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

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

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

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.

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

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 ;)

Quote:

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Originally Posted by 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 ;)

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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 !

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

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 !

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

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

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

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 .

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Originally Posted by gerry the neck

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.

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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

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.

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

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

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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.

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

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 ?

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.

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

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

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

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

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

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

HI Geoff

Thanks for your encouraging comments, and yes, you are correct, I have no formal training in spinal conditions. All I go on is my own C/S experience, and, although there may be many technical errors, to the trained eye, I'm only claiming that I use an intuitive approach. I totally understand that a trained P/T must be critical of these types of speculation, because, having to deal with many varying conditions, they must maintain a balanced judgement. Perhaps, some of the answers to the puzzles we all seek to resolve lie somewhere in the middle. I dream to think that some of my speculations may have relevance on a wider scale, but even in this I may be overstepping the mark.

It was the lack of identifiable descriptions of C/S which kick started my investigations, which, besides my proposed sleep therapies and avoidance of aggravation therapies, are only conducted on a private thinking level, and not on the levels which a P/T would encounter. I am always open to opinions on this, critical or not, and am prepared to adjust my overview as necessary. As you can probably detect, currently I believe strongly in what I have posted previously, but even those ideas evolved through changes. So, any comments are welcome, within reason.

PS. Any easy way to access your earlier writings on 'protective reactions' ?

Regards
Gerry Daly

Hi Gerry, some points to begin, as mentioned there is an essentially correct central paradigm which you have alluded to numerous times in your posts, that being spinal protective behaviour.(SPB)
This behaviour is the link to the brain ultimately providing pain, as well as a series of altered sensations and products of nerve irritation at the spine. These include numbness, tingling, reduced power, altered autonomic events etc.
It is not necessary ( or even common) for there to have been either trauma or disease for these protective behaviours and conseqent symptoms to be present.
The state of affairs when SPB occurs may be diagnosed as spondylosis or spondylitis, when it is assumed the major inflammatory involvement is to the spondyl. ( an anotomical term that can be googled for detail, but includes the facet joint, space through which the nerve root exits the spine, aspects of the spinal segment and the nerve tissues themselves). SPB will commonly induce inflammatory events in and of the spondyl as a result of limits to facet joint movements resulting from increased paravertebral tone of muscles near to the joints.
All pain is a product of the brain, in the case of spinal pain, as a feature of a successful protective response. This output from the living brain is highly variable under a range of internal and external circumstances.
Sleep is that state where movements are reduced normaly. not entirely to nil , but significantly reduced. Thus any pain associated with poverty of spinal joint movements will be likely to be felt more strongly in the morning. Movements commonly reduce this am pain for those whose internal driver for the SPB is NOT disease.
Sleep is also that time when a series of internal palliative effects reduce their effects, attention, altered higher frontal lobular inhibitions, emotional cues, as well as the effects of chemistry associated with wakefullness and activity ( opiate like substances ).
While improved sleep will doubtless rejuvenate and refresh the mind and body, it's effects and those of improved sleep related postures, are of little significance compared, for instance, to active and passive movement therapies in general.
It's been a big day on the water today, I'll get to the nitty gritty of what makes SPB go away tomorrow.
Cheers

Hi Geoff

I might be able to save you some work here. I've been able to access your CM theory under 'frozen shoulder' posts. Also got to see your vid on youtube. Much food for thought, indeed.......keeps the old grey matter bubbling over ! So far, I think we are on the same page regarding cause and effect, especially regarding cyclical protective behaviour being the cause of many 'associated' symptoms. Also, we both seek user friendly ways to deal with unpredictable on/off symptoms, rather than lumping them all together as some complex insurmountable whole. Although my approach is 'home based', and yours is 'clinic based' , so far I see no reason why they shouldn't compliment each other. I was wondering if your CM manipulations could be self applied (neck only obviously), or even applied by someone who has watched your vid, so I could assess for myself any benefits ? A 24,000 mile round trip would cause its own problems ! There are some issues I'd like to go into further, and will do, when I'm sure I can contribute intelligently....just working them over first.

