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2020-12-28 01:31:49 |
Cervical Spondylosis |
Epidemiology and Possible degenerative characteristics Clinical Presentation Diagnostic
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Procedures Why Do Exercises Help Cervical Spondylosis ? Physiotherapy Management Everyday “wear and tear” damages your spinal joints. In advanced stages, spinal arthritis can be painful and deteriorate into other conditions when the nerves become pinched. Unfortunately, there is no cure. But the good news is that there are numerous ways making your life easier via the correct management of the condition. Physiotherapy is a very important part of making your life less painful, more functional and very enjoyable. It should also slow down the speed with which your Spondylosis deteriorates. Physiotherapy has been shown by research to reduce the pain and disability associated with Spondylosis. The term Spondylosis is used to define a generalized natural ageing process that involves a sequence of degenerative changes in spinal structure. In the cervical spine this chronic degenerative process affects the intervertebral discs and facet joints, and may progress to disk herniation, osteophyte formation, vertebral body degeneration, compression of the spinal cord, or cervical spondylotic myelopathy. It has been defined as vertebral osteophytosis secondary to degenerative disc disease due to the osteophytic formations that occur with progressive spinal segment degeneration. The term is often used synonymously with Cervical Osteoarthritis. Although ageing is the primary cause, the location and rate of degeneration as well as degree of symptoms and functional disturbance varies and is unique to the individual. The cervical spine is made up of seven segments and is highly mobile. It performs 3 important functions; it forms the structural support for the head, protects the cervical spine cord and the exiting nerve roots enclosed within it. ** Epidemiology ** “Evidence of spondylotic change is frequently found in many asymptomatic adults, with 25% of adults under the age of 40, 50% of adults over the age of 40, and 85% of adults over the age of 60 showing some evidence of disc degeneration. Another study of asymptomatic adults showed significant degenerative changes at 1 or more levels in 70% of women and 95% of men at age 65 and 60. The most common evidence of degeneration is found at C5-6 followed by C6-7 and C4-5”. Age, gender and occupation are the risk factors for having cervical Spondylosis. The prevalence of cervical Spondylosis is similar for both sexes, although the degree of severity is greater for males. Although ageing is the major risk factor that contributes to the onset of cervical Spondylosis, repeated occupational trauma may contribute to the development of cervical Spondylosis. An increased incidence has been noted in patients who carried heavy loads on their heads or shoulders, dancers, gymnasts, and in patients with spasmodic torticollis, although this cause is not widely accepted. In about 10% of patients, cervical Spondylosis is due to congenital bony anomalies, blocked vertebrae, malformed laminae that place undue stress on adjacent intervertebral discs. Possible degenerative characteristics include: ##Degenerative Disc Disease ##Formation of osteophytes ##Facet and uncovertebral joint degeneration ##Ossification of the posterior longitudinal ligament ##Hypertrophy of the ligamentum flavum causing posterior compression of the cord especially as it buckles in extension ##Spinal stenosis ##Degenerative subluxation of cervical vertebra ##Dislocated fragment of annular cartilage compressing the spinal cord or nerve root ##Neural and vascular compression In some cases this degeneration also leads to a posterior protrusion of the annulus fibres of the intervertebral disc, causing compression of the nerve roots, pain, motor disturbances such as muscle weakness, and sensory disturbances. As the Spondylosis progresses there may even be interference with the blood supply to the spinal cord where the vertebral canal is at its most narrow. ** Clinical Presentation ** Cervical Spondylosis presents in three symptomatic forms as: 1. Non-specific neck pain – pain localized to the spinal column. 2. Cervical radiculopathy – complaints in a dermatomal or myotomal distribution often occurring in the arms. May be numbness, pain or loss of function. 3. Cervical myelopathy – a cluster of complaints and findings due to intrinsic damage to the spinal cord itself. Numbness, coordination and gait issues, grip weakness and bowel and bladder complaints with associated physical findings may be reported. Symptoms can depend on the stage of the pathological process and the site of neural compression. Diagnostic imaging may show Spondylosis, but the patient may be asymptomatic and vice versa. Many people over 30 show similar abnormalities on plain radiographs of the cervical spine, so the boundary between normal ageing and disease is difficult to define. Pain is the most commonly reported symptom. McCormack et al reported that intermittent neck and shoulder pain is the most common syndrome seen in clinical practice. With cervical radiculopathy the pain most often occurs in the cervical region, the upper limb, shoulder, and/or interscapular region. In some cases the pain may be atypical and manifest as chest or breast pain, although it is most frequently present in the upper limbs and the neck. Chronic suboccipital headache could also be a clinical syndrome in patients with cervical spondylosis, which may radiate to the base of the neck and the vertex of the skull. Par aesthesia or muscle weakness, or a combination of these are often reported and indicate radiculopathy. Central cord syndrome may also be seen in relation to cervical Spondylosis and in some cases dysphagia or airway dysfunction have been reported. ** Diagnostic Procedures ** Cervical Spondylosis is often diagnosed on clinical signs and symptoms alone. • Signs: * ##Poorly localized tenderness ##Limited range of motion ##Minor neurological