Cervical Spondylosis: Causes, Symptoms, and Treatments.
Cervical spondylosis is an age-related degenerative condition which is the most common cause of neck pain and other neck problems, It can be both painful and disabling; it is also common with around 15% of adults reporting they had experienced neck pain within the last six months (National Center for Health Statistics, 2012). Not everybody with cervical spondylosis experiences neck pain, as the condition can be asymptomatic. Although around 90% of people suffer from the condition by the time they reach 60, many don?t experience any symptoms, though for others it can result in chronic and severe pain.
Typical symptoms of cervical spondylosis include:
- Neck pain
- Shoulder pain
- Headaches that begin in the back of the head
- Sharp pain that travels down your arm and sometimes pins and needles ? this is a typical symptom of a slipped disc
- Problems with coordination, weakness, and walking indicates compression of the spinal cord
- Incontinence (urinary and/or bowel) can result in particularly severe cases
It is a degenerative condition that happens to the majority of us as we age. The bones and cartilage in our neck are susceptible to wear and tear. These are some of the things that can go wrong:
- Bone spurs, also known as osteophytes, are growths of bone that form over normal bone. Their function is to repair damage, but they can exert pressure on other bones, on tendons, ligaments, and nerves and cause pain. As well as cervical spondylosis, bone spurs are associated with a range of spinal conditions including spinal stenosis and scoliosis.
- Dehydrated disks ? the discs in your spine when you are born comprise around 80% water. This makes it spongy so that it acts as a shock absorber. Over time as we age the disc loses progressively more of its water and its sponginess.
- Herniated disks are what we also refer to as slipped discs. It happens when the outer fibrous ring becomes torn allowing the soft inner disc to bulge out through the tear. It can be caused by ageing and as a result of physical injury from lifting and straining.
- Injuries such as whiplash injuries can accelerate degeneration resulting in early-onset cervical spondylosis. Heavy lifting and repetitive movements can have a similar effect.
The first stage in the diagnosis is a physical examination which will assess your ability to move your neck and arms and test your reflexes and the degree of loss of sensation in your limbs. It is probable that you will be x-rayed to check for bone spurs and other indications of the condition. You may also be asked to undergo an MRI or a CT scan. Electromyography and a nerve conduction test might also be carried out.
Treatment aims to reduce the pain caused by cervical spondylosis and to prevent further damage, particularly to the nerves in your spine. Available treatments include the use of painkillers and nonsteroidal anti-inflammatory drugs (NSAIDs), injections, surgery and physical therapy.
- Over-the-counter painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs) can be effective. In particular ibuprofen, diclofenac, and naproxen. Paracetamol is useful if you can?t tolerate NSAIDs.
- Prescription drugs – opiates such as codeine may be prescribed if the pain is severe. Muscle relaxants may be prescribed in the case of painful spasms and low doses of tri-cyclic anti-depressants can be beneficial.
- Steroid injection into the nerve root at the point of exit from the spine can reduce inflammation and pain.
- Surgery may be recommended if bone or a slipped disc is pinching a nerve, the spinal cord is compressed, or if none of the other treatments will reduce the pain.
- Exercise and physical therapy can be highly beneficial; for instance, learning how to maintain good posture while sitting and standing, reducing the strain on the neck, and aerobic exercises such as walking and swimming. In the next section, the potential benefits of this approach are reviewed.
Physical therapy and exercise in the treatment of cervical spondylosis
A considerable amount of research has been carried out on the effects of exercise and physical therapies on cervical spondylosis. In a study of the effects of different treatments on pain, disability, mood and quality of life of cervical spondylosis patients (Telci & Karaduman, 2012), one group was treated using active and passive physiotherapy, another with just active treatment methods, and a third with medication, including NSAIDS muscle relaxants.
All three groups experienced pain recovery and reduced disability for at least three months. Only the group treated using active and passive physiotherapy still experienced reduced disability after six months. There was also improvement in the quality of life and patient satisfaction, though the overall conclusion was that exercise treatment was significantly more effective than medical treatment in providing long-term recovery.
Before embarking on this kind of treatment plan it is important to seek the advice of a physical therapist. The wrong kind of exercises can do more harm than good, and the right exercises depend on your particular condition and its severity.
For most people treatment of cervical spondylosis will bring relief, though the condition tends to recur after a while. The chance of recurrences can be reduced with proper management such as adopting the correct posture and sleeping with a supporting pillow. Your physical therapist will be able to advise you on this.
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National Center for Health Statistics. (2012). Health, United States, 2012: With Special Feature on Emergency Care. Retrieved from NCHS: http://www.cdc.gov/nchs
Telci, E. A., & Karaduman, A. (2012, January 19). Effects of three different conservative treatments on pain, disability, quality of life, and mood in patients with cervical spondylosis. Rheumatology International, 32(4), 1033-1040.