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

[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