Question
Hello,
I have had neck/shoulder/upper back and right arm pain for a couple of months now.  I went ot see a chiropractor who sent me off for spine x-rays.
The lordotic angle of my cervical spine is 20 degrees, with noderate spondylosis at C5/6.  No loss os disc height.
I am led to believe this is causing my pain, and that the apin can be made to go away.  I have had one session where a chiropract tapper was used, and there waqs minor manipulation of my shoulder muscle.  
I am still in pain, but booked to see the chiropractor another 2 times for 20 minute sessions next week.
My question is whether or not the pain will eventually subside, and what else I could be doing to speed up the process.

Answer
Thank you for your question.

Unfortunately, I can't answer your question specifically as to what is causing your neck, shoulder, upper back, and arm pain, or how long it will take to heal, as I don't have the benefit of your physical examination findings and other clinical information that would help guide that prognosis.

In general, however, pain that starts in the neck and radiates to the shoulder, upper back, and arm suggests the possibility of a herniated disc. The C5-C6 region is perhaps the most common level in the neck for disc herniations to occur.

Myofascial trigger points (discrete painful nodules in muscles that refer pain to other parts of the body) may also mimic the pain of disc syndromes.

Spondylosis is a term to describe degenerative changes of the spine, and disc degeneration often accompanies spondylosis. Spondylosis may often affect the spinal nerve roots, and the C5 and C6 nerve roots are most commonly affected when symptoms are present. Spondylosis causing symptoms is common in middle age, particularly in the 50- year-old range.

The intervertebral disc is not visualized on plain-film x-ray, although the space between the vertebrae that is occupied by the disc is apparent on x-ray. Discs are best evaluated with an MRI scan.

However, the presence of spondylosis on an x-ray or even of bulging or herniated discs on MRI do not always correlate with the presence of pain. That is, some individuals show significant degenerative changes of the spine on x-ray or disc herniations on MRI scanning, but don't have any symptoms. The radiographs or other imaging modalities should be used to rule in or rule out other pathological concerns, as well as to provide a broader clinical picture of a patient's condition, rather than to solely make a diagnosis.

I am given to understand from your description of the treatment that you received that some sort of a mechanical instrument was used to provide a manipulation. My only comment would be that if you don't notice any significant improvement in your symptoms within 6 to 12 treatments, your chiropractor should use a different approach. The use of mechanical instruments to perform spinal manipulation is generally regarded as safe, but I am not familiar with specific studies to indicate their efficacy for the type of problem you are describing (which is not to say that they don't work).

I have generally found neck mobilization (the gentle movement of the neck joints within their normal ranges without the quick manipulation thrust and "cracking") done by hand, gentle neck traction, and the prescription of specific rehabilitation exercises to be of help in reducing a patient's neck pain in the case of herniated discs.

One resource that might be of help to you for self-care is a book by the Australian physiotherapist Robin McKenzie called "Treat Your Own Neck". Your chiropractor should have reviewed some specific neck exercises that you could perform (depending upon the severity of your pain and your ability to do so) that would help speed up your recovery. If he or she has not, I would recommend reading this book, which can be purchased on-line, for additional information, and speaking to your chiropractor about it before engaging in self-exercise. If your chiropractor is not conversant in rehabilitative exercises, then I would recommend seeing a physical therapist who is.

Finally, if your pain progresses or you notice weakness of the arm or hand, I would recommend seeing a neurologist for further evaluation, which would probably include electrodiagnostic tests (electromyography and nerve conduction velocity testing to determine if there are nerve or muscle deficits in the neck and arm) and an MRI scan.

I hope that this answers your question, and I would encourage you to pose the same questions you asked to your chiropractor, who should be able to answer your concerns.