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Cervical Spine Conditions
This guide will help to define the common cervical spine conditions, anatomy, symptoms, evaluation findings, imaging indications, and findings.

DISC INJURIES
Inverteral Disc, Anatomy, Causes, Aggravating Factors, & Pain Patterns

Accurate diagnosis of cervical spine conditions is multi-factorial. Patient symptoms, physical examination and diagnostic testing is utilized in chiropractic offices. Historically, pain and imaging findings were heavily utilized. With improved research and ongoing development of best practices, the chiropractic profession has expanded its diagnostic and prognostic capabilities. Research has also demonstrated where pain and imaging alone may be misleading to the practitioner and when it may lack benefit to the patient.

Disc herniations typically follow consistent patterns. Disc herniations are usually caused by hyperflexion, or bending forward too much and too quickly. Hyperflexion causes the pressure on the disc to increase rapidly, and when the pressure is too great, the inside of the disc can be forced out.
When the inside of the disc herniates, it can put pressure on nearby nerve roots. Nerve roots are very sensitive to pressure, so this can lead to both local pain around the spine and radiating pain along the path of the nerve. This pressure on the nerve root is sometimes called impingement and can be referred to in lay terms as a “pinched nerve.”

The radiating symptoms occur in a “stripe” pattern called a dermatome. The cervical spine dermatomes are on the head, neck, and upper extremities. Pressure on the nerve roots can cause pain, numbness, tingling, burning, shooting, electrical or lightening-like sensations.
MRI findings do NOT equal pain.

Research has demonstrated prevalence of disc findings on MRI in asymptomatic adults beginning in the twenties and increasing with age (Matusmoto et al, 1998; Romeo et al, 2019; Alghamdi et. al 2021). Even in whiplash injuries, imaging findings are limited in their utility, with research concluding that trauma related findings are rare (Kongsted et al, 2008) and low correlation of post-injury imaging findings with prognosis for whiplash recovery (Sarrami et al, 2016; Brinjikji et al, 2015). Given the high prevalence of these findings and of back pain, the discovery by MRI of disc findings in people with neck pain may frequently be coincidental. 

FACET INJURIES 
Facet Joint Anatomy, Causes, Aggravating Factors, & Pain Patterns

Spinal vertebra contain superior (upper) and inferior (lower) articular facets. These joints are where motion occurs in the spine. Facet injuries are caused by hyperextension, or bending backward too much and too quickly. Hyperextension causes the facet joints in the spine to “jam” together. Someone with cervical facet pain typically has pain when they look upwards and/or reach overhead. These motions cause the spine to move into extension, increasing the pressure on the facet joints. If someone is experiencing pain because of a facet injury, common symptoms include:
  • localized, achy pain that may be sharp or dull
  • achy referred pain in a “square” like pattern
Nerves aren’t compressed like with disc injuries, so facet pain alone won’t cause changes in muscle strength, reflexes, or cause numbness, tingling, or sensation change.

A person with acute facet pain may not have any findings on an x-ray or MRI. However, enlarged facets are a common degenerative (age-related) findings which can be seen on both x-ray and MRI. According to Jenkins, et al. (2018), x-ray imaging is actually discouraged during the first 4 weeks of pain to allow for natural recovery. X-rays may be indicated if the patient fails to respond to a trial of conservative care.

SPRAIN/STRAIN 
Soft Tissue Injuries

Sprain/strain injuries, also called soft tissue injuries or whiplash injuries when they occur in the spine, are common after motor vehicle collisions. A sprain refers to ligamentous damage, while a strain refers to muscular damage. This damage occurs when the ligament or muscle is stretched beyond its limit, and in the cervical spine, this occurs with hyper-flexion. Strains can occur on their own or with an accompanying sprain. Just like disc herniations and facet injuries, sprain/strains can vary in severity, and health professionals will classify severity in terms of a grade (ie. grade 2 strain). The muscles of the back span a large area. People with a strain injury will complain of pain that follows a long, vertical pattern along the length of the spine. Strains can occur in the cervical, thoracic, and lumbar spine, but they are most common in the cervical spine because of the neck’s mobility. Patients with a strain may describe it as, “everything hurts” or “I’m sore everywhere!” Unlike disc and facet pain, spinal sprain/strain pain stays local to the spine, and they won’t have pain in the legs or arms.

Muscle damage can heal quickly, so strain injuries have fast resolution. Imaging won’t provide much useful information about a muscle strain. In the case of x-rays can be helpful to detect instability in the case of a severe ligament sprain.

DIAGNOSTIC IMAGES 

According to Chou, et al. (2007), 7 recommendations were made outlining history taking and exams, not obtaining regular imaging unless warranted, surgery or injection candidates, medication use, and non-pharmacologic conservative care options. Low back pain is the 5th most common reason for all patient visits in the US. Many patients have self-limited episodes and do not seek medical care. But for others, low back pain is very costly. As the anatomy is similar throughout the spine, the findings of Chou, et al (2007) could be related to the cervicalspine as well. Additionally, Lemmers, et al. (2019), and Hegmann, et al. (2019), found that diagnostic testing was not indicated for the majority of low back pain patients. The additional diagnostic testing was shown to increase medical costs, healthcare utilization, additional testing and treatment, and even delayed recovery.
Chiu, et al. (2015) and Zhong, et al. (2017) found that lumbar disc resorption (disappearance) is well supported in several countries after conservative treatment. Djuric, et al. (2020) believes the method of resorption is due to an active role of macrophages (acting like your body’s Pacman).

