Cervical Spondylosis 'Delayed' Symptoms. How C/S Symptoms manifest themselves.

ps.......Of course, its not my intention to push my arguments onto professionals who may be otherwise busily occupied with matters of delusional denial. Hope I haven't uncovered a new condition there, endemic amongst medical professionals who can't see the wood for the trees ! Systemised failure, rebranded as some kind of second class success, is not really an option here. I'm the one being served with this weird dish, and I'm sending it back. Surely you can do better !

Misconceptions.


Just to move on before the last posting is spotted !

The best therapist available to us is our own body. Indisputable. The body is a highly refined organism, genetically designed to conduct its own repairs where necessary. Like everything else, there are limitations, but mostly it does an excellent job. There are no fees, no appointments, no waiting, its available 24/7, and it seldom makes mistakes. It hasn’t had to study for many years how to deal with a crisis, it inherently knows its own best reactions. It could teach us a lot. All these services are available to us unconsciously, and our conscious appreciation of its methods is still someway behind the advanced systems it applies.

The first law of any applied therapy should be ‘ Try and understand what the body is already trying to do’. Of course there are situations where the body’s defences are overwhelmed, and we can intervene by, for example, removing the main threat, and then allowing the body to resume its self recovery role. There is no doubt than in many areas of medical crisis we have learned how to intervene beneficially. But not in all.

Where we fail, we must keep an open mind. There is no point in insisting that an applied therapy, which has been proven to work for one condition, should be applied to another where outcome is unknown. The history of medical practices is one of many failures, and some great successes. The arrogance of those successes must be contained if we wish to always be improving. There also isn’t much point to us entering self congratulatory mode whilst the job remains unfinished.

Where C/S is concerned, I can see where differences occur between my 30 years experience and the efforts of an interested professional, who doesn’t have the condition, to try and understand how the condition works. It might take such an interested party 300 years to achieve the same levels of intuitive understanding that I’ve had no choice but to learn. Its never going to be top of their ‘to do’ list, and results can only be monitored by evaluating trial and error over a wide demographic. It’s a slow process. Not so with me. I’ve been privileged to monitor the condition 24/7…..not a single moment lost. So, my 30years v 300years comparison probably doesn’t look so outrageous in that context.

However, its not a contest. We all want the same end result, and the best way to do that is to share our accumulated knowledge. That is why I chose to share on this site rather than challenging the views of a Physio in a clinic somewhere. I would just be reducing the options to that same old slow process. I believe that most professionals who deal with C/S have a particular ‘accepted’ overview of the condition which I have difficulty relating to, and that overview is determining treatments which don’t necessarily meet their purpose in ways which I consider beneficial.

The purpose of these postings is to try and encourage trained professionals and patients to revisit their basic understanding of the C/S condition, and to not ignore how the nervous system uses the sleeping process to instigate the varied ‘associated’ symptoms, which in turn can then be controlled somewhat by adjusting sleeping postures. I understand that there might be a certain loss of income associated with this suggested therapy, but I can also assure that there will be greater rewards in feedback feelgood factors !

The Neck’s Hierarchy of Priorities.


The neck is probably the most used organ of the body. Its worth saying because mostly we forget its there, which is also a good indication of its refinement. It has the responsibility of ensuring we can breathe, we can swallow, and that blood flow to and from the brain is uninterrupted. All vital functions. It is also designed to protect the routes which the nervous system uses to both gather and disperse vital information about threats to the body general. All these functions must be protected so that they operate successfully, otherwise, in theory, we die. On top of all this, the neck also has the responsibility to allow movement of the head, and thus the senses of seeing, smelling, hearing, tasting etc are fully utilised to aid our survival in a threatening world.

When an actual structural problem occurs in the neck, as with cervical spondylosis, the neck must then refer to its default protective system to decide which functions take priority, and which functions must be maintained, even if its at the expense of applying a direct reaction to that structural problem. These are pre-set inherent instructions which must be enacted regardless of any external interference. If this is true, then its not too difficult to see that how the neck deals with its own structural problem is demoted down the list of absolute priorities, simply because how it reacts cannot be allowed to endanger the other vital functions. In this way, its reactions differ from reactions to similar structural problems in other parts of the body ( perhaps with the exception of sciatica ). And it also helps to explain why the nervous system should choose to use referred pain, rather than direct pain, as a warning method. The use of direct pain in the neck area could easily cause a conscious reaction by us, which might endanger other functions. The nervous system inherently doesn’t trust these possible conscious reactions by us, and so, its methods are designed to counteract them, before they might occur. This is how refined the nervous system actually is.

So, we’ve established that how the neck reacts to structural problems might be well down the list of its priorities. Also, within those ‘delayed’ reactions there exists yet another sub-list of reactive priorities. Without these reactive priorities the neck would probably just stiffen up, painfully, until some sort of natural healing was achieved. It can’t do this because of the possible resulting dangers. And so, what it does instead, is to employ a whole range of ‘safe’ alternative muscular adjustments, which don’t threaten other functions, but which cause all sorts of ‘associated’ symptoms which we are familiar with as C/S ‘associated’ symptoms. It should be stressed here that these are not ‘actual’ trapped nerve symptoms, which in themselves don’t have such an effect on the neck. The ‘associated’ symptoms occur mostly because of threats to a nerve, rather than actual compression.

Basically, what I’m saying is this. The way in which the neck prioritises it reactions is always one step ahead of any possible conscious reaction on our part, and as such, any external manipulations should take this into account before being applied. If it doesn’t suit what’s already happening, its wrong. We might like to believe that we can outwit the nervous system, when in fact, we are always, by default, one step behind. Its inherent in the design !

G

What is ‘Referred Pain’ trying to tell us ?

Again, I’ll reiterate that I’m exploring these issues purely on an intuitive basis. Sometimes, too much knowledge is an obstruction. Just trying to focus rationally on why ‘referred pain’ exists at all, I believe, can reveal certain secrets about how the nervous system chooses to operate as it does.

I’m going to assume here that all referred pain originates with some actual threat to the nerve system itself. I don’t know if this is strictly true, but in my experience, it is. Its probably reasonable for anyone to assume that, where a nerve is compressed, it might cause pain further along its extremity, and only in that part of the body to which that nerve is dedicated. However, as I see it, it should cause numbness, not pain. Pain would only be relevant if there was an injury at that extremity. Where there is an occurrence of pain (referred pain) at an extremity, and there is no obvious injury there, then we must reverse our thinking on normal nerve system signalling processes so we can locate the actual problem.

To me, this is a clever tactic which the nerve system employs to slow down our responses, because it doesn’t trust how we might consciously react if it simply signalled pain at the actual source…i.e. a threat to itself. I know that sounds like I’m giving the nervous system a separate identity of its own, capable of making decisions and enacting processes, and capable of outwitting our conscious reactions. And I am, but only in the same way that we understand our conscious and subconscious beings tend to interact. One or the other must dominate according to the circumstances. But, with the nervous system, it must always dominate by default, otherwise its protective systems become vulnerable to corruption, and that just wouldn’t make sense. ‘Referred Pain’, in itself, causes this puzzle, and we must re-learn the process backwards to find the logic in it.

