Neck Pain #5 – Cervical spondylosis – Treatment 1
Treatment of Cervical Spondylosisor Herniated Cervical Disc or with any Cervical Painful Syndromesmay be listed as follows.
- Modalities – Applications of various Modalities
- Medications for the symptoms
- Cervical Traction
- Psychological Intervention
- Guidance on Activities of Daily Living
- Postural Corrections and Exercises
- Exercise Programs – Neck School
Rest is very essential and important if the injury is acute. Rest, in the strict sense, means minimizing or avoiding any activity that may aggravate the symptoms of neck pain or arm pain. Avoiding or minimising activities like excessive driving, excessive work at the Computer, using head pillows or any activity that may cause stress and strain to the neck is desirable. Bed rest or reclining in comfortable positions for short intervals may be helpful. These positions avoid stress of gravity on the neck.
2. Modalities – Applications of Various Modalities
a. Application of Ice – Cryotherapy –Cryotherapy is highly beneficial in the acute stage. Application of Ice relieves protective muscular spasm which aggravates the pain. Hence the pain is relieved. Prolonged application of Ice is preferred. Crushed Ice cubes wrapped in a thick towel is placed on the cervical region and the other painful areas. Ice is applied continuously for a period of 20 minutes. Remove the ice for 10 minutes Again reapply for 20 minutes. This procedure is repeated twice or thrice a day. Ice has an analgesic effect too. Some prefer intermittent application of ice to its continuous application just like brushing with the ice.
b. Application of Heat – Once the acute stage has subsided heat may be applied to the cervical spine and the painful areas. Heat relieves the protective muscular spasm and hence the pain is also relieved. As home program heat may be applied in the form of fomentation. It is to be noted that even though the pain is relieved on the application of heat, heat application does not have any direct effect on the deeply situated nerve roots in the foramina or on the degenerated intervertebral discs. Suitable exercise programs may also be carried out by the patients along with heat and cold applications.
c. Electrotherapy Modalities – In a Physiotherapy Department, Hot Moist Packs and Infrared Radiation are given for the purpose of superficial heating. For the purpose of deep heating Electrotherapy Modalitieslike Short Wave Diathermy(SWD), Ultra Sound Therapy (UST) and Laser Therapy are used. To relieve pain, especially the neurological radiating pain, Transcutaneous Electrical Nerve Stimulator (TENS) is applied.To strengthen the weak muscles and to prevent muscle wasting Electrical Stimulation is given. Before resorting to the Electrotherapy Modalitiesthe patient is subjected toa thorough examination so that the correct suitable modality may be chosen.
Medicines are given mainly to relieve the symptoms. Anti-inflammatory Muscle Relaxants, Analgesics, Oral Steroids, Epidural Steroids etc. are helpful. Anti-inflammatory Muscle Relaxant and Analgesic gels or ointments may be prescribed.
Cervical Collar or Cervical Brace that immobilizes the neck in a physiological position is found to be a great value. It maintains the head and the neck in the correct postural position. It places and maintains the head directly above and in line with the centre of gravity. A Cervical Collar or Brace provides the following-
- Provides rest to the neck by restricting its movements.
- Decreases the lordosis of the cervical spine.
- Provides stretch to the cervical spine.
- Maintains an adequate opening of the foramina.
- Decreases pressure on the nerve roots. And
- Minimises or avoids pressure on the disc.
Cervical Collar orBrace is never be used as a final solution. The main function of the soft tissues, the muscles, the ligaments and the joint capsules in the cervical region are to keep and maintain the erect position of the cervical spine, its mobility and its alignment as a whole and the functional unit of the cervical region in particular.Total dependency on a Brace or a Collar allows the soft tissues, the muscles, the ligaments and the joint capsules to relinquish their function ‘in toto’ as their functions are carried out by the Collar or Brace.Eventually these soft tissues, the muscles, the ligaments and the joint capsules may lose their contractibility and strength. Hence a stage will come when the Collar or Brace is weaned the cervical spine may ‘fail’. More over movement of the spine is essential for the intervertebral discs to get nourishment. Unlimited period of restriction of neck movement may lead to deficiency in the proper nourishment of the disc. This may lead to aggravation of degenerative changes of the discs (Please refer my earlier article on the Functional Anatomy of the Intervertebral Disc). Hence it is advisable to use it as a temporary measure. It may be used only during the acute stage. Care should be taken that the pros and cons regarding the use of Collar or Brace must be well explained to the patient prior to its prescription. An exercise program must be simultaneously implemented so that the adverse effects due to the use of Collar or Brace may be minimised. The patient must be monitored constantly as to the status of the neurological deficit.If there is improvement and symptoms have diminished, the patient may be ‘weaned’ from the Collar. Inspite of the use of cervical collar or Brace if the neurological symptoms continue to persist we can conclude that its use may be an inappropriate treatment method. Hence other treatment methods may be considered.