Qs 1: Doctor, my mother is 66 years old, she has cervical spondylosis. Kindly guide how the condition can be managed by physical therapy. She feels neck stiffness.
Ans: Cervical spondylosis is a term that encompasses a wide range of progressive degenerative changes that affect all the components of the cervical spine. In the cervical spine, this chronic degenerative process affects the intervertebral discs and facet joints, and may progress to disk herniation, osteophyte formation, vertebral body degeneration, compression of the spinal cord, or cervical spondylotic myelopathy.
Symptoms of cervical spondylosis manifest as neck pain and neck stiffness and can be accompanied by radicular symptoms when there is compression of neural structures.
Cervical spondylosis presents in three symptomatic forms as: Non-specific neck pain – pain localised to the spinal column. – complaints in a dermatomal or myotomal distribution often occurring in the arms. There may be numbness, pain or loss of function. – a cluster of complaints and findings due to intrinsic damage to the spinal cord itself. Numbness, coordination and gait issues, grip weakness and bowel and bladder complaints with associated physical findings may be reported.
Cervical spondylosis is often diagnosed on clinical signs and symptoms alone. Signs: Poorly localised tenderness, Limited range of motion, Minor neurological changes (unless complicated by myelopathy or radiculopathy. Symptoms: Cervical pain aggravated by movement, Referred pain (occiput, between the shoulder blades, upper limbs), Retro-orbital or temporal pain, Cervical stiffness, Vague numbness, tingling or weakness in upper limbs, dizziness or vertigo, poor balance, rarely, syncope, triggers migraine.
Most patients do not need further investigation and the diagnosis is made on clinical grounds alone however, diagnostic imaging such as X-ray, CT, MRI, and EMG can be used to confirm a diagnosis. In Physical Therapy management, mobilisation and/or manipulations in combination with exercises are effective for pain reduction and improvement in daily functioning in sub-acute or chronic mechanical neck pain with or without headache.
Treatment is individualised, but generally includes rehabilitation exercises, proprioceptive re-education, manual therapy and postural education.
Physical modalities such as cervical traction, heat, cold, therapeutic ultrasound, massage, and transcutaneous electrical nerve stimulator (TENS) can be used during treatment. In patients experiencing radicular pain, cervical traction may be incorporated to alleviate the nerve root compression that occurs with foraminal stenosis.
Home exercises can include cervical retraction, cervical extension, and deep cervical flexor strengthening, scapular strengthening, stretching of the chest muscles via isometric contraction of flexor of extensor muscles to encourage the mobility of the neural structures of the upper extremity.

Qs 1: My daughter is 10 years old and the doctors have diagnosed her with scoliosis. Please describe the condition.
Ans: Scoliosis is the deviation of the spine to the side (lateral deviation). It is commonly diagnosed in childhood or adolescence. In order to measure scoliosia, although the lateral deviation is highlighted in scoliosis, the element of rotation also adds to it.
The signs of scoliosis include lateral or sideways deviation of the spine, the sideways posture, shoulders are not aligned and one of them is higher than the other, muscles are aching, pulmonary issues (the concern in progressing scoliosis). In a number of cases, patients have back pain, though the diagnosis needs to be thoroughly confirmed.
There are three types of scoliosis, 1: Idiopathic: In most of the cases (about 80%) if no cause is identified the condition is said to be idiopathic. It can also occur in adults specially old adults due to degenerative changes of the spine, it is common in adolescents and is further divided into Infantile scoliosis (the child is 0-3 years old), Juvenile scoliosis (child is 4-10 years old, if the condition is not properly and timely treated, it can lead to cardiopulmonary issues. If the curve is more than 30 degrees it can progress and even require surgical procedures, Adolescent scoliosis (11-18 years of age).
2: Congenital scoliosis means that the condition is by birth, it may be due to any faulty or slow development of the spine at a location during pregnancy. 3: Neuromuscular scoliosis: The condition can develop as a complication of any neuromuscular condition like cerebral palsy, spina bifida or muscular dystrophy.
For the diagnosis of scoliosis, a physical examination, an x-ray, MRI or a CT scan. Cobb’s angle is used to measure the angle of scoliosis which will further define the severity and progression. An Adam’s forward bend test and a scoliometre is also used. An examination is required to check whether the scoliosis is structural (no plasticity is found generally and the pathology lies in the spine) or non structural (caused by any other factor or structure than the spine itself e.g. leg length shortening on one side).
The treatment is divided into conservative and medical or surgical. The patients who just have mild lateral deviations do not need any kind of treatment, in children however, regular checkups are recommended because of their growing age. The conservative management includes braces and physical therapy, if a child has mild scoliosis and wears a brace, it will keep the condition from progressing but will not work to reverse the deviation.
Severe conditions require surgical procedures like spinal fusion of some vertebrae, hence they lose movement and get fixed. In some cases, when scoliosis is continuously progressing, a rod is placed in the spine.
A physical therapist can help in muscular strengthening, coordination, equilibrium, respiratory education, ergonomics etc and plan an exercise program for the patient.