1. Cervical Spondylosis
09/17/2011
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Cervical Spondylosis
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.
2. 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-
3. 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
4. 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.
