

What is Cervical Disc Herniation? 

Cervical disc herniation occurs when the nucleus pulposus herniates through annulus fibrosis in cervical vertebrae. The spine or vertebral column comprises vertebrae and intervertebral discs containing the nucleus pulposus surrounded by a thick fibrous layer called annulus fibrosus. The overall extent of the vertebral column is from the base of the skull to the coccyx, including the cervical, thoracic, lumbar and sacral vertebrae. In this article, we will discuss the cervical vertebra.

The cervical spine plays a significant role in protecting the spinal cord, giving structural support, and allowing a wide range of neck mobility.

The neck is supported by seven cervical vertebrae (C1-C7) starting from the base of the skull to the thoracic spine (T1). This vertebra surrounds the spinal nerve and cervical canal. Therefore, whenever there is an outpouching of the nucleus pulposus from the vertebral disc, it causes significant impingement of the adjacent nerves, resulting in neck pain radiating towards the arm and shoulder.

All the main nerves of the body pass through the cervical canal and then spread to the body. The most important is the vagus nerve, which performs multiple bodily functions (lung function, heart rate, digestive system and collaborates with The hormones and glands.[2]


Cervical disc herniation is a common cause of neck pain presenting in every clinical setup nowadays. It progresses with age because ageing induces degenerative changes in the spine. It is usually more common at 30-50 years of age and targets 60% of the females. However, the overall incidence is 5-20 cases per 1000 patients.[3]

Anatomy of the vertebrae

As we have discussed, there are seven cervical vertebrae (C1-C7). Each vertebra has its unique shape and function. The C1 vertebra is a ring-shaped bone, also known as the atlas, that supports your neck, and the C2 vertebra axis acts as a pivot. These vertebrae are connected with the help of joints known as facet joints that support the flexibility and mobility of the neck.[4]

According to Dr Mikel H. G Hoff, the spinal vertebrae are separated from each other through intervertebral discs. These discs contain gel-like material that acts as a cushion between the vertebrae and avoids friction. These vertebrae surround your spinal cord and cervical canal through which spinal nerves transverse.

Components of Intervertebral discs:

Intervertebral discs consist of 3 components. These are:

  • Nucleus pulposus (innermost part of the intervertebral disc)
  • Annulus fibrosus (thick layer surrounding nucleus pulposus)
  • End plate (help in fixation of the vertebra)

What causes cervical disc herniation?

With progressing age, bone density and the flexibility of the vertebral discs decrease. According to Dr Mikel H. G Hoff, herniation is caused by weakness of ligaments around The neck supporting the vertebral column and due to weakness of the middle disc, also called the intervertebral disc. Therefore, in old age, minor trauma or compression can cause protrusion of the jelly-like material (nucleus pulposus) in the spinal canal and compress the adjacent nerves. The causes of cervical disc herniation are:[5]

  • Disc degeneration
  • Hit and fall
  • Trauma to the neck
  • Gene mutation
  • Chronic invisible inflammation
Cervical Disc

Which factors increase the risk of cervical disc herniation?

Some factors increase the risk of cervical disc in herniation. These factors include the following:[6]


Ageing is the most common factor that induces degenerative changes in the discs, resulting in cervical disc herniation and cervical radiculopathy. It causes:

  • Degeneration of vertebral column
  • Osteoporosis in females
  • Decrease bone mineral density
  • Joint stiffness

Weightlifting exercises:

High-impact exercises can cause severe damage to your vertebra. Heavy weight lifting puts pressure on the vertebral discs, tearing the annulus fibrosus that holds the nucleus pulposus between the discs.

Frequent driving vibratory vehicles:

Vibratory vehicles cause repetitive spine motion due to frequent vibrations during driving. These vibrations damage the spine and can cause cervical disc herniation.


Smoking speeds up the degenerative process of the vertebra. Therefore, smokers are at higher risk of getting cervical disc herniation. 

Other Risks Factors

  • Sedentary lifestyle
  • Abnormal sitting posture
  • High body mass index (BMI)
  • Positive family history

What is the clinical presentation of cervical disc herniation?

