Cervical Discogenic Pain Syndrome

Last updated: February 8, 2026Reviewed date: February 8, 2026Reading time: 17 min read
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Article Summary

Cervical discogenic pain syndrome is a type of chronic neck pain that originates from damaged or degenerative intervertebral discs in the cervical spine (neck region). Unlike pain caused by nerve root compression (radiculopathy), discogenic pain arises directly from the disc itself, often due to internal disc disruption, annular tears, or chemical irritation of pain-sensitive structures within the disc. Patients typically describe a deep, aching pain...

Key Takeaways

  • This article explains Anatomy of the Cervical Intervertebral Disc in simple medical language.
  • This article explains Types of Cervical Discogenic Lesions in simple medical language.
  • This article explains Causes of Cervical Discogenic Pain Syndrome in simple medical language.
  • This article explains Symptoms of Cervical Discogenic Pain Syndrome in simple medical language.
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Definition

discogenic is a type of neck pain that originates from damaged or degenerative intervertebral discs in the cervical spine (neck region). Unlike pain caused by nerve root compression (), discogenic pain arises directly from the disc itself, often due to internal disc disruption, annular tears, or chemical irritation of pain-sensitive structures within the disc. Patients typically describe a deep, aching pain in the neck that may radiate to the shoulders or upper back, worsens with neck movements, and is relieved by rest. This condition accounts for a significant share of chronic neck pain cases and can substantially impair daily activities and quality of life MedscapeNCBI.

of the Cervical Intervertebral Disc

The cervical intervertebral disc is a fibrocartilaginous structure located between adjacent cervical vertebral bodies (C2–C3 through C7–T1). Each disc consists of two main components:

  • Nucleus Pulposus: A gelatinous core rich in water and proteoglycans that distributes compressive loads evenly across the disc.

  • Annulus Fibrosus: Concentric lamellae of collagen fibers that surround the nucleus, providing tensile strength and containing the nucleus under pressure.

Blood Supply: Small blood vessels from the metaphyseal penetrate the outer annulus fibrosus and the vertebral endplates, supplying nutrients to the disc through diffusion. The inner annulus and nucleus are avascular and rely on endplate diffusion for metabolic exchange NCBIPhysio-pedia.

Nerve Supply: Sensory fibers from the sinuvertebral ( meningeal) nerves innervate the outer one-third of the annulus fibrosus and the adjacent vertebral endplate. These pain-sensitive fibers transmit nociceptive signals when the disc is injured or inflamed KenhubPhysio-pedia.

 Key Functions of the Cervical Disc:

  1. Absorption: Cushions forces transmitted through the spine during movement and loading.

  2. Load Distribution: Evenly spreads compressive loads across the vertebral bodies.

  3. Motion Facilitation: Allows flexion, extension, lateral bending, and rotation of the cervical spine.

  4. Height Maintenance: Preserves intervertebral space height to maintain foraminal openings for nerve roots.

  5. Spinal Stability: Contributes to overall stability by resisting excessive motion.

  6. Protection of Neural Elements: Maintains proper spacing and alignment to prevent nerve impingement NCBIKenhub.

Types of Cervical Discogenic Lesions

  1. Focal Herniation: Involves less than 25% of the disc circumference, typically resulting from a annular tear that allows nuclear material to bulge Medscape.

  2. Broad-Based Herniation: Encompasses 25–50% of the disc circumference, often causing more diffuse bulging of the annulus Medscape.

  3. Disc Protrusion: A contained bulge where the nucleus remains within the outer annulus but extends beyond the disc margin.

  4. Disc Extrusion: Nuclear material breaches the annulus fibrosus but remains connected to the parent disc.

  5. Disc Sequestration: Free fragments of nucleus pulposus separate completely from the disc and may migrate within the spinal canal.

  6. Internal Disc Disruption (IDD): Micro-tears in the annulus without true herniation, causing inflammatory pain.

  7. (DDD): Age-related wear and tear leading to disc , loss of height, and annular fissures.

