CERVICAL SPONDYLOSIS AND ITS AYURVEDA MANAGEMENT

CERVICAL SPONDYLOSIS

Spondylosis is a term meaning to degenerative Osteo Arthritis of the

joints between the centre of the spinal vertebrae and or neural foramina
resulting pain paraesthesia etc. If it is occurs on cervical vertebrae it is called Cervical spondylosis. So this is a diseases of elderly (more than 40 years) where there is degeneration of the apophyseal joints and inter-vertebral disc joints with osteophyte formation and associated with or without neurological signs.

PATHOLOGY:

With the progressing of age in the spine disc gradually breakdown and degeneration occurs. As the age advances disc begins to loses its water content, elasticity begins to weakens and age related wear and tear affecting the cervical vertebrae, cause settling and collapse of the disc space and loss of the disc space height.

As the facet joint experiences increased pressure they also begins to degenerate and develops arthritis. Resulting in bone rubbing. for this mechanism body develops some preventing measures as a result growing new bones in facet joins to help support, further result as spur. It may narrow space between the vertebrae (stenosis). Due to age and some other factors brings down the calcification leading to extra bone formation known as osteophytes.
Due to trauma, pressure etc some factors like intra vertebral disc herniation may also result to cause this disease.

INTRA VERTEBRAL DISC HERNIATION:

The disc are made up of two concentric layers, The inner gel like annulus pulposes and outer annulus fibroses. As a result of advancing age and other precipitating causes the nucleus loses fluid volume and resulting the entire disc structure become more susceptible to trauma compression (dehydration of the disc). The disc is then highly vulnerable to tears and wears. As a results inner annulus pulposes protrudes thereby fibrosis layer produce bulges in the disc (herniated disc) cause compression to the spinal cord and nerve root. When space narrows compression of nerve root emerging from spinal nerve may result radiculopathy (sensory and motor disturbances), direct pressure on the spinal cord may result myelopathy, weakness,  gait disturbances, loss of bowel and bladder control. May experience phenomena of numbness or burning sensation on hand and legs.

CAUSES and  AGGRAVATING FACTORS:

• Trauma
• Incorrect posture while sleeping and working.
• Excess intake of sour and spicy food- cause to early degeneration.
• Genetically
• Smoking- tends to increase the disease and other symptoms.
• Occupational- reduced physical activity, sedentary habit, stress,
• Repetitive strain injury (RSI)- caused due to lifestyle without ergonomic care (while working in front of  computer), travelling, etc.
• Age. 
• Cold food, direct exposure of wind, heavy meal at night time, heavy exercise, use of improper pillow, lack of sleep at night and sleeping during day time, etc may aggravate the condition.  

SYMPTOMS:

• Pain and stiffness of neck and shoulder.
• Radiating shoulder pain to arms and upper part of chest.
• Tingling and pricking pain in arms and hand.
• Difficulty in writing , holding objects etc.
• Abnormal reflexes and irritability and lack of co-ordination, movements aggravates pain.
• Nausea (vomiting sensation), blurred vision, loss of memory, sleeping, giddiness on jerky neck movements.
• General tiredness and anxiety.
• Fibromyalgia.
• Feel or hear grinding or popping in neck.

Symptoms aggravated in sometimes, worsened by looking up or down for a long time or with activities like long driving, reading etc. Subsides with rest or lying down. these may worsened in early morning while waking up from bed.

What is FIBROMYALGIA:

It is an associated symptom, but a different condition. pain in muscles following spasm associated with morning stiffness, disturbed sleep, a feeling of swelling, some points are tender and when palpated produce pain. But it is not associated with muscle weakness. The pain is severe and it is localized to certain points in skeletal muscles, particularly the large muscles of neck and shoulder girdle, arms and thigh. Tender nodules can be felt in the muscle tissue, which serve as a trigger points. Many of the patients are tense sedentary women.

INVESTIGATIONS AND DIAGNOSIS:

Through inspection and investigation is needed to diagnose this case. A detailed inspection and palpation is needed to locate any swelling and tenderness. Tenderness is a positive sign for cervical spondylosis .
it is needed to know that the exact location of pain, onset (gradual), occurrence, character and severity, aggravating and relieving conditions, etc.
History should be asked.

