Cervical Spondylosis Treatment with Physiotherapy at A&B Hospital Pokhara
Cervical spondylosis is the most common structural condition of the neck in adults over 40. It is the cumulative result of age-related degenerative changes in the cervical intervertebral discs and facet joints, and it is near-universal in radiological studies of the middle-aged population. The presence of radiological spondylosis is not in itself pathological — the question is whether it is causing symptoms, and whether those symptoms require treatment. When they do, physiotherapy is the most effective evidence-based intervention.
What Is Cervical Spondylosis and What Happens to the Neck?
Cervical spondylosis is the collective term for age-related degenerative changes in the cervical spine: disc dehydration and height loss, osteophyte (bony spur) formation at disc margins and facet joints, thickening of the ligamentum flavum (the ligament running behind the spinal cord), and narrowing of the intervertebral foramina (the tunnels through which nerve roots exit the spinal canal).
These changes develop over decades, starting typically in the 30s and accelerating through the 40s and 50s. They are driven by genetic factors, cumulative mechanical loading, and intervertebral disc degeneration. Occupations involving sustained neck flexion (mobile phone use, desk work, microscope work, farming with head-down posture) accelerate these changes.
In Nepal, a combination of mobile phone-associated flexed neck posture in younger people and physically demanding agricultural and portering occupations in older people produces a high burden of cervical spondylosis with symptoms.
What Symptoms Does Cervical Spondylosis Cause?
The most common presentation is axial neck pain — pain localised to the neck and upper shoulders, often with associated stiffness. This is produced by disc and facet joint degeneration and by the secondary muscle guarding that develops around a painful and stiff cervical spine.
Cervical radiculopathy occurs when an osteophyte or prolapsed disc compresses a nerve root exiting the cervical spine. This produces pain, numbness, and tingling radiating from the neck into the shoulder, arm, and hand — typically in a specific pattern corresponding to the compressed nerve root level. C6 nerve root compression causes symptoms in the thumb and index finger; C7 compression affects the middle finger; C8 compression affects the little and ring fingers. Weakness of specific muscles may accompany severe compression.
Cervicogenic headache — headache arising from structures in the upper cervical spine — produces pain that begins in the neck and radiates to the occiput (back of head), temple, and forehead. It is unilateral, aggravated by neck movement, and often accompanied by restricted cervical range of motion.
What Are the Red Flags (Myelopathy) That Require Urgent Assessment?
Cervical myelopathy is the most serious consequence of cervical spondylosis and represents compression of the spinal cord itself — not just nerve roots. It requires urgent investigation and often surgical decompression.
Warning features of myelopathy include: clumsy hands (dropping objects, difficulty with fine motor tasks like buttoning clothes or picking up small items), unsteady walking or balance problems (particularly on uneven ground or with eyes closed), bilateral arm or leg heaviness or weakness, and urgency of bladder or bowel function or, in severe cases, incontinence.
Any patient with neck pain plus any of these features requires urgent MRI of the cervical spine and neurosurgical or orthopaedic spinal surgery assessment. Physiotherapy mobilisation of the neck is contraindicated until spinal cord compression is excluded.
How Is Cervical Spondylosis Diagnosed?
Plain X-ray of the cervical spine demonstrates disc space narrowing, osteophytes, and facet joint changes. It is a reasonable initial investigation for axial neck pain and provides useful information about the level and extent of degeneration.
MRI of the cervical spine is the definitive investigation. It shows disc bulges and protrusions, nerve root compression, spinal cord signal changes (indicating myelopathy), and the precise anatomy relevant to surgical planning. MRI is indicated when there are neurological symptoms (radiculopathy or myelopathy), when symptoms are not responding to physiotherapy, and when surgical intervention is being considered.
CT myelogram provides additional detail when MRI is unavailable or inconclusive.
What Is the Physiotherapy Approach to Cervical Spondylosis?
Cervical traction applies a distractive force to the cervical spine, separating the intervertebral foramina and reducing nerve root compression. It is applied using a mechanical traction device or manually. Intermittent traction (alternating loading and unloading) is generally more comfortable than sustained traction. Evidence supports its use for cervical radiculopathy; it is less clearly beneficial for axial neck pain alone.
Joint mobilisation (Maitland Grade I–IV) is applied to restricted cervical facet joints to restore normal range of motion, reduce pain, and improve function. It is the most effective physiotherapy intervention for axial neck pain and cervicogenic headache.
Cervical manipulation (Grade V — a high-velocity thrust technique) is occasionally used for cervical dysfunction but must be applied with caution and appropriate patient selection. It is contraindicated in patients with vertebrobasilar insufficiency, osteoporosis, and prior cervical surgery.
Deep neck flexor strengthening — targeting the longus colli and longus capitis — is the cornerstone of the exercise programme for cervical spondylosis. These deep stabilising muscles are analogous to the lumbar multifidus: they become inhibited and atrophic in the presence of cervical pain, and their retraining produces sustained improvement in pain and function.
Cranio-cervical flexion exercise (chin tuck: gently drawing the chin inward while maintaining level gaze) is the entry-level deep neck flexor activation exercise. It is performed with feedback from a pressure biofeedback unit in the clinical setting and independently at home.
Scapular stabilisation and thoracic mobility exercises address the thoracic kyphosis and forward head posture that frequently accompany cervical spondylosis and perpetuate it by increasing the mechanical load on the cervical spine.
What Ergonomic and Postural Advice Is Given?
Screen height: the top third of the screen should be at eye level. A screen that is too low requires sustained neck flexion. Laptop use is particularly problematic — using a separate keyboard and raising the laptop screen to eye height is recommended.
Phone use: the habit of holding a phone in a bowed-head position for prolonged periods is a major driver of cervical spondylosis acceleration in young people. Holding the phone at eye level, or using voice control, substantially reduces cervical spine load.
Sleeping position: sleep on a pillow that maintains neutral cervical alignment — not so thick that the neck is laterally flexed, not so flat that the neck is unsupported. Side and back sleeping are both appropriate; prone sleeping (face down) maximally rotates and extends the cervical spine and should be avoided.
Driving: prolonged driving with the head supported in a fixed position, or with a headrest too far behind the head, stiffens the cervical spine. Take breaks on long journeys.
A&B International Hospital
Pokhara-02, Bindhyaabasini Way to Sarangkot
Phone: +977 061-412512
Website: abinthospital.com
Neck pain, arm tingling, or headaches linked to cervical spondylosis can be effectively managed with targeted physiotherapy at A&B International Hospital, Pokhara. If you have concerns about myelopathy symptoms, seek urgent assessment. ECHS polycards accepted.
