Exercises for cervical spondylosis pdf

Localized symptoms of spondylosis occur at the site of the issue around a herniated disc and they may include dull aching, limited movement or a feeling of instability. Radiating symptoms of spondylosis affect remote areas of the body when nerves in the spine area affected by other issues like bulging discs and bone spurs. Symptoms like pain, numbness, weakness and tingling sensations can affect the shoulders and arms in cervical spine degeneration, and they can impact the buttocks, thighs, legs and feet in lumbar spine degeneration.

Spondylitis implies ankylosing spondylitis which can affect almost anyone and tends to affect men more than women. Spondylosis symptoms usually begin after age of The onset of spondylitis, on the other hand, typically happens between the ages of 20 and 40 and when it reaches advanced stage the bones of the spine may actually fuse, making movement difficult and very painful.

Cervical spondylosis Cervical spondylosis is an age-related degeneration 'wear and tear' of the bones vertebrae and discs in the neck. To an extent, all develop some degeneration in the vertebrae and discs as become older. It tends to start sometime after the age of about Cervical spondylosis is another name for osteoarthritis that exists in the joints of the vertebrae of the neck.

This means that it is a degenerative disease where surfaces of the bones have lost their cartilage lining in the cervical vertebrae. The seven cervical vertebrae constitute the top portion of the spine which is the long and flexible column of bones that supports the skeleton and protects the spinal cord. Flat, circular pads of cartilage known as intervertebral disks serve as cushions between the vertebrae and allow for smooth movement.

In spondylosis, rupture of a disk, or overgrowth of the vertebrae or the ligaments that support the spine, or a combination of these may cause to compress the spinal cord or the nerves passing through it create pain apart from symptoms pertaining to spondylosis. This disease is common among those of middle aged and older people but many cases are mild and respond well to self-treatment of spondylosis.

If there is inflammation of the joint associated with this degeneration, it is termed as spondylitis where as spondylitis describes general dysfunction of the vertebrae. This is usually caused by the wear and tear due to old age, is often related to osteoarthritis, and is more commonly seen in the neck and may occur in any region of the spine.

One feature of the degeneration is that the edges of the vertebrae often develop small, rough areas of bone called osteophytes. More over many years, passed by, the discs become thinner. This degeneration is a normal ageing process which can be likened to Page having 'wrinkles in the spine'. In many people, the degeneration does not cause any symptoms. Neglecting the pain could lead to a slipped disc, which is a far more painful condition. ISSN NO: it could hamper abilities of body's coordination and make it hard to perform simple, day-to-day activities such as buttoning a shirt or brushing hair or teeth.

It can cause pain and radiate to the arms or legs, stiffness in the muscles surrounding outer of place of vertebra is also common, and may experience neurological symptoms, such as numbness and weakness, in extreme aggravated conditions.

However, certain sports, such as football, gymnastics, and weight lifting, are more prone to cause this particular condition because these activities require repeated hyperextension of the spine. Occasionally headaches may also occur, which usually start at the back of the head, just above the neck, and pass over the top to the forehead. Cervical spondylosis causes and risk factors Cervical spondylosis [8] often develops as a result of changes in the neck joints as age advances at about age of 40, as a result of which spinal disks can become dry and commences to shrink reducing the cushion between them duly developing cracks as well as bones spurs additional growth in bones of the neck region and the ligaments connecting the bones turns to stiff.

At this stage shrinked disks and bone spurs can put more pressure on the spinal cord and nerve roots, resulting joint pains and difficult to move the neck. Bones and ligaments get thicker, intruding on the space of the spinal canal. Another cause may be a old injury to the neck and poor posture.

This can affect not the arms, but also the legs. Other factors affecting cervical spondylosis By holding neck position uncomfortably for lengthy periods or repeating the same neck movements.

People who are very active at work or in sports and certain long term activities, such as carrying axial loads, professional dancing and gymnastics and participation of martial arts for many years are more prone to get cervical spondylosis.