Where the neck is concerned, I can easily see why the nervous system resorts to such ‘referred pain’ to achieve its protective aims. The neck must carry on functioning regardless of its own distress, and any actual neck pain is reserved by the nervous system as a last resort. Considering the human race has gone through many thousands of years unaware that referred pain in the hand might signify a threat to a nerve in the neck, I think that the nervous system has been very patient, waiting for us to gain the knowledge to interpret its signals correctly. And now that we know, what do we do ? It seems that we resort to interfering aggressively with external manipulations, which seem to me to go against the very reason why the nervous system adopted ‘referred pain’ signalling processes in the first place. Maybe the whole ‘referred pain’ system worked better when we knew less !

And, the nervous system hasn’t yet adjusted itself to our new methods. If its original intention was to somehow distract us from the source of the problem, what must it do now that we are no longer distracted ? Should it evolve an electric shock for anyone who dares to touch the damaged area ? Of one thing we can be sure. Now that the secrets of referred pain are being unravelled, we must assume that the nervous system is likely to resort to other, as yet unknown, methods, to maintain its position in the hierarchy of control over threats to itself.


Gerry

Pre-emptive Protective Nerve Behaviour


I think most would agree that nerve reactions are generally seen as post incident events. An injury or malfunction occurs, and the dedicated nerve reacts with whatever warning signals it deems necessary to alert us to the danger, and possibly to also kick start the immune system into instigating local reactions. I don’t think that we ever accept that the nerve could have predicted such an event in any way, and somehow managed to warn us before the injury / malfunction actually occurred. However, where there might occur an incident of a possible threat to the nerve system itself, I suggest that the nerve system can adopt a more pre-emptive protective warning and reaction role. It just makes sense that it would have the ability to protect itself and thus maintain it’s integrity for dealing with other problems in the usual way.

We train ourselves to rationalise events with a ‘cause and effect’ overview, which most of the time proves itself to be adequate. Where that ‘cause’ has not yet happened, but the nervous system has predicted that it might, we have to change our overview for assessing the problem, and try and see that it’s the nerve’s predictive ability which is the real ‘cause’. Obviously, because of the nerve system’s ability to instigate reactions, before the threat to itself becomes a reality, that reality can be avoided, and all we are left to deal with are the after effects of the nerve system’s pre-emptive protective measures.

The key to all this would be whether we accept that the nerve system can enter this pre-emptive mode, and if so, how we should react to it, because we may be dealing with muscular reactions which have been instigated for good reasons. Perhaps for better reasons than any external interference could claim. If we accept that this can happen, then what we really ought to be looking at, in terms of interfering, is how to remove the threat which the nervous system has recognised. Just dealing with the after effects does seem a bit pointless when we consider that the nervous system is always one step ahead of our reactions, and can pre-emptively instigate its own reactions to whatever manipulations we might attempt. So, recognising, and somehow relieving, the threat to the nerve is really the only way forward, and all therapies should be contained within the spectrum of limitations which such an overview allows.

My interest in all this mostly concerns the neck area, and particularly the Cervical Spondylosis condition, where the ‘associated’ symptoms familiar to all who have the condition are brought into sharp contrast. But, maybe the same theory can be applied to all spinal conditions where a nerve is threatened. Where a threatened nerve has evolved into a compressed nerve, there will be different symptoms and a different theory applies. How to read the symptoms correctly, and whether they are ‘associated’ to a possible threat, or whether they are ‘direct’ as a result of actual nerve compression, is all important when choosing an external treatment. I’ve experienced both types and have become familiar with their differing behaviours, and I’m on a little mission to help clarify the dynamics involved and, at the same time, to suggest exploring appropriate treatments, particularly concerning the remedial effects of adjusting sleeping postures.

I’m interested in hearing about any reports or investigations into sleeping posture therapies for these types of nerve threatened conditions, mostly because I’ve come to realise through my own experiences that the sleeping process seems to be where the nerve reactions are first instigated.

Frozen Shoulder.

Because there seems to be many contradictory opinions on what causes ‘Frozen Shoulder’, I’m going to add my opinion to further confuse, or resolve, our understandings. Firstly, I believe the terms ‘Frozen Shoulder’ and ‘Adhesive Capulitis’ are misleading, and only help to add to the confusion by directing attention to the fallacy that it is solely a shoulder problem. In my opinion, it’s not, and here’s why…….


The most common vulnerability to the nervous system, and how it distributes itself throughout the body, occurs where the nerves exit the cervical spine, between the C1 and C7 vertebrae. Because of possible degeneration or regeneration, whether due to an underlying arthritic condition (such as Osteoarthritis) or an injury based condition (such as whiplash), and because of the full range of flexibility allowed to the neck structure, the risk of a compressed nerve, or even the ‘threat’ of such a risk, becomes a greater possibility than would normally be the case.

Where an actual compression has occurred, there would be obvious indicating symptoms manifested in the hand, at the extremity of that particular nerve’s field of influence. These symptoms are usually self explanatory and point to a direct cause i.e. trapped nerve in neck area. Where there is just a ‘threat’ of nerve compression, the nervous system is capable of reading this vulnerability, and, in order to protect from such an event, it can instigate certain muscular reactions to help protect itself. So, the shoulder (which is the next flexible joint along the nerve route) muscles are instructed to restrict the arm’s movement. This is achieved simply by introducing pain for any arm movements which might refer their effects back to the neck, and thus increase the threat to the nerve.

Unfortunately, this process can enter a cycle, perhaps due to ‘muscle memory’ issues, and can take many months to resolve itself. The actual initial threat to the nerve may have already resolved itself, but the shoulder effects carry on regardless. If that initial threat didn’t resolve for any reason, then the frozen shoulder would keep repeating itself endlessly. This doesn’t happen normally…it does resolve with no obvious lingering damage. In fact, there was never any tissue or structural damage in the shoulder, and it returns to normal painfree flexibility in time, usually about 10 to 12 months. It can be very painfull for first 3 to 4 months, and then gradually reduces in pain intensity until eventually it disappears.

So, to summarise, the painful shoulder is just the nervous system’s way of restricting arm movement so that it can better protect a vulnerability to itself as it exits the cervical spine. Any manipulations of the shoulder, especially painful manipulations, are likely to increase that vulnerability in the neck, and thus lengthen any recovery timespan. Any surgical intervention in the shoulder, where no obvious damage is apparent, is even more questionable. Frozen Shoulder is caused by protective nerve behaviour, and it only resolves itself when the threat to the nerve eases off by itself..

I believe that a lot of confusion, particularly regarding a patient’s understanding, is caused by the use of the terms ‘Frozen Shoulder’ and ‘Adhesive Capulitis’. Perhaps it should just be renamed ‘Referred Shoulder Spasm’ to ease patient anxiety.