• Inspect and palpate the spine for deformity and for cervical rib.
• Peripheral pulses in detail.
• Movement of cervical spine and shoulder joint.
• CNS examination-motor, sensory and reflex change.
• Respiratory symptoms for pancoast tumor , TB.
• Spurlings test- rotate the patients head and placing downward pressure on it. a positive sign is neck or shoulder pain on he ipsilateral side. Radicular symptoms on extension and lateral rotation of neck due to narrowing of inter vertebral foramina.
• Lhermitte sign- feeling of electrical shock with neck flexion.

X-RAY:

AP and LATERAL view of neck x-ray is useful to find any spur, reduction in space, osteophyte formation, and cervical rib formation.

 CT-

 Helps to view bone and spinal canal.

 

MRI:

Get better image of soft tissue, spinal cord compression if any, degree of compression etc.

MYELOGRAPHY- X-RAY STUDY:

Injecting due or contrast material into spinal canal for evaluating spinal canal and nerve root.

EMG ELECTROMYOGRAPHY:

Nerve conducting study and EMG for evaluating nerve damage and pinching.

BLOOD TEST: To rule out any other diseases,

DIFFERENTIAL DIAGNOSIS: 

Neck pain may be due to spinal causes, extra spinal causes, or due to myalgia, etc.

Spinal- mechanical (OA, herniation)
Inflammatory (RA, polymyalgia rheumatica)
Metabolic (osteoporosis)
Spinal (metastasis)
Neoplasmic.
Extraspinal-
Brachial plexus pain.
Injury, Peri arthritis, bursitis, pancoat tumour of lung, soft tissue rheumatic pain, trauma.
CTS- carpel tunnel syndrome
Coronary artery disease.

NEUROLOGICAL SYMPTOMS IN RADICULOPATHY:

SENSORY DISTRIBUTION  - PAIN DISTRIBUTION

• C5 over deltoids, +/- index and thumb - Lateral arm and medial scapula.
• C6 thumb, index finger, radial hand, forearm - Lateral forearm, thumb, index finger.
• C7 middle finger, dorsum of forearm- Posterior forearm, dorsal forearm, lateral hand
• C8 little finger, medial hand, forearm - 4th 5th finger, medial forearm.

COMPLICATIONS:

• Chronic neck pain.
• Progressive loss of muscle function or feeling.
• Inability to retain fecal and urine ( fecal or urinary incontinence).
• If spinal cord is effected there will loss of balance and loss of bladder control and bowel control, muscle weakness, sensory loss, and gait disturbances.

TREATMENTS: (all these should be used as directed by the physician)

Hot fomentation is beneficial, hot and cold therapy and gentle massage is helpful. Violent massage with deep pressure is very harmful for the patient. Only gentle massage over the muscles of the neck and shoulder joint should be applied which directed outwards that is from the neck towards the shoulders.

Physical therapy:

Strengthening and stretching of weakened or strained muscles.
Traction and postural therapy.

Medication:

Acetaminophen- mild pain

NSAIDs with Acetaminophen
Ibuprofen and naproxen (pain, swelling)
muscle relaxant like cyclobenzoprene, or corisoprodol.
Soft collars- limit neck motion and give rest. only for short duration. long term duration will cause to muscle weakness.
Ice heat and other modalities, steroid based injections- will reduce pain.

CERVICAL EPIDURAL BLOCK- 

Steroid and anaesthetic medicines is injected into space next to covering of spinal cord. (for neck arm pain due to herniation).

CERVICAL FACET JOINT BLOCK:

Steroid and anaesthetic medicines is injected into the capsule of the facet joint. the facet joints are located in the back of neck and provide stability and movement, can develop arthritic changes that may contribute to neck pain.

MEDIAL BRANCH BLOCK AND RADIO FREQUENCY ABLATION:

This procedure is used in some cases of chronic pain. can be used  for both diagnosis and treatment of a potentially painful joints. During diagnosis portion the nerve that supplies the facet joints is blocked with local anaesthetic and check if pain neck pain is completely gone. If so that point is pinpointed the source of neck pain. Next step is to block the pain permanently by damaging the nerve radio frequency, A procedure called radio frequency ablation. Although less invasive than surgery. Steroid based injection are prescribed only after a complete evaluation by the physician.

Before considering these injunctions discuss with a good doctor about risk and benefits of these procedures for your specific conditions.

