Physical Rehabilitation of Cervical Osteoarthritis

Treatment of cervical spondylosis, also called Cervical Osteoarthritis by physical rehabilitation modalities. Cervical Osteoarthritis may be treatable in physiotherapy department by various means like:

Heat Modalities
Neck Exercises
Manipulative Therapy
Hydrotherapy
Postural Awareness
Relaxation
cervical traction
neck support

Aims of Cervical Spondylosis Treatment
To alleviate pain
To provide support towards the neck
To restore the neck movements entirely range
To re-educate the individual for posture correction
To bolster the cervical muscles
To analyse the fundamental precipitating causes of the patient's problem and are designed for alleviating those causes.

Strategy to Cervical Spondylosis

Heat Modalities

Heat is an efficient mean of reducing and relieving pain in cervical osteoarthritis. The modalities you can use are:-
a)Hot packs for moist heat.
b)SWD (pulsed or continous) for dry heat.
When the pain subside to some tolerable limit, then exercises ought to be started and progressed gradually based on the conditions and requirements from the patient.

Static Contractions and Strengthening Exercises
Isometric contractions from the cervical muscles improve the muscle endurance and tone because the contractions improve the blood supply thereby the nutrition towards the muscle is increased and therefore muscle strengthening is performed.
The basic technique of this being active is that both Physiotherapist and patient exert equal pressure to ensure that static; non dynamic action happens in the cervical muscles. During all of the movements, shoulder girdle ought to be stabilised so as to avoid trick movements. Pressure can be applied by the physiotherapist or through the patient himself after teaching him the strategy properly.

Soft tissue technique
Kneading helps you to release tightness of upper fibre of trapezius. Obtaining, wringing and skin rolling will help with relieving the tightness of scalene muscles, interspinous ligaments, paravertebral muscles and trapezius.

Traction
Oscillatory traction is regarded as effective in mobilizing the stiff neck. Continuous traction can be used to relieve nerve root pressure.
Traction is definitely given in comfortable position with minimum weight that ought to be graduated slowly when it comes to patient's recovery. This relies on the frequency of remissions and exacerbations from the condition. It can be succumbed sitting or lying position. The traction could be given either in the type of manual traction or positional traction.

Hydrotherapy
Float support lying in tepid to warm water is best for total relaxation and therefore gain relief of muscle spasm. To unwind the upper fibres of trapezius, patient is taught to push one hand then your other towards the feet within the float support lying position.
For that lower fibres of trapezius and serratus anterior, looking at the float with both of your hands holding down the float may be the preferred position. This stimulates the muscles and also the receptors of the neck and shoulder joint to keep the head in a good position.

Postural Awareness
Because the condition progresses, the abnormality of posture also increases, thus in the initial stage itself, postural awareness through proper advice and education ought to be planned and initiated through the physiotherapist.
The ideal posture is straight neck with chin tucked in and back straight without any compensatory actions or any trick movements. While sitting a higher backed chair is supplied to the patient with head, neck and shoulder supported; a little pillow in the lumbar spine, feet properly supported and arms sitting on a pillow within the lap or around the arms of the chair.
During sleep, side lying is easily the most preffered position, supine lying can also be adviced. A single pillow under head for head support is allowed. A Butterfly pillow is the greatest support for a patient of cervical osteoarthritis, because it is flattened in the middle in which the head rests and also the elevated ends offer the head on the sides.

Support
Support for that neck are crucial to keep the neck steady and also to relieve the pain. A strong neck collar is extremely beneficial especially during activities or during travelling. While patient is resting or sitting, the collar ought to be removed but then even the neck should be based on pillows or head rest.

Relaxation
Because of pain and spasm of cervical muscle, patient is definitely in discomfort and uneasiness. To alleviate these undesirable situations, relaxation techniques are taught in a variety of positions that is during rest, work or play.
While lying on bed, patient is adviced to loosen his system and stretch for rare occasions so as to reduce the muscular tension low. While relaxing the entire body should be fully based on pillows. He is then asked to think of something pleasent that will facilitate comfortable and relaxed sleep.

Surgery
might be necessary for a patient struggling with cervical osteoarthritis if he/she has severe pain that doesn't improve from other conservative treatments. It ought to be the last resort while there is always a risk factor involved.