Carragee, et al. (2004) found that findings on MRI within 12 weeks of serious LBP inception are highly unlikely to represent any new structural change.

Dr. Morgan Price is a staff chiropractor at the Seattle VA and attending for their residency program. She has 12 publications in peer-reviewed journals, some of which she has co-authored with fellow VA pain pharmacists, physiatrists, and neurosurgeons. She serves as a representative and alternate advisor for her professional organization (the American Chiropractic Association) on the American Medical Association (AMA) CPT Health Care Professionals Advisory Committee for billing and coding matters. She additionally serves on a scientific commission writing clinical practice guidelines for chiropractic and other conservative care efforts, as well as on the site team for the education accreditation council under the Department of Education for chiropractic schools and residency programs.

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3. Romeo, V., Covello, M., Salvatore, E., Parente, C. A., Abbenane, D., Biselli, R., Ciriello, M., et al. (2019). High prevalence of spinal magnetic resonance
(Continued on page 12) 
imaging findings in asymptomatic young adults (18-22 years)candidate to Air Force flight. SPINE, 44(12), 872-878. doi:10.1097/BRS.0000000000002961
4. Alghamdi A, Alqahtani A. Magnetic Resonance Imaging of the Cervical Spine: Frequency of Abnormal Findings withRelation to Age. Medicines (Basel). 2021 Dec 14;8(12):77. doi: 10.3390/medicines8120077
5. Kongsted, A., Sorensen, J. S., Andersen, H., Keseler, B., Jensen, T. S., & Bendix, T. (2008). Are early MRI findings correlated with long-lasting symptoms following whiplash injury? A prospective trial with 1-year follow-up. European Spine Journal: Official Publication of the European Spine Society, the European Spinal DeformitySociety, and the European Section of the Cervical Spine Research Society, 17(8), 996–1005.https://doi.org/10.1007/s00586-008-0687-9
6. Sarrami, P., Armstrong, E., Naylor, J. M., & Harris, I. A. (2016). Factors predicting outcome in whiplash injury: a systematic meta-review of prognostic factors. Journal of Orthopaedics and Traumatology, 18(1), 9–16. doi:10.1007/s10195-016-0431-x
7. Brinjikji, W., Luetmer, P.H., Comstock, B., Bresnaha, B.W., Chen, L.E., Deyo, R.A., Halabi, S., et al. (2015).Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.American Journal of Neuroradiology (36)4, 811-816. doi: http://doi.org/10.3174/ajnr.A4173
8. .Jenkins, H.J., Downie, A.S., Moore, C.S., et al. (2018). Current evidence for spinal X-ray use in the chiropracticprofession: A narrative review. Chiropractic & Manual Therapies (26)48. https://doi.org/10.1186/s12998-018-0217-8
9.Chou, R., Qaseem, A., Snow, V., Casey, D., Cross J. T., Shekelle, P., & Owens, D. K. (2007). Diagnosis andtreatment of low back pain: A joint clinical practice guideline from the American College of Physicians and theAmerican Pain Society. Annals of Internal Medicine, 147(7), 478–491. doi: 10.7326/0003-4819-147-7-200710020-00006
10. Lemmers, G. P. G., van Lankveld, W., Westert, G. P., van der Wees, P. J, & Staal, J. B. (2019). Imaging versus noimaging for low back pain: A systematic review, measuring costs, healthcare utilization, and absence from work.European Spine Journal (28)5, 937-950. doi: 10.1007/s00586-019-05918-1
11. Hegmann, K. T., Travis, R., Belcourt, R. M., Donelson, R., Eskay-Auerbach, M., Galper, J., Haldeman, S., et al. (2019). Diagnostic tests for low back disorders. Journal of Occupational and Environmental Medicine (61)4,e155-e168.
12. Whalen, W., Farabaugh, R. J., Hawk, C., Minkalis, A. L., Lauretti, W., Crivelli, L. S., Wyatt, L., Sheppard, M., &Walters, S. A. (2019). Best-practice recommendations for chiropractic management of patients with Neck Pain. Journal of Manipulative and Physiological Therapeutics, 42(9), 635–650. https://doi.org/10.1016/j.jmpt.2019.08.001
13.Chiu, C. C., Chuang, T. Y., Chang, K. H., Wu, C. H., Lin, P. W., & Hsu, W. Y. (2015). The probability of spontaneous regression of lumbar herniated disc: A systematic review. Clinical Rehabilitation, 29(2), 184-95.doi: 10.1177/0269215514540919
14. Zhong, M., Liu, J., Jiang, H., Mo, W., Yu, P., Li, X., & Xue, R. R. (2017). Incidence of spontaneous resorption of lumbar disc herniation: A meta-analysis. Pain Physician Journal, 20(1), E45-E52.
15.Djuric, N., Yang, X., el Barzouhi, A. et al. Lumbar disc extrusions reduce faster than bulging discs due to an active role of macrophages in sciatica. Acta Neurochir 162, 79–85 (2020). https://doi.org/10.1007/s00701-019-04117-7
16. Carragee, E., Alamin, T., Cheng, I., Franklin, T., van den Haak, E., Hurwitz, E., et al (2004). Are first-time episodes of serious LBP associated with new MRI findings? Spine (6)6, 624-35.

 

Tuesday, February 17, 2026
by: Dr. Morgan R. Price, DC – Chiropractic Expert, West Coast Chiropractic Expert
Section: Winter 2026
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