changes (unless complicated by myelopathy or radiculopathy) • Symptoms: * ##Cervical pain aggravated by movement ##Referred pain (occiput, between the shoulder blades, upper limbs) ##Retro-orbital or temporal pain ##Cervical stiffness ##Vague numbness, tingling or weakness in upper limbs ##Dizzyness or vertigo ##Poor balance ##Rarely, syncope, triggers migraine Most patients do not need further investigation and the diagnosis is made on clinical grounds alone however, diagnostic imaging such as X-ray, CT, MRI, and EMG can be used to confirm a diagnosis. Plain radiographs of the cervical spine may show a loss of normal cervical lordosis, suggesting muscle spasm, but most other features of degenerative disease are found in asymptomatic people and correlate poorly with clinical symptoms. It is important to realize that radiological changes with age only represent structural changes in the vertebrae, but such changes do not necessarily cause symptoms. It is believed that this mismatch between radiographic appearance and clinical symptoms is not only because of age, but also because of gender, race, ethnic group, height and occupation. MRI of the cervical spine is the investigation of choice if more serious pathology is suspected, as it gives detailed information about the spinal cord, bones, discs, and soft tissue structures. However, normal people can show important pathological abnormalities on imaging so scans need to be interpreted with care. ** What Can You Do To Help? ** Respect your pain – rest when the pain becomes significant Avoid over-stressing joints with forceful or prolonged weight-bearing activities eg lifting, jogging Avoid jarring or sudden movements Lose Weight – the less you weigh the less your spine has to support Keep up General Exercise where pain allows eg walking, swimming, cycling Perform Core Stability Exercises to best support your spine and reduce your pain ** How Do Exercises Help Cervical Spondylosis ? ** Exercises for people with Cervical Spondylosis should always be individually prescribed. Your physiotherapist is an expert at the prescription of exercises to suit your condition. As a general rule remember if any exercise hurts then DON’T DO IT! * Specific Exercises Help Spondylosis by * Maintaining or increasing joint movement Loosening and stretching tight muscles Improving joint lubrication and nutrition Restoring muscle strength, spinal height and control Improving circulation to improve your healing rate Improving core control, poor posture or joint position Maintaining your general fitness. The correct exercises will help you to feel better and retain or improve the health of your muscles and joints. Gentle regular exercises such as swimming, water exercise (hydrotherapy or aqua-aerobics), walking or cycling are recommended. Core exercises are essential! The end result is you’ll feel much better and you’ll start to enjoy life again! ** Physiotherapy Management ** ##There is little evidence for using exercise alone or mobilisation and/or manipulations alone. ##Mobilisation and/or manipulations in combination with exercises are effective for pain reduction and improvement in daily functioning in sub-acute or chronic mechanical neck pain with or without headache. ##There is moderate evidence that various exercise regimens, like proprioceptive, strengthening, endurance, or coordination exercises are more effective than usual pharmaceutical care. Treatment should individualised, but generally includes rehabilitation exercises, proprioceptive re-education, manual therapy and postural education Manual therapy is defined as high-velocity; low-amplitude thrust manipulation or non-thrust manipulation. Manual therapy of the thoracic spine can be used for reduction of pain, improving function, to increase the range of motion and to address the thoracic hypomobility Thrust manipulation of the thoracic spine could include techniques in a prone, supine, or sitting position based on therapist preference. Also cervical traction can be used as physical therapy to enlarge the neural foramen and reduce the neck stress Non-thrust manipulation included posterior-anterior (PA) glides in the prone position. The cervical spine techniques could include retractions, rotations, lateral glides in the ULTT1 position, and PA glides. The techniques are chosen based on patient response and centralisation or reduction of symptoms. Postural education includes the alignment of the spine during sitting and standing activities. Thermal therapy provides symptomatic relief only and ultrasound appears to be ineffective Soft tissue mobilisation was performed on the muscles of the upper quarter with the involved upper extremity positioned in abduction and external rotation to pre-load the neural structures of the upper limb. Home Exercises include cervical retraction, cervical extension, and deep cervical flexor strengthening, scapular strengthening, stretching of the chest muscles via isometric contraction of flexor of extensor muscles to encourage the mobility of the neural structures of the upper extremity. Clinical Bottom Line Cervical Spondylosis is a normal degenerative disorder of the cervical spine. Whether Spondylosis should be considered a degenerative change or an age related change is simply a matter of semantics, but the development of osteophytes and related changes can be viewed as a reactive and adaptive change that seeks to compensate for biomechanical aberrations. Approximately 95% of people by age 65 have cervical Spondylosis to some degree, it’s the most common spine dysfunction in elderly people. The symptoms can depend on the stage of the pathologic process and the site of neural compression. In many cases, on imaging Spondylosis can seen to be present, but the patient may not have any symptoms. Cervical Spondylosis is mostly diagnosed on clinical signs and symptoms alone. Treatment should be tailored to the individual patient and include supervised isometric exercises, proprioceptive reeducation, manual therapy and posture education.
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