Dear gerry the neck

I hope im not joining this band wagon a little too late, i just want to give my own two cents worth based on my own experience of patients with cervical spondylosis. you are definitely right in that sleeping positions play a great role in providing relief. Im not going to go into all the explanations already given by my colleagues as to management techniques etc. i personally believe that cervical spondylosis is an age related problem, by age related i mean the older you get the more likely you would have this problem. You dont have to be elderly to start showing signs, lifestyle postures in a daily activities makes us susceptible to this. in my experience postural problems are often the predisposing factors, trauma only adds to speed up the process.
i had a patient once who would suffer the whole day with neck pain but felt the most comfort when she was lying down on her side needless to say she always looked forward to going to bed at night. the pain most c/s patients feel usually are muscular pains, this can gravitate to nervous pains in time etc but 90 percent of the time the issue is muscular, once you take some of the load of the tensed muscles they feel relief almost immediately. All the treatments we provide from a physiotherapy point of view is to maintain range/improve range and strength, improve posture and reeducate on how to unload tensed muscles either through postural work, positioning, modification of daily activities. We only try to prevent the worsening of the problem. This lady in quesstion would get pain on neck rotations and extension, sometimes causing her a headache. now being the age she was and the medications/pmh , it was too risky to trial any manual therapy but with just some basic exercises and advice her neck pains on rotation improved dramatically. now there was no way she was going to get any significantly better because she was extremely kyphoscolitic. so in all fairness, you are right with regards sleeping positions which many of the sufferers automatically know anyway, what they often need help with is improving neck rom/and strength, they are often good at adjusting their own daily activities sometimes to their own detriment because in avoiding some movements they automatically make things worse.
I had another patient with a similar problem, her pain was from bothersome triggerpoints , she was a c/s patient as you would describe but had gotten in the habit of maintaining some awful sustained postures just to avoid pain. now again, she had rheumatoid arthritis and was on long term steroids so manual mobilizations for me was a no no!...a lot of soft tissue work was needed to help her regain some range , offload the overworked muscles and reduce her pain. will the pains come back, almost certainly but with the right advice and maintenance strategy (exercises) she was able to control it more. my take home message to you...yes, there is a neck problem, yes it is cervical spondylosis, but the it doesnt have to be as bad as some people suffer from it once we look at posture and the overwork some neck muscles are having to do

Hi Dr Damien

Again a great description of C/S. Will respond soon.

Thanks

Sorry, a bit of a delay in responding properly. Briefly I can say that such a sympathetic and constructive overview of C/S is more than welcome. Such an approach can only lead to improvements in treatments. I might have some reservations about usefulness of exercises / manipulations in the waking hours, but if some relief is achieved, and as long as there are no new symptoms appearing, that's ok. Inevitably, I keep returning to the fact that I don't necessarilly see an inclination towards further exploration of how the sleeping process, which in my opinion, is the catalyst by which all associated symptoms (as distinct from actual trapped nerve symptoms ) are instigated. Or, for that matter, why the sleeping process is not therapeutically investigated to reveal the benefits it can offer. Best I usually get is the default assumption that, of course, sleeping posture can affect the C/S experience. But where's the therapeutic plan in that ? Over 30 years, I've never had sleeping postures advised or explained to me, and my worry is that it might take the average C/S patient many years of unnecessary discomfort before arriving at such a conclusion themselves about how to somehow control what they are experiencing. I have to be frank and say, it seems to me to be an area of obvious benefit, certainly to someone who experiences those benefits, which has been ignored in terms of proper assessment, for whatever reason. Currently I'm trying to put together a good case for explaining why, in terms of assessing good therapies for C/S, it is all important to focus on what occurs during the sleeping process, and perhaps, that all external therapies should compliment the reactions instigated whilst asleep. Will post anon.

Gerry

Dear gerry the neck

I understand your frustrations and your idea with regards the influence of sleep on c/s, however in practice this is very hard to control. people do not develope c/s because of sleeping or sleeping positions, their everyday lifestyles and posture creates a cascade that starts the process which gets worsened by some unhealthy positions some of which you can get from sleeping. This is why the focus of treatment is on everything else that you do during the day, for sleeping there is very little you can do to control problems. I can advise you as a therapist to sleep in a certain way but because you move about in your sleep you find yourself in another position. I can say put x amount of pillows on certain areas of your bed and by morning all the pillows are on the floor. This is why inherently the onus is on the sufferer to find what works, unless of course you are a neurological patient that needs help moving generally. Its not as simple as you describe it, what position works for you may not work for someone else. There are so many factors to consider, comorbidities ie postural hypotension, breathing issues, postural issues ie.kyphosis, now when you are awake, the therapist can give good advice as to how you should sit, stand or walk because you are "awake" and can make necessary adjustments whenever alignment issues arise. To try and research problems with sleep and the cervical spine is a long shot.. im sure there are companies out there claiming to have the best sleeping equipment to protect your spine and what not however these equipment mean nothing for the restless sleeper, for the person with orthostatic bp issues, for the COPD patient, or for people with recent surgeries, im sure my colleagues will have even more factors that need to be considered to investigate this. I dont think you can get the best advice on how to sleep to protect your neck from a therapist, you may be better off discussing with an occupational therapist who can give the necessary equipment to mitigate these problems but it will always be a long shot for as long as you have the capacity to move independently.

Hi Dr Damien
Thanks for reply. Firstly, I fully understand the difficulties with monitoring or clinically assessing sleeping postures for C/S patients. Patients are awake when they attend clinic and must be dealt with as such. However, if I were to say that the quality of my life would have been improved if I had been advised to investigate sleeping postures myself, many years ago, I'm sure you can see where I'm coming from, and why I would like to see such guidance offered to patients as early as possible. All that's really required is that the patients are made aware of the possibilities, and then its up to them how they react. Its a means of empowering the patient to treat themselves through trial and error, it requires no appointments, no fees, no medications etc, and can be advised in conjunction with more conventional practices. Most C/S patients are frustrated and confused by their condition and perhaps not thinking too clearly about what might work for them. What I'm suggesting is an easy way to help ease symptoms, to stop the symptoms entering cyclical phases, and generally to encourage more confidence for managing the condition. The average patient is away from the clinic 99.9% of the time, and the benefits of being able to feel they can somehow control the symptoms without clinical help should be apparent.
My own experience was one of absolute frustration before realising the difference adjusting sleep postures could make. I no longer feel I have a need to take the problem to a professional, and I no longer feel undermined by worrying about what new symptoms are likely to appear tomorrow on waking. The adjustments make a dramatic difference to what I experience, and I suspect the same would be true for most C/S patients. If it works, its worth a try, even if my arguments in favour don't always convince. And when we consider the 'unproven' description of most current treatments for C/S, including medications and surgery, then I think that adjusting sleeping postures looks like a very favorable option for the patient. Its a complimentary option which C/S patierts should be made aware of at the earliest opportunity by their treatment advisors. Sometimes, the patient needs to hear that from a respected professional, before they rouse themselves to the challenge.

