Rehabilitation treatment for cervical spondylosis includes guidance of activities of daily living, exercise therapy, physical therapy, manipulation and massage, and drug therapy. Among them, guidance on activities of daily living and exercise therapy are the most basic and need to be carried out by patients for a long time, which can effectively reduce the recurrence rate of cervical spondylosis. The other treatments are mostly used during the active period of cervical spondylosis to relieve the symptoms during attacks.
1.Guidance on activities of daily living
Patients with all types of cervical spondylosis and postoperative cervical spondylosis should receive guidance. Bad posture is an important cause of the development of cervical spondylosis, so guidance on activities of daily living is an indispensable element in prevention and treatment. The normal cervical posture is to keep the neck in a neutral position, and the pressure on the cervical spine will gradually increase if the neck is flexed forward. Some scholars have measured that for every 1 inch of head movement forward, the pressure on the lower cervical spine will gradually increase by a factor of 1. Prolonged head down or head back can also cause muscle, ligament, joint capsule relaxation and strain around the cervical spine, affecting the stability of the cervical spine. Therefore, the neck should maintain the correct posture when working and living, and the computer and TV should be placed in a flat or slightly below flat position. Vertebral artery type should avoid the position that induces the disease. The height of the pillow during sleep should be to maintain the physiological curvature of the neck, avoiding too high or too low to cause cervical over-extension or over-flexion, and the hardness of the pillow should also be moderate. Depending on the position of the head.
There are two roles of the neck circumference: local braking and protection of the cervical spine. It can help to relieve symptoms during acute attacks and prevent high-risk cervical spine trauma. Postoperative patients should pay attention to wearing a cervical brace as required by the operator.
2.Exercise therapy
It is mainly divided into neck and shoulder muscle exercise and neck mobility exercise. The purpose is to enhance muscle strength, improve muscle compliance, relieve muscle contracture and tension, prevent joint stiffness, improve blood circulation in the neck, promote inflammation, reduce pain, restore muscle function, maintain the stability of the cervical spine, consolidate the therapeutic effect and reduce recurrence through cervical and shoulder muscle exercises.
Neck muscle strength exercise
(1) Posterior extension force: cross the fingers of both hands behind the pillow, force the arms forward, force the neck backward head hand for isometric contraction of the neck extension muscle group.
(2) lateral force: the palm of one hand placed on the side of the head, arm and neck force for isometric contraction.
(3) forward flexion force: hands placed on the forehead, arms and neck flexor muscle group force for flexor muscle group isometric contraction.
(4) anti-gravity muscle training: side, supine or prone on the side of the bed, respectively, for lateral flexion, posterior extension, forward flexion anti-gravity muscle training.
The above exercises are contracted for 10 seconds each time, with an interval of 10 seconds, 10 times per group. Gradually increase the intensity of the exercise, so that the muscles have a slight soreness and swelling after exercise.
Neck joint mobility exercise
The patient sits in a seated position and does forward flexion, back extension, lateral flexion, rotation and other neck activities as shown to increase joint mobility and stretch the neck muscles and other soft tissues.
Precautions.
(1) Not to be done during cervical spondylosis attacks.
(2) All exercises should be performed slowly and gradually.
(3) High-risk cervical spine should be exercised carefully, and if the symptoms worsen after exercise should reduce the amplitude or intensity of movement, or even stop exercising.
3.Physical therapy
(1) Cervical traction: Our hospital summarizes 143 cases of cervical spondylosis with traction treatment, of which 56% were cured and 15% were improved.
The function of cervical traction: restrict the activity of cervical spine, release the spasm of cervical muscles, so as to reduce the congestion and edema of nerve roots and protrusions; expand the vertebral space and intervertebral foramen, so as to reduce the compression of spinal cord or nerve roots; reduce the pressure of intervertebral disc, which is conducive to the swelling or retraction of the protruding fibrous tissue; reduce the stimulation of nerve roots and vertebral artery by the bone spur of hook vertebral joint; pull away the overlapping small joints or the embedded joint capsule.
Cautions for cervical traction: sitting or lying position is acceptable; weight 3-10kg, from light to heavy, time 30-60 minutes; flexion 10-15 degrees, avoid traction in the over-extended position, traction is not recommended for patients with heavy spinal cord type cervical spondylosis.
(2) Other physical factor treatment: including direct current drug introduction, modulated intermediate frequency electricity, short wave/ultra-short wave, ultrasonic wave, etc., the effect is antispasmodic, analgesic, reduce inflammatory edema, adhesions and promote the role of nerve recovery. The rehabilitation physician should also provide other targeted treatments according to a comprehensive assessment of the patient. For example, patients with spinal cord type or nerve root type with more obvious weakness and muscle atrophy should be given medium-frequency electrotherapy; spinal cord type with increased muscle tone in the lower extremities can be used in the anti-spasticity mode of muscle electrical stimulation, and more severe patients with neurogenic bladder can be given interference electrotherapy in the lower abdomen to improve smooth muscle excitability and bladder function training. It is important to emphasize both the main contradictory treatment and a comprehensive grasp of the factors that may affect the patient’s daily function.