CERVICAL SPONDYLITIS (Neck stiffness, Stambhan)

Cervical Spondylitis

(Neck stiffness, (स्‍तम्‍भन) )

Cervical spondylitis is a ‘wear and tear’ of the vertebrae and discs in the neck and is a common cause of neck pain. With the increase in the number of professionals who sit for long hours together doing desk work or sitting for hours in front of the computer and call center jobs which requires continuous sitting in one posture, the number of people suffering from neck pain or cervical spondylosis is on rising.

Though cervical spondylotic myelopathy is painless in more than 50% of patients, when pain is present it may be described as a stabbing, burning sensation or a persistent dull ache radiating throughout the arms to the forearms, at times to the fingers, associated with "pins and needles" paresthesia's extending into the fingers.

Patients often comment about dropping objects accidentally or having trouble fastening their clothes. If prolonged, there may be associated muscle wasting and overt loss of sensation to vibration, pinprick sensation, and pain and thermal sensation.

In addition, on examination, the doctor may notice increased resting tone of the arms and legs, focal weakness of muscles supplied by affected nerve roots, unsteadiness of gait, and abnormally brisk deep tendon reflexes.

Coordination may be affected as well, including impaired fine finger movement, as well as difficulty with coordinated walking, such as seen with reverse tandem gait. Neck flexion may induce electrical-like sensations running down the spine (referred to as Lhermitte's phenomenon). Sexual function may be adversely affected as well.

Introduction

‘Cervical' means a region of the neck, and ‘spondylo’ is a Greek word meaning vertebra. Cervical spondylosis is a degenerative condition of the cervical spine caused by age- related changes (wear and tear) in the inter-vertebral disks and vertebrae of the neck. Cervical region of the spinal cord is very delicate part of the body. It keeps the head in balance. As the brain  and spinal cord are protected by the skull and vertebral column from top to bottom. And all the nervous arising from it from the sides constitutes the nervous system. Which is responsible for the mobility.

Definition : Degeneration of cervical Inter-vertebral disc (I.V.D) and the secondary degeneration of cervical inter-vertebral joints, leads to injury of spinal chord, nerve roots and vertebral artery, and shows corresponding symptoms and signs.

After 40 years of age, the inter-vertebral discs get progressively dehydrated and they become more compressible and less elastic. Mineral deposition starts occurring in the inter-vertebral disc resulting in secondary changes.

The disease occurs due to the narrowing of the space between the cervical vertebrae resulting in the compression of the nerves There is a formation of osteophytes, which causes pressure on nerve roots and the cord itself. Spondylosis is common and worsens with age. This condition is often used to describe degenerative arthritis (osteoarthritis) of the spine. Most people don't have symptoms, but some may experience pain or muscle spasms.

"Cervical radiculopathy is a disease process marked by nerve compression from herniated disk material or arthritic bone spurs. This impingement typically produces neck and radiating arm pain or numbness, sensory deficits, or motor dysfunction in the neck and upper extremities."

Cervical radiculopathy occurs with pathologies that causes symptoms on the nerve roots. Those can be compression, irritation, traction, and a lesion on the nerve root caused by either a herniated disc, foraminal narrowing or degenerative spondylitic change (Osteo-arthritic changed or degeneration) leading to stenosis of the inter vertebral - foramen

Most of the time cervical radiculopathy appears unilaterally, however it is possible for bilateral symptoms to be present if severe bony spurs are present at one level, impinging/irritating the nerve root on both sides. If peripheral radiation of pain, weakness or pins and needle are present, the location of the pain will follow back to the concerned affected nerve root

What is the cervical spine?
The cervical (neck) spine is made up of small circular bones (vertebrae) stack down top of each other. Between each vertebra is an inter-vertebral disc which acts as a shock absorb er and allows flexibility of the spine. Muscles and ligaments run between and are attached to the vertebra's. Nerves from the spinal cord pass between the vertebrae going to the shoulder, neck, arm and upper chest.