Gerry

Have to say that, on revisiting these postings, I am very happy that I might have helped lever the idea of beneficial sleep postures for C/S into the professional consciousness. Always was amazed that sleep therapy should have been mostly ignored when it was obviously, to me anyway, the catalyst for 'associated' symptoms. I know many disagree with this understanding, but at least the option for exploring further has been aroused....and that, to me, is what's needed. The thing about sleep postures is that, although difficult for a professional to monitor and test (maybe the reason its been ignored), it is relatively simple for a patient to apply (although without being professionally advised it is difficult for a patient to adopt with confidence). If I could suggest a way to square that circle...I would. There should be no problem advising a safe therapy, even if the professional is unsure of its merits, but the patient should be made aware of all options, particularly options which don't carry risks.
I have noticed there have been over 7,500 views on these posts, mostly PTs, I assume, and hopefully some patients as well. The proof of the therapy will always be in testing, by whatever means. An interested patient might read the suggestions, decide to try it, and can start right now with no expense, appointments or specialised equiptment. It can be done at home, in their own time, and all evaluated within perhaps a week. Just sounds too easy by comparison with usual procedures....and can be disposed of if no improvements achieved quickly. My advice....Try It !

Might leave it there for the moment, and if you've read these posts.....thank you.

Gerry

This is a terrific thread. My C/S has recently been diagnosed, although I've been suffering symptoms for years (in particular the muggy head or headaches when waking). They have been getting worse these days. Gerry's advice on the sleeping position sounds very helpful. I've started to experiment with limited success to date but I'm hopeful. Certainly it is my experience that horizontal sleeping appears to be the trigger. I can be feeling fine most of the day, go to bed and then wake up 7 hours later feeling as though I have not been asleep at all - feeling as though I am jet-lagged.

Sleeping sitting up, or half-sitting up does seem to rest the neck a bit. Until it tries to drop down that is. I wonder have you experimented with a soft neck brace during sleep? I was wondering if this might be helpful in conjunction with sleeping in a semi-upright position. That way the neck would be kept in a good position, even when I nod off.

Hi McFly1

Just happened to be browsing today....so, bit of luck there seeing your comments. Thanks for the comments....I always try to get at the bits that are overlooked in other advice. Seems you have noticed the beneficial changes that can occur with changing sleeping postures....have to admit I don't get a lot of positive response on that management technique, so, glad to hear it might be working somewhere other than my own bedroom !

Firstly, I'd like to confirm that it works for me. Been doing it for nearly 3 years now, and few headaches resulting. Still got arm/hand issues, but without the muggy head it's so much easier to deal with those. Last year I had what they call 'mimicked thoracic outlet syndrome' (pain in shoulder/arm/hand and cold sensation in hands) which is a recognised CS referred symptom. It lasted about 3 months, was sore, but no different from any other pain issue, and easily managed without a sore head. Somethings working, without the meds.

Re the sleeping postures....I've thought a lot about ways to support upright whilst sleeping, especially on a sofa. Even considered a Polystyrene mould to help maintain posture. Without that, I tend towards pushing sofa against a slightly higher( 1 foot) set of drawers, and using 2 or 3 soft pillows to support semi upright. Best for a 'nap', because inevitably I slip downwards gradually....but it works....A sore stiff neck has eased many times....and once that's achieved, other maneouvres are possible. Have to admit, I have difficulty with anything around the neck itself. When lying down horizontal, for headaches, I also found a soft proper cervical pillow (ridge around outside and raised bit in middle...but 'soft') useful, but haven't used for a long time....I just nap or sleep on sofa when things get a bit rough, and it eases. I used to take painkillers almost every day, now it's less than once a week.

Glad to hear you're having similar experiences....maybe we're onto something here ! How nice would it be to replace other CS patients' medication reliance with such a simple alternative. I think it's an issue which is screaming out for some exposure....something that can only seemingly be achieved by word of mouth, or posting.

Regards
Gerry

Many thanks for the reply. Much appreciated. I agree with you that the whole sleeping position side of things is overlooked. And that is odd, because it seems as though many sufferers of C/S report that the symptoms (sore head / feeling unrefreshed / neck muscles stiff) are worst of all in the mornings. After SLEEP!

Many (and by many I mean hundreds of days) is the time when I have felt not too bad during the day, no headache, muscles relaxed. Then off to bed, and when I awake my head, neck and muscles are all hurting - and remain that way for hours making me like a zombie till they relax. When I mentioned to the orthopedic doc that "I seem to be damaging my neck as I sleep", he thought I was being a bit weird...!

I'm currently experimenting with a new bed position that (touch wood and fearful of cursing it) appears to be working reasonably well. This involves 2 large-ish foam pillows followed by a thinner, firm foam pillow - all 3 upright (normal orientation) and each one slightly lower than the other. Almost creating a 'wedge'. A 4th foam pillow for under / between the knees.

The sleeping position is then a 3/4 side-sleeping position (1/4 on my back, 3/4 left side). Head is resting mostly on the front and middle pillows. An optional 5th pillow is used to "hug" and also fill in under the chin.

The net effect is a very relaxed neck position - entirely neutral. No pressure at all on the back of the head or the back of the neck (I'm very suspicious of the pressure that horizontal sleeping gives out). I tend not to move a great deal in that position. And as the pillows are foam - the last one quite firm - it doesn't collapse much during the sleep process.

I'm combining this with a single Norgesic pill (450mg of paracetemol + 35mg of ophenadrine citrate) a muscle relaxant basically. This is to try and break the cycle of overnight muscle spasms and sore heads that I have been getting for months now. I'm also trying to swim most days to keep the shoulder muscles from stiffening up, and do a quick 20 press-ups before bed for the same reason.

Hi McFlyI

We're definitely on the same page here, although I do think that, depending on anyone's particular degeneration (regeneration?) state,the details of the best sleeping posture to adopt will vary accordingly. All trial and error/success, I suppose. I've experimented, just as you are doing, and I've tried to focus on the 'happy medium' postures which might suit a broader demography, rather than what just works for me. I've sliced memory foam stiffer pillows in half with a handsaw, and tried them in combination with softer feather pillows on top. Also I've used cerv pillow at 45 degrees on top of soft pillow (really allows the neck/shoulder to sink in for max support). However, I still find the propped up sofa sleep the most reliable. Bottom line, as you say, is to find the most comfortable possible posture before falling asleep, where there is least sense of strain on the neck, and I think the sleeping process then takes care of the symptoms which might appear next morning. If the symptoms have worsened, or even not eased, then I take the lessons, and brace myself for a tricky day ahead. If the symptoms have eased, then I feel like the holidays have come early....a kind of post-easing euphoria sets in where it actually takes some time to come down from the sense of relief, and I have to readjust myself to more normal activities.