  8. Retro-Odontoid Disc: Upward migration of disc material from the C2–C3 level, sometimes impinging on the MedscapeMedscape.

Causes of Cervical Discogenic Pain Syndrome

  1. Age-Related Degeneration: Natural wear and tear leading to dehydration and fissuring of the annulus NCBIOrthopedic Pain Institute.

  2. or Whiplash: Sudden hyperflexion–hyperextension injuries that tear annular fibers Orthopedic Pain InstitutePMC.

  3. Repetitive Microtrauma: Occupational or sporting activities causing repeated stress on discs Physio-pediaPMC.

  4. Poor Posture: Forward head posture increasing disc pressure over time WebMDPMC.

  5. Occupational : Jobs involving prolonged neck flexion or vibration (e.g., truck driving) NCBIWebMD.

  6. Predisposition: of early disc degeneration NCBIPhysio-pedia.

  7. Smoking: Nicotine impairs disc nutrition and healing NCBINCBI.

  8. Obesity: Excess weight increases axial load on cervical spine PMCOrthopedic Pain Institute.

  9. Sedentary Lifestyle: Weak neck stabilizers leading to uneven disc loading Physio-pediaPMC.

  10. Inflammatory Disorders: , causing endplate Orthopedic Pain InstitutePMC.

  11. Metabolic Disorders: affecting disc metabolism NCBIPhysio-pedia.

  12. Malalignment or : Abnormal curvature altering load distribution PMCOrthopedic Pain Institute.

  13. Facet Joint Arthropathy: Secondary loading on discs due to facet degeneration MedscapePhysio-pedia.

  14. Vertebral Endplate Changes: Schmorl’s nodes and endplate fissures weakening disc integrity NCBIPhysio-pedia.

  15. High-Impact Sports: Weightlifting, contact sports causing axial compression injuries Orthopedic Pain InstitutePMC.

  16. Previous Spinal Surgery: Altered biomechanics at adjacent segments leading to disc overload MedscapeNCBI.

  17. : Vertebral compression fractures altering disc mechanics NCBIMedscape.

  18. Tumors or Infections: Rarely, neoplastic or infectious processes can weaken annulus PMCFrisbie Memorial Hospital.

  19. Disc Nutrition Deficits: Poor vascular supply to endplates limiting nutrient diffusion NCBIKenhub.

  20. Chemical Irritation: Release of inflammatory cytokines from degenerating nucleus causing nociception NCBIPMC.

Symptoms of Cervical Discogenic Pain Syndrome

  1. Localized Neck Pain: Deep, achy discomfort in the midline or paraspinal region.

  2. Shoulder Pain: Referred pain to the trapezius or scapular area.

  3. Arm Pain: Non-dermatomal, diffuse aching in the upper limb.

  4. : Limited range of motion, especially in rotation or extension.

  5. Pain Worsening on Extension: Increased discomfort when tilting the head backward.

  6. Neck Muscle Spasms: Involuntary tightening of paraspinal muscles.

  7. Headaches: Occipital or cervicogenic headaches triggered by neck movement.

  8. Cervical Crepitus: Grinding or popping sounds during neck motion.

  9. Night Pain: Discomfort disrupting sleep, often requiring head support adjustment.

  10. Activity-Related -ups: Pain spikes during lifting or prolonged posture.

  11. on Palpation: Local sensitivity over the affected disc level.

  12. Pain Relief with Rest: Symptoms ease when the neck is unloaded.

  13. : Slight reduction in neck extensor or flexor strength.

