What is Cervical Spondylosis ?
Epidemiology and Possible degenerative characteristics
Why Do Exercises Help Cervical Spondylosis ?
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
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
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
##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
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
** 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
##Vague numbness, tingling or weakness in upper limbs
##Dizzyness or vertigo
##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
Use a TENS machine to assist pain relief in the comfort of your own
home at any time of the day or night.
** 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. Our HKP team ready
to help you out.
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
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
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
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
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.