The swimming, and the press ups, would be beyond me. But I am a self employed decorator, and when I work, I get plenty of exercise....many times exceeding my own limitations and then living with the consequences. Bit of a phase at the moment after helping a friend with a heavy duty printer into a third floor flat. 'The road to hell' etc. Got to admit I tend towards less is more, especially if outcomes might be unknown....learning by misadventure is a hard route when the sofa beckons so invitingly ! Having said that, the many stressed physical situations which my work has offered up have helped me recognise the triggers for aggravation of the neck (looking up, reaching behind, lifting weights etc). I always try to be horizontal with, or even above, if possible, any strenuous manual work. If I can't manage that, I have a willing helper who does all the overhead stuff. A few years ago, due to numb right hand, I couldn't paint a straight line, or hammer a nail home, or even use a scewdriver properly...but I persevered, and eventually, although still numb, the ability has returned to an acceptable level. Next week I've got a small job on scaffolding, up four stories, and I've asked the scaffolders to give me access through a top floor window so I don't have to drag tools up the scaffold ladder....I know my limitations, and I don't want to spend the following two weeks recuperating !

I'd be glad to hear of any successes you have with your experiments, to add to the theory.....good tips need exposure !

Regards

Gerry

- - - Updated - - -

PS.....

Just thought I add a comment to something you posted :

"When I mentioned to the orthopedic doc that "I seem to be damaging my neck as I sleep", he thought I was being a bit weird...! "

I know exactly what you mean by that, but have to admit I've got a problem with the 'damaging' description. AS I see it, and this probably goes against how most would interpret it, what happens during sleep is 'corrective' or 'protective'. Depending on the vulnerabilities detected by the nervous system during sleep, when all is relaxed and assessable, the resulting symptoms are instigated as protection against further aggravation. Unfortunately, the protective symptoms can be worse than an unmanifested threat to the nerve, and often the patient percieves those symptoms as representing a general deterioration. As I see it, it's usually only temporary, and doesn't necessarilly denote any deterioration or degeneration. I'm inclined towards seeing it as 'regenerative', because the neck is merely responding to threats...as it must do. Sorry if this sounds a bit picky, but understandings depend on the overview.
Just wondering what you might think about that overview ? Would it fit your own subjective experiences ?

Gerry

I'm combining this with a single Norgesic pill (450mg of paracetemol + 35mg of ophenadrine citrate) a muscle relaxant basically. This is to try and break the cycle of overnight muscle spasms and sore heads that I have been getting for months now. I'm also trying to swim most days to keep the shoulder muscles from stiffening up, and do a quick 20 press-ups before bed for the same reason.


Just a little comment response on the 'swimming' and 'press ups'......I'm inclined to be wary of any activities which might come with an 'unknown' muted or delayed response, perhaps even a couple of days after the activity....being the very reason I started this thread. To err on the side of caution would be my mantra on that, particularly if something hasn't been previously subjectively assessed. I know from my own experience that, even a little attempted digging in garden, and I can sense a rapid energy loss, which in turn seems to create a vulnerability for over-straining the neck area, with subsequent symptoms only manifesting a day or two later. I'd say the same for any 'strained' exercising, or any even well intended external manipulations. There are many recorded cases of stroke, or even fatality, resulting from neck manipulations which haven't considered this known risk....there have also been legal cases proving mistreatment. There will always be an impulse to attempt to remove the discomfort by aggressive means, but knowing the risks beforehand should help to temper any unwarranted interference. I suppose the choice for surgery should also be similarly tempered, because there's usually more at stake than just 'an improvement or not', considering outcomes can vary, and in some cases can result in creating an even more vulnerable state.

My take on all this tends to be.....There is most likely an attempted self corrective process going on in the background, in fact most associated symptoms are most likely originating in these corrective processes, and any interference, whether it be exercising, manipulations, surgery, or even plain old good advice, should be accomodating the processes already in play. Anything else might very well conflict with those processes, thus worsening, delaying, or negating those processes. The crucial approach is to read the corrective processes correctly, and then decide what activities might enhance that process. That's not easy without a familiar understanding of the dynamics of those processes, something which is usually only apparent to the person experiencing them....despite all the well intentioned efforts of science-based studies. Those studies tend to assume normal physical dynamics as their premise, and so any exploring or obtained results usually don't reflect the rather tricky dynamics at play where a nerve is threatened....different rules apply, and this isn't always obvious to the investigators.

Just a quick update and some thoughts.

"Damaging my neck as I sleep". I see what you are saying there - that the pain / muscle tension is not in fact the damage but rather a reaction to it. And that certainly seems logical. Perhaps I am in some way damaging the neck as I sleep, and then the protective measures kick in to give me the morning headache and muscle spasms? As a long-time insomniac I have had some nights where I'm awake till 4 or 5am - watching TV or just bored - and the neck remains fine. On other nights, I wake after just 1.5 hours asleep to find that the headache and bad neck have already kicked in. Hence my recent conversion to finding the most appropriate position that minimises the damage and its reaction.

So far, I'm doing OK. The multi-pillow, half-on-the-side wedge of pillows is doing not bad.

One new ingredient to add into the mix - CAFFEINE. Normally (as an insomniac) I've studiously avoided any caffeine after 12 noon. But recently I found a 1-2-1 correlation between a better sleep and a single Anadin Extra (paracetamol / aspirin / caffeine). If I try it without the caffeine - using the same dosages of the other two - a poorer sleep. So either I'm suffering withdrawal from caffeine, or somehow the caffeine is helping the other 2 to give me a better sleep.


Finally - on the exercise. Interesting point about the delayed reaction. I've got rid of the press-ups as I think they were putting too much strain on. I'm keeping the swimming though as I find it loosens off my shoulder muscles. I'm careful to stick with breast-stroke under water (using goggles) so that there is zero strain on the neck as I do the lengths. I won't be able to swim during December so that will act as my control month to see if things improve or deteriorate.

Keep on experimenting!

Glad to hear some improvements ongoing. Not sure about the caffeine issue, but I'd be inclined to think that the caffeine helps the painkiller ingredients to kick-in and distribute quicker. My choice tends to be nurofen, always with a snack to avoid any stomach issues, but I've managed to cut cut down in the last few years to about one tenth of my previous consumption (20+ years of taking painkillers just to do normal stuff, or to sleep)....the sleeping postures did that. The altering of sleeping postures has created its own bearable 'normality' which doesn't require the med dependency, thankfully. With C/S we can never say what it's going to be like next week, but 'so-fa' so good, and I'm optimistic in a way that I had become convinced would be impossible. My previous overview of the condition, probably fed by everything we read and are told, has flipped into a self management program that actually delivers results. I'd like to think that others who are going through the same chronic pain and confusions, at least have an opportunity to consider that, as I've learned, things can be different. However, from communicating directly with C/S patients on other sites, I realise that it's difficult to convince by suggestion alone...even with good experiential insight into what they may be going through. Chronic conditions have a tendency to create a mindset, where best decisions are not always made....the symptoms create their own urgency at the expense of good reasoning etc. I'd hope that the professionals pick up somehow on the sleeping postures as good therapy because that might be the quickest way to inform those who need to know.

