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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[physiobob]

This sounds like a 'note to self' and a good one of course

[gerry the neck]

Hi PhysioBob

Yes. 'Note to self' is fine. And from there to forum. And from there, who knows. I'm only working off one case study...myself, and hoping that the overview I've developed is applicable more generally. I like to imagine that when I was first diagnosed with C/S 30 years ago that I would have been lucky enough to have been exposed to the kind of advice, which I now know would have improved the quality of my life. After much trial and error/success I'd consider it wasteful not to share.
I guess I'd also like to think that someone, with proper qualifications, might see something in my approach, and perhaps help to take it further...particularly regarding sleeping posture therapies, and then, one day, a therapist might be able to say to a C/S patient..." Yes, it's chronic. But we can help you to manage it with reasonable comfort ". And mean it !

So far, I'm grateful to have been able to post my views on this site...so, thanks.

[gerry the neck]

Hi Physiobob

I feel a need to respond twice to your last comment, mainly because that little exclamation mark at the end of your comment is bugging me ! " Does he mean....?" Whatever.

Just a thought to lighten the mood. The guidelines laid down to ensure safe practices are simply that....guidelines. They're not carved in stone, as the less enlightened might like us to believe. I'm a bit of a lapsed atheist on that one. They were laid down to set parameters for safe practice at various times when understanding of the problem was at a particularly developed stage. Wouldn't it be ironic if those same parameters restricted research into even safer practices, which our evolved understanding of the problem requires today. It may well be the case that a certain denial, of less than positive results, cloaked in euphemisms, has become the order of the day when it comes to justifying recommended therapies which have a question mark hanging over them. The ambition of the profession should always be to re-assess and improve, and if, as I sometimes suspect, the whole thing simply boils down to a 'radical change v career prospects' argument, then there is only one loser...the patient.

I'm reminded of the recent event of an Australian researcher who had an educated hunch about certain ulcers being caused by Pylori bacteria. The establishment ostracized him, but he explored his radical approach regardless, even to the point of infecting himself, getting very ill, and then taking the antibiotic remedy. He's now a Nobel Laureate, and much more importantly, 500 million people around the globe now have a remedy for their ulcers. A hero for our times, no doubt.

Now, I'm not suggesting that a researcher should somehow develop C/S and then test the therapies. But, as I've already got C/S, I reckon I'm already half way there, if this guy's example is anything to go by.

Gerry

[physiobob]

How about I changed it from a '!' to a ' ' which is to day that I wholeheartedly agreed with your 'note to self' and appropriate others

[gerry the neck]

How about I changed it from a '!' to a ' ' which is to day that I wholeheartedly agreed with your 'note to self' and appropriate others

That would be fine....if it weren't for my allergy to emoticons and their occassional misuse. Poor things must be sick of forum abuse. Maybe, it's just me !

[gerry the neck]

Patient v Therapist Relationships

I suppose one of the good things about posting my views on an anonymous forum like this, is the fact that I would never dare expressing them in real time i.e. at the GP's, at the P/therapist's or at the Neurologist's. I simply can't afford to risk alienating professionals who are my gateway to medications, p/therapy or surgery. Whenever I have, in the past, expressed doubts about anything, it has usually ended up in embarassing silences, not good for either party. I've also always got the impression, from communicating on other forums with C/S patients, that they consider these encounters as something of a 'charade' where, no matter how disappointed the patient is with any advice, they should just accept it, because that's all that's on offer. An unlikely situation of the patient patronising the professional !

The patient is aware that the professional's attitude is tempered by their own uncertainties about treatment, although the professional will try to mask this aspect, and, as such, all is forgiveable in an unperfect world. Perhaps it's the attempted masking which makes it all so obvious ! It all works on certain levels, keeping the wheels turning. However, it can also be a systemised denial of patient inclusion, perhaps because it is already assummed that there exists, at the core of treatments for the condition, a presummed inevitability about degenerative processes, and the prospects for improved treatments are inherently bleak.

As C/S patients, we are aware of, and encounter these scenarios regularly. In a way, I suppose, we assume the charade before any treatment, and we don't like to leave a lingering sense of futility behind us when we leave...that could count against us in any future dealings. We don't want to shut any doors. Gradually, we become complicit in the general denial of the usefulness of questionable therapies, or we stop attending. Strangely, either choice will probably have few repercussions on our general well-being, because the therapies don't guarantee improvement, and the lack of therapies doesn't necessarilly mean a worsening of symptoms.

I know the choice that attracts me most, because I have no desire to be a victim on two levels. Once we strip away the supposition that the professionals might hold all the answers where C/S is concerned, we free ourselves to face the dilemmas it creates and perhaps to trying to manage these on a home-based, daily level. It is so much easier to accept our own attemps / failures than it is to accept why advised therapies are not working. And if something does happen to work, it's usually a reward that makes all the effort worthwhile.

One last observation here. The word 'Regenerative' never crops up in any description of C/S. 'Degenerative' is the classic description upon which all theory is based. Some time ago I read a book called 'The Body in Action' by Sarah Keys, which disputes the 'degenerative' overview and seems to make a lot of patient friendly sense. On the downside, I found I didn't agree with her suggested regime for exercising. Can't win 'em all.

Gerry

[gerry the neck]

Not doing a reply to myself here. Just another 'note to self'. But, as I consider myself part of the 'Global Self' anyway, that seems ok !

