Physical Therapy Treatment For Cervical Spondylosis | Goal & Techniques

Musculoskeletal diseases are evaluated and treated by a branch of medicine known as “Physical Medicine and Rehabilitation”, also referred as PMR division of medicine. Physical Therapy is a subsection of the rehabilitation medicine. Physical therapy involves evaluation and treatment of musculoskeletal disease under the supervision of physical therapist. The physical therapist are highly trained in scientific method of treatment and hold either PhD or Master degree. Physical therapy is a non-invasive and non-operative treatment.¹

Cervical spondylosis is degenerative disease of cervical vertebrae and disc. Scientific literature suggests physical therapy is beneficial in relieving pain when compared with treatment using pain medication².

• Degenerative Disease of Cervical (neck) Vertebral Column
• Cervical Spondylosis is also caused by wear and tear of cervical (neck) disc
• Cervical Spondylosis is more common in elderly patients
• 90% patients suffering from Cervical Spondylosis are over 60 years

• Wear and tear causes disc dehydration resulting in shrinking of the disc.
• Aging vertebrae and disc forms osteophytes and bony spurs.
• Spinal foramina become narrow as disc become thin and fragile.
• Spinal nerve is often irritated by bony spurs.
• Foraminal stenosis causes compression or pinch of spinal nerve.

• Treat acute and chronic pain if not responding to pain medications and muscle relaxants
• Treat muscle spasm
• Slow down the progression of the musculoskeletal disease
• Improve neck movements
• Improve sleep pattern
• Assist in maintaining normal activities

• Improve neck movements
• Relieve neck pain
• Decrease intensity of pain and discomfort during daily activities
• Increase pain tolerance
• Decreases muscle stiffness
• Decrease consumption of pain medication and muscle relaxants

• Neck is a important segment of vertebral column.
• Patient suffering with neck pain should see physician for evaluation and diagnosis.
• All the neck exercises should be supervised by specialist like Physical Therapist.
• Supervision is essential to prevent any structural damage to skeletal system or nerve in neck.
• Physical therapy is non invasive option of treatment.

1. Heat Therapy
2. Cold Therapy
3. Electric Muscle Stimulation
4. Transcutaneous Electric Muscle Stimulation (TENS)
5. Soft Wave Diathermy
6. Exercise Therapy

• Local Heat Application-
  • Hot towel is placed directly on neck muscles
  • Hot water bag (heating pad) directly applied on neck muscles
• Goal of Treatment-
  • Improves blood circulation
  • Decreases nerve and muscle inflammation
  • Relieves muscle spasm

• Ice Application-
  • Ice is directly applied over skin
  • Ice covered by cloth or filled in a bag is placed over aching neck muscles.
• Treatment With Cooling Spray-
  • Fluromethane-
    • Spray is applied over skin, causes immediate cooling
    • Acts as a counter irritant and modulates pain receptors
• Goal of Treatment-
  • Decreases inflammation
  • Relieves muscle spasm
  • Reduces nerve irritation by reducing nerve edema

• Objective of Electrical Stimulation For Cervical Spondylosis –
  • Stimulates neck muscles, which results in muscle contraction.
  • Electric current alternates contraction and relaxation just like specific exercise would initiate specific muscle contraction and relaxation.
  • Relieves sustained spasm caused by nerve stimulation and pinched nerve.
  • Decreases silent spasm of the muscles caused by nerve irritations

• Technique of Electrical Muscle Stimulation For Cervical Spondylosis-
  • Electrodes are placed over target muscles group at the back of the neck.
  • Electrical impulses are delivered through skin to underlying muscle and nerves of the target muscles
  • Electric stimulation creates rhythmic contraction and relaxation of the group of muscles
  • Procedure is repeated few times during each session.
  • Patients are trained to use equipment at home after few training sessions.
• Goal of Electrical Muscle Stimulation Treatment For Cervical Spondylosis-
  • Relieves sustained silent spasm
  • Periodic neck muscle stimulation stengthens neck muscles.
  • The procedure is also considered as passive muscle training to improve tone and strength of the muscles.
  • Helps to improve blood circulation within group of muscles
  • Treatment helps to relax the patient once spasm is relieved and pain is decreased.