To try and explain the onset of morning symptoms as something instigated during sleep, I see it like this.............Whatever activities we've engaged in during the day, we inevitably aggravate or further threaten the nerve/s in the neck, but because we are awake, we are in protective/defensive mode....in other words, the neck is defying its own vulnerabilities. Then, when we fall asleep, that defense mode is relaxed, the nervous system can then read its own vulnerabilities, and it instigates protective measures for when we next wake up. A threatened or pinched nerve should really only manifest as numbness/pins and needles in a dedicated area, whether radiated or referred. So, any painful symptoms such as headache, sore neck, pain in shoulder/chest/arm, I see as resulting from protective muscular adjustments which are instigated to help towards less aggravation to the actual nerve. Relieve the threat to the nerve by any means, in my case by altering sleep postures (nothing else has worked for me), and the protective associated symptoms are also immediately relieved. Any actual deterioration of the cerv spine, with resulting further threats to nerves, shouldn't actually cause pain in itself....the bone structure degeneration doesn't hurt, and endangered nerves usually manifest referred numbness. There are few C/S patients who complain of disabling pain at point of nerve compression. So, with the sleep thing it's about sensing the least vulnerable/stressed postures, where the neck's own dynamics don't need to instigate protective responses whilst we sleep. That takes a bit of getting used to, and because we can't eliminate 'error' from a trial and error approach, I suppose those in most need will always show some reluctance to take a risk.....especially when they are constantly being told that medications might deliver a more appropriate solution...which they don't. The medication culture needs to be challenged because, with C/S there's a ready-made population all too ready to be zombified, and if that's the best they can do, I think I'll just carry on with my own research.

I liked your previous idea of having something to stabilise the sleep posture....am looking into that one.

Gerry

Referred Symptoms and ‘Nerve Misbehaviour’

On the understanding that I am exploring approach overviews for neurological conditions, particularly Cervical Spondylosis, I think there’s one issue which creates a tendency for overview error. Most ‘normal’ injuries/diseases manifest as symptoms which are referred to an ‘emergent’ perception in the mind. There is usually a direct correlation between perceived symptoms and actual injury/disease. This correlation, alone, is very reassuring for the patient....it insists on applying treatments to enable and assist healing. The mindset, which accompanies the perceptions, is usually non-contradictive and determined in organising a response.
When it comes to neurological conditions, particularly where there may be a trapped, or even a threatened nerve, what is observed is, first, a referral of symptoms (and their perception) to a different location than the threatened site, before a confused ‘emergent’ perception is created in the mind. The correlation between injury/disease and perception is broken, as perceived intuitively, the subsequent mindset is confused about ‘cause and effect’, and it becomes difficult to construct a meaningful response. I’m also inclined to think that operators have considerable difficulties defining (and treating) referred symptoms in a meaningful way, and have a tendency to write-off referred symptoms as ‘nerve misbehaviour’. Referred symptoms simply don’t react as one would expect from more ‘normal’ injury symptoms. This , of course, carries over to the patient in a ‘best to ignore’ sub-text.

My problem with all that is simple. If we can’t define what proper nerve behaviour ought to be, then we can’t assume that there is any such thing as ‘nerve misbehaviour’. The referred symptoms, and their perceptions, are meant to happen. They happen consistently over the global population, and they are anything but nerve misbehaviour. They most likely are the nervous system’s least threatening method of response to a threat to itself....i.e. a trapped or threatened nerve. By giving a ‘purpose’ to the referred symptoms, which we should be obliged to do for science reasons alone, we would also help settle the patient mindset into a more constructive mode, to help with coping and treating. Any overviews, reflected back onto the patient, because of lack of understanding of unusual nerve behaviour, will undoubtedly have an opposite unsettling effect.

Obviously, the science hasn’t yet caught up with the difficult to define referred symptoms associated with trapped and threatened nerves. The symptoms must have a ‘purpose’....but their behaviour seems to contradict normal nervous system behaviour, and that creates an anomaly in the thinking, which then reflects onto a patient’s consideration of treatment options. Referred symptoms are probably best treated with programmes which enhance and assist normal coping mechanisms....but that option is perhaps being unintentionally undermined by reflected misunderstandings of nerve behaviour when a nerve is, itself, threatened.

Cervical Spondylosis Explained

What exactly is Cervical Spondylosis ?

The term ‘Spondylosis’ refers specifically to any form of bone deneration in the spinal column. The term ‘Cervical’ refers to the neck area, specifically the 7 spinal vertebrae ( named C1-C7, from base of skull to top of shoulder area ) in the neck. So, put together, Cervical Spondylosis (C/S) just means any degeneration of bone in the spine in that area. Although C/S is often used as a descriptive term for Osteoarthritis in neck area, it is not, in itself, a diagnosed disease in the same class as any underlying arthritic disease. It is a descriptive term for bone degeneration only.

How does C/S happen. ? What are its origins ?

C/S can result from two different sources. It can happen because of an underlying arthritic condition ( usually Osteoarthritis ) causing a deterioration of bone structure, at any age, but usually later in life. It can also happen, more gradually, following an injury to the neck, at any age, but usually occurring in earlier years. That degeneration, in itself is painless/symptomless, but if any nerves are threatened or compressed by the degeneration, a range of symptoms can appear. It is possible for someone to have extensive C/S ( degeneration), and have little or no symptoms besides some discomfort. It is also possible for someone with minor degeneration to suffer the full range of painful symptoms. It all depends on how a nerve is threatened, which nerve it is, and how transient or permanent the compromising is. The extent of the degeneration doesn’t determine the symptom outcomes....it just creates the options for vulnerability to possible arising issues.

What is ‘Degeneration’ ?

Degeneration of the bone , either by injury or underlying arthritic condition, varies between individuals who have C/S. Bone structure, when damaged like that, tries to repair itself. In the case of C/S, that usually means that bone spurs ( osteophytes ) can grow on the bone between the vertebrae, as a means of stabilising the neck against the vulnerability of any dysfunction resulting from the degenerative changes. Bone structure all over the body can behave in this manner, but anywhere on the spine it is called Spondylosis, and it is generally painless/symptomless. As a rule, bone structure attempts to repair itself with adaptive adjustments to guarantee continued functioning. With the neck area, and C/S, because the neck must retain flexibility to continue the functioning of other organs which use the neck ( breathing, swallowing, blood flow, nerve distribution etc ) , the bone repairing can lead to reactions in the local area or to ‘referred’ areas. These reactions are listed below.

Spondylosis, Stenosis, Myelopathy and Radiculopathy ?