I'm going to go out on a limb here and try to explain, in layman's terms, what might be at the core of the problem of why so many long term C/S patients are not content with available treatments. And, it's got nothing to do with the fact that they're just a load of whingers. Much the opposite, it causes the whingeing and moaning.

Firstly, I believe that my C/S condition, first diagnosed 30 years ago, to be an injury based ( I/B ) C/S, although this has never been confirmed. Suffice it to say that, at age 59, I have no other arthritic based ( A/B ) symptoms. Therefore, the C/S is unlikely to have been caused by an underlying arthritic condition, which would, in turn, have it's own 'wear and tear' 'degenerative' connotations. I also believe that the (vast ?) majority of C/S cases, particularly where the elderly are concerned, are arthritic based ( A/B ) and, as such, they come with a certain inevitability of degenerative rates of deterioration normally associated with underlying arthritic conditions.

However, with ( I/B ) C/S this isn't the case, where an injury may have occured at a young age, and the neck may be continually trying to repair itself, without the hindrance of an underlying condition. This constant / intermittent / unpredictable process, (regeneration), over many years, even before any trapped nerve symptoms might manifests themselves, can cause 'associated' reactive symptoms, which I would argue are more difficult for the patient to deal with, because of their nature, than any actual trapped nerve symptom. In fact, when a trapped nerve symptom does eventually occur, it is very likely that the 'associated' symptoms will ease off, simply because the neck no longer needs to protect a nerve from being trapped....it's already happened ! This is what happened to me a couple of years ago, and kickstarted my attempts to understand the complex changes I was experiencing.

Meanwhile, the professionals, seemingly, are basing their overview of C/S on recognising that the majority of cases are ( A/B ) and are elderly, with all the inevitability that that implies. Any consideration of long term ( I/B ) C/S seems to come under the same umbrella, and therefore, treatments are meted out the same for both. This might be a mistake because it doesn't necessarilly take into account that, as with long term ( I/B ) C/S, any regenerative reactive processes which the neck engages in over long periods, whilst further 'wear and tear' only progresses at normal rates, as in a healthy neck. What I'm really saying is that different therapies should apply where one condition ( A/B ) is definitely degenerating, but the other ( I/B ) is constantly repairing itself. Perhaps they ought to be classified separately so the appropriate treatments can be targeted properly.

There's also the implication that a younger ( I/B ) C/S patient will experience 'associated' symptoms without having the luxury of manifesting a 'real' symptom which other people can relate to and empathise with. Maybe they should just be grateful they haven't got ( A/B ) C/S, but that's just meaningless, speculative, relative comparisons, as we all know. The 'associated symptoms can cause all sorts of difficulties ( a sub-text of undermining disbelief ) when dealing with others, and yes, even when dealing with professionals.


So there you have it. Plenty for any aspiring P/therapist to get their teeth into. Use or discard at will !

[gerry the neck]

From the patient's perspective

Anyone bothered to read my posts might rightly notice that I avoid describing details of the mechanics of the neck when theorising. I know some technical terms and I've read studies. But I choose to ignore them because I find, when I read them, that the detail quite often confuses the intuitive approach. On the understanding that the neck is pre-programmed to always allow it's own best functioning, I think, that takes care of that. The mechanics are important, but they happen regardless, even when there are added manipulations. I find it easier to present a clearer picture without the obstruction of technical detail.

Anyway. Having visited many C/S patient forums on the internet, I can honestly say that what I've encountered is generally quite depressing. Most C/S posters seem to describe their predicament in terms of ever increasing toxic doses of exotic medications intermingled with an increasing despondency regarding therapies or surgery. Despite occasional outbursts of new hope in ‘the next level drug’, it is evident that the main player is a downward spiral of dashed hopes. Not exactly the best psychological climate in which to be tackling a chronic condition, and perhaps one that is, in all innocence, partially supported by the establishment. The negativity comes with the territory and has been assumed into a general accepted overview.

I understand the difficulties a C/S patient encounters, especially those recently diagnosed, when trying to figure out how to include this, seemingly insurmountable, condition into their everyday lives. Most C/S patients will think they really ought to be on some disability benefit to help them cope, until they realise that only those, a small percentage of cases, with real mobility problems (usually Myleopathy) will ever qualify. So, they are also faced with having to cope with earning an income to survive, and constantly juggling that with unpredictable symptoms. Thus the dependency on ever increasing medications.

In my case, I became self employed about 5 years after initial diagnosis with C/S (25 years ago), and this allowed me the possibility to take time out whenever needed, and thus recuperate before facing the next work challenge. I seldom did 4 weeks work without taking 1 week off. (unpaid). Luckily, it has worked ok for me, but only just. For most C/S patients, the prospect of trying to hold down a 9 to 5 job must be daunting, if not impossible.

Also, because my work was physical, I was able, over time, to figure out what sort of activities would trigger the neck problems, and learned to avoid such triggers as best I could. However, I will say that I worked through many long painful phases (months) with the help of painkillers, until I eventually realised that this was just easing one problem by superimposing another. Today I manage a system of non-aggravation, topped up with good sleeping therapies, and I can say that the world of physical work holds less fear for me than it used to. I manage ok, within the limitations imposed on me, and I cherish my comfort zone with a reverance I didn’t think I was ever capable of.