Regards
Gerry

Hello Gerry, glad you have been able to see the CM method. When applied to the cervical spine I find this is a means to reliably reduce protective tone and most often the means to restore normal pain free movements for long periods. There will always be a subset of neck pain sufferers that do so when SPB is driven by structural losses to normal integrity and/or trauma/disease processes. Many of those however who I have treated successfully are victims of the cyclical tightness , mentioned by you, that is more likely the "natural"product of internal drivers of protective behaviour , where the threshold of inflammatory irritants induce a repeat of and incremental additions of SPB.
Most of the longer posts I have written on this subject can be found on the Rehabedge.com website, further more recent posts on Somasimple.com.
Self treatment is possible with CM to the neck. Results depend to a large degree on the quality of and duration of these passive movements. Try sitting in the littlest room ( on the throne) where you can position your elbows at head level on the adjoining walls. This is of course possible where your throne is indeed in a little room, alternatively sit in the corner so that your elbows can be set and movements by the neck INTO the treating thumb can offer reasonable approximations of CM type movements.
What beneifits you may get however I warrant will be limited and short term this way. Best without doubt would be to offer the CM info to a friend with strong hands or enlist a willing physio who may already have skills of a similar kind. You appeal to me as a relentlessly curious kind of guy Gerry, I have little doubt you will find value. Good luck and keep posting.
Cheers

Hi Geoff

Thanks for advice re CM. What I like about your methods is the non-aggravational aspect. Although you do manipulate the facet joint somewhat, it is relatively gentle, and it doesn’t involve traction, twisting exercises, collars, or even medications. All big plusses in my book….I’ve had all these to no avail. I think we both understand that the principal goal is relief rather than the prospect of even further aggro….a principle which all too often escapes the attention of the practitioner ! Probably best that your methods are applied by a willing helper, rather than self applied, and I will try it out in the fullness of time and report anon.

However, I don’t want to let you off the ‘sleeping postures’ so easily, without knowing that you’ve had a good think about it. There may be some misunderstanding in the way that I describe why the whole ‘sleep / C/S thing is so important, and seemingly always casually overlooked. Usual response ‘ Of course, a good sleep is important to general well-being’ . This misses the point that something strange happens when we sleep which instigates all sorts of protective reactions. This may well be only apparent to an actual C/S sufferer, who experiences these on/off unpredictable changes. The sleeping posture alterations I speculate upon, do actually have an effect on these processes, usually beneficial, and, as a means to lessening the intensity of symptoms and instilling a sense of self control and self management, they are a quick, home-based, and self applied method for achieving these ends…even if only temporarily.

In my particular case its about getting rid of cyclical headaches and muggy head sensations as quickly and as effectively as poss. No medications, except when absolutely needed, and no waiting for appointments either. The first goal is to restore clear headed thinking, thus allowing a better environment for considering further self management techniques. This might all sound a bit wishy washy to someone who constantly deals with the mechanics of the spinal structure, but, from my point of view, after years of these types of disorientating symptoms, and after years of distracting ineffective therapies, it looks like a very worthy goal to me.

I understand that sleeping postures are difficult to monitor, in a clinical sense, and as such may have been overlooked in favour of more clinic-based techniques. However, I would feel guilty about myself if I didn’t make a big noise about this, in the same way you might feel aggrieved if your CM methods were being overlooked by fellow P/Ts with their heads buried in the sands of textbooks !

Enough ‘soap-box’ for now, and thanks again.

Gerry

Dear Gerry, I ought to have said that your approach viz sleeping postures is entirely fitting and valuable. Your idea about inadvertant postural complicity in the natural inclination spines have where already present irritations and protective behaviours , may become worse with even vague extra loads . I do actualy agree with you. That point may have escaped proper spelling out as it were in my post earlier. I see no reason why your ideas and methods could and should not be further explored, for your own as well as the potential for benefit broadly.
The point I attempted clumsily was that movement trumps rest everytime as the means to 'unlock' protective spinal behaviour leading to pain etc. By unlock here I mean to resolve and eliminate both the behaviour and the symptoms with long term effect.
Happy Ioster, good egg hunting and hope you get amongst the fertility rituals wherever you may over the coming festive period.
Cheers

Of course, I nearly forgot……Happy Easter. Note to self…” must remember not to forget the niceties when I’m stuck in the bunker scratching my theories onto two constantly crumbling stone tablets !”. As ever, some more speculations below.