  14. Radiation to Upper Back: Discomfort spreading to paraspinal muscles.

  15. Lightheadedness: Occasional dizziness related to neck positioning.

  16. Loss of Endurance: Inability to maintain neck-supported activities.

  17. Pain on Cough or Sneeze: Increased intradiscal pressure exacerbates pain.

  18. Paraesthesia: Occasional tingling or “pins and needles” without true radiculopathy.

  19. Reduced Grip Strength: Secondary to pain-induced disuse of upper limb.

  20. Emotional Distress: Anxiety or frustration due to chronic discomfort MedscapeOrthopedic Pain Institute.

 Diagnostic Tests

  1. Clinical Examination: Assessment of pain location, motion, and provocative maneuvers MedscapePMC.

  2. Magnetic Resonance Imaging (MRI): Visualizes disc degeneration, annular tears, and herniations.

  3. Computed Tomography (CT) Scan: Detects bony changes and calcified disc fragments.

  4. X-Rays (Dynamic): Flexion–extension films to assess instability or alignment issues.

  5. Provocative Discography: Injection of contrast into the disc to reproduce pain and confirm the pain generator MedscapePMC.

  6. CT Discography: Combines discography with CT imaging for annular fissure visualization.

  7. Electromyography (EMG): Rules out radiculopathy by assessing muscle innervation.

  8. Nerve Conduction Studies (NCS): Evaluates peripheral nerve integrity.

  9. Selective Nerve Root Block: Differentiates radicular from discogenic pain sources.

  10. Spinal Injections (Diagnostic): Facet or epidural injections to isolate pain sources.

  11. Ultrasound Imaging: Limited use for evaluating soft tissue and guidance of interventions.

  12. Bone Scan: Rarely, to detect infection or neoplastic activity.

  13. Laboratory Tests: ESR, CRP to rule out inflammatory or infectious etiologies.

  14. Pain Questionnaires: Standardized tools like the Neck Disability Index (NDI).

  15. Pressure Algometry: Quantifies tenderness thresholds over the disc area.

  16. Surface Electromyography: Monitors muscle activation patterns.

  17. Functional Capacity Evaluation: Assesses work-related neck function.

  18. Psychosocial Screening: Identifies barriers to recovery such as depression or fear-avoidance.

  19. Gait and Balance Assessment: In cases with associated dizziness or proprioceptive changes.

  20. Videofluoroscopy: Dynamic imaging to evaluate cervical segment motion MedscapePMC.

Non-Pharmacological Treatments

  1. Physical Therapy: Tailored exercises to restore strength and flexibility.

  2. Manual Therapy: Mobilization and manipulation to improve joint mechanics NCBIPMC.

  3. Therapeutic Exercise: Isometric neck strengthening and range-of-motion drills.

  4. Posture Education: Techniques to maintain neutral cervical alignment.

  5. Ergonomic Assessment: Workspace modifications to reduce neck strain.

  6. Cervical Traction: Mechanical or manual traction to decompress discs.

  7. Heat Therapy: Superficial or deep heat to relax muscles and improve circulation.

  8. Cold Therapy: Cryotherapy to reduce acute inflammation and pain.

  9. Ultrasound Therapy: Deep heating to promote tissue healing.

  10. Transcutaneous Electrical Nerve Stimulation (TENS): Electrical stimulation for pain relief.

  11. Acupuncture: Needle insertion to modulate pain pathways.

  12. Massage Therapy: Soft-tissue techniques to reduce muscle tension.

  13. Myofascial Release: Manual therapy targeting fascial restrictions.

  14. Dry Needling: Trigger point release within neck muscles.

  15. Kinesio Taping: Support and proprioceptive feedback for neck stability.

  16. Yoga: Gentle stretches and postures emphasizing spinal alignment.

  17. Pilates: Core strengthening and postural control.

  18. Aquatic Therapy: Low-impact exercise in a pool environment.

  19. Mindfulness Meditation: Stress reduction to lower muscle tension.

  20. Cognitive Behavioral Therapy (CBT): Addresses pain-related thoughts and behaviors.

