Cervical spondylosis (from the Greek word 'spóndyl', meaning vertebra) a term used for age related wear and tear affecting the bones (vertebrae), joints and discs of the neck (cervical spine),usually occurs in men and women older than 40 and progresses with age. In course of time, the elasticity of the inter-vertebral disks is lost and it predisposes the disks to injury and tear. It also leads to inflammatory changes which in turn brings about calcification (deposition of calcium) leading to extra bone formations called osteophytes in the adjoining structures. These osteophytes put pressure on the on the spinal nerve roots or spinal cord resulting in pain.
The spines of majority of people above the age of 50 have certain degree of osteoarthritic changes. But they seldom cause acute symptoms. Certain precipitating factors like trauma, incorrect posture of the body, pressure while sleeping and excessive intake of sour food usually precipitate these attacks.
Cervical Spondylosis, known as Griva Sandhigata Vata in Ayurveda, is one of the most common problems affecting people on the move and is also often seen in people with sedentary habits especially those who tend to do a lot of work sitting on a chair in a bent down posture, or practice a semi erect posture, producing undue strain on the vertebral column. Consequently, the age of people with cervical spondylosis has reduced from the 50s to the 30s.
|Cervical Spondylosis vs Ankylosing Spondylosis
|Even though ankylosing spondylosis and cervical spondylosis sound similar, they are different. Spondylosis is a term relating to "wear and tear" and is more common with the people of older age. Ankylosing spondylosis relates to an inflammatory condition in which new bone is produced and then leads to fusion. The vigorous exercise therapy suggested for people with ankylosing spondylosis might be harmful to those suffering from spondylosis.
Symptoms can vary from mild to severe. Symptoms often develop slowly over time, but may start suddenly. There are quite a few symptoms that indicate cervical spondylosis. These symptoms may show up distinctively, or may overlap one another.
| The following are the commonly seen symptoms of cervical spondylosis:
- Pain in the neck and shoulder regions. This may spread to the base of the skull and shoulders. Movement of the neck may make the pain worse. The pain sometimes spreads down an arm to a hand or fingers. This is caused by irritation of a nerve which goes to the arm from the spinal cord in the neck. The pain tends to wax and wane with flare-ups from time to time. However, some people develop chronic (persistent) pain. The pain in the neck region is usually followed by stiffening, which gradually increases. The pain in the neck area can also move downwards to the shoulders and the arms. Some patients may also experience swelling. Neck stiffness and pain may be worse with upright activities.
Pain in the lower areas at the back of the head, called the sub-occipital region. This pain can move downwards to the base of the neck, as well as the top of the head.
- Radicular symptoms. Patients may sometimes display loss of reflexes in certain areas due to the compression of the spinal nerves. Other radicular symptoms include numbness and pain in specific areas, usually the arms, shoulders, fingers and weakness in the legs.
Cervical Spondylotic Myelopathy (CSM). Patients with CSM may experience difficulty in writing, unusual sensations, as well as weakness.
In rare cases, one may find loss of control over the sphincter, as well as incontinence while passing urine. Some patients may also experience urgency in passing urine.
A patient suffering from cervical spondylitis suffers from compression of the spinal cord, which in turn leads to a compression of the spinal nerves. This may manifest itself in the form of an unstable gait.
Another prominent symptom is the weakening of the muscles in the upper arms, slowly progressing to the lower regions of the arms. This is preceded by pain in the upper region of the arms.
- The movement of the spine generally aggravates the pain of the neck. In an aggravated state it may present with nausea, blurred vision, and may also be associated with induced tendency of vomiting.
- It is often associated with loss of memory and sleeplessness.
- May feel or hear grinding or popping in the neck when you move.
Age – Cervical spondylosis is often associated with age. While only less than 25% of people below 40 years of age experience cervical spondylosis, about 60% or more above the age of 40 are affected by it. By age 60, most women and men show signs of cervical spondylosis.
Injury – A neck or spine injury which may have occurred years back can predispose to spondylosis. Other precipitating factors such as incorrect body posture, trauma, and excessive intake of sour food (according to Ayurveda), can trigger spondylitis attacks. undue pressure on the spine while sleeping;
Herniated Discs: The inter-vertebral disks are made-up of two concentric layers, the inner gel like annulus pulposus and the outer fibrous annulus fibrosus. As a result of advancing age, the nucleus looses fluid, volume and resiliency and the entire disc structure becomes more susceptible to trauma and compression. This condition is called as dehydration of the disc. The disc then is highly vulnerable to tears and as these occur, the inner annulus pulposus protrudes through the fibrous layer, producing a bulge in the inter-vertebral disc. This condition is named as herniated disc. This can then cause compression to the spinal cord or the emerging nerve roots and lead to associated problems.
Genetics – Research has shown that variations of the HLA-B gene, part of a family of genes called Human Leukocyte Antigen (HLA), influences the occurrence of spondylosis.