I’m going to try and explain how the nervous system might behave when it recognises a threat to itself, as might happen when a nerve, exiting the spine, is threatened with compression of any nature. The nervous system, as a highly refined protective system, and besides its other duties, must have an inherent ability to protect itself, perhaps using means which are a bit beyond our comprehension. Otherwise, its function as our primary defence would be vulnerable to malfunction….and this simply must not happen. It would defeat its own purpose.

In the case of a threatened, but not yet compressed, nerve in the neck, that nerve most likely sends a signal, through the brain, to instruct local muscles, close to the vulnerable point, to stiffen up and protect. However, those same muscles are also receiving signals, by means of our default operating processes (again, nerve signals), to do their normal duty of maintaining normal flexibility and functionality of the neck. The neck is a conduit for other vital organs, and their best functioning must be ensured.

So, it seems that the local muscles must be receiving contradictory instructions from the nervous system, and without the ability to determine which might be its primary role, the muscle can enter a phase of repetitive internal conflicts with itself, causing varying symptoms in the surrounding area, or even as referred spasm as in frozen shoulder or cyclical headaches etc. Assuming that the nervous system must be ‘ pre-aware’ of any possible outcome resulting from its protective signalling, we have to assume that it allows this muscle conflict to continue, without either signal taking priority, for a good reason. Perhaps the nervous system has already ‘decided’ that this is better than allowing the stiffening signals to dominate, and thus threaten further other functions of the neck.

So, in summary, perhaps the nervous system allows this muscle conflict and cyclical protective reactions as a less risky alternative to shutting down any specific neck functionality, although such shutting down can occur in more critical circumstances. Although speculative, this might help to explain the variety of symptoms experienced by a C/S patient who doesn’t also display any direct symptoms of actual nerve compression, as occurs with long term C/S with no underlying disease apparent.

How to deal with this possible scenario is the big question here. If it were possible to intervene in such a way that one set of nerve signals could relax their intentions, then, without the confusion of conflicting signals, the other set of signals could also resolve quickly (i.e. achieve their purpose ), and thus the reacting muscles could return to their normal duty of maintaining unstressed functionality. I’m inclined to believe that something of this nature happens when each rough phase of C/S relaxes back to its default status, which is within a range of allowable flexibility.
How to intervene is another question, which I and others here have already gone into before in these postings. What I’ve tried to do here is simply is to try to reduce the nerve behaviour to a less confused description, and hopefully render options for suitable therapies less confusing also.
Gerry

---------- Post added at 12:52 PM ---------- Previous post was at 12:47 PM ----------

ps...forgot to mention that the only fertility rites I engage in these days are cerebral. I know that's unfortunate for anyone who happens upon my postings !
Have a good one !

I know. It seems I contradict myself. However, there must be some way, besides instigating referred pain to an area where no problem exists, that the nervous system recognises its own vulnerabilities and reacts to protect. Otherwise the whole system becomes vulnerable and I can't visualise that this could ever happen. The weird thing is that pain doesn't register at point of nerve compression, so we have to assume the nerve has other means of warning / reacting in order to preserve its integrity and to instigate muscular reactions to this end. Thus the speculations on confused priorities of signals and their possible effect on the muscles.
Gerry

"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.

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

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

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

Why must I be both Einstein and Oppenheimer embodied as one ?



There are many ways to tackle any problem, but basically there are only two methods of approach. One is to take the actual or envisioned end result and work the thing backwards, to reveal where things may have gone wrong that may have produced that particular result, and hopefully, try and reconfigure those elements to produce a better result next time. The other is to approach the problem from a ‘before the problem arose’ perspective i.e. to assume that everything should work normally, and then to try and spot, and limit, the errors as it progresses, with a view to returning to some kind of normality. I see these two approaches as highlighting the differences between intuitive assessment and textbook assessment.

