Are there some cervical spondylosis exercises that I can do?

As a practicing orthopedic physical therapist, I treat people with neck pain almost every day. Degenerative changes in the neck are so common that I would be surprised to see someone over 60 not have them. However, many people do not have symptoms. But for those that do, it can be very disabling. Degenerative changes in the neck is known as cervical spondylosis. The good news is that it tends to respond very well to treatment and there are cervical spondylosis exercises that you can do at home. Read on to learn more about this condition and what you can do to treat it. Let’s start with anatomy!

The spine

In order to understand cervical radiculopathy, you need to be familiar with the structure of the spine. The spine is made up of 33 vertebrae. The vertebrae are the bones of the spine. Each is stacked on top of one another to make a column. The spinal cord travels through the column with nerves exiting at each vertebral level. The first 7 vertebrae make up the cervical or neck region. The middle 12 vertebrae are the thoracic or mid back region. The next 5 vertebrae are the lumbar, which is also known as the low back. The next five make up the sacrum which is the triangular bone at the base of the spine. The sacral vertebrae are fused meaning they have grown together. The last 4 vertebrae are also fused. This is the coccyx or tailbone. The discs are in between the cervical, thoracic, and lumbar vertebrae. The sacrum and coccyx have grown together and have no space between the vertebrae for a disc.

“Radiopaedia – Drawing Iliotibial band – English labels” by Matt Skalski, license: CC BY-NC-ND

The cervical spine

The cervical spine is made up of 7 unique vertebrae. It’s job is to support and soften loads to the head and neck while allowing movement. It also functions to protect the spinal cord. The cervical vertebrae are named C1 through C7. C1 is the first vertebra below the skull and C7 is the last vertebrae of the cervical spine.

“Anatomy Standard – Drawing Cervical Part of Columna Vertebralis (C1-C7): lateral aspect – Latin labels” by Jānis Šavlovskis and Kristaps Raits, license: CC BY-NC

The cervical spine has 8 cervical nerve roots. These nerve roots come off of the spinal cord and travel between the vertebrae at each level. The cervical nerves provide sensation and movement to our neck, shoulders, arms, and hands. Each nerve root innervates a different area of the body.

“RCSI – Drawing Dermatomes C2-T1: anterior and posterior view – labels” by Royal College of Surgeons of Ireland, license: CC BY-NC-SA

Along with the vertebrae, discs, and nerve roots, the cervical spine has many other structures which allow it to smoothly function. These include joints between the vertebrae which allow movements and several ligaments which add stability to the spine.

Let’s talk about the discs

The spinal discs are the shock absorbers of the spine. The disc sits in between each vertebrae and creates space between the vertebrae. This space allows the joints and the spine to move freely. The disc has very dense, tough outer rings and a soft, jelly-like core. This allows it to absorb the various forces through the spine. As we age the disc begins to dry out and lose height, and the boney vertebrae become closer together. This is the beginning of cervical spondylosis. It can lead to bone spurs or osteophytes in the joints of the spine and degenerative changes of the ligaments.

“OpenStax AnatPhys fig.9.3 – Intervertebral Disk – English labels” by OpenStax, license: CC BY. Source: book ‘Anatomy and Physiology’, https://openstax.org/details/books/anatomy-and-physiology.

So what exactly is cervical spondylosis?

Cervical spondylosis is condition that refers to the degenerative changes to any structure of the cervical spine. This includes the vertebrae, joints, ligaments, and discs. This can lead to compression of nerve roots, blood vessels, and the spinal cord. Cervical spondylosis can present in 3 different forms with different symptoms for each form.

Non-specific neck pain – This is when pain is located only in the neck and upper back region.
- Symptoms include
  - Stiffness and pain in the neck
  - Decreased motion in the neck
  - Pain is worse when upright and improves when lying down
  - Pain is worse when looking over the affected shoulder
  - Pain may radiate up the head, down to the shoulder, or into the upper back
- Cervical radiculopathy – This is when there is compression of a nerve root. It can cause numbness, pain, or loss of strength in the area of innervation. This will typically present in the arm or hand.
  - Symptoms include
    - Pain on one or both sides of the neck
    - Pain, numbness, and/or weakness in the shoulder, arm, and/or hand
    - Symptoms increase with tilting the head or looking over the shoulder toward the affected side.
  - Cervical myelopathy – This is when the spinal cord itself is being compressed.It can cause a whole slew of symptoms throughout the body.
    - Symptoms include
      - Neck pain may or may not be present
      - Hand weakness and clumsiness – difficulty tying shoes or buttoning a shirt
      - Coordination and balance problems – unexplained falls
      - Numbness
      - Problems with bowel or bladder – tends to occur later in the progression of the condition

How common is cervical spondylosis?