Again, for most C/S patients, this ‘lifestyle’ is probably considered out of the question because of their dependency on employers, benefits and medications. They will find themselves in continual conflict with assumed expectations and will develop a fairly negative overview of their prospects. There’s also the constant battle for recognition of their difficulties when trying to fit in, either at work, or socially, or even simply to justify an inability to get involved in anything on a normal level. The pressure will always intensify if you view yourself as less than able. Increased pressure equals increased medications etc etc. The cycle of reactive dependency can easily become a downward spiral.

Breaking that cycle is all important if the patient wishes to regain some control over their condition, and to do this the patient needs to start seeing the negative cycle as something which has been imposed on them by exterior forces i.e. the imposed ‘unreal’ expectations of others. Once that fog has been lifted, it becomes more obvious that there are things one can do to affect the overall experience of one’s symptoms, and thus regain a sense of control over an otherwise unpredictable condition.

This is where the skills of the P/T could be applied with purpose, in helping the patient regain their sense of empowerment and purpose. Because of the varied nature of symptoms for each individual, it is probably best for each to explore in their own way what works for them. But implanting the confidence to do this, and then guiding the efforts, should be the therapist’s job. I know that this is current thinking anyway, but, unfortunately, the recommended therapies may be outdated and , as a result, the whole enterprise suffers. We all expect a little failure in the application of any science, but, in the case of C/S therapies, perhaps a new approach breakthrough is what’s required. A good place to start would be an exploration of sleeping postures.

Gerry

[gerry the neck]

How the neck regulates itself, day and night


All C/S patients will testify, without exception, that ‘associated’ symptoms are always worse first thing in the morning, upon rising. There is only one logical explanation for this and that is, that the neck has been engaged in some activity whilst we slept. Assuming this to be true, then it becomes imperative to be able to interpret these neck activities in order to find ways to accommodate them. Firstly, lets break down the daytime and night time neck activities, because they differ.

During the day, when awake, the neck is capable of tensing it’s protective mode with our assistance. As conscious beings, we are capable of recognising vulnerabilities, to some extent, and so we assist what the neck is already doing, with further instructions to stiffen up. This allows us to engage in activities, regardless of the threats to an already vulnerable neck. If it had the power, the neck would never allow us to do this, because it conflicts with it’s default programming…i.e. it must always protect to allow some functioning. In extreme cases, the neck will insist on precedence by instructing the neck muscles to set in one position, and not allow any movement whatsoever without painful repercussions.
Essentially, the neck allows us some voluntary movements, until the need for greater protection becomes paramount, and then it takes over operations. Proof, if proof is needed, of the hierarchical placement of the neck’s protective system in the order of who’s calling the real shots. So, in summary, during the day, the neck protects, we compliment this process, and thus we are able to function.

It’s worth saying, at this point, that a ‘nap’ during the day can alter the intensity of symptoms, or even get rid of or create new symptoms. But the interpretations for that scenario come under neck activities whilst we sleep.

During the night, it’s a completely different process. When we sleep, we obviously relax all muscular tension. This allows the neck an opportunity to re-read it’s vulnerabilities, and to set in place any precautions (muscular reactions) deemed necessary for proper functioning when we next wake. It will react to any threats perceived the previous day, by increasing it’s protective measures, with relative symptom increasing included. It can also go into ‘shock mode’ if there has been a serious threat, and the reactions will be purposefully delayed in order to maintain functioning. It could be argued that the neck can instruct an ‘over-reaction’, with the purpose of encouraging minimal activities, and thus lessening future threats to an already vulnerable state. So, in summary, all this planning and precautions occur whilst we sleep, and we feel the effects of it all, first thing in the morning.

Assuming all this to be correct, or near enough, it should become obvious that it makes no difference what physical therapies are applied during the day. The real action takes place whilst we sleep, whilst the neck is relaxed, and accommodating these processes should only be concerned with providing a comfortable environment for any muscular adjustments to be made, with the least possible symptom repercussions. I’d like to hear any arguments, if there are any, that these are not the default processes which cause ‘associated’ C/S symptoms.

I should also clarify that these processes do not necessarily apply to ‘actual trapped nerve’ symptoms, because these symptoms behave differently, and are well documented. However, this theory might apply where ‘actual trapped nerve’ symptoms are accompanied by ‘associated’ symptoms. There has always been an imbalance, in the treatment of C/S, between the attention given to trapped nerve symptoms and that given to ‘associated’ symptoms. Perhaps it’s time for the ‘associated’ symptoms to grab the headlines !

I apologise if it appears that my posts can seem more like a lecture than an inquiry, but I find it easier to cut to the chase when I use this method of communication, and time is of the essence when it comes to encouraging a change of practice.

Gerry

[gerry the neck]

Hi

Just to wind up the previous posts, which hopefully will have given a little food for thought on the subject of therapies for cervical spondylosis, here’s a little story of recent events which might help put some meat on my speculative theories.

About 4 weeks ago, I was due to have a new kitchen fitted at home, and I had agreed with the chosen fitter to help out where I could with disassembling the old one and helping with collecting the new one from Ikea (of course) and various other tasks. I know my limitations regarding certain types of work (overhead, heavy weights etc) , so I thought that, with care, I could manage without too much aggravation of the neck. So, pre-empting his arrival, I started disassembling the old sink unit. It was awkward, fixings and screws in funny places, and I was a little worried I might have twisted too far. The previous evening I had also helped collect the worktops and units, so I knew I was pushing at the limits.

