Cervical Spondylosis

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Cervical spondylosis also known as Cervical Osteoarthritis by physical therapy modalities.

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

·         Osteopytosis

·         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.

Site:
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.

Paraesthesia

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.

Muscle spasm:

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.
Cervical spondylosis is usually associated with headache, vertigo and loss of balance which is due to postural changes.

Investigations:

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
  • Hydrotherapy
  • Postural Awareness
  • Relaxation
  • Cervical traction
  • Neck support
Aims of Cervical Spondylosis Treatment
  • 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.
Treatment

Medication
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

Massage

Strengthening Exercises Of Neck

Stretching Exercises Of Neck

Traction
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.


 
 

Cervical Radiculopathy ( Pinched Nerve )

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Cervical radiculopathy is a dysfunction of a nerve root of the cervical spine. The seventh (C7; 60%) and sixth (C6; 25%) cervical nerve roots are the most commonly affected.

In the younger po pulation, cervical radiculopathy is a result of a disc herniation or an acute injury causing foraminal impingement of an exiting nerve. Disc herniation accounts for 20-25% of the cases of cervical radiculopathy. In the older patient, cervical radiculopathy is often a result of foraminal narrowing from osteophyte formation, decreased disc height, degenerative changes of the uncovertebral joints anteriorly and of the facet joints posteriorly.

Risk Factors: include heavy manual labor requiring the lifting of more than 25 pounds, smoking, and driving or operating vibrating equipment. Injury to the cervical, debeties


Symptoms
Pain:Pain is a common symptom of a pinched nerve in shoulder. It might be sharp or burning, it could cover the whole shoulder area, or a specific spot. This depends on the location of the nerve. If it is close to the spinal cord and originating from the neck then neck movements may agitate it as well.

Numbing: Numbness or tingling can occur due to a pinched nerve in shoulder. You might get a feeling that your shoulder is dead, or when you touch it you don’t feel as much, there is less sensation. Pins and needles is another common complaint. It may occur any place between your hand to your neck and depends on where the nerve is being compressed.

Weakness: Since the nerve are what activates muscles, if one is being compressed, the signal to your muscle will be weak. You will therefore experience muscle weakness as a result of a pinched nerve in shoulder. You may experience it when you are reaching above your head to try to grab something, and occurs in different parts of the arm depending on the nerve location.

Muscle Spasms: Muscles spasms and twitching can occur as a result of a pinched nerve, especially one that is originating in the neck area.

  • C5- The main result of a pinched C5 nerve root is shoulder pain, weakness in the deltoid muscles, along with the possibility of a numb sensation in the shoulder area.                                                                                                             Weakness: shoulder abduction
  • C6 - The main result of a pinched C6 nerve is pain radiating down your arm and into your thumb. Other less common symptoms include weakness in the biceps and wrist muscles.                                                                                     Weakness:elbow flexion, wrist extension
  • C7 - The main result of a pinched C7 nerve is pain and numbness radiating down the arm and into the middle finger. Weakness:elbow extension, wrist flexion
  • C8- The main result of a pinched C8 nerve is a numb sensation or pain felt in the outside of the hand.                        Weakness: thumb extension, wrist ulnar deviation
Investigation:

X-Ray                                                                                                                                                                                         Spurling Test: Laterally flex clients head and apply a downwards compression force.


   

        Treatment For Cerivcal Radiculopathy

Medication:

ü  Nonsteroidal anti-inflammatories (NSAIDS). These include drugs like aspirin and ibuprofen, and may be helpful if the arm symptoms are from nerve swelling.

ü  Oral corticosteroids. A short course of oral corticosteroids may also help reduce swelling, as well as pain.

Soft Collars. Soft collars allow the muscles of the neck to rest and limit neck motion. This can help decrease pinching of nerve roots with movement. Soft collars should only be worn for short periods of time, because long-term wear can decrease the strength of neck muscles.

Physical Therapy Treatment:

1.        Apply a heat pack onto your shoulders and neck.

2.        Massage the neck and shoulder. Make sure that you don’t apply too much pressure. The massage should be light and gentle.

3.        Apply heat cream or herbs onto the affected area. Again, this doesn’t remove the cause of the problem but can give you plenty of relief.

4.        After about 10 -12 days, you can start Exercises. It helps strengthen and stretch the muscles, relieve pain and pressure, alleviate stiffness and improve the range of motion.

5.        Stretching Exercises

6.        Strengthening Exercises

 
 

Cervical Posture Syndrome (Kyphosis)

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Kyphosis is a postural syndrome of the upper back and neck. Typically the upper back appears curved with rounded shoulders, the scapula (shoulder blades) are protracted (positioned further away from the spine) and the chin pokes forwards rather than being tucked in.

This occurs in all sections of the population. In the sports world cyclists and baseball catchers are at risk as they have to hold postures for long periods as well as the amateur bodybuilder who over develops and tightens the pectoralis (chest) muscles neglecting the muscles in the upper back.

Cervical posture syndrome is sometimes also called upper crossed syndrome. This is due to the muscle imbalances which are present with this type of posture. For example, the pecs and posterior neck muscles are tight and the muscles of the upper back and deep neck flexors are weak. If you connect the two tight muscle groups and the two weakened muscle groups with two straight lines, they form a cross shape, giving the condition its name.

Causes
Cervical postural syndrome is caused by adopting poor posture over a prolonged period of time. This may occur during sitting (e.g. at a computer or driving) or during everyday activities such as cooking and cleaning.