  21. Biofeedback: Teaches muscle relaxation techniques.

  22. Ergonomic Pillows: Cervical support during sleep.

  23. Neck Braces (Short Term): Limited immobilization to reduce pain flare-ups.

  24. Education and Self-Management: Guidance on activity modification and pacing.

  25. Weight Management: Reducing axial load on the cervical spine.

  26. Hydrotherapy: Warm water exercises to enhance mobility.

  27. Balance Training: Proprioceptive exercises for cervical stability.

  28. Stretching Programs: Posterior and anterior neck stretches.

  29. Postural Taping: Provides tactile cues for neck positioning.

  30. Nutritional Support: Anti-inflammatory diet and hydration NCBIPMC.

Pharmacological Treatments

  1. Ibuprofen (NSAID): Reduces pain and inflammation.

  2. Naproxen (NSAID): Longer-acting anti-inflammatory effect WebMD.

  3. Diclofenac (NSAID): Potent cyclooxygenase inhibitor.

  4. Celecoxib (COX-2 Inhibitor): Lower gastrointestinal risk than non-selective NSAIDs.

  5. Ketorolac (NSAID): Short-term use for moderate to severe pain.

  6. Acetaminophen: Analgesic with minimal anti-inflammatory action.

  7. Cyclobenzaprine: Muscle relaxant for acute spasms.

  8. Tizanidine: Central α₂-agonist reducing muscle tone.

  9. Baclofen: GABA_B agonist for spasticity relief.

  10. Carisoprodol: Short-term muscle relaxation.

  11. Gabapentin: Neuropathic pain modulation.

  12. Pregabalin: Similar to gabapentin with fewer side effects.

  13. Duloxetine: SNRI for chronic musculoskeletal pain.

  14. Tramadol: Weak opioid agonist with serotonergic effects.

  15. Oxycodone: Potent opioid for severe pain under strict monitoring.

  16. Prednisone (Oral Steroid): Short-term anti-inflammatory therapy.

  17. Epidural Steroid Injections: Targeted anti-inflammatory delivery.

  18. Facet Joint Injections: Local steroid and anesthetic to confirm and treat pain source.

  19. Capsaicin Topical: Depletes substance P to reduce nociception.

  20. Lidocaine Patch: Local anesthetic for focal pain relief MedscapeWebMD.

Surgical Options

  1. Anterior Cervical Discectomy and Fusion (ACDF): Removal of the disc and fusion of adjacent vertebrae.

  2. Anterior Cervical Discectomy (ACD) Alone: Disc removal without fusion in select cases MedscapeVerywell Health.

  3. Cervical Disc Arthroplasty (Artificial Disc Replacement): Prosthetic disc insertion to preserve motion Verywell Health.

  4. Posterior Cervical Laminoforaminotomy: Decompression of nerve roots through a posterior approach.

  5. Posterior Cervical Laminectomy: Removal of the lamina to decompress the spinal cord.

  6. Posterior Cervical Fusion: Stabilization following laminectomy or laminoplasty.

  7. Microdiscectomy: Minimally invasive removal of herniated disc fragments.

  8. Cervical Corpectomy: Resection of vertebral body and disc for multilevel disease.

  9. Foraminotomy (Anterior/Posterior): Enlargement of the neural foramen to relieve nerve compression.

  10. Endoscopic Discectomy: Percutaneous removal of disc material under endoscopic guidance Verywell Health.

Prevention Strategies

  1. Ergonomic Workstation: Adjustable chair and monitor at eye level.

  2. Frequent Breaks: Change posture every 30 minutes.

  3. Proper Lifting Techniques: Use leg muscles, keep load close to the body.

  4. Postural Exercises: Daily routines to strengthen neck stabilizers.

  5. Healthy Weight Maintenance: Reduce axial load on the spine.

  6. Smoking Cessation: Improves disc nutrition and healing.

  7. Hydration and Nutrition: Adequate water and anti-inflammatory diet.

  8. Supportive Pillows: Cervical contour pillows for neutral spine during sleep.

  9. Regular Physical Activity: Low-impact aerobic exercise for spinal health.

  10. Stress Management: Relaxation techniques to minimize muscle tension PMCSELF.

When to See a Doctor

  • Persistent Pain > 6 Weeks: Despite home care and OTC medications Desert Institute for Spine CareFrisbie Memorial Hospital.