Clinically, the cervical nerves supply the neck, arm, shoulder and upper back of the human body. Compression of nerves due to herniation produced symptoms associated with the affected nerve. Symptoms include the following:[7]

  • Cervicalgia (neck pain) can be moderate to severe, even affecting daily lifestyle activities depending upon the degree of compression
  • Tingling sensation in hands and arm
  • Headache
  • Migraine
  • Numbness
  • Paresthesia
  • Hypotonia
  • Autonomic areflexia

Clinical findings of solitary nerve lesions due to compression by cervical disc herniation include the following:

C2 nerve:

Compression of the C2 nerve causes pain in the ear and eye associated with headaches.

C3-C4 nerve:

Injury to the C3 and C4 nerves causes shoulder muscle spasms and trapezius tenderness.

C5 nerve:

Injury To the C5 neck causes pain in the neck, shoulder and scapular region. Other symptoms include;

  • Paresthesia on the lateral side of the arm
  • Restriction of shoulder movement, usually abduction and elbow flexion
  • Absent nicely reflex
C6 Nerve:
Injury To the C6 nerve Causes pain in the neck, arm and shoulder. Symptoms include:
  • Paresthesia on the forearm’s lateral side, including the hand’s lateral side and two digits.
  • Elbow flexion and wrist extension are affected
  • Diminished brachioradialis reflex

C7 Nerve:

Injury To this nerve Causes pain in the neck and shoulder. Symptoms include:

  • Paresthesia of the posterior part of the forearm and third digit
  • On examination, the triceps reflex is diminished

T1 Nerve:

It causes pain in the neck and shoulder associated with the Paresthesia of the medial side of the forearm. There is a weakness in the abduction and adduction of fingers.

Differential diagnosis for neck pain

Multiple conditions are associated with neck pain. There are some differential diagnoses of neck pain. These are:[8]

  • Cervical radiculopathy
  • Cervical myelopathy
  • Cervical disc herniation
  • Infections such as meningitis and vertebral osteomyelitis
  • Cervical spondylosis
  • Fibromyalgia
  • Spinal tumors
  • Spinal stenosis
  • Muscle strain
  • Brachial plexus injury
  • Shoulder impingement
  • Frozen shoulder
Each disease has a clinical presentation that helps the doctor differentiate and diagnose.


Complications of cervical disc herniation can occur if not diagnosed early and treated. These complications include:[9]

  • Irreversible nerve injury
  • Infection
  • Hematoma formation
  • Epidural abscess
  • Infection of the spinal cord

Surgical complications:

Surgery is usually not indicated in cervical nerve Injury unless In severe, complicated cases. Because spinal surgery has multiple post-surgical complications that sometimes remain life-long. These complications include:

  • Injury To recurrent laryngeal nerve, superior laryngeal nerve and hypoglossal nerve
  • Post-surgical infection
  • Injury To the trachea and esophagus
  • Dysphagia
  • Vascular injuries (carotid artery)
  • Pseudoarthrosis
  • Horner syndrome

Diagnosis And Treatment of Cervical Disc Herniation With ANF Therapy®️?

Diagnosing and treating cervical disc herniation with ANF Therapy®️ is a step-by-step procedure involving history taking, detailed examination, palpation, application of ANF Devices, and maintenance treatment. However, Dr. Mikel states that 80% of the patients came up with their MRI report showing cervical disc herniation.[10]


This is the initial and most crucial step for diagnosing any disease. ANF Neuro Orthopedic Practitioners gather detailed patient histories, focusing on presenting complaints, history of trauma, previous medical and surgical history, and family health background. They also ask about factors that aggravate or relieve neck pain, the radiation of pain, and stress and anxiety problems. However, the general questions may include:

  • What is your age?
  • Where do you feel pain?
  • The severity of the pain
  • Do you smoke or not?
  • History of trauma or fall
  • Muscle weakness
  • The feeling of something crawling on your arm and hand
  • Any positive family history
2-Physical examination:

In the physical examination, ANF Therapists assess range of motion, muscle tenderness, shoulder movement and cervical lymph nodes. There are about three provocative tests that are performed physically to diagnose cervical disc herniation. These tests include:

1- Spurling test:

In this test, the doctor will put his hand on your head and ask the patient to extend his head and move it towards the affected side. If symptoms reappear, the test is considered positive; otherwise, it is negative

2- Hoffman test:

The Hoffman test, also known as the Hoffman’s reflex, is a neurological test used to detect the presence of abnormalities in the central nervous system, particularly in the spinal cord. It’s primarily used to identify signs of upper motor neuron lesions.

