CERVICAL SPONDYLOSIS

1. CERVICAL SPONDYLOSIS

2. Outcomes Be familiar with the anatomy and function of the intervertebral segment. Be able to explain the pathology to the patient. Be familiar with the clinical presentation of a typical patient with Cervical Spondylosis. Be familiar with the typical objective signs of a patient with Cervical Spondylosis. Be familiar with the most widely used medical as well as physiotherapy treatment protocols for a patient with typical Cervical Spondylosis. Be able to give appropriate exercises and advice to a patient with typical Cervical Spondylosis.

3. Definition Complex of degenerative changes in a joint with degeneration of the articular cartilage and formation of osteophytes.

4. General Shows signs of degeneration from 18 – 20 years. Takes place in the spinal movement segment. Disc determines the amount of movement. Facet joint the direction of movement. Result in pain and stiffness with possible referred pain as a result of the pressure that the osteophytes exert on the nerve-roots. Usually the transitionary areas first (C2/C3 and C7/T1)

6. Causes • Previous injuries. • Degeneration of joints as a result of injury or normal ageing. • Disc lesions (less common) • Repeated light strain - posture

7. Three Stages • Dysfunction • Instability • Stabilisation period

8. Clinical Presentation • Older patients • Preceded by injury and/or fatigue • Pain due to synovitis in facet joints • Complain about dull pain behind the neck in the area of m. trapezius • Pain is worse in the morning with visible stiffness

9. Clinical Presentation (cont) • Sometimes audible crepitations • Pressure of osteophytes on nerve-roots may cause neurological signs.

10. Objective Signs • Reduced cervical lordosis • Tenderness over the post. paravertebral muscles • Pain through range of movement • Sometimes headache • Stiffness of physiological and accessory movements • Possible neurological signs • X-rays: constricted disc space with osteophytes.

12. Treatment • Change of procedure if posture is the causative factor • Analgesic for severe pain • Anti-inflammatory drugs for synovitis • Surgery if indicated • Supports

13. Physiotherapy Treatment • Aim is to obtain the fullest possible pain-free range of movement • Only 75% of symptoms can be alleviated – healing can not take place • Passive mobilisation – direct techniques to Grade 3; indirect techniques if indicated • Intermittent mechanical traction • Heat and other electro modalities • Special soft tissue mobilisations

14. Physiotherapy Treatment (cont) • Exercises: mobilising, stabilising and strengthening • Care of the neck and advice • Acquiring the correct posture and sound kinetic handling.

15. Mobilising and Stabilising Exercises • Flexion exercises in supine • Extension exercises in supine • Rotation exercises in supine: strengthening; mobilising • Shoulder mobilising in sitting • Exercises for correct posture against wall • Exercises against self-resistance.

16. Advice • Keep neck warm and avoid a draft on the neck • Avoid sustained neck positions • Sleep with head in a neutral position and avoid too firm a pillow. • Avoid sudden jerky movements. • Maintain a good posture • Avoid over-fatigue.