We already know that Spondylosis is a description of bone degeneration. So , what do these other terms mean.
Stenosis: When the distance between the vertebrae and the nerve root, which is located in the central nerve root canal in the spine, is shortened by degenerative changes, that is called Stenosis. The vertebrae can actually touch the nerve root itself, but are unlikely to damage it. Stenosis is a description of this physical dysfunction.
Myelopathy: When stenosis occurs, it can give rise to Myelopathy, which is the name for a range of nerve symptoms caused by any compression or impingement of the nerve root within the spinal nerve canal. Myelopathy symptoms are usually restricted to numbness, pins and needles, tingling, burning sensations, general fatigue, loss of power or clumsiness, in any combination.
Radiculopathy: Where a nerve is restricted as it exits the spine ( usually by a growth of bone spurs [ called osteophytes]), it can give rise to a range of referred or radiated symptoms. These symptoms include all the ‘associated’ issues which are not included in the Myelopathy range of symptoms, such as...cervicogenic headaches, stiff neck, referred or radiated shoulder/arm/hand/leg/chest pain, muggy head, any compensatory aches in lower back, and sometimes anxiety and depression, in any combination. Generally speaking, these symptoms result from physical adjustments required to help protect any threatened nerve in the neck from becoming worse. Anxiety and depression usually results from the confusion aroused by not being able to predict ‘tomorrow’s’ symptoms, and continual worrying about how to ‘fit in’ with work or domestic duties, all giving rise to a sense of impending negative functionality. It is probably worth noting that any threatened nerve will attempt to rectify its vulnerability by instructing muscular reactions, particularly in the neck area, which can result in residual painful reactions elsewhere. It is probably also worth noting that most of these ‘associated’ issues indicate ongoing protective/corrective measures adopted by the nervous system attempting to contain the problem. The neck must maintain some flexibility to support the other functions which also use the neck, and it seems that referring or radiating symptoms to other local areas is the only means of allowing a continuance of flexibility.

Treatments:

One of the major problems facing any C/S patient is the number of treatments and medications on offer, none of which offer any guarantee of success. Painful issues usually require medication, whereas general discomforts usually require physiotherapy. Sometimes the only offered treatment will be surgery, which comes with the risk of not knowing the long term effects. Also, mistakes can happen in surgery, because of its intricate nature, and the condition can worsen. None of the current available treatments, including physiotherapy, medications and surgery, are proven to offer much better results than a simple ‘wait and see’ policy for treatment.
Managing C/S usually comes down to decisions about ‘bearability’ and ‘tolerance’ before making decisions for any medical interventions. Some C/S patients seem capable of managing without interventions, whereas others will tend to rely on the interventions.....perhaps all hinged on the toleration levels involved. Even if a patient submits to all the recommended interventions, they will still have to self-manage afterwards....so, in theory, nothing much is likely to change except for some possible temporary relief, gradually reverting back to a similar situation as prior to intervention. Medications, whilst possibly offering transient relief, will have no long term effect, except maybe creating dependency issues for the patient. And physiotherapy for C/S is unproven, and comes with the possibility of aggravating nerve issues. Probably important , with any exercises, is to always be mindful of any possible delayed reactions occurring up to 2 days after the exertions. Gentle movements are usually ok, but best to be aware that any stress applied to neck can have repercussions. Generally speaking, any resulting increasing of symptoms should dissipate over time, perhaps 2 or 3 weeks, if not further aggravated.

Overview

C/S is a ‘chronic’ condition, based on continued degeneration of cervical spine. Degeneration rates can differ depending on cause of C/S. If C/S has resulted from a middle-aged onset of osteoarthritis, for example, it can degenerate rapidly over a couple of years, giving rise to combination of symptoms which are difficult to rationalise. That can be a confusing issue to contend with, for any patient or medical adviser. If C/S has resulted from an earlier injury, degenerative progress will be much more gradual, with symptom phases more identifiable, as with normal ‘wear and tear’ issues. For all cases, symptoms can come and go in all combinations depending on how nerves are threatened. It is possible to have severe degeneration with few symptoms....it really all depends on nerve vulnerabilities, and that’s something which is almost impossible to predict with any certainty. Even a current phase with a painful range of symptoms, can settle down by itself overtime, allowing better manageability....and that option, despite the ‘unknowing element’, should not be overlooked in any consideration of future options. If any C/S patients are concerned about their medical advisers’ seeming lack of commitment to advising definite treatments, it is probably due to the uncertainty they already have about predicting progress.
Ultimately, C/S requires self-management, despite the interventions, and it usually comes down to a patient’s own ability to adapt to their condition as best they can, whilst still considering the treatment options available. Understanding the symptoms and their causes is a required first-step in learning how to ease the symptoms, and adjusting to an accommodating lifestyle can evolve from that understanding, leading hopefully to better options for self-management. There are many reasons why any C/S patient might despair of such an overview, given the difficulties they usually have to face, but, really, in terms of future prospects, it is a positive overview with potential for exploring any new ideas which might help with the general experience of living with C/S.
All C/S patients seek improvements in their quality of life. How they go about that probably depends on how re-assuring they perceive the available treatments to be. If their experiences confirm an unreliability in those treatments, then the option for improving self-management techniques might become the only option with potential for general improvement. It’s a challenging choice which most C/S patients will probably have to face at some point, at least until the treatments offered are proven to be fit for purpose.
In general, C/S patients will inevitably encounter a confusion of advice from various medical providers. The treatment options have not yet been standardised , so options and opinions and choices will vary across the board. Such confusion can easily lead to anxiety about prospects, which in turn can feed into a ‘catastrophising’ overview being difficult to avoid. Only the C/S patients, themselves, can contain that prospect from becoming their default negative overview of their own condition. Frustration from failing treatments can also feed into a patient’s overview in a similar manner. Really, the only means, despite the difficulties, of avoiding these possible negative influences, is to develop a robust self-management (self-efficacy) regime which allows the patient to learn to cope as best as possible....and doesn’t allow the failing treatments or the confused advice to dominate the mood. The medications and treatments have to be perceived for what they are before a patient can begin to think of other possible means of managing the condition. The medications, treatments and surgery will still be available if all other methods fail, but probably wise to try to manage without first. A search on Google for self management advice for C/S would be a good place to start. There are some useful sites which offer advice, and a process of trial and error might offer up some results. Just be wary of anything which suggests a further stressing of the neck, or anything which suggests dietary changes, or anything which requires a fee.

Thank you for reading.

Cervical Spondylosis Symptoms Explained
A personal overview of C/S symptoms and their relevance.