By attaining the age of 60, majority of persons face signs of cervical spondylosis as seen on x-ray observations. Being overweight and not exercising properly quicken this disease. Over load activities that requires heavy lifting or a lot of bending and twisting, put extra strain on the neck. One more cause is long ago spine surgery, ruptured or slipped disk, severe arthritis and petty fractures to the spine due to osteoporosis. Symptoms A symptom [9] is something the patient himself feels and reports, while a sign is an unknown thing that other people or the health provider detect.

To cite an example pains are symptoms while rashes are signs. One common symptom is pain around the shoulder blade, along the arm and in the fingers. The pain may improve on standing, sitting, sneezing, coughing, or backward tilting of the neck. Another common symptom is muscle weakness which make it difficult task to raise the arms or keep hold of the objects strongly.

A stiff neck and pain that becomes worse. Headache that mostly originate in the back of the head. Tingling or numbness that mainly affects shoulders and arms, although it can also occur in the legs. Symptoms that include loss of control and loss of bladder or bowel control, abnormal reflexes. Inability to fully turn the head or bend the neck, sometimes interfering with driving. Grinding noise or sensation when the neck is turned.

Symptoms are severe in the morning and again at the end of the day. Symptoms of cervical spondylosis with myelopathy include tingling, numbness, weakness in the arms, hands, legs, or feet. Lack of coordination and difficulty while walking and muscle spasms leading to sudden pain. The most common symptom of cervical spondylosis is cervical radiculopathy [10, 11], which causes pain shooting down into one or both arms. The patient may feel the pain over the shoulder blade or it may spread to the upper arm, forearm, or fingers and it may get violent after standing or sitting, at night, when you sneeze, cough, or laugh and when bending the neck backwards or walk more than a few yards apart from weakness in certain muscles.

Neck stiffness — This is more common after a long period of inactivity which includes sleep also. Other problems — Coordination difficulties. Arms and legs may become feeble and lack of dexterity. Affect of brain — If blood vessels are pressed the blood supply to the brain may be affected slightly which in turn occurs dizziness, and even blackouts. Dysphagia [12,13] is a sign of difficulty to swallow when the bones press against the oesophagus which is a rare symptom.

When to Seek Medical assistance from a doctor If continuous neck pain does not respond to self-treatment, if pain is not healed with the prescribed medications and other conservative treatments and unable to start or stop urinating or numbness in the groin area indicate serious nerve dysfunction which insists immediate need to consult a doctor. If weight loss or fever more than F is coupled with back or neck pain. Because the diagnosis of spondylosis is made with images of X-ray, CT scan, or MRI scan, most of the people have already consult their doctor with this diagnosis more than once.

Therefore the valid reasons for re-evaluation by the health-care professional include the following. ISSN NO: Diagnosis The doctor will generally begin by asking the patients about symptoms of medical history following physical examination mainly focusing on the neck, back and shoulders, bending tests and the strength of hands and arms, loss of sensation and walking test.

A positive sign denotes that neck or shoulder pain exists on the side to which the head is laterally bent. Lhermitte sign indicates feeling of electrical shock with neck flexion. Reduced range of motion of the neck is the most frequent objective finding on physical examination []. MRI and CT scans are helpful for pain diagnosis but generally are not certain and must be considered together with physical examinations and history.

Lumbar back pain is the result of spondylosis, but most common outcome is muscle strain. Apart from the above tests other tests need to be done include imaging examinations [18,19] such as X - rays, computed tomography CT , and magnetic resonance imaging MRI. In the MRI scans large magnets, radio waves, and a computer to exhibit the optimum clear images of the body are the best helping aids to decide the specific type of disease.

This tests vividly show the bone spurs on vertebral bodies in the spine, thickening of facet joints the joints that connect the vertebrae to each other , and narrowing of the intervertebral disc spaces including the degree of disc herniation, the facet joints, the nerves, as well as the ligaments in the spine and able to visualize the spine in greater detail and can diagnose correctly narrowing of the spinal canal spinal stenosis if present. The main objective found in physical examination is to reduce the range of motion of the neck.

Surgery There is no treatment to end the process of gradual growth spondylosis, because it is a degenerative process. But the back pain and neck pain which caused by spondylosis can be checked with proper treatment. Hence the treatment of spondylosis [] is akin to the treatment of back pain and neck pain.