SURGERY:

It is preserved only for the patients who have sever pain that has not been relieved by other treatment. Some patients with severe pain will unfortunately not be candidates of surgery. This is due to the widespread nature of there arthritis other medical problems or other causes for their pain such as fibromyalgia. People who have progressive neurological symptoms  such as weakness, numbness or falling are more likely to be helped by surgery.

EXERCISES:

Mild exercise is beneficial for first stages of diseases. Vigorous  diseases are not advisable to these patients. One should always start gradually mild exercises in beginning. And gradually increasing the types and time. There are many types of exercises which mainly concentrates on cervical region. Exercise flexion of neck, extension, rotation etc.

EXERCISES AND CORRECT POSITIONS:

AYURVEDIC APPROACH TO CERVICAL SPONDYLOSIS

The Ayurvedic medicines are for prevention and therapeutic purposes. The basic treatment of Ayurveda is based on the principle of balancing three doshas namely VAATA, PITHA, and KAPHA. In a healthy individual these three are in a balanced proportion and are mainly have the functions like movement, change and metabolism, growth and stability respectively. If there is any change in the nature of the three will cause disease. These functions in a state of equilibrium lead to the health and in-equilibrium lead to disease. The treatments in Ayurveda is aimed at restoring the equilibrium through correction of the underlying in-equilibrium by the treatment like shodhana (purification and elimination), samana (pacification), yoga and naturopathy, By changing the lifestyle and food habit, by maintaining and increasing the spiritual, mental, physical well being, through panchakarma therapies etc.

In these particular disease treatment treatment comprises of three approaches -

shamana chikitsa- 

This includes various drugs are administered to a person to bring the three doshas in equilibrium. This is the choice of the treatment in the persons where panchakarma is not advises. (very young children or very old peoples, or patients who cannot follow strict rules of diet and life styles etc.

shodhana treatment- 

This means removing excess doshas in the body the cause ailments by means of panchakarma. These treatments are double edged swords and need to be undertaken with lot of care. Done correctly they provide quick relief from the symptoms but would prove hazardous if done incorrectly. Also before and after undergoing the panchakarma a person has to strictly follow the diet and lifestyle advised by the physician for a few days. Even if the shodhana therapy done correctly if a patient not follow correct diet and regiment it will cause other complications.

Rasayana therapy- 

Correction of the entities responsible for altered functioning and rejuvenation of the bodily tissue to regain and maintain natural strength and vitality.

According to Ayurveda this disease can be correlate to as  APABAHUKA or GREEVA SANDHI GATA VAATA. Vata the principle of movement is the predominant function with nervous system and musculoskeletal system. any problem relating to these systems are predominantly caused by vata vitiation. The vitiation of vaata is caused mainly by the two mechanisms. One of them is the obstruction of vata to there proper functioning and channel by kapha and pitha, and the second one is increase of vaata independently. The obstruction of vaata will result symptoms and disease like inflammation and fibromyalgia etc as in this case. Aggravation of vata will result some degenerative process, herniated disc, etc.

Treatments in Ayurveda:

Ayurveda treatment protocol is primarily focused on normalizing the vitiated and obstructed vata by means of shodhana and shamana therapy, and to rejuvenate the effected tissue. Since these conditions may also related to the stress, etc recommends a holistic approach with medicines and therapies, life style modifications and diet minimal exercises and yoga.
The therapeutic approach to the two types of vitiation is different. If vata obstruct due to other doshas as in the case of elimination, fibromyalgia etc, Correcting them through shodhana(elimination) and shamana(pacification)is the methods to be adopted. If vaata alone act as in the case of degeneration, etc use medication which arrest the degeneration and further degenerative process, and give rejuvenation therapy.
The treatment can be advised in OP and IP level.
According to the treatment given these disease can be categorised in to three stages.

1st stage- Early progressive stage. only slight symptoms like slight pain occasionally, stiffness there. in these stage should treat the patient with vata-kapha hara medicines and therapies.
2nd stage- Here patient should treated with vata-pitha hara medicines and therapies. In these stage symptoms like pain during movement of neck, stiffness, pain on back of the head, radiating pain to shoulders and arm etc can seen.
3rd stage- Consider as the last stage. in these stage symptoms like nausea, gait disturbances, bladder and bowel incontinence, giddiness etc may be seen. Here pure vaata hara treatment is advisable.