My feet are firmly planted in the intuitive approach for the simple reason that, as a method, it allows an option to assume a required result which looks beneficial, and any deviations on the route to that result can be highlighted and avoided next time. Thus a continuous self repairing method. So, where an assumed required result might merely be, as in the case of C/S, to achieve minimal discomfort from a chronic health condition, the elements which disrupt such a requirement make themselves obvious. For instance…I can easily assess that my discomfort has increased because I lifted something heavy two days ago, etc, etc. Must remember etc.


With the textbook approach, the entire problem tends to be overviewed with the assumption that all efforts should be geared towards regaining normal functioning. This may well be an impossible required result which has, over time, become the standard upon which most recommended C/S therapies are based. To me, it seems the required result of this method doesn’t fit the problem. Also, to try and tackle a progressively degenerative ( or regenerative ?) condition with knee jerk reactions each time a new phase kicks in, seems to lack a reasonable ‘assumed required result’ in the first place. The overall plan is continually thwarted by unpredictable events and any reactions are usually after the event. In fact, there seems to be no plan for learning from past events, or for applying lessons learned to possible cyclical repetitive events in the future….a glaring omission in any learning process. With no plan, except to react to events as they arise, and with no reasonable assumed required result to guide a path to progress, how can such a method ever hope to achieve progress, or even to acquire an ability to recognise its own failings.

Basically, what I’m saying, without wanting to appear to be too cynical about textbook approaches, is this…..if we lower our expectations and just focus on achieving an assumed required result of ‘less discomfort’ , then other methods of approaching the problem will make themselves apparent. Setting the post too high, as in requiring an assumed ‘ back to normal’ result, may well be over-influencing decision making when devising C/S therapies. It seems its just too easy to overlook the little things which might really matter.

Hope this makes sense.

Ps…Perhaps I should have titled this post “ Welcome to the lecture. Today we’ll be discussing my complete disregard for the obvious lack of responses to my recent posts” !

A Little Rant…..

Anyone, on first being diagnosed with Cervical Spondylosis ( C/S ), will initially want to fight the problem aggressively. For the first few years there may just be a sense of continual discomfort at rear of head / neck, and maybe some referred aches / pains in shoulders etc., and the natural response will be to try and shake off these symptoms with aggressive exercises, traction, medications etc. Unfortunately, this desire to be rid of the symptoms by any means lends itself to the entire culture of C/S treatments.
The professionals also have a need to respond with suggested treatments that look convincing. Thus the cycle of patient’s expectations being met by treatments which simply ignore the on-going behavioural patterns which the neck adopts to protect its delicate disposition. Whether the neck is ‘degenerating’, as might be the case where an underlying disease is evident, or whether it is ‘regenerating’, as with an injury based condition, is critical to being able to adopt treatments which are fit for purpose. Perhaps ‘slow degeneration’ is really ‘regeneration’ with normal wear and tear, as would occur with any injury based structural problem. Rapid degeneration obviously indicates an underlying problem. They are different processes, and they require different approaches. One is acute, and needs responsive damage / distress limitation. The other simply needs guidance to accommodate the behavioural processes which the neck is already engaged in.
Non-aggravation is essential to the success of any treatment, for either condition. Think of it this way….there are unlikely to be any changes to the faulty structure simply by mobilising the surrounding area, so why bother ? Why take a risk which could backfire ? The only flexible element in the equation is the manner in which the local muscles are instructed, by the nervous system, to respond. Believing that we can interfere beneficially in that process with aggressive therapies, without really understanding these complex muscular reactions, is perhaps an arrogance too far. However, simply accommodating the process, by allowing it to inform us of how it wants us to engage with it, can reap benefits. The aches and pains are indications of where we have not responded properly to signals, which we may not have recognised in the first place, and thus must endure a rectifying process. The neck knows what it is doing. Trust it, and, importantly, allow it to reveal its methods in its own language, and the management of C/S will get easier.

Most C/S patients experience confusion and distress when trying to understand their predicament, leading to bad decision making and possible acceptance of inappropriate treatments. A proper analysis of why the neck behaves as it does helps to clear up this confusion / distress, and opens the door to assessing the benefits of approaching the whole condition with a more open mind. Paticularly important, in my opinion, is the role that sleeping arrangements play in generating cyclical symptoms, and which can be controlled with intelligent sleeping posture therapies, as described previously.

Gerry

Here’s a story……..

