DEGENERATIVE CERVICAL SPINE
At one time or another, most people have experienced neck pain. In the vast majority of cases, this is a benign, self-limited complaint. Symptoms are commonly described as a soreness or stiffness of the neck, which may or may not be associated with a minor injury. Patients often attribute this to a "cold wind" or "sleeping wrong" that may or may not be a factor. Most commonly, degenerative disorders of the spine are responsible. Degenerative "disease" is the changes associated with spinal wear and tear or age. Though among the most frequent causes of neck pain, it is the sometimes the most difficult to treat.
DEFINITION
Degenerative disease of the spine refers to a breakdown of the normal architecture of the various components of the cervical spine. Normally, the neck is very flexible. As you may demonstrate on yourself, the neck allows the head to rotate from side to side nearly 180 degrees, to flex forward to touch your chin to your chest, and extend backwards to almost touch the back of the head to your upper back, as well as bend your head toward your shoulder. These motions are afforded by the various joints of the cervical spine.
There are seven cervical bones in the spine known as vertebrae. The more joints and vertebrae, the more motion is allowed. The cervical vertebrae are connected by three joints. This gives the spine more stability, while still allowing motion. The extremes of motion must be limited because of the fragile "freight" that the vertebrae hold - the spinal cord. The spinal cord is located in the centre of the vertebrae.
Joints are comprised of two opposing surfaces of bone. Some joints are covered with smooth, glistening cartilage. The slippery properties of cartilage (car-til-ledge) make the two surfaces move easily in relation to each other. The facet joints of the cervical spine have these properties.
Facet Joints
In contrast, the main joint between two cervical vertebrae is made up by a large spongy mass, the intervertebral disc. This disc sits between the two broad flat surfaces of the vertebral bodies. The disc is made up of specialised materials that act as a soft "glue" between the bones, while still allowing them to move. The disc is extremely important to spinal stability. However, it is a frequent site of degeneration or breakdown.
Vertebral Segment
The disc can be considered as a firm, shock-absorbing pad in between two bones. This can softly resist the downward forces placed on the vertebrae from the weight and movement of the head. The pad allows some movement between the vertebrae, but because the pad is well fixed to both bones, it resists the tendency of the bones to become misaligned. With time and use the gelatinous pad can become flattened.
In this state the disc no longer provides adequate cushioning between the vertebrae. The bones then come closer and closer together. Because the disc is no longer sustaining the forces that it usually does, the other joints of the spine are forced to take on these extra loads. The two smaller sliding joints have greater demands placed on them.
Since they were designed to sustain only a small portion of the forces of the spine, the previously glistening, healthy cartilage starts to breakdown. As the cartilage degenerates, the underlying bone becomes exposed and an inflammatory reaction begins. This causes irritation of the joint, which can lead to pain. This sets up a vicious cycle of events. The more the facet joints become degenerated, the less they are able to tolerate the increased demands. Thus, greater demands will then be placed on the intervertebral disc, causing it to further degenerate (or breakdown) as well. The changes in the intervertebral disc and facet joints are not reversible at this time.
PHYSIOTHERAPY CAN HELP
Neck pain can be successfully treated with physiotherapy. You don’t need a doctor’s referral. The physiotherapist will investigate the pain and determine its cause. Treatment depends on the cause, but may include:
- Soft tissue massage
- Mobilisation to stretch tight muscles and ligaments
- Special exercise programs
- Acupuncture
- Relaxation therapy
- Various treatments such as heat or ultrasound treatment
- Information on how to correct postural problems.
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