OP LEVEL TREATMENTS:

Kashayas

• Prasaranyadi kashaya
• Maharasnadi kashaya
• Naadee kashaya
• Kasaya prepaird with dashamoola and amukkuram
• Vidaryadi kashaya

Arishta and asava:

• Balarishtam
• Nimbamrtasavam
• Punarnavasavam

Tailam:

• Parinatha kera ksheeradi oil.
• Karpasathyadi tailam.
• Balaguduchyadi- for  head
• Bala aswagandhadi - for head
• Ksheerabala ( 101)- internally.(can also be used as nasya)
• Balahadadi cocunut oil- for head
• Dhanwanthaaram kuzhampu
• Murivenna

Gulikas :

• Yogaraja gulgulu
• Tab-cervilon
• Gandha tailam cap

Lepam:

With kottam chukkadi churna etc

Small types pf treatments like elakkizhi, fomentation etc.

IP LEVEL TREATMENT:

• Snehapana
• Nasya with ksheerabala etc.
• Elakkizhi.
• Naranga kizhi.
• Taila dhara
• Greeva vasthi with dhanwantharam+murivenna.
• Podikkizhi with sathahwadi churna etc.
• Pizhichil
• Navarathepppu.

With all these types of treatments according to the condition of the disease and the patient also should undergone strict exercise and life style. By all these medicines and treatments it is found that very useful to cervical spondylosis and can arrest further progression.

YOGA THERAPIES:

Few yoga postures are restricted for particular complaints. One should start gradually by following few mild process in beginning and gradually increase the steps to relive from pain and to enhance the quality of life style. few yogas are explained here.

PADMASANA-  

Cross the legs keeps the thighs such that both the heels are near the navel. breath normally. It will calms the body and mind. strengthens the nerves and muscles.

 BHUJANGASANA:

Keeps the palms besides the chest. While inhaling raise head and chest up to navel. Keep elbows folded near the body. Breath normally. While exhaling return to normal.

It helps to relieve back pain, diabetes, asthma, neck pain.

PAVANAMUKTHASANA: 

Inhale raise both the legs, exhale press the legs against abdomen touching the chin between the knees. Breath normally, inhale , release the legs while exhaling, return. repeat head should rest on ground.

Helps in curing constipation, diabetes, high blood pressure, obesity, joint pains, and flatulence. In case of neck and shoulder pains.

 UTTANA PADASANA: 

While inhaling lift both legs. Breath normally and exhale as you return. Keeping the knees straight.

Prevents gas formation and strengthens muscles of legs, back, shoulders and varicose veins. Avoid in back pain, lumbar spondylosis, knee pain, ulcer, abdominal surgery.

Here in this picture only mentioned one leg only keep practicing with both leg.

SHAVASANA:

In the supine position relax the whole body and concentrate only on the breathing.

Helps in controlling heart problems, high blood pressure insomnia, and mental  tension. This should be performed at the end of yogasana.

SHALABHASANA: 

Keep both the hands under the thighs, inhale lift both the legs. Exhale and return.

strengthens the lungs, abdominal organs, sciatic nerves, prostate glands, kidney etc. Avoid in hernia ulcer and cardiac problems.

PRANAYAMA:

This is a type of respiratory exercises, some of them are anuloma viloma, nadi shodhana, bhramari. etc.

NATUROPATHY: 

Diet therapy, fasting therapy, mud therapy, hydro therapy, etc. 

HOW TO PREVENT:

 "PREVENTION IS ALWAYS BETTER THAN CURE"

Life style exposure to cold and cold bath etc, very violent exercises of the neck muscles including pressure, are very bad for the patients of cervical spondylosis. While reading and writing should maintain a comfortable posture. Give rest and movement to the neck after a long sitting in front of the computer, long driving. Always try to keep spine and neck in erect position while sitting, walking, sleeping etc. 

Avoid very hot and cold and spicy food items ( avoid its continuous usage).

Sleep well at night, give exercise and proper rest for body and mind.

If any disturbance occurs consult a doctor.

Practice exercise like yoga that will help to calm the body and mind.

Ref: many medical and Ayurveda books, internet etc.
Please comment your experience from this site. Expecting any good suggestions also. Thank you.

by:Dr.Rimin Razak
Thank you.