  • Neurological Deficits: Numbness, tingling, or weakness in the arms.

  • Signs of Spinal Cord Compression: Gait disturbance, hand clumsiness.

  • Severe Headaches or Dizziness: Associated with neck movement.

  • Infection or Systemic Signs: Fever, unexplained weight loss.

  • Trauma History: Recent fall or motor vehicle accident.

  • Unrelenting Night Pain: Waking from sleep.

  • Loss of Bowel/Bladder Control: Indicates possible myelopathy.

  • Rapid Symptom Progression: Worsening pain or neurological signs.

  • Failed Conservative Care: No improvement after a month of therapy.

Frequently Asked Questions

  1. What is discogenic neck pain?
    Discogenic neck pain is discomfort originating from a damaged cervical disc rather than nerve compression.

  2. How is it diagnosed?
    Diagnosis involves clinical exam, imaging (MRI), and sometimes provocative discography.

  3. Can it heal on its own?
    Mild cases often improve with conservative care within weeks to months.

  4. Is surgery always required?
    No—surgery is reserved for severe, refractory cases or neurological compromise.

  5. What exercises help?
    Isometric neck strengthening, gentle stretches, and posture correction.

  6. Are epidural steroids effective?
    They can provide temporary relief by reducing inflammation around the disc.

  7. Can poor posture cause discogenic pain?
    Yes—sustained forward head posture increases disc stress.

  8. What is provocative discography?
    A diagnostic injection into the disc that reproduces the patient’s pain.

  9. Does smoking affect cervical discs?
    Yes—it impairs disc nutrition and accelerates degeneration.

  10. How long is recovery after ACDF?
    Most patients resume light activities in 4–6 weeks, with full fusion by 3–6 months.

  11. Are artificial discs better than fusion?
    Disc arthroplasty preserves motion but may not be suitable for all patients.

  12. Can nutrition help prevent degeneration?
    A balanced diet rich in anti-inflammatory nutrients supports disc health.

  13. What pillow is best for discogenic pain?
    A cervical contour pillow that maintains neutral spine alignment.

  14. Is discogenic pain hereditary?
    A genetic predisposition can increase the risk but lifestyle factors also play a large role.

  15. When should I consider ergonomic assessment?
    At the first sign of persistent neck discomfort related to work or daily activities.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members

Last Updated: May 04, 2025.

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  149. Spine7 Treatment of Fractures of the Thoracic and Lumbar Spine[rxharun.com]
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  1. Understand the condition Begin with the essential facts and a clear explanation of the topic.
  2. Recognize symptoms Learn common symptoms, signs, and patterns of presentation.
  3. Know when to seek help Review urgent warning signs and when professional assessment may be needed.
  4. Understand causes and risks Explore causes, risk factors, mechanisms, and contributing conditions.
  5. Explore tests and diagnosis Learn how clinicians assess the condition and which investigations may be discussed.
  6. Learn treatment approaches Review general treatment categories and management principles.
  7. Understand medicines safely Continue to medicine education, uses, precautions, and monitoring.
  8. Plan monitoring and follow-up Understand monitoring, complications, rehabilitation, and follow-up learning.
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Doctor visit helper

Prepare before seeing a doctor

A simple rural-patient checklist to help you explain symptoms clearly, ask better questions, and avoid unsafe self-treatment.

Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

Orthopedic doctor, spine specialist, neurologist, or physiotherapist depending on severity.

What to tell the doctor

  • Mark pain area and whether pain travels to leg.
  • Write numbness, weakness, bladder/bowel problem, fever, injury, or night pain if present.
  • Bring previous X-ray/MRI and medicine list.

Questions to ask

  • Is this muscle pain, disc problem, nerve pressure, arthritis, infection, or another cause?
  • Do I need X-ray or MRI now?
  • Which activities should I avoid and which exercises are safe?
  • When can I return to work?