The test is performed by flicking the nail or the tip of the third or fourth finger from the side, causing a quick flexion of the fingers or thumb. If the thumb flexes and adducts spontaneously in response to the flicking, the test is considered positive. A positive Hoffman sign can indicate issues like cervical myelopathy or other neurological conditions, but it should be interpreted within the context of other clinical findings.

3- Lhermitte sign:

In this test, the doctor flexes the neck of the patient to produce shock-like sensations that travel down the nerve root into the extremities (hands)


During this, an ANF Neuro Orthopedic practitioner will deeply palpate the patient’s neck. Palpation is done between the different muscles and also through the front of the neck to locate the area of herniation, as the cervical disc herniation is very easy to feel when you palpate the front of the neck. During palpation, the lymph nodes of the patients are also examined.

4-Neurological examination: 

In neurological examination, the ANF Neuro Orthopedic practical will examine the patient’s whole body. He will examine how much a patient rotates his neck and at what point he feels pain. He will do manual examination procedures, including passive and active neck movements, to locate the painful area, check muscle power, and perform neurological assessments. Neurological assessment includes:

  • Checking the radiation of the pain from the neck to shoulder, arm and the hand of the patient
  • Checking muscle weakness
  • Complete nerve examination of the shoulder arm and hand (axillary, radial, ulnar and median nerve)

Management of cervical disc herniation with ANF Therapy®️: Innovative treatment for cervical disc herniation

ANF Therapy and Back Pain

ANF Therapy®️ is an emerging treatment modality for cervical disc herniation, utilising specialised ANF Devices to target both symptoms and the underlying causes of the condition. These devices work by restoring damaged neurological frequencies in the body, reducing pain and inflammation, and promoting self-healing.[11]

Dr. Mikel H. G Hoff suggests using various ANF Devices, such as HD2, HD3, HD4, AGL, ACA, P+ and P-ve. An ANF Therapist places these devices over certain areas of the neck. These devices are designed to reduce inflammation and alleviate symptoms, enhancing the body’s natural healing processes.

ANF Therapy®️ aims to offer not just symptomatic relief but a long-term resolution by addressing the root causes of cervical disc herniation, promoting faster recovery and improved quality of life.

Expected outcomes:

ANF Therapy®️ is an emerging treatment designed to repair damaged tissue, enhance normal body frequencies, and significantly reduce inflammation, oxidative stress and free radicals. It promotes self-healing mechanisms and restores normal body function.

ANF Therapy®️ has helped thousands of patients with cervical disc herniation lead pain-free lives without complications. Many patients experience rapid pain relief, usually within 10-60 minutes of treatment. The benefits of ANF Therapy®️ include:

  • Significant reduction of pain and inflammation
  • Increased neck mobility
  • Reduced muscle spasms
  • Strengthening of weakened nerves

The duration of treatment varies, ranging from several days to a month, depending on the patient’s severity and response to the therapy.

ANF Therapy®️ aims to repair the weakened frequencies and damaged tissue of the body, reduce inflammation and oxidative stress, and promote self-healing. It restores the normal function of the body.

Principal of ANF Therapy®️:

ANF Therapy®️ operates on the principle of neurofrequency modulation. It corrects weak and damaged frequencies in the patient’s body that are causing pain and inflammation. Placing ANF Devices on specific neck areas stimulates neuroreceptors of the body and creates communication between the nervous system and other body parts. Moreover, these devices initiate natural processes in the body that treat cervical disc herniation from the root cause.  

Benefits of ANF Therapy®️ over other treatment options

ANF Therapy®️ provides effective pain relief by addressing the leading cause rather than treating only symptoms like other treatment options. It strengthens the weakened and damaged neurological frequencies of the body and enhances its ability to repair the damaged tissues. It helps the body to heal naturally.[12]

Unlike other invasive procedures that can cause post-surgical complications. ANF Therapy®️ is a non-invasive or non-surgical approach for treating cervical disc herniation without causing any complications.

