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

[Dr Damien]

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

[gerry the neck]

Hi Dr Damien

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

Thanks

[gerry the neck]

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