Muscle imbalance may also contribute to poor posture. Imbalance of muscles in the upper back and neck means that the pectoralis major muscle in the front of your chest and the muscles in the back of the neck are shortened and tight. The muscles at the back of the shoulders and upper back (trapezius, latissimus dorsi and rhomboids) are weakened and stretched.

Symptoms:
  • A burning or aching sensation in the upper back and neck.
  • Pain is made worse by prolonged standing or sitting especially leaning forwards.
  • Pain eases with movement and is usually not present once active.
Diagnosis:
A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose postural syndrome of the neck. Investigations such as an X-ray, MRI or CT scan may be required, in rare cases, to rule out other conditions.


           Physiotherapy Treatment For Postural Syndrome

Physiotherapy treatment for postural syndrome can significantly help to reduce symptoms, ensure an optimal outcome and prevent recurrence. Physiotherapy may comprise:

  • Postural education and retraining
  • soft tissue massage (particularly to the upper cervical extensors, pectorals, upper trapezius and levator scapulae muscles)
  • Electrotherapy (e.g. ultrasound)
  • Postural taping
  • Postural bracing
  • Joint mobilization (particularly to the lower neck and upper back)
  • Exercises to improve strength, posture or flexibility
  • Activity modification advice
  • Biomechanical correction
                                  Exercises For Cervical Postural Syndrome


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(( Chin Tucks )) Begin sitting or standing tall with your back and neck straight, shoulders should be back slightly. Tuck your chin in until you feel a mild to moderate stretch pain-free. Keep your eyes and nose facing forwards. Hold for 2 seconds and repeat 10 times.
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(( Shoulder Blade Squeezes )) Begin sitting or standing tall with your back straight. Squeeze your shoulder blades together as hard and far as possible pain-free. Hold for 5 seconds and repeat 10 times.
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(( Extension in Sitting )) Begin sitting tall, with your back and neck straight, shoulders back slightly. Gently take your neck backwards, looking up towards the ceiling until you feel a mild to moderate stretch pain-free. Repeat 10 times.
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(( Rotation in Sitting )) Begin sitting with your back and neck straight and your shoulders back slightly. Turn your head looking over one shoulder until you feel a mild to moderate stretch pain-free .Keep your neck straight and don't allow your head to poke forwards during the movement. Repeat 10 times to each side.
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(( Side Bend in Sitting )) Begin sitting tall with your back and neck straight, your shoulders should be back slightly. Gently bend your neck to one side until you feel a mild to moderate stretch pain-free. Make sure your neck does not bend forwards during the movement. Repeat 10 times on each side.
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(( Flexion in Sitting )) Begin sitting tall, with your neck and back straight, your shoulders should be back slightly. Gently bend your neck forwards, taking your chin towards your chest until you feel a mild to moderate stretch pain-free (figure 6) . Repeat 10 times.
 

Whiplash

09/16/2011

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Whiplash

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Whiplash is a nonmedical term used to describe neck pain following an injury to the soft tissues of your neck (specifically ligaments, tendons, and muscles). It is caused by an abnormal motion or force applied to your neck that causes movement beyond the neck's normal range of motion.
  • Whiplash happens in motor vehicle accidents, sporting activities, accidental falls, and assault.

  • The term whiplash was first used in 1928, and despite its replacement by synonyms (such as acceleration flexion-extension neck injury and soft tissue cervical hyperextension injury), it continues to be used to describe this common soft tissue neck injury. Your doctor may use the more specific terms of cervical sprain, cervical strain, or hyperextension injury.
Symptoms:
  • Pain and stiffness in the neck which may not come on immediately but develop over the following 24 to 48 hours
  • Reduced range of movement in the cervical spine (neck)
  • Headaches
  • Dizziness
  • Blurred vision (this should go within 24 hours, if they persist consult your doctor)
  • Pain and stiffness may last a few days, to a few weeks, depending on the severity
Watch out for the following:
  • Severe pain in the back of the head
  • Pins and needles or numbness in the shoulders or arms
  • Memory loss
  • Unconsciousness
All of these symptoms could indicate a more serious injury or concussion. If any of these symptoms are present you should return to the Doctor or hospital.


                                                       Whiplash Exercises


Mobility Exercises for Whiplash
Active exercises start to gently mobilise the neck without overstressing the muscles. These exercises can be used in the early stages, provided they are not painful. Some aching and stiffness is likely.



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Neck Flexion

  • Solwly tilt the head as if trying to place the chin on the chest.
  • Take the head as far as is comfortable, hold briefly and return slowly to looking straight ahead again.
  • Repeat 5-10 times, each time trying to get a little more moevement.

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Lateral Flexion
  • Start looking straight forwards.
  • Slowly move the head to the side as if trying to get the ear to the shoulder.
  • Hold briefly before slowly returning to the start position.
  • Repeat 5-10 times, each time trying to get a little more movement.

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Rotation

  • Start looking straight forwards.
  • Slowly rotate the head to look over your shoulder.
  • Hold briefly before slowly returning to the start position.
  • Repeat 5-10 times, each time trying to get a little more movement.

Stretches for Whiplash
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SCM stretch
  • To stretch the left side, take the right ear towards the right shoulder as far as possible.
  • From this position, turn the chin upwards as though you were trying to look at the ceiling.
  • You should feel s a stretch in the large sternocleidomastoid muscle at the front of the neck.
  • Hold this position for 20 seconds, rest and repeat 2-3 times.

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Trapz stretch

  • To stretch the left side, take the right ear towards the right shoulder as far as possible.
  • From this position, move the shin down towards the chest, until you feel a stretch in the Trapezius muscle (between the neck and shoulder).
  • Hold this position for 20 seconds, rest and repeat 2-3 times.

 
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