Anyway, the following morning I woke, and my neck was stuck. Very little movement without searing pain, mostly at top of shoulder blade, to the rear. I apologised to the fitter and said that I wouldn’t be able to assist any more. He knows me, and my C/S problems, so he was understanding. That day was a write off, and that night I slept in my usual memory foam mattress to try and ease it. The next morning it was just the same, so I knew I was perhaps looking at a long recovery, as has happened many times before. However, I know the ropes, and I also saw this as an opportunity to try out different sleeping postures and just see what happens.

That afternoon, I took a nap on my sofa ( easily done because of the fatique ), semi-upright, with hand supporting chin. I woke after an hour and, to my relief, there was little pain, and flexibility had been restored. Something was working. That night I again slept on mattress, and awoke next morning to find the stiffness and pain had returned. So, bearing all this in mind, I decided to try and only sleep on sofa for a couple of days, and see what happened. I pushed the sofa against a bookcase and put some soft pillows in place so I could sleep upright, just leaning to one side. Although I could only sleep for about 4 hours in this position, without slipping down, it worked again. The pain reduced by 80%, and I didn’t feel so fatiqued. After a couple of nights like this I was able to return to mattress and sleep without waking in pain.

In summary, it was quite obvious that horizontal sleeping compounded the symptoms, whereas, upright sleeping almost completely removed the pain and restored normal flexibility. The fact that initially the pain receded with sleeping upright, but then returned after a horizontal sleep, is key to what’s going on. Why this happens has undoubtedly got something to do with how the neck relaxes and reacts when horizontal. Perhaps it detects it’s own vulnerability more acutely and instigates greater reactive protection, accompanied by relative painful symptoms. When sleeping upright ( or semi-upright ) perhaps the neck doesn’t detect the vulnerabilities and so restores itself to normal functioning. So it seems to me, and this is how I will be treating any future mishaps. I could easily have been looking at a week or two, or more, of incapacity, if previous mishaps are anything to go by. Instead, I was in pain for three days and, almost beyond my wildest hopes, it abated…..just like that ! That first little upright nap on the sofa showed me that the symptoms can disappear, almost magically. The fact that the symptoms reappeared next morning just shows me that I was a bit slow in learning the lessons.

I should also add that, throughout all this, my numb/clumsy hand was totally unaffected, which highlights the fact that trapped nerve symptoms ( numb hand etc ) and ‘associated’ reactive symptoms are basically unrelated. The ‘associated’ symptoms (stiff neck, headaches, shoulder pain etc ) can kick in on their own when the neck reacts to perceived threats to the nerve roots, and, although they can accompany trapped nerve symptoms, or vice versa, there is no direct link, where one is dependant on the other. The neck will react to a trapped nerve with very distinguishable symptoms, and it will react to a perceived threat of a trapped nerve with a variety of protective symptoms. These ‘associated’ symptoms can be controlled by firstly, adhering to a regime of least possible aggravation, and secondly, by applying good sleep posture therapies to minimalise the duration of the symptoms following any aggravation.

I know that this is just an account of one experience I’ve had, but I see no reason why the same lessons shouldn’t apply across the board to include many others with a similar C/S condition,

Gerry

[gerry the neck]

A while ago I came across a posting, on this site, which referred to a theory of ‘Benign Neglect’ devised, I believe, by some American research into Cervical Spondylosis therapies. I think it was posted by ‘ginger’, but I haven’t been able to relocate it since. If anyone can help me out and redirect me, I would be grateful. I want to see if there is any substance to their theory or if they’re just some slackers looking to get home early ! Why I undermine my purpose with such frivolous comments I’ll never understand. Perhaps my mere patient status is a justifiable excuse !



Trapped Nerve Syndrome for ‘Laypersons’

Almost all areas and functions of the body are protected by the nervous system. The purpose of the nervous system is to warn the conscious body of any threats, injuries or malfunctions. 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. Each nerve is dedicated to a particular area, and it’s sole purpose is to report on that area. It is not capable of reporting an injury to itself, because it would need a separate independently functioning nerve to do this, and it doesn’t have one.

Basically, the nervous system is seemingly unprotected. How this manifests itself is usually seen when a nerve root is compressed, and the resulting symptom is usually a numbing, or loss of sensation, in the area of the body to which that nerve is dedicated. This may, or may not, be accompanied by a burning sensation along the route of the affected nerve, which acts as a kind of non-specific warning signal (perhaps the nerves do have some inbuilt protection !)

With the neck, in particular, the actual compression of the nerve causes no pain, so there is little indication that that’s where the problem lies. Any neck pains, headaches etc. usually result from muscular adjustments, which kick in to protect the threatened nerve root. This process happens unconsciously and, as such, needs to be interpreted carefully in order to be understood properly. The symptoms which a C/S patient will experience, anywhere between chest and head, are unlikely to be caused directly by any actual nerve compression. They are the manifestation of muscular protective reactions to any perceived threat of nerve compression. In fact, with the onset of actual nerve compression, these ‘associated’ symptoms and protective muscular adjustments become less necessary in the default process, because the threat has already become a reality, and symptom focus has been redirected to the area of the body to which the nerve is dedicated. These direct symptoms can be deciphered more clearly, and can help to pinpoint the area where nerve compression is occurring.