Cervical slip disc can also occur. In cervical  spondylolisthesis, the inter-vertebral disc is displaced due to sudden jerk. Sometimes fall from the tree can also lead to this condition or the joy rides of an amusement park. Cervical spondylitis usually occurs at the age of 35 - 45 years of age. But can manifest early due to the wrong lifestyle.

Cause

                                                   

●  Cervical spondylitis myelopathy (C.S.M) is the most common cause of not - traumatic weakness in limbs and a persistent stiffness and nagging pain in the neck.

●      Poor posture resulting from soft chairs and coaches, which facilitates slouching and sitting incorrectly.

●      Sleeping on too soft a mattress which results in an improper back and neck posture, can cause tension, headaches and pain in upper and lower back and high pillow.

●   Lack of exercise is another important cause of spondylosis. When muscles are not exercised and remain weak, the chances of injury to them is increased manifold.

●      Chronic Mal-position / above 40 years

●      Neck Injury caused by an accident

●      Incorrect nutrition

●      Strain resulting from sitting for a long time

●      Improper lifting of weights

●      Repeated occupational trauma such as carrying loads on head, back, professional dancing, gymnastics may contribute

●      Psychological strain leading to muscle spasm

●      Emotional problems which may cause painful muscles cramps

●   The habit of holding the neck in one position, drivers, who keep the neck in the same position for a long time, watching TV in abnormal positions or when lying down.

●      Conditions like congenitally fused spine, cerebral palsy, Down's syndrome etc.

●      Telephone operators or persons who cradle the phone on the shoulder

●  Doing work that demands minute concentration, like watch repairing or people who constantly work by bending their neck e.g. knitting.

●      Travelers who travel a long distance and sleep in sitting position

●      Computer professionals, bike users

●     Stress- when a person is under constant stress the muscles in the neck goes into spasm and causes pain and stiffness in the neck. (physical, mental, emotional)

●    Long hours of working using computers like IT professionals, carrying a laptop and sitting posture are the culprit. And Heavy helmets and use of two wheeler.

●      lifestyle- watching TV for a long time

●      Use of mobile for prolong period

●      Wrong posture/ Uncomfortable chair

●      Using extra pillow while sleeping

●      Washing utensils by bending the neck

●      Weak muscle due to ageing

●      Jerk - In monsoon season there are lots of potholes on the road which gives a jerk to the neck and ends up in cervical slip disc/ cervical spondylosis.

●      Walking with neck bending in front/ hunchback

●      In Ayurveda parlance, it is Vata vitiation (Air element)in the bone tissue resulting in degeneration of the bone. It is said that when Vata vitiates on bones (Asti) and when there is a loss of bone (Asthi kshaya अस्थि - क्षय ), there will be severe pain and also the weakness of the bone marrow, and also pain on the joints and lack strength.

 Physical Examination

Spurling Sign : Radicular pain is exacerbated by extension and lateral bending of the neck toward the side of the lesion, causing additional foraminal compromise.

Lhermitte Sign : This generated electrical shock sensation is associated with neck extension.

Hoffman Sign : Reflex contraction of the thumb and index finger occurs in response to nipping of the middle finger. This sign is an evidence of an upper motor neuron lesion.

Sign & Symptoms

●     Radiculopathy (nagging and severe pain in both the shoulders, the back side of the neck, collar bone and head side.

●      Stiffness acute or chronic may lead to restricted movements.

●  Numbness and tingling or complete loss of sensation on the affected side, headache, giddiness.

●   Occasionally weakness of muscles of arm or hand and loss of reflex due to compression and irritation of spinal nerve)

●      Vertigo/frozen shoulder/chest pain

●      Difficulty in writing/cannot pick glass

●      Spastic paraplegia

Postures that can worsen cervical spondylitis

1 . The head held forward from normal position

2 . The shoulder held up and forward (Hunchback, कूबड़ )

3 . The chest bent and rounded

4 . The pelvic area tilted backwards

5 . The hips, knees and ankles bent
                                              

                                                 Hand Pain -  Cervical Rediculopathy

• Weakness, numbness or clumsiness of the arms, hands, and/or fingers
• Altered walking ability perceived as poor balance, weakness, heaviness or numbness in the legs
• A painful, stiff neck
• Variable degrees of radicular arm pain (pain that radiates down the arm and possibly into the fingers).