At present numerous types of treatments in practice such as medications, own-care, performing exercises and physical therapy, adjunctive therapies like chiropractics and acupuncture, duly reducing with injections, and surgery as far as possible. Spondylosis is a chronic condition which requires unending absolute care even though it is not progressive in several cases. Any type of spinal cord compression could result in permanent functional disability. The goal of surgery is to wipe out the source of pressure on the spinal cord as well as nerves.

The surgery may also include adding stabilization in the form of implants or through fusion of the vertebrae but it can be preferred only when there is a severe loss of function of neck organs mainly loss of feeling and loss of function in the arms, legs, feet, or fingers.

In advanced cases to relieve pressure on the spinal nerves, surgery can be preferred. Surgery is necessary to remove overgrowth of bones in the vertebrae to avert severe stiff joint movement. Exercise or physical therapy can render help a great deal in this context. Surgery is suggested for cervical radiculopathy in patients who suffered from serious pain or weakness if no relief is found with conservative therapy.

For cervical spondylosis with myelopathy CSM [27] doctors option is to suggest operation therapy over conservative therapy for moderate-to- severe myelopathy[].

The surgeon can approach the cervical spine from the front anterior or the back posterior. Approaching from the front might be used to remove the discs and spurs that are causing pressure. The disc may be replaced with an implant. A more extensive surgery may be necessary for the removal of both discs and parts of the vertebra which are to be replaced with a bone graft or implant. Numerous surgical procedures have been evolved to cure the signs and symptoms crept in with spondylosis.

The vertebral column can be operated by the surgeon from the front, side, or rear positions. Osteophytes and sometimes parts of intervertebral discs are generally removed through surgery to relieve pressure on the adjacent nerve roots or the spinal cord.

Surgery is rarely necessary to the patients with acute back pain, unless progressive neurologic problems develop as most patients improve dramatically after treatment with medications and physical therapy with in brief period soon after back pain starts. The operation is executed through a small, minimally invasive, incision by using appropriate suitable microscope where in structures are lucidly magnified for clear view and enable to operate without any flaw to avoid tissue damage.

Surgery is sometimes performed for acute sciatica, if nerve problems such as weakness and numbness are severe and worsens rather than improve, causing neurological problems.

Spinal decompression surgery procedures are performed to relieve pressure on the nerves in the back due to spinal stenosis, herniated intervertebral discs, or foraminal stenosis to narrow openings between the facet joints due to bone spurs. Fusion of the vertebrae is sometimes combined with one or more of these procedures in order to stabilize the spine.

Various common techniques for decompression are briefly explained below. Laminectomy is a procedure to take away the bony arches of the spinal canal lamina subsequently increasing the size of the spinal canal and decreasing pressure on the spinal cord. Discectomy is a procedure to remove a portion of an intervertebral disc that is exerting pressure on a nerve root or the spinal canal.

Foraminotomy is a procedure to open out enlarge the openings for the nerve roots to exit the spinal canal. Osteophyte removal is a procedure to get rid of the bone spurs from an area where they are causing pinched nerves. Corpectomy is a procedure to take off a vertebral body and discs. In a laminectomy surgery the rear parts of the vertebrae in the neck, the lamina and spinous processes are removed. In this type of surgery the vertebra is cut to free along one side.

Both procedures relieve pressure on the spinal cord or nerves. Surgery is normally followed by suitable rehabilitation programs. In addition to treatment options, there is need to follow appropriate changes in the lifestyle to enable, to live with relief even if arthritis exists. Disc replacement is a relatively new operation where the degenerated and comp ressed disc is removed duly replacing by an artificial disk which consists more elasticity and allow better movement.

Even then, surgery for patients with Page chronic low back pain is controversial, since certain examinations prove improvement in pain and disability, but majority studies do www. ISSN NO: not show improvement when compared with nonsurgical treatment like physical and pain therapy management.

Close observations evidently prove that numerous patients still persist chronic back pain after successful surgery. Treatment Reduction of pain and restoration of normal function are the main objectives of treatment [34 ].

