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

[ginger]

"The only exceptions to this are the brain, which isn't served by the nervous system, and the nerves themselves, which don't have other nerves dedicated to warning of any threats to the nervous system."

Our homo sapiens brain has a huge prefrontal cortex to assimilate and understand our environment, guage, relate to and percieve all manner of potential threat to self as well as an equal ability to confuse, become disoriented, and just plain stuff it up. We've all heard of the operations going ahead on living human's brains with the patient responding, without pain to various probings into the cortex. The surrounding soft tissues are however, endowed with the common elements of local sensitivity to pressure, inflammation and disease. While the central processor , so to speak, has very limited capacity to relate to direct threat when occuring deeply, the balance is made up for , for the most part, by periphery.
Nerves, as mentioned further up the chain of these posts, have the nervo nervorum as well as blood vessels. Nerves are indeed capable of having sensations of pain ( created in the brain like all other pain ), such pain is apparent at sites local to trauma, compression etc.
The far more common experience however is that caused by protective spinal behaviour, where irritations to spinal nerves give rise to nociceptive input such that the brain will interpret the threat ( and therefore provide the pain ) as if required at the presumed site of threat, the structure served by the nerve, rather than the nerve body itself. This gives rise to the experiences grouped together known as referred events. These include, altered sensations, altered patterns of muscle recruitment, altered autonomic functions and pain.
The chronic sufferer of spinal pain ( with or without it's attendant three other states) is suffering from the disposoition that this successfull feedback loop has to reinvigorate and redispose itself to continued action, untill turned off.
Movement does this, provided that any historical or present threat is minimised or not present.

[gerry the neck]

This all makes good sense, particularly with the final proviso…..”Movement does this, provided that any historical or present threat is minimised or not present.”. However, there is one issue with pain experience which keeps bouncing around my head unresolved. The nervous system, like all protective systems, must be an integral incorruptible system. It exchanges information with the brain by means of coded signals, and the brain hopefully decodes properly and instigates local reactions. This end seems to be accomplished quite comfortably when we are not conscious, i.e. when asleep, offering us a fairly pain free environment for healing to proceed. I’m not so sure about this decoding ability of the brain when we are conscious, perhaps due to possible distractions, and I’m playing with the idea that pain sensations might result from an obstruction in the decoding processes, i.e. due to a failure to decode when we are conscious. Otherwise, there doesn’t seem to be much sense in the nervous system allowing the distress of pain to occur when really whats needed is a good environment for healing….like when we’re asleep. I’m inclined to think that the nerve signal contains all the information needed to instruct the brain to react efficiently, and where the need for a sensation of pain fits in is a mystery. All purely speculative……but why not ? Don’t know if you’ve visted my “Re: Pain Explored” page yet, where I’m trying to get my head around these types of issues, just to see if any new insights appear out of the blue. Save yourself a headache and avoid at all costs !

Gerry

[gerry the neck]

Hello again


Having just re-read all the previous posts here, after a short break, I feel a need to clarify, to present a more rounded, easily understood, picture of the C/S problem, and thus hopefully highlight the pertinent issues which might affect the options for appropriate treatments being applied.
The most important issue, as I see it, is to be able to make the distinction between actual compressed nerve referred symptoms ( ‘ARS’….I know…that’s very close ! ) and associated protective symptoms ( ‘APS’ ). Just my little acronyms to ease the effort of typing the whole phrase out later. In my case, with my C/S condition, I had nearly 30 years of the latter, without any real manifestation of the former, and I believe this caused certain confusions when it came to applying appropriate treatments. So, here’s the picture……


Actual referred symptoms (ARS) are usually easily definable. Any sensations of clumsiness / numbness / tingling / pins and needles / pain / burning in the hands / legs / arms / bowel or bladder ( although I’m not really familiar with these last two ) usually signify an actual compressed nerve in the neck area, whether it be in the root canal ( stenosis ) or where the nerve exits the cervical spine. I don’t think there is any argument about the source of these referred symptoms, and the options for treatment , although debatable, are well documented. The reason why the nervous system should choose to manifest it’s own distress in this manner may not yet be fully understood, but at least the symptoms will hopefully direct us to the source of the problem and we can make our own choices for relevant treatments. It’s not a perfect science yet, but we can clearly see cause and effect and we can try and rationalise it from there.