1. Objective of TENS Therapy For Cervical Spondylosis
   • TENS unit therapy is most common therapy used in physical therapy practice.
   • Helps to relieve continuous muscle spasm
   • Modulates pain transmission to brain
   • Decreases silent spasm of the muscles caused by nerve irritations
2. Technique of TENS Therapy For Cervical Spondylosis
   • Electric stimulation is passed through skin to underlying nerves.
   • Spinal Nerve Stimulation-
     • Stimulates sensory nerves of spinal nerve and it’s peripheral branch
     • Stimulates dorsal horn nerve cells (neurons) of spinal cord
   • Stimulation of Sensory Spinal Nerve
     • Causes peripheral feeling of tingling and numbness
     • The symptoms of tingling and numbness spreads along the nerve stimulated.
     • The retrograde impulses modulate pain impulses in spinal cord and causes pain relief.
   • Stimulation of Sensory Nerves in Dorsal Horn of Spinal Cord
     • Modulates pain stimulation in dorsal horn of spinal cord.
     • TENS stimulation, blocks pain signal from being carried to the brain.
   • TENS stimulation also promotes release of endorphin.

Goal of TENS Therapy Treatment For Cervical Spondylosis

• Relieves muscle irritation resulting in muscle contraction and spasm.
• Modulation of Pain Impulses-
  • Modulate transmission of pain impulses passing to brain
  • Modulation of pain impulse results in increased inhibitory impulses to dorsal horn cells.
• Endorphin Secretion-
  • Increased endorphin secretion helps to relieve pain and also decrease pain intensity.

• Objective of Short Wave Diathermy Treatment For Cervical Spondylosis
  • Relieves muscles spasm

• Technique of Short Wave Diathermy Treatment For Cervical Spondylosis –
  • Heat is generated by using high frequency electromagnetic waves
  • Alternatively heat is also generated using ultrasonic waves.

• Goal of Short Wave Diathermy Treatment For Cervical Spondylosis –
  • Relieves muscle spasm and causes muscle relaxation
  • Reduces inflammation
  • Improves blood circulation

• Objective of Exercise Therapy For Cervical Spondylosis-
  • Obtain detailed history of muscle and nerve pain.
  • Detailed examination of skeletomuscular system.
  • Plan exercise therapy.
  • Evaluate muscle and neck joint flexibility.
  • Evaluate entire body stability.
  • Plan appropriate neck posture for exercise and daily activities.
  • Evaluate range of neck movement.
  • Strengthen neck muscles.
  • Achieve optimum stretching of neck muscles.
  • Improve range of neck movement.
• Technique of Exercise Therapy For Cervical Spondylosis
  • Stretching
    • Apply Heating Pad Before Stretching-
      • Apply heating pad to warm up muscles
    • Active Stretching-
      • Patient is encouraged and advised to perform optimum flexion, extension and rotation of the neck and head.
      • The optimum position in flexion, extension or rotation is kept in hold position for a brief period as long as patient can tolerate.
      • Patient is also advised to move head without assistance in different directions as directed by physical therapist.
    • Passive Stretching-
      • Physical therapist will hold the head in neutral position. Therapist will rotate the neck and head in different direction to achieve optimum flexion, extension and rotation of neck depending on provoked pain.
      • Physical therapist does the movement of the neck while holding the neck and head.
  • Strengthening
    • Isometric Contraction-
      • The neck movement is initiated against resistance so that the joint or muscle length and angle does not change.
      • The exercise tends to tighten up the muscles and improves the strength of the muscles of upper back and neck.
      • Most beneficial exercise for pain in the joints of the neck.
    • Isotonic-
      • Isotonic exercise is done using weights and machines.
      • The muscle length changes with lifting weight and joint position changes from flexion to extension or vice versa.
    • Joint movement occurs with muscle contraction.
    • Cervical vertebrae strength technique exercises tend to tighten up and strengthen the upper back muscles by making them move weights.
• Goal of Exercise Therapy For Cervical Spondylosis
  • Improves blood circulation
  • Improves range of motion.
  • Improves muscle strength
  • Increase range of motion helps to prevent initiation of pain.
  • Increases pain tolerance.
  • Enhanced functional ability and prevent functional limitation.
  • Restore normal neck movements
  • Prevent progression of impairment

• If you are predisposed to cervical spondylosis, you need to avoid roads in bad condition while traveling.
• While traveling use firm collars.
• Use firm mattress, butterfly shaped pillow or thin pillow.
• Avoid sitting for extended time in postures which can strain the neck muscles.
• Avoid lifting heavy weights on head.
• When getting up from a lying down posture, turn to one side.
• Do prescribed exercises regularly.
• Avoid lying flat on the stomach.

References:

Also Read:

• • What is Physical Therapy?
  • Physiotherapy Management for Neck Pain
  • Physiotherapy and Recovery for Fractured Tibial Plateau or Tibial Plateau Fractures
  • Treatments in Sports Physiotherapy & Its Benefits