                            "Consult a Orthopedics specialist, Neurologist or Neuro - surgeon."

Diagnosis

 Physical tests and imaging aid in determining the source of disability.

●   Physical examination : Include testing your reflexes, checking for muscle weakness or sensory deficits, and testing the range of motion of your neck. Your doctor might also want to watch how you walk. All of this helps your doctor determine if your nerves and spinal cord are under too much pressure.

●     Imaging tests

●    X - Ray : Of cervical region P.A view  AND Lateral view. (include flexion, Extension and oblique view). Findings - a Reduction of one or more disc spaces. b Change in the normal curve of the spine. c Formation of osteophytes. d Sclerosis of parts of the vertebra adjacent to the damaged disc e Cervical spine C5, C6 and C7 are affected f  X- Ray can be used to check for bone spurs.

●    Computerized Tomography (C.T.) Scan : It can provide more detailed images of your neck.

●   Magnetic Resonance Imaging (M.R.I) Scan : Which produces images using radio waves and a magnetic field, helps your doctor locate Pinched nerves.

●   Myelogram : A  dye injection is used to highlight certain areas of your spine. CT scans or X-rays are then used to provide more detailed images of these areas.

●   Electromyologram (E.M.G) : It  is used to check that your nerves are functioning normally when sending signals to your muscles. This test measures your nerves’ electrical activity. A nerve conduction study. Checks the speed and strength of the signals a nerve sends. This is done by placing electrodes on your skin where the nerve is located.

Lifestyle

●      Do regular exercise to maintain neck strength, flexibility and range of motion.

●      One should use thin pillow or avoid altogether. Use a cervical pillow. 

●    Can use towel below neck for support.

●     The patient should sleep on a firm mattress on their sides with knees bent at right angles to the torso.

●      Do turn to one side while getting up from lying down position.

●      Wear a cervical collar during the day

●   In order to avoid holding the head in the same position for long periods, take a break while driving, watching TV or working on a computer.

●      Use a seat belt when in a car and use firm collar while travelling.

●      Computer should be kept at the level of eye

●      Comfortable chair should be used while sitting

●      One should sit straight on the chair without giving strain to the spinal cord.

●   Exercise your neck and keep active. The aim is to keep your neck moving as normally as possible.

●      As far as possible continue with normal activities

●   Professional who spend hours doing desk work or in front of computers should take small breaks in between and try do simple neck exercises. 

●   After bath hold both the ends of towel and rub at the back of neck.

Yoga

Bhujangasana  (Cobra Pose)

●      Lie down on your abdomen by keeping legs apart

●      Keep the palm beside the chest

●      Breathing in, lift the upper part of your body, up to naval region

●      Hold it for 10 seconds by feeling the stretch on your abdomen

●      It is good for the cervical spine.

Dhanurasana

●   Begin by lying flat on your stomach with your chin on the mat and your hands resting at your sides.

●      Reach back with both hands and hold onto your outer ankles.

●    On an inhalation, lift your heels up toward the ceiling, drawing your thighs up and off the mat. Your head, chest, and upper torso will also lift off the mat. Draw your tailbone down firmly into the floor, while you simultaneously lift your heels and thighs even higher.

●      Lift your chest and press your shoulder blades firmly into your upper back. Draw your shoulders away from your ears.

●     Shavasana (Corpse Pose)

Relieves stress, depression and fatigue. It helps the body relax and prepare for sound sleep. It also stimulates blood circulation.

●    Ardha Matsyendra Asana

●    Setu Bandha Asana

●   Matsya asana

●     Marjari Asana  (Cat stretch Pose)

Pranayama

●      Anolom Vilom

Inhale through one nostril and exhale through other alternatively.