A long time ago, about 1990 in fact, I was referred to a certain London general hospital for Xrays, physio and neurologist assessment for my C/S. Had the xrays…..no problem. Attended physio (traction and exercises) which left me with a muggy sore head. I felt like I’d been physically mugged ( I often describe early morning C/S symptoms as being like having been mugged whilst asleep ). A few weeks later I got to see the Neurologist. Although she said that the xrays showed my neck to be stiff and tensed, with restricted curvature, she couldn’t actually see anything causing it (I’d been diagnosed 10 years previously with C/S by means of xray) and I was more or less dismissed as not requiring further investigation or treatment. I was more than aware of the symptoms I’d had for those 10 years, and I left that hospital feeling like I’d been cast adrift by those I most relied on. I felt both physically and psychologically mugged, having placed myself willingly in their hands. It was a bad experience which seriously affected the frustration and confusion I was experiencing with my condition. And, I should add, not a single word of advice on how to manage it on a daily basis. Needless to say, my attitude to these unfit for purpose systemised processes has been coloured ever since. In fact, I felt inclined to avoid having to endure such a disappointment ever again, and , on second thoughts, I’m going to name and blame. They deserve it. It was Chase Farm Hospital. Done.

About 3 years ago I developed the numb hand / painful arm symptoms, which needed attention. GP referred me to Physio, who referred me to a hospital based Physio, who referred me for MRI scan, then back to hospital Physio, who referred me to a Neurologist. She offered me 2 choices of Neuro, one being at the previous hospital I had attended in 1990. No thanks, I said, I’ll have the other, which was a lot further away. Rather strangely she said “ Good choice. You chose the best in London”. Hmmmm! I got a copy of DVD with MRI scan (which I cleverly made a copy of myself, and which I still have) to take to the Neuro. A few weeks later I attended for assessment. I was seen by a trainee Neuro (I assumed) who did all reflex testing and talked me through the MRI. I had some stenosis and multilevel degen. from C3 to C7, much as expected really. At the end I asked if it was possible for current symptoms ( not condition ) to self resolve in any way, and was told no, only with surgery. I was booked for further tests, EMG and another MRI, and eventually returned after 3 months to see the actual Neuro consultant. I briefly explained my 30 years of symptoms and how I like to try and manage it my own way, and she agreed that was a good idea, unless it suddenly got worse. So, any intervention was put on hold. Suited me. From GP to this point all took about 6 months, and 9 separate appointments at varying venues. True. In all that time, not once did I get any advice on how to manage my condition daily ( Perhaps I should exclude the Neuros from that criticism, because they’re busy enough with surgical matters ).

Anyway, I returned a year later for an appointed review. This time, as all seemed to be going well, although still with semi numb hand, I was offered the option of physiotherapy. I declined, explaining my new belief in benign neglect and sleeping posture therapies. At this the Neuro laughed, in a way I can only describe as ‘knowingly’, and when I left I thought to myself “ At last, a little common understanding”. Still no advice on self managing, but, after 30 years, I was getting used to that.

I really hope I haven’t blown my precious anonymity here. Don’t really want my Neuro inviting me in for an early retirement…for being too mouthy !

Moral of the story is this…..each time, and there have been many, I seek treatment, I go through the motions, and then I am very politely shunted back to square one, with no guidance, to start the whole process over again. Is it really any wonder that I choose to put my faith in home based therapies, which I’ve had to devise myself, and which seem to work better than what I’ve been offered. And, is it really any wonder that I should explore the theory of the C/S condition and try to rationalise how it really works. I have accumulated a lot of information on how a C/S patient might change their overview of their condition, and on how they can self manage it, to some degree, without endless clinical appointments, medications, or bad advice, and without conflicting with current practices. Controlling the intensity and unpredictability of symptoms is the way forward. My intention is to combine all into a comprehensive guidance booklet and make it available. Unfortunately, I don’t have independent means, I must work to survive, and therefore it may take some time. In the meantime, I hope that the arguments I have put forward in these postings are convincing enough to attract any C/S patients seeking a better way, and perhaps they might also encourage any concerned professionals to rethink systems which may look workable to them but are, in fact, mostly a repeating disappointment to C/S sufferers.


Gerry