Spondylosis is one of the common progressive and degenerative diseases of the spine. Ageing is the prime trigger factor of spondylosis. It starts with some acute and chronic symptoms like neck pain, and gradually it turns into cervical radiculopathy. (Cervical radiculopathy is a condition, where the nerve of the neck is irritated. It happens when the nerve root is pinched by the herniated disc.)

Approx. 95% of the population, above the age of 60, experiences cervical spondylosis with some intensity. In the early stage of the condition, desiccation (severe dryness) occurs in the discs, which leads to the loss of disc height. As a result, it reduces the ability of the disc to maintain and bear additional loads alongside the cervical spine. Spondylosis affects not only cervical (neck), but also thoracic (mid-back), or lumbar (low back) regions of the spine.

Cervical spine (neck):

It is the delicate part of the spine (neck). It houses the spinal cord, which passes messages from the brain to all body parts, controlling the flexibility, movements in all directions, and strength. It is more susceptible to deterioration.

Thoracic spine (mid back):

It is less affected as compared to the cervical and lumbar spine, due to its reduced mobility. If there is spondylosis in this region, there will be an outward curvature of the back, and it leads to hunching of the curve. This condition is called a kyphosis.

lumbar spine (lower back):

It refers to the lower spine or lower back. It carries most of the body weight. It is more prone to have degenerative changes, which impacts on its surrounding structures also, like a disc, spinal cord, spinal nerve, etc., causing difficulty in walking, standing, or lifting any object. For example, radiculopathy is a condition, where one or more nerves are impinged by the osteophytes or bone spurs, causing severe pain.

Where spondylosis can attack

Symptoms of Spondylosis:

The patient of spondylosis may have the following signs and symptoms:

Cervical spondylosis:

According to the Journal of Disease-a-month, the incidence of spondylosis related neck pain is approx. 20-25%, worldwide

  • Neck pain (may radiate to the shoulder or down the arm)
  • Neck stiffness (gets worse over time)
  • Weakness or numbness in the arms or legs
  • Loss of sensation in the arm, shoulder or legs
  • Headache (back of the head)

  • Thoracic spondylosis:

  • Pain in the middle of the back on bending the spine backwards
  • Pain in moving the spine backwards and forwards
  • Lumbar spondylosis:

  • Risk of lumber spondylosis increases above the age of 40
  • Pain and other symptoms aggravate on sitting for a long period
  • The patient suffers from pain and stiff back, particularly in the morning
  • Pain becomes worse with activities like bending or lifting any object
  • Causes of Spondylosis:

    Spondylosis is an age-related process. As the age advances, the bones and ligaments of the spine start wearing, resulting bone spurs or osteoarthritis. In addition, the intervertebral discs degenerate and weaken, and causes bulging and herniation of the disc. Apart from the age, the other factors which trigger the condition, are:

  • Congenital bone malformation
  • Secondary to trauma
  • Bad posture
  • Chronic strain and stress
  • Diseases affecting spine
  • Old intervertebral disk prolapse
  • Obesity
  • Smoking
  • Commonsite of spondylosis:

  • Cervical spondylosis: C5-C6
  • Lumbar spondylosis: L4-L5
  • Pathophysiology

    With advanced age and overuse, the cartilage that covers and protects the joint becomes degenerated gradually. When the cartilage wears away completely, the bones come in the direct contact with each other, resulting friction between them. In spondylosis, the stress over the cartilaginous end plates increases due to the thinning of the intervertebral disc (IVD). The thinning of the IVD begins with nucleus pulpous (inner part of the IVD). The fluid part of the IVD decreases in quantity and moves inwards, and the outer layer of the IVD becomes bulged outwards.

    Comparison of healthy spine and spondylosis effected spine

    Signs and symptoms

  • Pain
  • Stiffness
  • Restricted movements
  • Tenderness
  • Muscular spasm
  • Radiating pain to limbs if nerve roots are involved
  • Crepitations (crackling sounds)
  • Giddiness
  • Diagnosis:

    Computed tomography scans (CT): To evaluate any changes in the bone and spinal canal.

    MRI : To evaluate images of soft tissues, such as muscles, disks, nerves, and the spinal cord.