With associated symptoms ( APS ) , i.e. any symptoms or discomforts between and including head and chest (including shoulders) , the picture gets more confusing. Both types of symptoms ( ARS and APS ) can act independently, or together, in various combinations. I would argue that APS are more predominant long before any ARS symptoms might manifest themselves, and, by their nature, are difficult to define and present their own problems in determining cause and effect. Consequently, the recommended treatments for APS are confused, and sometimes inappropriate. Mostly, these APS symptoms are caused by protective reactions to a perceived threat of nerve compression ( not actual compression ), and so, any treatments should be focussed on alleviating that threat. Where ARS symptoms tend to be more permanent, even more stable although degenerating slowly, the APS symptoms will vary and fluctuate depending on the required reactions which the neck instigates in order to negate any other perceived threat to the nerves, especially any nerves which have not yet been compressed but are in danger of being so. Thus the ever varying re-occurrence of headaches / muggy sore head / stiff neck / frozen shoulder / chest pains etc. etc. The key to treating these APS symptoms is simply to understand how best to remove the threat of nerve compression, whether by external manipulation, or by developing means of allowing the neck to quickly find its own best solution, for instance with sleeping posture therapies. All debatable, of course. Where it can’t be proved that the outcome will not be further aggravation, then an option for Benign Neglect will become apparent. I fully realise that both patients and professionals have a desperate need to engage actively in aggressive therapies to try and improve the patient’s condition, but we shouldn’t allow that to override our instincts when assessing the options as thoroughly as we can……. “ Where angels fear to thread “ .


I hope this presents a more recognisable picture of the issue of distinguishing between the 2 sets of symptoms, ARS and APS ( do feel free to criticise my acronymising ) , which, in my opinion, is critical to any consideration before trying to rationalise any appropriate treatments.

Gerry

[gerry the neck]

And again…..


I started these postings describing the ‘delayed’ nature of ‘associated’ C/S symptoms, and the confusion such reactions can cause when assessing the benefits of manipulative therapies. Added to that, there also exists the possibility of shock / numbing effects, resulting from aggressive therapies, which also confuse assessments. I’m not suggesting that all manipulative therapies don’t work, but assuming that any do work, without consideration of the above proviso, is, in my opinion, an assumption too far. Any therapy which wilfully overlooks or ignores the reactions which the neck is already engaged in, as it tries to protect from even greater distress, is inherently heading in the wrong direction.


Put simply, if I were to say that a particular treatment, whether it be massage, traction, exercises, or even medications, were to result in unnecessary worsening of symptoms, and without any long term benefits, wouldn’t it be wise to put a question mark before that treatment. And, accepting such treatments as standard, when results so often expose their ineffectiveness, is really a practice which belongs more to a less enlightened era. I accept there is a need to engage in positive action, whatever form that may take, both for the patient and the professional, if only to try and re-assure a difficult situation. However, that, in itself, shouldn’t become a stumbling block to exploring other less well documented ways of tackling the problerm.#


Perhaps the best way to re-assess treatments would be to choose a starting point which assumes that the neck, itself, is already applying the most appropriate therapy, and any external manipulations which may not complement this process, or may even counteract it, must be questioned. Understanding how the neck chooses to react to any given threat is complicated, for sure, but not impossible, especially when it is assumed that the neck is always trying to maintain a certain flexibility and functionality. The two main protective purposes of the neck reactions, with C/S, are to protect from threatening nerve compression, and to not allow any nerve threat to hinder other vital functions e.g blood flow, breathing, etc. So, rather than just stiffening up until healing has been achieved, the neck engages in various complicated reactions which, although distressing, allow a limited functionality.

It seems that most of these ‘associated’ neck reactions are instigated during sleep, thus the typical C/S patient’s common experience of worst ‘associated’ symptoms on waking. Therefore, the most useful and safe therapies might well be applied during the sleeping process, when the neck can best read its own vulnerabilities and can instigate its best possible reactions. Treatments applied during waking hours can be easily resisted, in fact such resistance can cause further problems. Alternating sleeping postures, as discussed before, can have a remarkable effect on how the neck chooses to react to any given threat. The obvious difficulties in monitoring sleeping postures, on a clinical basis, is probably the only reason why such methods have never been explored with any intent. But that, in itself, is not a justifiable reason for ignoring the possibilities.

I also accept that there will be differences in how a C/S patient will experience the dynamics of their condition ( i.e what seems to work and what doesn’t ), and the technical understandings of the professional. As patients, we have no inclination to enter the world of technical disagreements. We see that as an obstruction to our instinctive understanding of what we experience. So, we place ourselves in the trust of professionals who are in dispute with each other ! Double trouble ! I’m reminded of Ambrose Bierce’s definition of a Dentist in the ‘Devil’s Dictionary’……..” A highly trained professional who, whilst implanting metal in your mouth, extracts metal from your pocket”. No offence.


Gerry