 Be familiar with the anatomy and function of the intervertebral segment.  Be able to explain the pathology to the patient.  Be familiar with the clinical presentation of a typical patient with Cervical Spondylosis.  Be familiar with the typical objective signs of a patient with Cervical Spondylosis.  Be familiar with the most widely used medical as well as physiotherapy treatment protocols for a patient with typical Cervical Spondylosis.  Be able to give appropriate exercises and advice to a patient with typical Cervical Spondylosis.

 Complex of degenerative changes in a joint with degeneration of the articular cartilage and formation of osteophytes.

 Shows signs of degeneration from 1 8 – 20 years.  Takes place in the spinal movement segment.  Disc determines the amount of movement.  Facet joint the direction of movement.  Result in pain and stiffness with possible referred pain as a result of the pressure that the osteophytes exert on the nerve-roots.  Usually the transitionary areas first (C2/C3 and C7/T1)

 Previous injuries.  Degeneration of joints as a result of injury or normal ageing.  Disc lesions (less common)  Repeated light strain - posture

 Dysfunction  Instability  Stabilisation period

 Older patients  Preceded by injury and/or fatigue  Pain due to synovitis in facet joints  Complain about dull pain behind the neck in the area of m. trapezius  Pain is worse in the morning with visible stiffness

 Sometimes audible crepitations  Pressure of osteophytes on nerve-roots may cause neurological signs.

 Reduced cervical lordosis  Tenderness over the post. paravertebral muscles  Pain through range of movement  Sometimes headache  Stiffness of physiological and accessory movements  Possible neurological signs  X-rays: constricted disc space with osteophytes.

 Change of procedure if posture is the causative factor  Analgesic for severe pain  Anti-inflammatory drugs for synovitis  Surgery if indicated  Supports

 Aim is to obtain the fullest possible pain-free range of movement  Only 75% of symptoms can be alleviated – healing can not take place  Passive mobilisation – direct techniques to Grade 3; indirect techniques if indicated  Intermittent mechanical traction  Heat and other electro modalities  Special soft tissue mobilisations

 Exercises: mobilising, stabilising and strengthening  Care of the neck and advice  Acquiring the correct posture and sound kinetic handling.

 Flexion exercises in supine  Extension exercises in supine  Rotation exercises in supine: strengthening; mobilising  Shoulder mobilising in sitting  Exercises for correct posture against wall  Exercises against self-resistance.

 Keep neck warm and avoid a draft on the neck  Avoid sustained neck positions  Sleep with head in a neutral position and avoid too firm a pillow.  Avoid sudden jerky movements.  Maintain a good posture  Avoid over-fatigue.