    X-ray : It shows bony changes, like loss of disk height or bone spurs.

    Radiological features :
  • Narrowing of intervertebral disk spaces.
  • Lipping of peripheral osteophytes
  • Subchondral bone thickening
  • Treatment

    The spondylosis treatment focuses on providing pain relief and reducing the risk of any permanent damage so that you can lead a normal life. Usually, non-operative treatment works excellent for the condition. Your health care provider will prescribe the following medications if over-the-counter drugs don’t give you any relief:

  • Muscle relaxants: Drugs such as cyclobenzaprine or carisoprodol can be used in case of painful muscle spasms.
  • Nonsteroidal anti-inflammatory drugs: It is considered as the first line of treatment for neck pain. Drugs like Acetaminophen and Ibuprofen are mostly recommended for a few weeks to address both pain and swelling.
  • Narcotics drugs for pain relief.
  • Antiepileptic drugs like Gabapentin to reduce the pain caused by the nerve damage.
  • Steroid injections for tissue inflammation and pain relief.
  • Surgical management

    Surgery is reserved for patients who have severe pain that has not been relieved by other treatment. Surgery is not indicated for some patients with severe pain and other complications. This is due to the widespread nature of their arthritis, any other medical problems, or other causes for their pain, such as fibromyalgia.


  • Advice the patient to use a cervical collar in case of spondylosis is related to the cervical spine and lumbar corset of the lumbar spine.
  • Bed rest
  • Static cervical and lumbar exercises.
  • Intermittent mechanical traction for 20min daily.
  • Moist heat can relieve pain and muscle spasm.
  • Electrotherapeutic treatments like ultrasound to relieve chronic inflammation and pain.
  • Interferential therapy in case of acute conditions.
  • Transcutaneous electrical nerve stimulator (TENS) can be given to relieve radicular pains.
  • Gentle mobilization techniques can be used to regain range of motion and to relieve stiffness. Eg: metlands, mulligan.
  • Electrical stimulation:

    TENS unit may be recommended to a patient for home use. In this, the e-stimulator is used that stimulates your muscles through the various intensities of electrical current. It helps decrease muscle spasms and act as a natural painkiller. TENS is also effective to drive out inflammation, and to relax the muscles involved.

    Heat therapy:

    Physiotherapists use different heating modalities to improve blood circulation to the target area. It helps increase blood flow with more oxygen and nutrients to that particular area, which is required to remove waste created by the muscle spasms, and is also effective in decreasing the pain.

    Soft tissue manipulation:

    This technique is effective in treating spasms, chronic muscle tension, and also the pain produced in daily life stress. The physiotherapist uses direct pressure and friction to release the tension from the soft tissues (ligaments, tendons, and muscles).

    Cold therapy:

    Cryotherapy (cold therapy) reduces the circulation and help reduce the inflammation, muscle spasms, and pain. You can use the cold packs and sprays in the target area for this purpose. Ice massage is also effective to reduce the spasm and pain.


    McKenzie Exercises:

    This is a set of exercises we asked her to do for 30 min.

  • Prone Lying.
  • Extension in prone lying (forearm support).
  • Extension in prone lying (hand support).
  • Extension in prone lying with belt fixation.
  • Sustained extension in tilt table.
  • Extension in standing.
  • Extension Mobilization (Therapist doing passively).
  • Physiotherapy for spondylosis

    Soft collars and braces:

    The braces and collars are used to limit the neck & back motion, and to permit the muscles to rest. The patient should wear these for a short period of time because wearing the collar and braces for a long time, may decrease the strength of neck muscles.

    Accessories to help relief spondylosis pain

    Back education:

  • Environmental changes-proper lifting techniques
  • Selecting the proper chair when sitting
  • Proper Workplace modifications and good ergonomics serve to reduce strenuous neck positions during work.
  • General advice

  • Avoid stressful activities if neck pain is present
  • Warm fomentation of the neck region
  • Avoid lifting heavy weights
  • Take leisure while driving, watching TV or working on a computer
  • Maintain good posture
  • Take adequate rest
  • When lying down it is best to lie on your side. Avoid sleeping on the face.
  • Use a thin pillow to support the head and neck.