Most C/S patients will find it psychologically difficult to separate and understand all the recurring symptoms, and so they will tend to lump them all together as an indication of further degeneration, with all the negative implications that are implied. However, seen separately, a different picture evolves. Actual trapped nerve symptoms, because of their inherent complexity, are best left to the neurologists. ‘Associated’ symptoms, on the other hand, can be dealt with by the patient themselves, or with help, with the goal of minimalising any discomforts and decreasing the duration of cyclical reactions. Not forgetting that the ‘associated’ symptoms originate with perceived threats to the nerve roots, learning how to avoid this should be the first goal. Minimal aggravation equals minimal repercussions.

With conscious application we can overcome the unconscious reactions which lie in store. When a reaction does occur, then, having a ready made programme for quick recovery becomes goal number 2. Whether that programme should include ‘Benign Neglect’, alongside good advice on sleeping postures, or whether it should include exercising or external manipulations, is a current ongoing debate relating to C/S therapies. Statistics and test results show that current accepted practices are not proven to be effective. Perhaps it’s the relatively untried programme that stands a better chance of success .

[bikelet]

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. Each nerve is dedicated to a particular area, and it’s sole purpose is to report on that area. It is not capable of reporting an injury to itself, because it would need a separate independently functioning nerve to do this, and it doesn’t have one.

This is not entirely true. Nerves have the nervi nervorum- which refers to nerves which occur in the outside connective tissue of the main nerve which have the sole role of monitoring and protecting the main nerve. The nervi nervorum can report nerve pain itself.

Elsevier

[gerry the neck]

Hi bikelet

Thanks for this, and the link. I was unaware of these nervi nervorum. They might just be a key to something I've always wondered about i.e. How is it that, with no pain registering at the point of compression, there must still be some sort of signal generated to kickstart muscular protective reactions. Actual nerve compression symptoms are kind of self evident, but the source of, or catalyst for, muscular reactions in the neck area is still a bit of a mystery. That also raises the question...Are they capable of, as yet, undetectable painfree signalling, something like the symptom free shock effect after a serious trauma. I'll have to look into this more thoroughly !
Hopefully, the rest of my speculations passed your scrutiny ok.

[bikelet]

Hi Gerry, it is very interested to think about. Don't worry about my scrunity, I am no expert, still learning and working things out just like you. I was just aware that anatomically what you had written wasn't 100% accurate, and now reflecting on the implications of that raises a load of questions! I think it makes sense that it would be involved in nerve compression episodes as you say...I'm not sure what your last question meant about painfree signalling

[gerry the neck]

Hi bikelet

Re ‘painfree signalling’. I’ve always had the notion that the nervous system can predict what our conscious reaction to it’s signals might be, and perhaps it has the means to alter it’s signalling methods, in the interests of recovery, to avert what might be deemed as possible adverse reactions. Given a circumstance where the nerve is ‘aware’ that a painful signal might cause, for instance, a panic reaction which could lead to further injury, can the nerve generate a ‘painfree’ signal and thus avert such a reaction whilst initiating a local response at the same time. I think this might sometimes be the case where vital organs are concerned, and it might also help to explain why victims of a serious injury sometimes feel no pain when they are in ‘shock’. Perhaps, a compressed ( or threatened) nerve root also fall into this category, thus explaining why there is no pain at the point of compression.

My own personal concern here is that for almost 30 years I experienced C/S ‘associated’ symptoms before an obvious compressed nerve symptom actually manifested itself. I always felt that these ‘associated’ symptoms were ignored somewhat in treatment….most treatments were focused on relieving a trapped nerve or painkilling meds. On reflection, I’ve come to some speculative conclusions about the causes for these ‘associated’ symptoms and how they can best be treated, Any easing of, or duration shortening of these symptoms can greatly affect the prospects for managing the whole C/S condition, including eventual trapped nerve/s. I’m pretty sure that any professional study of how sleeping postures can affect the intensity of these ‘associated’ symptoms would reveal surprisingly positive results. I’m also fairly convinced that physical therapies applied during waking hours, for this condition, are pretty useless, because the neck is already in protective mode and it resists manipulation, with possible negative outcomes.

Still checking out the ‘nervi nervorum’. They seem to be a recently discovered phenomenon. We learn as we go.


Gerry

[JayPhysio]

Re ‘painfree signalling’. I’ve always had the notion that the nervous system can predict what our conscious reaction to it’s signals might be, and perhaps it has the means to alter it’s signalling methods, in the interests of recovery, to avert what might be deemed as possible adverse reactions. Given a circumstance where the nerve is ‘aware’ that a painful signal might cause, for instance, a panic reaction which could lead to further injury, can the nerve generate a ‘painfree’ signal and thus avert such a reaction whilst initiating a local response at the same time.

Mosley at his finest:
TEDxAdelaide - Lorimer Moseley - Why Things Hurt - YouTube

[gerry the neck]

Thanks for this link. Brilliant. Pain is an abstract psycological event. The key to our toleration of it perhaps lies in our ability to logically rationalise it's intended purpose. Before the advent of modern painkillers it seems that people had an inherent disregard for pain in general, perhaps because, with no relief available, they were forced to rationalise it's effects and thus were able to view it for what it really is....a warning system. The everyday use of painkillers have perversely promoted pain to a higher regard than it deserves ! Abstract problems require abstract solutions. If I can rationalise why I'm experiencing pain then it becomes less necessary for that pain to manifest itself. The original purpose of that pain was to direct my attention to a problem. Once that purpose has been achieved, and my nervous system is satisfied that I am dealing sensibly with the problem, the pain becomes superfluous to requirements. Is this possible ?

