Cervical Spondylosis refers to the “ degenerative condition of the cervical spine” including the intervertebral joints in between the vertebral bodies and the vertebral discs.
The term also use for this condition are;
· Degenarative Disc Disease
· Degenarative Spondylosis
· Spondylitis Deformans
It is very common in persons above 50 years of age and those who have got to do work like typing or persons who have to keep the neck in one position as in reading, writing and other table works.
It starts with degeneration of disc resulting in, reduced space in between two vertebrae, later osteophytes are formed in the periphery.
The osteophytes formed may also compress the cord which will produce weakness of whole of the limb.
Causes Of Cervical Spondylosis:
· Occupational stresses causes continous pressure on the cervical segments. The sections of society prone to stress and strain are-
a) Officers, typists and others working on poorly and wrongly positioned desks and tables.
b) Drivers prone to prolonged driving.
c) Persons involved in occupations including lifting and carrying things on their head.
d) Habit of holding phone on one shoulder while talking.
e) Sleeping in awkward positions, using inappropriate pilows.
· Built of the body Persons having thick neck with a Dowager's Hump and long backs are much prone to spondylosis.
The segments commonly affected in the cervical region are C4 to T1
Clinical Feature Of Cervical Spondylosis:
Onset: The condition gets precipitated by fatigue, mental tensions, worries, anxiety or depression. It occurs gradually due to faulty posture.
Pain: The region of pain depends on the site where the cervical spine is affected by the pathology.
a) Upper cervical spine- Headache
b) Mid cervical spine- Neck pain
c) Region from C4 to T2- Radiating pain; pain in shoulder girdle, shoulder and arm, either unilateral or bilateral.
Muscle weakness:Depending on which nerve root gets compressed, the concerned muscles that are supplied by that nerve root gets affected and weakened. Usually, the postural muscles of the neck are weak. They are: upper cervical spine flexors, lower cervical spine extensors and side flexors.
Limitation of movement: All the neck movements get limited, often bilateral but is unilateral in case of acute onset of pain. The movement which gets very much limited is flexion of the upper cervical spine and extension of the lower cervical spine.
Postural disturbance: The posture gets disturbed in cervical osteoarthritis as follows-
- Stress at C5,C6, so tightness of upper cervical spine extensors.
- Chin placed forward.
- Kyphosis of thoracic spine.
- Tight pectorals.
- Flattened, sometimes lordotic lumbar spine.
- Flexion of elbows and hand.
1. X-Ray of cervical Spine
The X-ray finding reveals that there is:
- Osteophyte formation at the margin of the apophyseal joints
- Reduced space between the vertebral bodies
- Lipping of the vertebral bodies.
Treatment Of Cervical Spondylosis In Physical Therapy
Cervical Osteoarthritis can be treated in physiotherapy department by various means like:
- Heat Modalities
- Neck Exercises
- Manipulative Therapy
- Postural Awareness
- Cervical traction
- Neck support
- To relieve pain
- To provide support to the neck
- To restore the neck movements in full range
- To re-educate the patient for posture correction
- To strengthen the cervical muscles
- To analyse the basic precipitating causes of the patient's problem and aim at alleviating those causative factors.
Acetaminophen: Mild pain is often relieved with acetaminophen.
Non-steroidal anti-inflammatory drugs (NSAIDs) Often prescribed with acetaminophen, drugs like ibuprofen (Advil, Genpril, Ibu, Midol, Motrin, Nuprin) and naproxen (Aleve, Anaprox)are considered first-line medicines for neck pain.
Muscle relaxants. Medications such as cyclobenzaprine or carisoprodol can also be used in the case of painful muscle spasms.
Heat Modalities: Heat is an effective mean of reducing and relieving pain in cervical osteoarthritis
Strengthening Exercises Of Neck
Stretching Exercises Of Neck
Oscillatory traction is considered to be effective in mobilizing the stiff neck.
Continuous traction is used to relieve nerve root pressure.
Support: Support for the neck are of great importance to keep the neck steady and to relieve the pain. A firm neck collar is very beneficial especially during activities or during travelling. While patient is resting or sitting, the collar should be removed but then also the neck should be supported by pillows or head rest.
Postural Awareness: The ideal posture is straight neck with chin tucked in and back straight with no compensatory actions or any trick movements. While sitting a high backed chair is provided to the patient with head, neck and shoulder supported; a small pillow in the lumbar spine, feet properly supported and arms resting on a pillow over the lap or on the arms of the chair.
While sleeping, side lying is the most preffered position, supine lying is also adviced. A single pillow under head for head support is allowed. A Butterfly pillow is the best support for a patient of cervical osteoarthritis, as it is flattened in the middle where the head rests and the elevated ends support the head on the sides.
Surgery: may be necessary for a patient suffering from cervical osteoarthritis if he/she has severe pain that does not improve from other conservative treatments. It should be the last resort as there is always a risk factor involved.