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

[gerry the neck]

One of the main problems with assessing Cervical Spondylosis symptoms is the tendency for the symptoms not to manifest themselves for maybe 2 days after aggravation of the nerve roots. For instance, a C/S patient might try shifting or lifting a heavy item, say a piece of furniture. There will be absolutely no sign that a problem has occurred. The following day the patient may even feel less aches than usual ! This may be because the neck has entered a 'shock' mode as it prepares it's response to the aggravation. By the third day, the reactive symptoms, whether they be headaches, stiff neck or shoulder/arm pains etc. will have, at last, manifested fully. The neck will be attempting to protect from further aggravation and, as such, will over-compensate it's reaction in the hope of restricting the patient's activities whilst in this vulnerable phase, because further aggravation would undoubtedly exacerbate the existing symptoms. So, in theory, the symptoms, when they eventually manifest themselves, are as much protective as they are reactive.

If the above description is a reasonable assessment of long-term recurring C/S symptoms, then it follows that the same processes also apply to physical therapies or exercises applied to the patient. It is possible for the patient to actually feel better after treatment, or the day after treatment, only for the reactive symptoms to kick in the following day. This response can easily confuse any assessment, and the therapist can easily be misled into thinking that the treatment worked temporarilly, and should be applied again. What the patient doesn't need is to enter a cycle of 'shock' mode/reactive symptoms (headaches, stiff neck, pain in shoulders/chest etc.) as a result of aggressive therapies. The key to easing the symptoms, in the early stages of any flare up, is to assist the neck to find it's most comfortable postures, especially whilst sleeping, and thus create the best environment for the threat of further aggravation to pass. Recognising the need for a '2 day delayed reaction' is also essential to any assessment of any worsening or improvement of symptoms. Adding extra exercises or therapies simply over-confuse any meaningful assessment. The therapist should be wary of any immediate 'muted' responses after treatment.

It should be noted that this only applies to reactive 'associated' symptoms (headaches, stiff neck, pain in shoulders/arms etc.), and not to actual nerve compression symptoms ( numb hand, leg pains etc.). These actual nerve compression symptoms behave differently and can really only be treated with painkilling meds or neurosurgery. However, the reactive 'associated' symptoms are quite often the more distressing, unpredictable, symptoms, especially with long-term C/S, and any easing or duration shortening of these phases is welcome.

I should point out that this overview of how C/S symptoms manifest themselves is how I, as a long-term patient, have come to know them, and any advice I give is based on my own experiences. Personally, I distrust current accepted practices and I would like to see a review of therapeutic procedures for the treatment of Cervical Spondylosis which includes a more patient inclusive approach. There's something not quite right when a patient, after 30 years of various treatments, puts more faith in home-based therapies rather than all the combined recommended advice. Perhaps a little encouragement to re-think the basics is all that's needed !

Gerry

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[gerry the neck]

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

[gerry the neck]

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

[McFly1]

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.

[gerry the neck]

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

[McFly1]

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.

[gerry the neck]

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

[gerry the neck]

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.

[McFly1]

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!

[gerry the neck]

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

[gerry the neck]

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.

[gerry the neck]

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.

[gerry the neck]

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

[McFly1]

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.