C/S symptoms should really be broken down into 2 classes......indirect ‘associated’ symptoms, and direct ‘neurological’ symptoms.
‘Associated’ symptoms are reactive symptoms caused by any threatened nerve instructing muscular reactions as a means of protecting an endangered nerve from becoming more compromised. The first duty of any nerve is to protect its own functionality, thus ensuring continued protection for the body area it serves. A threatened, but not actually yet compressed, nerve tends to adopt behaviour which produces symptoms (referred and radiated) that, in themselves, are not further threatening to the source problem ( threatened nerve in neck ). Some continued functionality of nerve sensations along the nerve extension is all that matters....so, for instance, in the case of a ‘numb hand’, the accompanying ‘pins and needles’ or ‘tingling’ usually indicates a continued functionality of the nerve in that area, although reduced. Although ‘Associated’ symptoms won’t produce a numb hand, they will attempt to help stop that result from happening.
‘Neurological’ symptoms are a direct result of some actual compression of any nerve in the cervical spine. The compression can be transient or more permanent depending on degeneration levels. The symptoms are more nerve sensation based....numbness, tingling, burning, loss of power etc., and tend to be more lasting than ‘associated’ symptoms. These are the symptoms that Neurologists are concerned with when assessing options for surgery. Most ‘neurological’ symptoms are an indication of continued functionality of ‘reduced’ protection along the full extension of the nerve. Again, that protective duty is all that matters. There is no need for the nerve to manifest its endangered status at the source of the problem (trapped nerve in neck).

A threatened or trapped nerve will always try to continue its duties. It will also try to adjust its positioning within the spine to a lesser compromised position. In order to achieve that result, it can instruct various muscular reactions to either restrict certain movements, or to help with re-positioning. Most C/S symptoms, except for ‘neurological’ symptoms from actual trapped nerve, result from these efforts to ‘self-correct’.

Breakdown of Symptoms:

Associated symptoms:
Cervicogenic headaches...caused by muscular reactions at base of skull.
Pain in Shoulder / Chest / Arm...caused by muscular reactions at base of neck.
Stiff Neck...caused by muscular reactions in neck area, to reduce movement.
Frozen Shoulder...caused by cyclical muscular reaction between neck/shoulder.
Muggy Sore Head....caused by muscular reactions at base of skull.
Stuck Neck...caused by muscular reactions to reduce movement neck area.
General Fatigue.....caused by exhaustion due to continued reactions.
Anxiety/Depression....caused by uncertainty about symptom progression.

Neurological symptoms:
( All caused by actual compression of nerve, and it should be noted that local area functionality, in all instances, is reduced rather than stopped )
Numb Hand.... Indicates compression in neck, and reduced nerve functionality. Is really only semi-numb/clumsy.
Pins n Needles/Tingling.... Indicates continued sensitivity in local area.
Burning along nerve....Indicates sensitivity along nerve extension.
Loss of Power....indicates reduced nerve functionality. Really only semi-loss of power .
Bowel/Bladder Dysfunction...Indicates reduced nerve control. Again semi-reduced.
Leg Dysfunctions....Indicate reduced nerve control.
All these ‘reduced’ symptoms indicate that the nerves will continue their duties in a limited capacity, even at the expense of creating ‘lesser threatening’ symptoms. The only other option available to the nervous system to protect and heal the source problem would be to completely shut-down the flexibility of the neck until healing occurred naturally, but doing so would compromise so many other vital neck functions that it’s really not an acceptable option. The ‘stuck neck’ symptom usually only occurs at the beginning of the C/S, last a few weeks, and then moves on to more referred and radiated response methods as a lesser threatening option.

Generally speaking, in terms of overviewing the progressive tendencies, the ‘associated’ symptoms come first, can last many years before a nerve is eventually compromised, and the symptoms will change to ‘neurological’ symptoms. But all symptoms can come in all combinations depending on transient vulnerabilities created by particular neck movements. Strangely, an onset of neurological symptoms can help relieve previous ‘associated’ symptoms, seemingly because the previous threat of compromise has become a reality of compromise, and there is no longer a need for the protective ‘associated’ symptoms. In my opinion, the ‘associated’ symptoms are usually the more painful, are not easily recognisable by the medical advisers, and their lack of definition can cause many side issues for coping and management. The neurological symptoms, being more identifiable, and having direct correlation to particular nerve entrapments, are given more attention by the medical advisers....and there is generally better support available.
Personally, I consider the headaches and muggy sore head the worst symptoms because of how they can interact with the other symptoms, making the other symptoms seem worse than they are. I think it is really important to learn how to deal with the headaches before attempting any other treatments. Will post the next instalment on headache treatments shortly.

Hope this helps clarify the complexities we all experience.
This is a personal overview of C/S symptoms.

Gerry Daly

An Update - MRI's and Sleep Positions

Just an update on a couple of items for the thread. I got myself an x-ray and MRI to find out what is going on in my neck. Turns out that my issues are a combination of disk dessication (and slight protrusion) plus some bone spurs. The combination leading to a severe narrowing of the pathway for the nerve between C4/C5 on the right side, and some narrowing on the left. Likely related to age (50+) and poor posture for a career in front of computer.

Sleep Posture

As per this article, I'm finding that sleep posture is critical. The pillow combination that seems to work for me is a "step" effect (2 pillows at the back, 1 pillow in front) as follows:

1. Tempur pillow as a base
2. Soft feather (or down) pillow on top of it
3. Soft feather (or down) pillow in front of them

This creates a stable inclined sleep position (horizontal is disastrous as GerryTheNeck points out). The single pillow at the front supports my shoulders, and the 2 pillows at the back hold my head. It's critical that the top pillows be soft. If they are firm (or tempur) then there is too much pressure on the neck muscles, and pain in the morning is guaranteed.

I position myself slightly on the left side leaning away from my vulnerable right shoulder / neck -using a 4th (foam) pillow under my right-side back and butt to minimise the risk of rolling onto that right side as I sleep.

Also I'm careful not to have too much extension on my side neck muscles as I lie on the pillows.

I did experiment with a soft cervical collar during sleep but found that it didn't protect as well as I had hoped. Correct posture throughout the night (a challenge unless you wake frequently) is much more important.

Medications

The best med for me remains Anadin Extra (paracetamol + aspirin + caffeine). One of those before sleep usually means no pain in the morning. I've tried nurofen and muscle-relaxants, but for me the Anadin mix is the winner.

In the mornings, if I have a fuzzy head, or just feel muggy / tired - then a single paracetamol plus a very strong black coffee works wonders and kicks in after about an hour / 90 mins. The power of the caffeine seems to really help. I've tried it without the paracetamol (just the coffee) and also without the coffee. Of the two, the coffee seems to be the more effective. I'm trying to phase out the meds at night, and try to lean on the strong coffee shot to clear any residual mugg. With the new sleeping arrangement, that seems to be feasible and perhaps shows again just how vital it is to get the sleeping position right. It's taken me maybe 3 years to get a stable sleeping posture but it's worth it to not wake EVERY day with a headache and feeling sick for the rest of the day.

Of course there are still some bad days (after a lot of heavy lifting / bad posture, or a bad position during sleep) and no meds can improve it. Time only heals that. But for all sufferers, persevere with your sleep position and make sure your mid-morning coffee is EXTRA strong and powerful.