Cervical Arthritis: Exploring Conservative Therapies

For individuals with cervical arthritis, can physical therapies help manage symptoms and bring pain relief?

Cervical Arthritis

Cervical spondylosis, more commonly known as cervical arthritis or arthritis of the neck, refers to the wearing down of neck bones, discs, tendons, ligaments, and joints. The primary symptoms are neck pain and stiffness. However, it is also possible to have cervical spondylosis and not have any symptoms. The condition affects over 85% of individuals over age 65. (American Academy of Orthopaedic Surgeons, 2021) Treatment can consist of conservative therapies and includes physical therapies, alternative medicine therapies, at-home self care, and over-the-counter and prescription medications. Severe cases of cervical spondylosis are treated with surgery to repair damaged parts of the spine.

Symptoms

Neck pain and headaches at the back of the head are usually the first symptoms. (Kazeminasab S. et al., 2022) The neck can also feel stiff, with worse morning symptoms that improve throughout the day.  (Johns Hopkins Medicine, 2024) Symptoms can range from mild discomfort to severe pain. As cervical spondylosis progresses, individuals can experience:

• Inability to turn the head or bend the neck.
• A clicking or grinding noise when turning the neck.
• Tenderness with pressure on the neck.
• Pain that radiates to the shoulders or shoulder blades.
• Pain and symptoms that disrupt sleep, sometimes causing waking up throughout the night.
• Symptoms that decrease with rest.

More severe symptoms include:

Cervical Bone Spurs – Osteophytes

Some with cervical spondylosis have bony growths that can place pressure on the spinal nerves (a pinched nerve) (Bon Secours, 2024). Compression of spinal nerve roots produces cervical radiculopathy, which leads to pain, tingling, and weakness that radiates into the shoulders, arms, and hands.

Cervical Myelopathy

This refers to spinal impingement that leads to spinal cord dysfunction. (Spinal cord dysfunction is a nervous system disorder with interruptions in the spinal cord’s motor, sensory, and autonomic functions.) Symptoms include pain, tingling, numbness, muscle spasms, and weakness in areas below the neck. Spinal cord dysfunction can affect mobility, hand use, and bladder or bowel function control.

Causes

Where degenerative changes are commonly associated with cervical spondylosis, other conditions, and factors can lead to it and include:

Autoimmune Diseases

• Rheumatoid arthritis and psoriatic arthritis can cause chronic inflammation in the cervical spine.

Trauma

• Neck trauma, including injury and repetitive stress on the neck.
• Cervical spondylosis is commonly seen in occupations that involve neck-stressing activities, such as sports.

Age

• Wearing down of the spinal discs cartilage between the vertebrae.
• Developing cervical spondylosis increases with age, especially after 40. (Kazeminasab S. et al., 2022)

Genetics

• Genetic components have been identified in connection with cervical spondylosis, meaning that some types of arthritis that lead to spinal damage are hereditary. (Kazeminasab S. et al., 2022)

Treatment

Treatment begins conservatively, using protocols to preserve function and avoid surgery. Nonsurgical treatments include medications, physical therapy, at-home exercises, and alternative medicine. The treatment method a healthcare provider chooses will depend on how severe the spondylosis is and other factors like age, how much pain is being experienced, the cause, and overall health. The main objectives are to relieve pain, prevent long-term damage to the spinal cord and nerves, and help maintain performing daily activities. (Bon Secours, 2024)

Medications

Medicines used to treat cervical spondylosis include:

Nonsteroidal Anti-inflammatory Drugs NSAIDs

• NSAIDs, including ibuprofen and naproxen sodium, are available without a prescription to relieve pain and inflammation.
• A healthcare provider can prescribe a more powerful NSAID to help manage severe symptoms.

Corticosteroids

• A corticosteroid injection or a short course of an oral corticosteroid, like prednisone, can ease pain and reduce inflammation.

Muscle Relaxants

• If cervical spondylosis causes muscle spasms, a healthcare provider can prescribe cyclobenzaprine, a muscle relaxant, to manage symptoms.

Antidepressants

• Some types of antidepressants can ease neck pain from cervical spondylosis.

Anti-seizure Meds

• Some anti-seizure drugs can cause nerve pain resulting from damaged nerves.

Physical Therapies

• Physical therapy will help manage pain and stiffness and keep muscles loose and relaxed.
• A physical therapist will teach the patient exercises to stretch and strengthen neck and shoulder muscles.

At-Home Self Care

At-home exercises can help relieve pain, stiffness, and swelling. Some can include:

• Reducing inflammation and stress on the neck through posture training.
• At-home targeted stretches and exercises will help bring pain relief.
• Ice treatment reduces swelling.
• Heat will increase circulation.
• A neck brace may be recommended briefly to avoid muscle weakness and stiffness.

Alternative Medicine

• Chiropractic adjustments and massage therapy are alternative treatments that will help manage cervical spondylosis.
• Chiropractic adjustments can relieve neck pain and stiffness. (American Chiropractic Association, 2024)
• X-rays are done before to ensure it is safe. (Jenkins H. J. et al., 2018)
• Acupuncture can also be beneficial in reducing neck pain and increasing energy circulation. (Gu C. L. et al., 2019)
• Various therapeutic massage therapies will help relieve neck pain and stiffness. Talk to a healthcare provider before starting treatment so they can advise on whether neck massages are safe.

Surgery

A healthcare provider may recommend surgical treatment when all other treatments have failed, if neurological symptoms are severe, or if neck arthritis causes extreme pain or disability. Surgery to treat cervical spondylosis can involve removing bone spurs, part of the cervical vertebra, or a herniated disc. The removed portions of the cervical spine are fused with hardware and bone grafts.

Injury Medical Chiropractic and Functional Medicine Clinic

Chiropractic therapy is among the more conservative treatment options and may be tried first before proceeding with surgery. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution.

Arthritis Explained

References

American Academy of Orthopaedic Surgeons. (2021). Cervical spondylosis (arthritis of the neck). orthoinfo.aaos.org/en/diseases–conditions/cervical-spondylosis-arthritis-of-the-neck/

Kazeminasab, S., Nejadghaderi, S. A., Amiri, P., Pourfathi, H., Araj-Khodaei, M., Sullman, M. J. M., Kolahi, A. A., & Safiri, S. (2022). Neck pain: global epidemiology, trends and risk factors. BMC musculoskeletal disorders, 23(1), 26. doi.org/10.1186/s12891-021-04957-4

Johns Hopkins Medicine. (2024). Spinal arthritis (arthritis in the back or neck). www.hopkinsmedicine.org/health/conditions-and-diseases/spinal-arthritis

Bon Secours. (2024). Cervical osteoarthritis (arthritis in the neck). www.bonsecours.com/health-care-services/spine-care/conditions/cervical-osteoarthritis

American Chiropractic Association. (2024). Neck pain. www.acatoday.org/patients/neck-pain-and-chiropractic/

Jenkins, H. J., Downie, A. S., Moore, C. S., & French, S. D. (2018). Current evidence for spinal X-ray use in the chiropractic profession: a narrative review. Chiropractic & manual therapies, 26, 48. doi.org/10.1186/s12998-018-0217-8

Gu, C. L., Yan, Y., Zhang, D., & Li, P. (2019). An evaluation of the effectiveness of acupuncture with seven acupoint-penetrating needles on cervical spondylosis. Journal of pain research, 12, 1441–1445. doi.org/10.2147/JPR.S199798