Cervical spondylosis becomes increasingly common as we age. There is evidence of cervical degeneration of 25% of adults under the age of 40, 50% of adults over the age of 40, and 85% of adults over the age of 60. Most of these adults show no symptoms and have no pain. For those that are symptomatic, neck pain is the most common symptom.

What are the risk factors?

There are severe risk factors associated with cervical spondylosis. These include:

More common in females
Increased age
Degeneration of the discs
Significant or repeated spinal trauma
Congenitally narrow vertebral canal
Dystopia cerebral palsy
Sports such as American football, soccer, rugby, and horse riding

Will I need surgery?

The answer is probably not. Most can be treated with conservative measures such as physical therapy, medications, and possible injections. Surgery is typically not performed with the exception of the following conditions:

Progressive or severe cervical myelopathy
Persistent neck pain that did not improve with non-operative treatments
Cervical radiculopathy that did not improve with non-operative treatments

Who do I see?

Physical therapy – Physical therapy is the mainstay treatment of cervical spondylosis and we see it A LOT. Hence, we are pretty good at treating it. Treatment could include joint mobilization or manipulation, soft tissue mobilization, dry needling, stretching, and strengthening. Your PT should be able to help decrease your pain while helping to improve your mobility, posture, and strength.
Primary care physician – Your primary care physician can examine you and provide medications such as anti-inflammatories or muscle relaxers if appropriate. Imaging might also be ordered to provide more detailed information. A referral to a specialist might also occur depending on your symptoms and the results of the imaging.

What can I do?

Aerobic – Performing low impact aerobic exercise is very beneficial for the spine.It increases the flow of nutrients and blood. Examples of low impact aerobic exercise include walking, swimming, and biking. If you don’t currently have an exercise program, then carefully work into one. You might begin by walking for 5 to 10 minutes a day and slowly work up to 30-60 minutes over several weeks or months. Be sure that whatever you choose does not exacerbate your symptoms.

Ice – Ice can help decrease pain in the neck, shoulder, or upper back. Ice the painful area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or is preventing you from participating in an activity. Ice immediately after activity.
Posture – Having forward rounded shoulders causes the chin to poke forward and the neck to forward flex. This takes the cervical spine out of its natural alignment. If the pectorals and biceps are tight, they will cause the shoulders to round. Below is a video showing how to stretch the pecs and biceps and also how to use a wall to check your posture.
- Doorway pec stretch, bicep stretch, posture at wall

Strengthen and stretch the muscles around the cervical spine – Strengthening the deep neck flexors are vital in strengthening the neck and being able to maintain proper posture.The deep neck flexors are attached to the vertebrae and are the key stabilizers of the cervical spine. The upper trapezius and levator scapula are muscles that attach to the neck and shoulder. These muscles are commonly tight and can cause neck pain and headaches. Below is a video on how to strengthen the deep neck flexors and stretch the upper trapezius and levator scapula.
- Cervical exercises

Strengthen the scapular stabilizers –The scapular stabilizers are the muscles around the shoulder blade which help stabilize the shoulder joint while your arm is performing different activities. They are also very important in maintaining good posture. Activating these muscles will help properly align the thoracic spine which will help with proper posture of the cervical spine. The videos below review some strengthening exercises for the scapular stabilizers. Using loop resistance bands and resistance bands can increase strength and difficulty.

- Scapular stabilization

Latex pillow – There has been some research showing that an ergonomic latex pillow can help decrease neck pain. The pillow can support the spine and the head which can improve sleep and decreased pain.

In review

The cervical spine is made up of 7 unique vertebrae (spinal bones).
- It’s job is to support and soften loads to the head and neck while allowing movement.
The cervical spine has 8 cervical nerve roots.
The cervical nerves provide sensation and movement to our neck, shoulders, arms, and hands.
- Each nerve root innervates a different area of the body.
Along with the vertebrae, discs, and nerve roots, the cervical spine has many other structures which allow it to smoothly function.
As we age the disc begins to dry out and lose height, and the boney vertebrae become closer together.
- This is the beginning of cervical spondylosis.
- It can lead to bony spurs or osteophytes in the joints of the spine and degenerative changes of the ligaments.
Cervical spondylosis is condition that refers to the degenerative changes to any structure of the cervical spine.
Cervical spondylosis can present in 3 different forms with different symptoms for each form.
- Non-specific neck pain
- Cervical radiculopathy
- Cervical myelopathy
Cervical spondylosis is very common above the age of 40 but many are asymptomatic.
Physical therapy is the preferred treatment for those suffering from cervical spondylosis.
Surgery is considered in certain cases.
Your primary care physician might be needed if your condition is not responding to PT.
There are things that you can do.
- Aerobic exercise
- Ice
- Posture
- Strengthen and stretch the muscles around the cervical spine
- Strengthen the scapular stabilizers
- Ergonomic latex pillow