2. = Arthritis of the neck  Degenerative condition  Affects the vertebral bodies, the intervertebral discs,the facet joints and eventually the contents of the spinal canal  Involves the degeneration of cartilage and the formation of osteophytes (spurs)  Results in pain and stiffness  Worsens with age

3. Denegation that occurs naturally with age Occurs in the facet joints and the intervertebral discs Discs lose water and weaken Movement segment

4. Increase in mechanical stress at cartilage end plates with an increase in pressure at the facet joints Cartilage therefore gets worn away and results in bone on bone contact

5. Body response is the formation of osteophytes=spurs Supports the decaying vertebrae Creates a narrow space for nerves to pass

6. Disc:  Decreased elasticity of annulus fibrosis  Loss of fluid in nucleus pulposes Therefore unable to withstand compression forces and bulges decrease in disc height  Formation of osteophytes: ◦ Forms where tension is the greatest ◦ Forms at the edges of the vertebrae

7. Facet joints  In closer contact due to decreased height of the disc  Stretching of the capsule due to inferior facet moving down on the superior facet  Facet joints move into a position of extension and therefore experience an increase of stress during normal daily activities

8. Vertebral body:  Development of sclerosis= hardening of tissue/structures Intervertebral foramen:  Decreased due to the formation of osteophytes and loss of disc height Spinous processes:  Formation of a false joint due to the spinous processes coming into contact with one another

9. Collapse of intervertebral disc and joint space

10. Three stages occur during degeneration 1. Dysfunction ◦ Dysfunction of the trunk fascia, muscles, ligaments, capsule, neural structures and z- joints. ◦ Results from mechanical stress, injuries and overuse injuries 2.Instability ◦ Disc mal-alignment and degeneration due to a loss of protection from these structures ◦ Results in segmental stability

11. 3. Stabilisation period ◦ This is the body's effort towards healing

12.  Age –especially above 60 years  Family history of neck pain  Overweight  Sports  Occupations involving excessive neck motion/overhead working  Previous neck injury/trauma  Ruptured/slipped disk

13. Spur formation with narrowing of the disc space

14.  Can develop ◦ Slowly ◦ Sudden onset  Headaches  Neck stiffness  Weakness ◦ Difficulty with lifting arm or squeezing hand  Abnormal sensations or numbness ◦ Shoulder/arms/legs

15.  Pain ◦ Mild ◦ Severe Location: behind neck, m.trapezius, upper arm, forearm and fingers Aggravated by: ◦ Sudden movements ◦ Stretching at end range Worse in the morning

16.  Loss of balance  Muscle spasms of neck and shoulders  Grinding/popping noise with movement  Reduced reflexes  Difficulty rotating head in all directions

17. Conservative:  Physiotherapy ◦ Strengthening of neck muscles ◦ Stretching ◦ Neck traction ◦ Posture therapy ◦ Ice/hot packs ◦ Care of the neck and advice ◦ Passive mobilisations

18.  Medication ◦ NSAIDS (aspirin,ibuprofen) ◦ Muscle relaxants ◦ Steroid injections ◦ Anti convulsants/antidepressants ◦ Narcotics/opiods (not on a daily basis)  Soft collars NB ! Short term only! ◦ Limits neck motion

19.  Surgery (foraminotomy,laminectomy, spinal fusion) ◦ Uncommon ◦ If conservative management fails ◦ Only for severe pain ◦ Neurological symptoms

20. Long lasting Cervical Radicular Pain Managed With Surgery, Physiotherapy, or a Cervical Collar: A Prospective,Randomized Study.  Compared the effect of surgery, physiotherapy and a cervical collar on cervical radicular pain as a result of cervical spondylosis  Included 81 patients who have experienced cervicobrachial pain for at least 3 months

21.  The pain must be a direct result from a root compression with or without a bulging disc  Patients were randomly allocated to each treatment method  It was concluded at the end of a 12 month evaluation that either method was a successful as the next  This implied that the condition is dominant in its degeneration

22. Persson,L.C.,Carlsson,C.,Carlsson,J.1997.Long- Lasting Cervical Radicular Pain Managed With Surgery,Physiotherapy, or a Cervical Collar : A Prospective,Randomized Study. Sweden : Lippincott, Williams & Wilkins. Fox.M.L.2009.American Academy of Orthopaedic Surgeons. http://orthoinfo.acios.org/topic.cfm Retrieved on 12 May 2012.

23. Vorvick,L.J.,Benjamin,C and Zieve,D.2011.National Center for Biotechnology Information:US National Library of Medicine. www.ncbi.nlm.nih.gov/pubmedhealth/PMH001 4721 Retrieved on 12 May 2012. Barnes,R.2011.NEUROMUSCULAR-SKELETAL REHABILITATION DICTATE.(Unpublished dictate.) University of the Free State, Free State.