In modern times, and in the 21st century, the incidence and forms of disease have changed quite a lot. In today's scenario, in developing countries like India, the epidemic of cervical spine pain — with symptoms of referral and radiation — is on the surge. This is primarily a lifestyle and posture related condition which creates pain, cervicogenic vertigo and headache, and radiating, referral symptoms to the upper back, upper limb and even the chest.

These symptoms keep patients in stressful situations at all times, as they mimic cardiorespiratory pathophysiology and many times the patient misunderstands them as some heart-related condition existing or growing in the body. Working office professionals, as well as the common household population — including children and housewives working on computers, laptops or smartphones regularly — are more prone to such health hazards.

The Role of Physiotherapy

Physiotherapy plays a very critical and important role in managing such aches and pains, as it works at all stages of treatment intervention — preventive, curative and rehabilitative. Among these, the preventive and curative aspects of physical therapy work best and reduce the patient's dependency on medications like NSAIDs, muscle relaxants and invasive steroid injection interventions — and even prevent many patients from cervical spine surgical interventions.

In physical therapy, treatment intervention plans ideally need to be tailor-made, evidence based, patient-specific, target oriented, flexible in approach and result oriented — using the principles of neurophysiology, pathology, anatomical orientation and biomechanics, biological fluid mechanics and human joint kinematics.

The plan should consider the current stage of healing (acute / subacute / chronic) of the specific soft tissue involved, individually or in combination — e.g. vertebral bones, deep fascia, articular cartilage, bursa, intervertebral disc, interspinous ligaments, paraspinal muscles and the tendons attached to them, the bursae surrounding the involved region, CSF movement related to the spinal cord and spinal column, spinal canal lumen dimensions, and nerve glide and mobility. The primary intervention aims to reduce symptoms, improve blood circulation naturally and thus foster healing in and around the involved tissue, regain healthy mobility and active–passive range of motion of the involved and surrounding structures, and finally prevent recurrence.

Common Physical Modalities

• Short wave diathermy (SWD)
• Interferential therapy current (IFT)
• Transcutaneous electrical nerve stimulation (TENS)
• Therapeutic ultrasound
• Laser (class 3 and class 4)
• Intermittent cervical spine traction

These are chosen according to the specific condition and need of the individual patient, based on the principles of dermatome, sclerotome and myotome structure and function.

Therapeutic Exercise Interventions

Along with these modalities, therapeutic exercise interventions are incorporated — isometric, isotonic and isobaric exercises, postural correction exercises, and specific stretching (e.g. of the involved-side upper trapezius, latissimus dorsi, deep cervical muscles, sternocleidomastoid) and strengthening exercises (e.g. of the deep cervical flexors, extensors, cervical side flexors and rotators).

These are based on the principles of reflex inhibition, post-exercise relaxation, the deep breathing reflex and stimulation of the vagus nerve. Many exercise interventions also involve the thoracic spine (specifically the upper and mid part) for better and longer-lasting results, as spinal segments are never involved individually but rather in combination.

Advanced Techniques

Some advanced techniques are also incorporated judiciously — spinal mobilization, Muscle Energy Technique (MET), Proprioceptive Neuromuscular Facilitation (PNF), specific segmental mobilization, nerve gliding / stretching and neural flossing exercises. Healthy nutritional supplementation of Vitamin B12 can be added for better results in promoting tissue and irritated-nerve healing.

Workstation & Posture Correction

After all these interventions, workstation and postural habit correction is a must — the healthier the workstation, the lesser the chances of postural hazards. The distance of the computer/laptop from the eyes, the height of the workstation table, the height and mobility of the employee's chair, and the posture of the working upper-limb joints and cervical spine all become most critical to prevent future physical health problems.