It bypasses the use of expensive medications that disturb your stomach and gut and cause complications. It solely works in an efficient way to treat all the presenting symptoms of cervical disc herniation.

Join ANF Therapy®️ To Upskill Your Clinical Practice

ANF Academy offers clinical training for medical professionals to provide them with detailed knowledge about frequency medicine. It mainly focuses on neurological oscillations, neurobiochemical processes and their functions in the body, advanced palpation skills, and techniques to assess the neurological system. The ANF Clinical Training Program provides expertise on the ANF methodology for managing injuries and inflammation effectively, aiming for optimal patient outcomes.[13]

Training Highlights Include:

  • Mastering advanced clinical skills and techniques for neurological examinations.
  • Techniques for identifying the differences between healthy and inflamed nerves.
  • Methods to investigate the physical effects (signs and symptoms) of disrupted neurological oscillations.
  • Strategies to pinpoint and treat the underlying causes of pain, injury, or pathology, focusing on addressing root causes rather than merely symptoms.

The ANF Clinical Training Program:

  • It starts with developing the ability to locate, palpate, and evaluate nerves and the level of inflammation.
  • Enhances advanced clinical skills to discover the interconnections among different body systems and the underlying causes of symptoms.
  • Provides education on the various stages of treatment using ANF neuro tech Devices tailored to match the healing phases of injured tissues.

For further information about ANF education programs and clinical training, visit www.anfacademy.com


Sharrak, S., & Khalili, Y. A. (2023, August 28). Cervical disc herniation. StatPearls – NCBI Bookshelf. 

‌2. Staehler, R., MD. (n.d.). Cervical herniated disc symptoms and treatment options. Spine-health. https://www.spine-health.com/conditions/herniated-disc/cervical-herniated-disc-symptoms-and-treatment-options

3. Ms, M. B. F. M. (n.d.). Cervical disc disease clinical presentation: history, physical, causeshttps://emedicine.medscape.com/article/305720-clinical?form=fpf#b4

About Authors


Picture of Dr. Shahzaib Nasir

Dr. Shahzaib Nasir

Dr. Shazaib Nasir, MBBS, RMP, is a medical writer at ANF Academy. He graduated from Multan Medical and Dental College, Pakistan. He works as a medical officer in the Oethpaedics department at Ibn-e-sina Hospital and Research Institute, Multan. He deals with patients suffering from chronic orthopaedic problems and pain. He is passionate about healthy eating and exercising. Moreover, he believes that frequency medicine can be the future of Orthopaedics.


Picture of Dr. Shama Nosheen

Dr. Shama Nosheen

Dr. Shama Nosheen, MBBS, RMP, is a skilled medical editor and writer at ANF Academy, specializing in medical communications. For 5 years, she has been working with renowned international healthcare companies as a medical writer, aiming to bridge the gap between patients and doctors. She is a graduate of Nishtar Medical University Multan. She grabbed American Board certification (ABAMS) in Aesthetic Medicine after graduation. Working with ANF Academy, she has developed a thorough understanding of ANF Therapy® that works on the principles of frequency medicine.


Picture of PT. Irina Heinisuo Berná

PT. Irina Heinisuo Berná

Her background includes a Degree in Physiotherapy and a Master’s in Innovation and Research in Health Sciences, enriching her expertise in holistic health care. At ANF Academy, she seamlessly integrates clinical practice, academic teaching, and research into her daily activities to shape the future of ANF Therapy®. Irina’s work symbolizes integrating education and compassionate care to improve global health outcomes.

Final Reviewer:

Picture of Dr. Mikel H-G Hoff

Dr. Mikel H-G Hoff

Dr. Mikel H-G Hoff, Founder of ANF Therapy®, holds a bachelor’s degree in medicine and a Ph.D. in biochemistry, specializing in the bio function of the human body, specifically the neurological system. He is a manual therapist and sports psychologist. He is committed to revolutionizing healthcare by educating medical professionals and directly treating patients to enhance their quality of life. His extensive background in sports injury therapy, manual therapy, and various medical specializations, including biochemistry and nerve system signalization, empowers him to deliver pain-free solutions and lasting patient outcomes.

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