To reduce the pain of inflammation, anti-inflammatory drugs non-steroidal anti-inflammatory drugs are prescribed for brief spells which should never be taken without medical consultations. Treatment is usually conservative in nature. Patient education on lifestyle modifications and NSAIDs and physical therapy is brought forward to manage spondylosis symptoms apart from substitute therapies such as massage, chiropractic, trigger-point therapy.

Yoga and acupuncture therapy may be suggested. Some other varieties of physical therapies Chiropractic therapy can be used to manage episodes of acute pain. Injecting drugs relaxants or tranquilizers ensuring relief may be used. Understanding anatomy of the body particularly the neck is the key factor for conservative management of spondylosis.

Spondylosis Medications No medication is available to reverse the degenerative process of spondylosis successfully.

Treatment of pain for spondylosis commonly includes anti-inflammatory medications, pain medicines like analgesics and muscle relaxants [38]. Nonsteroidal anti- inflammatory medications NSAIDs namely Ibuprofen Advil, Motrin and Naproxen Aleve which are available over the counter are very effective to relieve back and neck pain due to spondylosis. Muscle relaxants like Cyclobenzaprine Flexeril and Tizanidine Zanaflex [39] can relieve the muscle spasm connected with spondylosis.

Analgesics pain medications , such as Acetaminophen Tylenol and Tramadol Ultram can be used to get relief from pain and in case of extremely acute pain a narcotic medication such as Norco, Vicodin or others are suggested for a short period.

Fish oil is known to be anti-inflammatory agent and studies show that it may reduce back and neck pain symptoms. Certain anti-depressants are helpful in treating chronic back pain. Medications like tricyclic anti-depressants, including Amitriptyline Elavil and Doxepin Sinequan and Duloxetine Cymbalta have been used in small doses, to relieve chronic back pain, neck pain, and other pains.

Some people find topical medications, which are massaged directly onto the location of the pain, helpful in relieving pain from spondylosis namely aspercreme and capsaicin cream are anti-inflammatory and act as helping aids to reduce inflammation. Injections for spondylosis Steroids may be injected into the facet joints which connect the vertebrae, trigger points in the soft tissue, or directly into the intervertebral disc spaces to manage acute radicular pain which radiates into a limb.

Steroids cortisone as an epidural injection can be injected into the epidural space which is the space surrounding the spinal cord. Other injection procedures for back and neck pain such as intradiscal injections cortisone injection directly into an intervertebral disc , trigger point injections of steroid, anaesthetic, or both, facet joint steroid injection, steroid injection into the sacroiliac joints and also steroid injection into the piriformis muscle for piriformis syndrome; Radiofrequency denervation destruction of painful nerves using a radiofrequency current are also in practice at present.

Exercises, physical therapy, and additional therapies While there is no cure for cervical spondylosis, it is possible to use various treatment options, as detailed below to reduce the pain caused by this condition.

Exercise increases blood flow to the muscles, which supplies healing nutrients like oxygen which protects the function of the spine and related muscles and improves the release of endorphins which is a substance produced in the brain causing reduction of pain. People consists of degenerative disc disease ought to do moderate exercises not less than 30 minutes daily including low impact strength gaining activities like mild activity exercises such as walking, biking, and swimming.

Physical therapy may be effective for restoring a range of motion, flexibility, and strength. Decompressive therapies namely Page manual mobilization, mechanical traction may also help to eliminate pain yet physical therapy and chiropractic cannot cure the degeneration of spine and disks. Regular exercising on a regular basis, mainly walking and yoga, have proved to be beneficial for chronic back pain. ISSN NO: Acupuncture for back pain involves inserting very thin needles at various depths into specified affected areas in the body.

The needle placement is designed to balance the chi or qi which is thought to flow on meridians throughout the body. Studies of acupuncture for back and neck pain have mixed results. Spondylosis exercises Spondylosis treatment usually commences with a conservative steps since an individual with spondylosis is basically experiencing the aches and pains due to old age factor. Better relief from spondylosis symptoms through massage, yoga, herbal treatments, acupuncture and other prescribed holistic procedures.

Low-impact exercises such as walking, swimming, aerobics and light weight training can be effective physical treatments to be followed in consultation with a physical therapist to get relief from spondylosis.

