A Modern Lifestyle Epidemic

In modern times, the incidence and forms of disease have changed quite a lot. In today's scenario, in developing countries like India, an 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, along with radiating and referral symptoms to the upper back, upper limb and even the chest.

These symptoms keep the patient in stressful situations at all times, as they mimic cardiorespiratory pathophysiology. Many times the patient misunderstands the condition as some heart-related problem 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 the level of 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/client's dependency on medications like NSAIDs, muscle relaxants and invasive steroid injection interventions — and even prevent many patients from cervical spine surgical interventions.

An Evidence-Based, Tailor-Made Approach

In physical therapy the 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.

It should consider the current stage of healing (acute / subacute / chronic) of the specific soft tissue involved, individually or in combination — e.g. involvement of vertebral bones, deep fascia, articular cartilage, bursa, intervertebral disc, interspinous ligaments, paraspinal muscles and the tendons attached to them, the different 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 needed is to reduce symptoms, improve blood circulation naturally and thus foster healing in and around the involved tissue, regain biologically healthy mobility and active–passive range of motion, and then avoid recurrence.

Modalities of Physical Medicine

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

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

Therapeutic Exercise Interventions

Therapeutic exercise interventions — isometric, isotonic and isobaric exercises, postural correction exercises, and specific stretchings (e.g. involved-side upper trapezius, latissimus dorsi, deep cervical muscles, sternocleidomastoid) and strengthening exercises (e.g. deep cervical flexors, extensors, side flexors and rotators) — are incorporated 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 & Nutrition

Some advanced techniques are also incorporated judiciously — spinal mobilization, Muscle Energy Technique, Proprioceptive Neuromuscular Facilitation, specific segmental mobilization, nerve gliding/stretching and neural flossing exercise techniques. Healthy nutritional supplements such as Vitamin B12 can be added for better results in promoting tissue and irritated nerve healing.

Workstation & Postural Correction

After all these interventions, workstation and postural habit correction is a must — the healthier the workstation, the fewer the chances of postural hazards. The following become most critical to prevent future physical health problems:

• Distance of the computer/laptop system from the eyes
• Height of the workstation table
• Height and mobility of the employee's chair
• Posture of the working upper limb joints and cervical spine

In modern times, physiotherapy has become an essential healthcare branch for the management of one of the most common modern health problems — cervical spinal pain.