[physiofi]

I read all your posts with interest, and it's refreshing to have someone present their opinion honestly, from a patient's perspective. I would much rather my patients be completely honest up front with me so I can reassure them as much as possible regarding any concerns/doubts/disbelief about physio etc. I don't have the wealth of experience that some physios on this site do, I'm relatively new (graduated last July) and have been working in a static position as an outpatients physiotherapist for the past 10 months. I've been lucky enough to see a wide variety of patients - most with chronic conditions, and many with neck pain.

Without getting too in-depth about the scientific processes and neural symptoms (although I have read all points raised with interest) I agree that sleeping posture has a large effect on symptoms. Having recently suffered with neck pain for the first time in my life (22year old female) after a nasty whiplash injury which is taking a long time to resolve...I noticed a large improvement in my symptoms when altering my sleeping position.

I keep an open mind and will try a variety of treatments to help people manage their symptoms...I've seen several people with discal problems and cervical spondylosis, but likewise, a lot who had cervical spondylosis which appeared to be linked to trauma or injury - although, several of these patients did have osteoarthritis in other joints. I think helping people manage their symptoms to improve their function is a better goal than focusing on "curing" pain as this is usually not realistic. I think your post about identifying triggers and altering your activities to avoid aggravating your neck is great advice for any person suffering with neck pain.

Personally, I've found the most effective treatments (with both my patients and myself) to be heat in combination with good posture and exercise. That said, I think musculoskeletal pain is highly complex, and emotional/psychosocial and other factors play a hugely important role in affecting this and how we deal with it.

[gerry the neck]

Hi Physiofi

Thanks for this posting. You probably won't be aware of what it means to me that there are others thinking along the same lines...especially regarding sleeping postures being at the heart of C/S associated symptoms, and possibly other neck conditions like whiplash. I've posted quite a lot on patient forums but I've always found that there was a reluctance from patients to overcome their medications dependancy and try to view the problem from a different perspective. The two therapies don't necessarilly have to conflict, if applied sensibly. Ideally, I would hope that someone with professional qualifications starts exploring the sleeping postures ideas, but I also realise that probably means explaining them as rationally as possible before anyone would want to risk applying them in real time. If anyone was interested I would be prepared to provide an easy guide to helpful sleeping postures and sleeping arrangements. These are methods that work better for me than medications (although they're still necessary in an emergency) or other physical therapies I've experienced over many years. It would be a shame to think that the next generation of C/S patients must endure many years of disappointments before figuring out what works best. I realise that change can take time, so, initially the battle is for the hearts and minds of those who matter.

Gerry

[gerry the neck]

Cervical Spondylosis ( C/S ): Sleeping Posture Therapies Explained



Following on from recent posts, I’ve decided to post a brief description of sleeping posture therapies which could be used by anyone wishing to test or explore further their usefulness in reducing the intensity of various ‘associated’ C/S symptoms. The simplicity and non-aggravational nature of these therapies means they can be used in conjunction with other physical therapies, with medicinal therapies and even with post op therapies, to achieve results sooner than current practices might predict.

To begin with, I’ll explain my C/S condition, which I’ve had, with various symptoms, for 30 years. About 2 years ago I was diagnosed with ‘multilevel degeneration’ from C3 to C7, and stenosis occurring mostly at C5/C6. This manifested as numb/clumsy hand, arm pain and reduced power in right arm and hand. At present there is little or no pain with this symptom, except occasional cramping, usually first thing in the morning, on waking. Previous to this diagnosis, I had 28 years of ‘associated’ symptoms ( headaches, stiff neck, frozen shoulders etc etc ) which I found much more difficult to deal with when compared to the actual trapped nerve symptoms which I now experience. I also still experience ‘associated’ symptoms, but to a lesser degree than before, and I put that reduction down to the sleeping posture therapies I have adopted. The idea that sleeping posture therapies can greatly affect the intensity of symptoms is key to the overall goal of rendering the whole C/S condition more manageable on a daily basis.

So, here’s a brief description of equipment used and sleeping postures required.

A) Bedding: I use a memory foam / sponge hybrid mattress ( one third M/F; two thirds sponge ), which I got direct from a manufacturer. I find sleeping on the floor best, with suitable insulation underneath mattress ( carpet or cardboard or both). It’s important to stay warm when asleep, as body temperature is inclined to drop and aches can set in. I find it uncomfortable to try and sleep on a normal raised bed, perhaps because of mild vertigo sensations. On top of mattress, m/f side up, I also use an opened up regular sleeping bag, as extra direct insulation, before my normal bed linen is placed. This system takes care of all shoulder-downwards aches, which were a constant feature with normal mattresses in the past.

B) Pillows: I use a variety of pillows, for various purposes, listed below.
1: Cervical Ortho Pillow. This is a normal feather or sponge pillow which has been stitched in such a way that there is a ridge around the outside and a soft raised section in the middle. The outside ridge reduces where the neck would meet the pillow. It’s best use is for breaking the pattern of cyclical headaches and muggy sore head feelings. Once the pattern is broken, it is usually ok to revert to a normal pillow. Probably best to say here that, when changing pillows, it can take a couple of nights for any adjustments to become noticeable, and it may even be uncomfortable until the changes occur.