Tests to discuss

  • Spine and neurological examination
  • Straight leg raise or similar nerve tension tests
  • X-ray if trauma/deformity/chronic pain is suspected
  • MRI if leg weakness, sciatica, or red flags are present

Avoid these mistakes

  • Avoid heavy lifting, long bed rest, and untrained spinal manipulation.
  • Avoid NSAIDs if ulcer, kidney disease, blood thinner use, pregnancy, or allergy unless doctor says safe.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

  • Avoid heavy lifting, sudden bending, and prolonged bed rest.
  • Use comfortable posture and gentle movement as tolerated.
  • Discuss physiotherapy, X-ray, or MRI only when clinically needed.

OTC medicine safety

  • For mild back pain, pain-relief medicine may be discussed with a doctor or pharmacist.
  • Avoid repeated painkiller use if you have kidney disease, stomach ulcer, uncontrolled blood pressure, or are taking blood thinners.

Avoid these mistakes

  • Do not start antibiotics without a proper medical decision.
  • Do not use steroid tablets or injections casually for quick relief.
  • Do not delay emergency care because of home remedies.

Get urgent help if

  • Back pain with leg weakness, numbness around private area, loss of urine/stool control, fever, cancer history, or major injury needs urgent care.
Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

Patient health record and symptom diary

Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Orthopedic / spine specialist, physical medicine doctor, or qualified clinician
Tests to discuss with doctor
  • Neurological examination for leg power, sensation, reflexes, and straight leg raise
  • X-ray only if injury, deformity, long-lasting pain, or doctor suspects bone problem
  • MRI discussion if severe nerve symptoms, weakness, bladder/bowel problem, or persistent symptoms
Questions to ask
  • What is the most likely cause of my symptoms?
  • Which warning signs mean I should go to emergency care?
  • Which tests are really needed now?
  • Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?
  • Is physiotherapy, posture correction, or activity modification needed?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Safe pathway to proper treatment

Care roadmap for: Cervical Discogenic Pain Syndrome

Use this simple roadmap to understand the next safe steps. It is educational and does not replace examination by a doctor.

Go to emergency care if you notice:
  • New leg weakness, numbness around private area, or loss of bladder/bowel control
  • Back pain after major injury, fever, unexplained weight loss, cancer history, or severe night pain
Doctor / service to discuss: Orthopedic/spine specialist, physical medicine doctor, physiotherapist under guidance, or qualified clinician.
  1. Step 1

    Check danger signs first

    If danger signs are present, seek emergency care and do not wait for online information.

  2. Step 2

    Record the symptom story

    Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.

  3. Step 3

    Visit a qualified clinician

    A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.

  4. Step 4

    Do only useful tests

    Discuss neurological examination first. X-ray or MRI may be needed only when red flags, injury, nerve weakness, or persistent severe symptoms are present.

  5. Step 5

    Follow up and return early if worse

    If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips
  • Take a written symptom diary and all previous prescriptions/test reports.
  • Do not hide medicines already taken, even herbal or over-the-counter medicines.
  • Ask which warning signs mean urgent referral to hospital.
  • Avoid forceful massage or bone-setting when there is weakness, injury, fever, or nerve symptoms.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

Internal learning pathway

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Degenerative Bones, Joints, and Spine Care (A - Z)
  1. Undescended Shoulder Disease DefinitionUndescended shoulder disease is not the usual medical name. Doctors usually call this condition Sprengel deformity,…
  2. Sprengel Deformity DefinitionSprengel deformity is a birth condition in which one shoulder blade?, called the scapula?, stays higher…
  3. High Shoulder Blade DefinitionA high shoulder blade? usually means one shoulder blade sits higher than normal from birth. The…
  4. High Scapula DefinitionHigh scapula? is a condition where one shoulder blade? sits higher than normal on the back…
  5. Upward Displacement of the Scapula DefinitionUpward displacement of the scapula? usually means congenital? elevation of the scapula, which is most often…
  6. Congenital Elevation of Scapula DefinitionCongenital? elevation of scapula? means a baby is born with one shoulder blade? sitting higher than…