●   Bhastrika Pranayama (Breath of fire) Increases oxygen supply to all parts of the body, thus improving blood circulation. It relieves stress and hypertension.

Meditation

A simple method to do meditation. Sit comfortably, close your eyes. Force every individual thought out of your head. Focus on your breathing and only your breathing. Feel each inhalation and exhalation. Feel your stress go away with each breath.

Exercise

For Flexibility, Try Neck Rotations

How

While doing neck rotations keep your shoulders and hip facing forward.

Neck Flexion

Why

                                                 

Exercise have to be integral part of the treatment. Exercise improves the supply of nutrients to spinal discs, thereby delaying the process of deterioration that comes with age. To start with, exercises should be done sitting and the feet must rest on the floor or stool.
Exercise should be done in front of a mirror, in order to get correct movements.
Exercise should be done at least four times a day.
a . Isometric exercises of the neck.
b . Dynamic exercise of the neck.
c . Scapular exercises.
d . Mobilization of the spine.
e . Myofascial release.

●      Mobilization exercises : To be done only once a day and once only.
1 . Head bending forwards.
2 . Head bending backwards.
3 . Head bending to the left side trying to touch left shoulder.
4 . Head bending to the right side trying to touch right shoulder.
5 . Head turning to look towards left side.
6 . Head turning to look towards right side.
●   Progression of exercises : (5 times, increases to 7 - 10 times) with half kg weight in each arm :
1 . Arm lift forwards and up and down.
2 . Arm lift sideways and up and down.
3 . Arm lift forwards, part and together.
Increases to 1 kg weight if after  3 to 4 days, patient can carry 1 kg.

●   Instructions :
1 . Do not look down to read (or any other work). Try and bring reading material to an eye level.
2 . All neck movements can be performed with practice, by using trunk movements.
3 . Use a thin pillow supporting a head and neck; pillow line up to the shoulder line only.
4 . While lying on sides, head should be in neutral position. use one pillow and your hand, to adjust the head or in addition, one small pillow to adjust the head. Place one pillow in front to support the right arm if you are lying on left side. If you are lying on right side , place a pillow to support your left arm.

●      Safe exercises include walking, swimming and cycling. The later should be done keeping the back upright.

●     Other exercise joint movements like folding and unfolding of fingers, moving the wrists up and down, rotating them in both clockwise and anti-clockwise direction. Folding and unfolding of the forearms and rotating the shoulder clockwise and anti-clockwise. Head and neck exercises like moving the neck up and down, moving to the sides, rotating the neck clockwise and anti-clockwise and nodding the neck from one shoulder to another. All these exercises should be taken three times a day.

●       Isometric Exercises These exercises in general help to build strength, flexibility and increase the range of motion. They help to strengthen the neck muscle. In isometric exercises, there is very little or no joint movement. In these exercises, the hand provides resistance. It is important to begin these exercises in an erect position. So, sit up straight and slightly tuck your chin before beginning.

      

●     Neck extension-Place your palm at the base of the head and apply light forward pressure. Meet the resistance with your head and neck. 

●      Side bending- Sit erect with your head in a neutral position. Place your palms above/ around the ears. Apply light pressure with the hand and meet the resistance with the head.

●      Neck flexion- Place the index and middle fingers of both your hands in between your eyes and apply light backward pressure, meet the resistance with your head and neck.

Flexibility exercises

●      Neck extension- Take your head back so that your chin is pointing upwards. Repeat 8 -10 times.

●      Neck rotation- Sit erect, then first turn your head slowly to the right. Move it back to the forward position. Relax move it to the left. Repeat 8-10 times.

●      Neck side bend - Sit erect, tilt your head so that your right ear moves towards your right shoulder. Then tilt your head so your left ear moves towards your left shoulder. Make sure you do not rotate your head while tilting or toward your head raise your shoulders.

●      Other suggestions Those with sedentary occupation should take a break to stand up every hour.