It is therefore very possible for a person with a family history of cervical spondylosis to have it himself, without the influence of any of the other factors. However, this possibility exists in only a few cases, as the number of people with spondylosis as a hereditary disorder has been found to be relatively low
Work Activity – Cervical spondylosis is often found among people who carry heavy loads on their head or shoulders, than those who do not. Another crucial factor is doing work that puts pressure on the neck region, like lifting heavy loads, gymnastics, etc. Other variations of this factor are work environments that require people to work in one position, usually bending, for long periods of time
In short, any activity that puts undue stress on the neck for prolonged periods can cause cervical spondylosis. Some examples are watching the TV seated at an odd position that puts pressure on the neck, travelling for long distances and sleeping while seated, working the phones for long hours, etc. Incorrect sleeping postures, use of very soft sleeping mattresses can also lead to cervical spondylosis.
Examination often shows limited ability to bend the head toward the shoulder and rotate the head.
Weakness or loss of sensation can be signs of damage to specific nerve roots or to the spinal cord. Reflexes are often reduced.
- Neem (Azadirachta indica) is very useful in cervical spondylosis. The flowers as well as leaves can be consumed on daily basis.
- Any oil available at home mixed with camphor (karpur) can be used for massaging the neck.
- 2-3 cloves of garlic should be taken in the morning on an empty stomach. Oil prepared by frying 10 cloves of garlic in 60gms of oil, cooled should be applied on affected part. Let it remain for 3 hours and then take a warm bath. This should be followed for 15 days.
- Lemon juice mixed with salt should be taken 2-3 times daily and Chebulic myrobalan (Haritaki) after meals gives quick relief.
- One tablespoonful of turmeric should be consumed once every day, after boiling it in milk for half an hour. It is a very useful herbal treatment for cervical spondylosis
- Drinking water from a copper pan after keeping it overnight is also very useful in rheumatoid arthritis and cervical spondylosis
- Consuming castor oil at night with or without milk is a very useful herbal remedy for arthritis, especially rheumatoid arthritis and cervical spondylosis.
- Use herbal juices like aloe vera (ghikumari) juice and gooseberry (amla) juice in routine. Gooseberry is the richest source of natural Vitamin C which improves the natural immunity of the body. 100 gm of gooseberry juice contains 30 times more vitamin C than 100 gm of oranges.
Improving nutrition is the first step. It plays an important role in the fight against disease. Sour things particularly curd, are strictly prohibited. Fried things, pulses and various preparations of pulses are also contraindicated in this condition. Bitter vegetables like bitter variety of drumstick, neem flowers and bitter gourd are very useful. Wheat is better than rice for the patient.
Refined food preparation items like oil ghee or other solid and liquid finished food products must not be taken at all.
|The Ayurvedic treatment for cervical spondylosis s a three-fold approach:
- Elimination (Shodhanam), of the accumulated toxic products of digestion, metabolism and the disease process
- Pacification (Shamanam) and correction of the entities responsible for altered functioning
- Rejuvenation (Rasayanam) of the bodily tissue to regain and maintain natural strength and vitality.
Vata, the principle of movement is the predominant function with the muscloskeletal (also known as the locomotor system) and the nervous system. Problems relating to these systems are predominantly caused by vitiated Vata. The vitiation of vata is caused by two mechanisms. One of them is obstruction to vata due to malfunctioning of kapha and pitta. The other one is increase of vata independently (the degenerative problems).
Exercise your neck and keep active and aim to keep your neck moving as normally as possible. As far as possible, continue with normal activities. Some people wearing a neck collar for long periods, when a flare-up of neck pain developed, may cause the neck to 'stiffen up'. So, try to keep your neck as active as possible. Professionals who spend hours doing desk work or in front of the computers should take small breaks in between and try and do simple neck exercises.
Some of those neck pains and stiffness which does not improve in spite of exercise and medication are most certainly due to stress. When a person is in constant stress the muscles in the neck goes into spasm and causes pain and stiffness in the neck so it is very important for the doctor to identify the cause and treat it accordingly.
Violent massage with deep pressure is very harmful on patients suffering from cervical spondylosis. Only a gentle massage over the muscles of the neck and shoulder joints should be applied and for this purpose Mahanarayan tailam is best suited. This gentle massage is directed outwards, that is from the neck towards the shoulders, and can be given 2-3 times a day. In winter season; this medicated oil should be gently warmed before application. This is a physiotherapeutic measure and similar measures are advised even in modern medical system. Modern medical science advises cervical traction in severe cases which exists in Ayurveda in the form of yogic exercises which are aimed at keeping the spine erect. Padmaasana, or Shirshasana may be recommended.
Hot fomentation on the vertebrae of the neck is very useful for this condition. In a big handkerchief about 500gm of salt should be kept on a frying pan till it becomes tolerably hot. This should then be applied over the neck. Those suffering from cervical spondylosis may not able to feel the quantum of heat applied during fomentation as they sometimes develop anaesthetic patches in the back, neck, shoulders and arms because of the pressure from nervous systems. Be sure to check the heat of the bolus before applying it on the affected parts.