2: Soft Feather Pillow. This is my normal pillow, which I wrap a cotton sheet around several times, just to soften the contact between head and any spikey feather ends. This is a good pillow for the head to sink into and it allows the neck to find it’s optimum position of least resistance. It is important for figuring out those limited positions where the neck is completely relaxed, because that will be instrumental in determining which reactive symptoms will kick in next morning. Find the right position and next days symptoms can be greatly reduced.

3: I also use a flatter feather pillow sometimes, and place it at 45 degrees across the other pillow. This allows me to nestle the shoulder into the point where the two pillows meet, and with no real height adjustment, the head can loll forwards with no strain. This can sometimes be a useful position, again mostly for headaches or muggy head. Being able to assess when the neck is most comfortable, that is, when there is no conscious awareness of any stiffness, is all important, and it will help achieve best results. It also means that the head is unlikely to shift from this position during the night, with resulting reactions next day.

4: Memory foam pillows are usually too resistant for finding these comfort zones, and are probably best avoided.

C) Sofa: This is a bit more difficult because of the need to obtain a sofa which can be slept on comfortably, and with arms at a suitable height and soft enough to allow a good sleep. The use of the pillows can be helpful here to adjust arm heights to suit. It will vary from person to person and might require some trial and error / success before determining what works best. But it is important, in that a sofa allows more upright postures when sleeping, and it is effective in breaking the patterns of cyclical aches which sleeping in a horizontal bed can be responsible for. A good test for a sofa would be that a person can stretch out fully, with no hindrance, that the arms and cushions are soft enough, and that the head, when placed on the arm, seems to be in it’s most natural position in relation to the shoulder. Appropriately positioned pillows can all help to make an unsuitable sofa more user friendly. The best thing about using a sofa is that even a one hour nap, with suitable pillow support, can completely alter the intensity or placement of the symptoms. When used properly, instant relief can be achieved. Sleeping in a bed is unlikely to achieve such results, in fact it can compound the problem by helping develop cycles of repetitive aches. Being prepared to switch between bed and sofa, when necessary, should probably be the first step in adopting sleep posture therapies.

Sleeping Postures: The theory behind sleeping posture therapies lies in the fact that the neck will restore it’s own painfree flexibility, depending on whether it perceives if there is an imminent threat to the nerve roots, which it is designed to protect, or not. If the neck assesses (when asleep) that it is in a comfortable state, with minimal threat of nerve compression, then it will automatically lessen it’s protective reactions and thus lessen any resultant symptoms. Finding the optimum sleeping positions to achieve this can mean a certain amount of trial and error / success. But, if I was to say that two months of experimenting might result in reasonable control of the intensity of all future ‘associated’ symptoms, does it start to sound attractive ?

A) Horizontal Sleeping: Horizontal sleeping, on a mattress, can be part of the cause of the extended cyclical nature of headaches, muggy sore head, frozen shoulder and arm / shoulder blade / chest pains. Breaking the cycle is all important, and having the option of using a sofa, where a more upright sleep can be achieved, can do this. Once the cycle is broken, it’s usually ok to revert to horizontal sleeping again. It might only take a couple of nights of adjustments to relieve a long standing problem.

B) Upright or Semi-Upright Sleeping: This can be experimented with using a sofa with soft pillow support. For some reason, perhaps because of the way in which the neck reads it’s own vulnerabilities when sleeping upright, certain symptoms, which just seem to get worse with horizontal sleeping, can completely disappear with a short nap on a sofa in this position. Different postures will suit different reactive aches and pains, so, again, it’s a learning process for each individual case. The resulting effects can be assessed after each sleep, or nap, and the same postures used for future reference. With frozen shoulder, or arm pain, it is also important to find the most comfortable position for the offending arm or shoulder when sleeping ( frozen shoulder….best with arm tucked into ribs ; arm pain…best with arm draped over head ). Again, the key is in finding the postures where the least resistance or pain is felt, as this will help to break the repetitive cycle of reactions. The general beneficial effects can be better assessed with minimal use of medications, because any medications will disguise and confuse a proper assessment of results.



That’s it, so far. All very simple really. But the difference it can make to achieving a better quality of life for C/S patients, is what its all about.



Gerry

[gerry the neck]

Hi

Just something I need to clarify regarding the above Sleeping Posture Therapies. These therapies are aimed at symptoms (headaches, muggy sore head, stiff neck, pain in arm/shoulder/chest) which are indirect associated symptoms resulting from a threat of nerve compression. Of these symptoms, the most important ones to deal with first, are the headaches and muggy sore head symptoms, because of the manner in which these symptoms compromise our resistance to the other symptoms. Headaches and muggy sore head seem to be caused by overactive muscular reactions whilst we sleep, as the neck prepares its protective adjustments for the next day. Unfortunately, they can enter a cyclical phase, especially if sleeping arrangements are not altered as suggested in the posture therapies above. Personally, I've had these types of phases which have lasted for a month, or longer, before they gradually eased off. That was before I learned how to deal with them. Once the overall negative effects of these two symptoms are eased off, it becomes much easier to deal with the remaining symptoms, although they may have eased as well with the same procedures. The main goal of these therapies is to restore the neck to manageable levels, and to implant a sense of control over fluctuating unpredictable symptoms/

Gerry

[gerry the neck]

And finally. I hope I’ve done my best, for the moment, to try and explain my problems with current C/S therapies, and the direction which I feel they should be going in. All things must be tested on their merits, and the only way to accept new therapies is to test them. I could go into further, more precise detail, but enough for the moment. And, hopefully I have helped to fulfil, in some small way, the original purpose of this open forum. I should thank this site for allowing me the opportunity to offer my opinions on such an accessible scale. Another ‘great leap for mankind’.

