ATHLETIC EDGE
Sports Medicine
Sports Injury Prevention & Rehabilitation
 540 BRYANT ST, PALO ALTO, CA 94301
(650) 815-6552

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Neck Arthritis

(Also known as Neck Osteoarthritis, Cervical Degeneration, Spinal Degeneration, Cervical Spondylosis)
 
Note -  Although the term 'neck osteoarthritis' would most accurately describe the condition in this document, the term 'neck arthritis' will be used as it is more widely known.
 
What is neck arthritis?
Neck arthritis is a relatively common condition characterized by wear and tear to the joints of the neck over time. It is usually seen in older patients (> 60 years of age) and may cause a variety of symptoms such as pain and stiffness in the neck.
The spine comprises of many bones known as vertebrae each of which has a large hole in its center. Because these bones are situated on top of each other, their holes line up, forming the spinal canal. This canal provides protection and space for the spinal cord and nerves to travel from the brain to the rest of the body. Each vertebra connects with the vertebra above and below via two types of joints: the facet joints on either side of the spine and the disc centrally. There are also small holes on each side of the spine known as intervertebral foramen (IV foramen). These are located between adjacent vertebrae and allow nerves to exit the spinal canal.
Over time, wear and tear to the discs, joints and bones can occur resulting in degenerative changes to the spine. These degenerative changes may include decreased disc height, loss of joint cartilage, bony spurring (osteophytes) and thickening of bone. This condition is known as neck arthritis (osteoarthritis). As the condition progresses the spinal canal and intervertebral foramen can begin to narrow and may eventually place pressure on the spinal cord and nerves resulting in a variety of symptoms.

Signs and symptoms of neck arthritis
Many patients with minor neck arthritis may experience little or no symptoms. As the condition progresses patients may experience pain and stiffness in the neck and a reduced available range or neck movement. In more severe cases involving spinal cord or nerve compression, pain, pins and needles, weakness or numbness may be experienced in the neck, upper back, shoulders, arms or hands. Occasionally, headaches may also be present.
Patients with neck arthritis generally experience an increase in symptoms during activities that repetitively or continuously straighten or extend the neck. Symptoms may also increase during end of range neck movements (such as turning the neck to one side fully), during lifting or with prolonged slouching (particularly when sitting). Symptoms tend to ease when lying down (in good posture) or upon applying warmth to the neck (such as during a warm shower).

Diagnosis of neck arthritis
A thorough assessment from a physician combined with appropriate investigations is usually required to diagnose neck arthritis. An X-ray of the spine will typically demonstrate degenerative changes associated with the condition. Other investigations such as CT scans, bone scans or MRI's may also be indicated to assess the severity and to determine the exact structures that are affected.

Treatment for neck arthritis
Patients with neck arthritis are generally managed well with appropriate physical therapy. Whilst little can be done to reverse the degenerative changes to the spine, patients can generally remain active by modifying their activities appropriately. The primary goal of treatment is to remain as active as possible without aggravating symptoms in order to maintain strength and mobility and to avoid deterioration. This can be achieved by having regular breaks from levels of activity that increase symptoms with positions of comfort. Activities should be balanced ideally to prevent any increase in symptoms. A gradual increase in activity and exercise can occur provided symptoms do not increase.
Exercises placing minimal force through the neck should be performed to maintain fitness, strength and mobility provided they do not increase symptoms. This may include regular walking, hydrotherapy exercises or gentle range of movement and strength exercises as determined by the treating physical therapist. It is also important to maintain good posture (or as close to good posture as possible without increasing symptoms) to minimize stress on the neck.
Patients should follow RICE for the first 72 hours following significant aggravation of their condition or when inflammatory signs are present (i.e. morning pain or pain with rest). For neck arthritis, this should primarily involve rest from aggravating activities (this may include the use of a postural support or postural taping) and regular icing. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation.
When inflammation is not present, the use of a heat pack and massage can be of benefit to relieve symptoms and assist with maintaining and improving neck range of movement.

Physical therapy for neck arthritis

Physical therapy treatment for patients with neck arthritis is important to assist with pain relief, improve flexibility and strength, and to ensure an optimal outcome. Treatment may comprise:
  • soft tissue massage
  • electrotherapy (e.g. ultrasound)
  • mobilization
  • traction
  • dry needling
  • postural correction
  • use of a postural support
  • ce or heat treatment
  • education
  • activity modification advice
  • clinical Pilates
  • hydrotherapy
  • exercises to improve flexibility, strength, posture and core stability

Other intervention for neck arthritis
Despite appropriate physical therapy management, some patients with neck arthritis continue to deteriorate. When this occurs, other intervention may be required. This may include pharmaceutical intervention, corticosteroid injection, the use of supplements such as glucosamine and chondroitin, investigations such as an X-ray, CT scan, bone scan or MRI, or assessment from a specialist. The treating physical therapist can advise on appropriate management and can refer to the appropriate medical authority if it is warranted clinically. In more severe cases of neck arthritis involving spinal canal stenosis or nerve compression, surgery may be required to relieve the pressure on the spinal cord or nerves.