This fomentation should be continued about 30 minutes every day. After fomentation the affected part should not be exposed to cold wind. In winter season therefore immediately after fomentation, the affected part should be covered with some woollen garment. In other seasons also the affected part should be kept covered with some cotton garments after fomentation. It is very convenient to take the fomentation before bedtime.
To recover from cervical ailments, the patient should not suffer from constipation. Constipation leads to vitiation of Vata and formation of gas, which may increase bouts of increased pain in neck.
Simhanada Guggulu is the best medicine for the treatment of cervical spondylosis. It is given in a dose of 2-4 tablets, 4 times a day. Usually hot water or hot milk is given to the patient after the administration of this medicine. This medicine has a slight laxative effect.
For patients having clear motions, this medicine should be given in a dose of 2 tablets and constipated patients the dose should be 4 tablets. If the constipation is not relieved even by taking 4 tablets the dose can be further increased to 6 tablets. At night some medicines should be given to the patients, which will act as a purgative.
Triphala powder is the best medicine for constipation. One teaspoonful of triphala should be given to the patient, mixed with a cup of warm milk and one spoon of sugar.
If the motions become regular by the intake of simbanada guggulu, then triphala powder should be given only twice a week otherwise it can be given every day.
Most of the patients respond very well to Ayurvedic treatment of cervical spondylosis as the principles of healing are focussed on balancing the Vata. The vitiated vata is controlled by herbs like Kaishora Guggulu, Aloe vera juice, Yogaraja Guggulu and Stress Support, as stress also causes stiffness in neck joints and Ashwagandha is the herb which is beneficial in stress related muscle stiffness. It is also a good natural anti-inflammatory herb without any side effects.
There are sometimes very painful conditions in cervical spondylosis, where pain and inflammation needs to be tackled quickly. There are very common herbs for painful joints which work instantly. They are dry ginger, turmeric (Curcuma longa), fenugreek (Trigonella foenum-graecum, methi), ashwagandha (Withania somnifera, Indian ginseng), Nirgundi (Vitex negundo, five-leaved chaste tree, sindhuvara), sallaki (Boswellia serrata), Guggul, and Giloy (Tinospora cordifolia). The extracts of these herbs are more effective in reducing the pain and inflammation of all types of arthritis and joint pains.
Panchakarma therapies are recommended for a period of 7 to 28 days depending on the severity of the disease. The therapies for cervical spondylosis comprise of are:
Abhyangam: This is a whole body massage with select warm herbal oils.
Swedam - medicated steam bath
Nasyam: This is administration of medicated oil through the nose. It cleanses accumulated Kapha toxins from the head and neck region.
Elakizhi: An innovative classical massage with medicated leaves used to provide relief from joint pain, muscle cramps, stress and arthritis.
Shirodhara is the pouring a continuous stream of medicated oil, buttermilk etc on the forehead and simultaneously doing a gentle and soothing head massage. This therapy, given along with abhyangam achieves deepest healing effects by naturally harmonizing body, mind, soul and the senses.
Shiro vasti: This is a special technique of bathing the head in medicated oils using a special chef cap like apparatus.
Pizhichil: This is a very intensive treatment where medicated fluid, mostly oils, is poured all over the body of an individual for 60 minutes every day for a period ranging from 7 to 21 days. It is effective in a wide range of conditions including rheumatoid arthritis, slipped disc, cervical spondylosis, osteoarthritis, partial paralysis, total paralysis and sciatica.
Shastika Sali Pinda Swedam/ Navarakizhi: A highly effective rejuvenation technique using a special type of rice that is cooked, tied into boluses and dipped into an herbal decoction and warm milk and then skilfully massaged all over the body after the abhyangam.
Greeva vasthi: It is a treatment done on to the neck to decrease cervical spinal compression.
Prevention and Lifestyle
Many cases are not preventable. Preventing neck injury (such as by using proper equipment and techniques when playing sports) may reduce your risk.
|Pay special attention to the manner in which the patient sits especially while reading, writing or doing any work on a table. The height and distance between the chair and table should be such that the patient can comfortably reach the table top. The back and the neck must remain straight. See that these two portions of the body do not bend at the table. In other words, the spine and the neck muscles should not feel any pressure.
Never read or write while lying down or while lying on the stomach on the bed or the floor.
Don’t resort to head bath if the cervical spondylosis pain is acute.
Quit the habit of sleeping on sponges or soft mattresses. Instead, choose a hard mattress.
Even while walking, walk straight with the shoulders straight, chest out, stomach tucked in and the head held high.
Make morning walk a habit. It gives considerable relief to the patient suffering from this condition. However, don’t venture outside if the weather is too cold. In cold weather or climate, always don a woollen scarf around the neck.
Many resort to neck exercises under the false impression that the pain may be due to muscle cramps. Beware! Such forced pressure on the neck also has adverse effects on the already weak spine and its vertebrae. The symptoms and the condition would only accentuate. Hence, it is always advisable to consult the doctor prior to resorting to any exercises by patients suffering from cervical spondylosis.