These exercises strengthen the small muscles combined with the spine to provide better structural support to the vertebrae to improve flexibility of the spine particularly in the cervical and lumbar regions and to improve cardiovascular health to ensure proper blood flow throughout the spine.

Spondylosis exercises can be an effective conservative method of treatment for degenerative spine problems but excessive exercise or the wrong performance can become the neck or back pain more violent. This is an effective measure to manage the symptoms of stiffness and nerve compression associated with degenerative spine conditions. If conservative treatments such as exercise, pain medication, physical therapy, or behavior changes yield no relief form spondylosis pain, after lapse of prolonged period, steps to be taken for other suitable surgical treatment.

In the event of conservative or alternative treatments fail to mitigate symptoms after several months, surgical spondylosis treatment may become an option worth to be considered. Restorative gentle form of yoga: It is designed specifically to reduce stress and rehabilitate injuries by performing a series of simple prescribed yoga poses, a patient can achieve relaxation and symptom relief.

Chiropractic adjustment: It can be done to misaligned spinal vertebrae which exerts pressure on sensitive neural tissues helps to reduce inflammation and improve joint function.

Conservative spondylosis treatments: Conservative course of treatment include a combination of narcotic pain medication. Non-steroidal anti-inflammatory drugs NSAIDs , Thermotherapy, cryotherapy, posture modification, physical therapy, lifestyle modification.

Losing weight, limiting or eliminating alcohol and tobacco use etc. In most cases, the discomfort that results from spinal degeneration can be managed with conservative spondylosis treatments. The goal of conservative spondylosis treatment is to achieve symptom relief non-surgically through one or more of the following methods. Limited rest: In severe cases, a patient may benefit from a brief period of rest, but any inactivity or rest should be limited to a maximum of one to three days since lengthy period of bed rest can enhance risk of the patient resulting to develop deep vein thrombosis which is a form of blood clots in the legs.

Simple physical activity is a must since it enable the movement of fluids around the spine. Physical therapy: The main goal of physical therapy as a spondylosis treatment is to increase the flexibility and endurance of the core muscles that support the spine, particularly those surrounding the area of degeneration.

Molded cervical pillows can better align the spine during sleep and provide symptomatic relief for some patients. Immobilization curtails motion of the neck, thereby reducing nerve irritation. Soft cervical collars are recommended for use especially in day time. Mechanical traction: It is a widely used technique. This form of treatment may be useful because it promotes immobilization of the cervical region and widens the foraminal openings.

The use of cervical exercises has been advocated in patients with cervical spondylosis which are beneficial to maintain the strength of the neck muscles. Neck and upper back stretching exercises, as well as light aerobic activities, also are helpful. Manual therapy: Page In this technique massage, mobilization, and manipulation, may provide further relief for patients with cervical spondylosis.

Manual traction may be better than mechanical traction in some patients. ISSN NO: Heat therapy: This easily available no cost treatment which can be treated at home, not only provide comfort and facilitates relaxation, but also help to reduce back pain and the blood vessels in the muscles surrounding the spine will become dilated, and increase the flow of oxygen and nutrients which enables healing of damaged tissue. Cold therapy: In this technique treatment can be taken up by using a variety of tools, like reusable cold packs, instant disposable ice packs, a plastic baggie filled with ice and wrapped in a towel, a frozen towel or sponge for effective relief of pain by applying to painful areas several times a day up to 20 minutes for each time.

Medications: Over-the-counter prescription medications, such as non-steroidal anti-inflammatory drugs like Ibuprofen and Naproxen, and pain relievers like Acetaminophen, can reduce inflammation and discomfort around degenerated area of the spine.

Therapeutic exercises: Physical activity aid the patient to maintain a healthy weight, which reduces stress on the spinal cord causing pain relief apart from strengthen the core muscles that support the spine.

Lifestyle modifications: Good health habits and discarding smoking and drinking habits paves way to enhance spinal health conditions.

Epidural steroid injections: If severe symptoms do not respond adequately to conservative treatments of spondylosis, a physician takes up a series of epidural steroid injections to get relief from pain and inflammation. Recreational therapy: It renders assistance to the patient to maintain physical strength, social skills, motivation and increase individual self- confidence, provide community integration and independence duly adjusting to the disability to face and curtails existing behavioral ill habits which adversely affects spinal cord and discs degeneration act.