But, before I finish (did you really expect differently), here’s another one ! Its more to do with side-issues but shouldn’t be ignored all the same. I don’t want it to distract from the purpose of the previous posts on sleeping posture therapies.


How Cervical Spondylosis can cause Social Interaction Problems.

I’m aware that a second or third party perception of my general social interactions might well be ( is ) one of a changeable mixture of OK / Grumpy / Difficult / OK. Strangely, despite often being perceived as such, I am also aware that, behind the façade, I actually feel quite stable, balanced and normal. On days when I’ve got a muggy sore head, or some other symptom, I don’t present myself too well, and I’ve probably acquired a reputation with some people for ‘grumpiness’, breaking arrangements, making excuses etc, when these ‘protective’ attributes interfere with their expectations. I can’t go on explaining, in detail, all the time, what the real problem is. Its too much hard work, and it only exposes an already sensitive state to further irritation. Basically, my face displays the signs of wear and tear, although I feel emotionally ok behind it, and this is continually misinterpreted by others. On good days, I don’t have this problem….I seem to mesh in without fuss. To counteract the unnecessary reactions, I must assume that those reactions are based on ignorance of the real situation. Its sometimes difficult not to succumb to a bit of arrogance in these situations, just to force an understanding to happen. That usually goes wrong. Such is life !

I’m sure most C/S patients experience these sorts of negative reactions constantly, not least when dealing with medical professionals, who we feel should know better. Maybe this only helps to highlight the sensitivities involved, and thus a readiness to feel even more disappointed with outcomes. But, they’re only human after all, and without really understanding the over-sensitised nature of the patient, they will behave mostly just like everybody else. Bottom line here is that, as patients, we must patronise these situations as best we can, hoping that a glimmer of mutual understanding might appear at some stage. I wouldn’t really expect anyone, who hasn’t had C/S , to grasp the whole complexity of that experience, and so I adjust my expectations to accommodate this and try to allow for interactions which reassure the other person, but don’t necessarily have a similar effect on me.

This is my arrogance, and I feel it is justified. Perhaps, over the years, it has also not helped with some of these interactions, but then again, only because I didn’t want to be interfered with by people whose opinion I didn’t necessarily respect. And, by the way, I do respect everyone, up to the point where they give me reason to think otherwise. I have no pre-conceptions of the possibilities of any given situation, unless previous experience has made me wary.

So, C/S patients, and others with similar ‘mood’ altering conditions, must not only deal with the actual symptoms, but quite often are also forced to deal with a recurring cycle of seemingly negative reactions from others. To me, these negative reaction options have evolved culturally, because we live in a society that mistrusts excuses, and any excuse can be perceived as an unwillingness to be fully engaged in the combined efforts of our society to better itself materially. Perhaps, our society, in its self obsessed quest to improve, has gradually lost sight of its own members who don’t quite fit into the equation too well. Who knows ? Either way, it would be difficult to not admit that there exists a patronising overview of people with less ability, and perhaps even this is not afforded to people with an unobvious chronic condition. Some societies have not yet succumbed to classifying their less than able members in this manner, and thus are better able to accommodate them without any underlying confusion about who fits where. But our society seems to be losing this all encompassing embrace, thus the need for ever increasing legislation to protect the diminishing inclusivity. Let’s at least make sure that this aspect of political correctness is not ignored.

I’ve wandered off the subject matter here, I think. The real question I’d like to ask is….”How should I react to the reactions of others, when I know that they shouldn’t have reacted like that in the first place ?” I suppose I’ll just have to put it down to a perversion of cultural standards, and if I remind myself that, well, I’m probably guilty of similar reactions myself, in other circumstances, I’m sure I can neutralise any imbalances in the overall equation.

Note to Self: Must remember to react badly as often as possible in the future !!


Gerry

[ginger]

Hello Gerry,
I am , firstly amazed and astonished to read your posts, such intense consideration of and attempts at understanding the seemingly complex array of neurophysiological details about your condition deserve great respect. I commend your efforts. Particularly when viewed from the perspective of a sufferer, rather than as ( I presume) someone with advanced clinical training.
I have stumbled across your posts between patients in my physiotherapy practice, and have so far only skimmed half. I look forward to continuing my enjoyment of your writing when able, I do have some relevant comments to make but will leave that for when I am able to make what I hope to be meaningful contributions to your efforts to understand your neck pain.
Cheers

[ginger]

Gerry,
I was in a quandary when reading over your material wether it would be best to avoid offering corrections to the many errors relating to the physiology and anatomy of "spondylosis", or wether to simply offer my encouragements to seek these details yourself.
One thing is clear to me, that you have offered insightful connections to some of the apparent puzzle about spinal pain. The important one I believe, is to see spinal pain as the inevitable product of protective behaviour.
We all have instinctive, hard wired behaviours linking threat to eg, withdrawal, tonic changes, spasm, etc. One of these is the spinal protective mechanism that is, according to the model I first wrote in 2005, the ubiquitous element in many pain conditions.
It may interest you to know , that some forms of manual treatment are valuable in reducing and often eliminating this behaviour. The most effective being, continuous mobilisation (CM ).
I look forward to discussing this with you if you wish.
Cheers
Geoff Fisher