Cervical Osteoarthritis

Cervical Osteoarthritis refers back to the degenerative condition of the cervical spine such as the intervertebral joints in between the vertebral bodies and also the vertebral discs. The other terms employed for this condition are

Degenerative disc disease
Degenerative spondylosis
Osteopytosis
Spondylitis deformans
It's very common in persons above Half a century of age and those who have to do work like typing or persons who've to keep the neck in a single position as in reading, writing along with other table works.
It comes down to degeneration of disc leading to, reduced space among two vertebrae, later osteophytes are formed within the periphery. This is followed by involvement from the posterior intervertebral joints leading to pain in the posterior area of the upper limb. Generally, this pain is together with tingling, numbness and radiating anyway.
The osteophytes formed could also compress the cord that will produce weakness of whole from the limb.

Predisposing Factors For Cervical Osteoarthritis
Faulty posture adapted is assigned to wrong habits, anxiety and mental tension.
Occupational stresses causes continous pressure around the cervical segments. The parts of society prone to stress and strain are-
a) Officers, typists yet others working on poorly and wrongly positioned desks and tables.
b) Drivers vulnerable to prolonged driving.
c) Coal miners and divers.
d) Persons involved with occupations including lifting and carrying things on their own head.
e) Practice of holding phone on a single shoulder while talking.
f) Over sleeping awkward positions, using inappropriate pilows.
Built from the body Persons having thick neck having a Dowager's Hump and long backs tend to be prone to spondylosis.
Sites
The segments commonly affected within the cervical region are C4 to T1. Together with these sites, other parts of spine will also be affected due to compensatory adjustments.

Clinical Feature Of Cervical Osteoarthritis
1)Onset: The problem gets precipitated by fatigue, mental tensions, worries, anxiety or depression. It happens gradually due to faulty posture.
2)Pain: The location of pain depends upon the site where the cervical spine is impacted by the pathology.
a) Upper cervical spine- Headache
b) Mid cervical spine- Neck pain
c) Region from C4 to T2- Radiating pain; pain in shoulder girdle, shoulder and arm, either unilateral or bilateral.
3)Muscle weakness: Based on which nerve root gets compressed, the concerned muscles which are supplied by that nerve root gets affected and weakened. Usually, the postural muscles from the neck are weak. They're: upper cervical spine flexors, lower cervical spine extensors and side flexors.
4)Sensation: There occurs paraesthesia which means, pins and needles or altered sensation from the particular dermatome which is given by the impinged nerve root.
5)Nature of pain: Usually referred to as dull, aching pain, sometimes gets exaggerated as sharp, stabbing pain and sometimes occurs as cramping type.
6)Limitation of motion: All the neck movements get limited, often bilateral but is unilateral in the event of acute onset of pain. The movement which gets greatly limited is flexion from the upper cervical spine and extension from the lower cervical spine.
7)On palpation: It's detected that there is lack of mobility of soft tissues together with loss of movements from the accessory intervertebral structures.
8)Muscle spasm: There's spasm mostly of the scalene muscle usually unilaterally. Because the middle and lower fibres of trapezius get lengthened and reduced in tone. Imbalance results resulting in the upper trapezius to bear increased tone and therefore there occurs muscle spasm and muscle tightness.
9)Postural disturbance: The posture gets disturbed in cervical osteoarthritis as follows-

Stress at C5,C6, so tightness of upper cervical spine extensors.
Chin placed forward.
Kyphosis of thoracic spine.
Tight pectorals.
Flattened, sometimes lordotic lumbar spine.
Flexion of elbows and hand.
Backward tilt of pelvis.
Hip flexed and knee flexed.
Ankles dorsiflexed.

10) Cervical spondylosis is generally associated with headache, vertigo and lack of balance which is because of postural changes.
Investigations
The only real investigation which can easily read the diagnosis apart from the the signs of the patient is radiograph. Early and proper diagnosis is essential for Treatment Of Cervical Spondylosis/Cervical Osteoarthritis. The X-ray finding reveals that there's:
Osteophyte formation at the margin from the apophyseal joints
Reduced space between your vertebral bodies
Lipping of the vertebral bodies