Life style modifications may involve an evaluation of work place ergonomics, postural training, neck-school therapy, stress management and vocational assistance. The muscles and most ligaments are not shown in the diagram, for clarity.

The spinal cord which contains nervous tissue carrying messages to and from the brain, is protected by the spine. Nerves from the spinal cord come out from between the vertebrae in the neck to take and receive messages to the neck and arms. A major blood vessel called the vertebral artery also runs alongside the vertebrae to carry blood to the rear posterior part of the brain.

This leaflet is aimed at people who have been told they have cervical spondylosis as a cause of their neck symptoms. Cervical spondylosis is a 'wear and tear' of the vertebrae and discs in the neck. It is a normal part of ageing and does not cause. However, it is sometimes a cause of neck pain. Symptoms tend to come and go. Treatments include keeping the neck moving, neck exercises and painkillers.

In severe cases, the degeneration may cause irritation or. This can cause arm or leg symptoms detailed below. In these severe cases, surgery may be an option.

What is cervical spondylosis? Cervical spondylosis is an age-related degeneration 'wear and tear' of the vertebrae and discs in the neck. To an extent, we all develop some degeneration in the vertebrae and discs as we become older. It tends to start sometime after the age of about One feature of the degeneration is that the edges of the vertebrae often develop small, rough areas of bone called osteophytes. Also, over many years, the discs become thinner. This degeneration is a normal ageing process which can be likened to having 'wrinkles in the spine'.

In many people, the degeneration does not cause any symptoms. For example, routine X-rays of the neck will show these features osteophytes and disc thinning in many people who do not have any symptoms. However, in some people, the nearby muscles, ligaments, or nerves may become irritated or 'pressed on' by the degenerative changes.

So, cervical spondylosis often causes no problems but can be a cause of neck pain, particularly in older people. What are the symptoms of cervical spondylosis? If symptoms develop, they can range from mild to severe. Symptoms may include:. This may spread to the shoulders and base of the skull. Movement of the neck may make the pain worse. The pain sometimes spreads down an arm to a hand or fingers.

This is caused by irritation of a nerve which goes to the arm from the spinal cord in the neck. The pain tends to come and go with flare-ups from time to time. You may have a flare-up of pain after unaccustomed use of your neck, or if you sprain a neck muscle or ligament. However, a flare-up often develops for no apparent reason. Some people develop chronic persistent pain. The headaches often start at the back of the head just above. This symptom is. However, do tell a doctor if loss of feeling numbness or weakness develops in a part of a hand or arm.

These symptoms suggest more pressure on a nerve. This is called a 'cervical radiculopathy'. This is called 'cervical myelopathy'. Again, it is important to report these symptoms to a doctor. Cervical radiculopathy and cervical myelopathy are discussed further later in the leaflet. The following section concerns cervical spondylosis without radiculopathy or myelopathy.

What are the treatments for cervical spondylosis without radiculopathy or myelopathy? Exercise your neck and keep activeAim to keep your neck moving as normally as possible. During flare-ups the pain may be quite bad, and you may need to rest for a day or so. However, gently exercise the neck as soon as you are able.

You should not let it 'stiffen up'. Gradually try to increase the range of the neck movements. Every few hours gently move the neck in each direction. Do this several times a day. As far as possible, continue with normal activities. You will not cause damage to your neck by moving it. For an adult this is two mg tablets, four times a day. Some people find that these work better than paracetamol. They can be used alone or in combination with paracetamol.

They include ibuprofen which you can buy at pharmacies or get on prescription. Other types such as diclofenac or naproxen need a prescription. Some people with stomach ulcers, asthma, high blood pressure, kidney failure, or heart failure may not be able to take anti-inflammatory painkillers. Codeine is often taken in addition to paracetamol. Constipation is a common side-effect from codeine.

To prevent constipation, have lots to drink and eat foods with plenty of fibre. The dose of amitriptyline used for pain is mg at night. At higher doses, tricyclic antidepressants are used to treat depression.