“Be kind to your joints and they will treat you right”.

Chakra

Concentrate on Vishuddha chakra which is located in the neck region.

Mudra

●    Vayu Mudra

Formation- Index finger tip is to be placed at the base of the thumb and the thumb is to be placed on the back of the index finger gently. Other fingers are to be straight.

●      Prithvi Mudra

Formation- Join the tip of ring finger with the tip of the thumb.

Diet

●      Salad of raw vegetables such as tomato, carrot, radish, lettuce

●      Two steamed or lightly cooked vegetables such as cauliflower, legumes,  spinach

●      Plenty of fruits

●      Patients should have four meals daily

●      May take milk and fruits for breakfast

●      Steamed vegetables and whole wheat chapattis during lunch

●      Fresh fruit or fruit juice in the evening

●      A bowl of raw salad, soups and sprouts during dinner

●      Consumption of black gram, horse gram, wheat rice, gingerly oil, mustard oil, ghee, milk, butter, fruits, dry grapes, garlic, drumstick fruits and leaves  are good for DDD degenerative discs diseases

●      The patient should take adequate amount of proteins and vitamin C as they are essential for the development of a healthy bone matrix. Vitamin D and calcium, phosphorus and the essential trace minerals are also necessary for healthy bones.

Avoid

●      Patient should avoid fatty, spicy and fried foods sour curd, sweets, sugar, condiments as well as tea and coffee

●      Do not consume potato, cucumber, cold drinks, ice cream, rajma, dry meat etc.

●      Avoid sitting for prolonged period of time in stressful postures

●      Avoid running and high impact aerobics, if you have any neck pain

●      Avoid sitting in a speed boat and rickshaws

●      Soft cushioned seats should be avoided and position should be changed as often as possible

●      Do not lift heavy weights on head or back

●      Avoid bad roads if travelling by two or four wheeler

●      Do not drive for long hours, take breaks

●      Avoid habit of holding the telephone on one shoulder and leaning at it for a long time

●      Do not use extra pillows below the neck and shoulder while sleeping

●      Do not lie flat on your stomach

●      In order to turn around, do not twist your neck or the body; instead turn around by moving your feet first. Do not undergo spinal manipulations if you are experiencing acute pain.

●      Knitting, Bending, sudden stretching, weight lifting

●      Sitting in abnormal posture and sitting for a long time should be avoided

●      Those who smoke and take tobacco in any form should give up completely

Herbs

●     Garlic The use of garlic has been found beneficial in the treatment of spondylosis. 2 - 3 cloves of it should be taken daily in the morning. It will give good results. An oil prepared from garlic and rubbed on the affected part will give great relief. The oil is prepared by frying 10 cloves of garlic in 60 grams of Mustard oil in a frying pan. They should be fried slowly till they are brown. After it is cooled, it should be applied vigorously on the affected part and allowed to remain there for three hours. It is followed by a warm bath.

●     Ginger Make muscle pain a memory with ginger. Add at least one teaspoon of dried ginger or two teaspoons of chopped ginger to meals daily.

●      Turmeric Tame chronic pain with turmeric. Sprinkle ¼ teaspoon of this spice daily onto any rice, poultry, meat or vegetable dish.

●      Harad  A piece of the Chebulic myrobalan (Harad or haritaki) taken after principal meals also gives quick relief. Combination of Harad different seasons :

●      a Shishir Ritu.      Harad+ long pepper

●      b Hemant Ritu .     Harad Dry ginger 

●      c Vasant Ritu.       Harad +Honey

●      d Grisham Ritu.    Harad +Jaggery

●      e Varsha Ritu.      Harad +Rock salt

●      f  Sharad Ritu.     Harad +Sugar (Khand)

Marma

Amsa Marma 

●      Location- It is located in between neck and shoulder

●      With both the hand's touch at the back of shoulders. The place where middle finger points. It is stimulated by pressing with the help of middle finger 15-18 times

Krikatika  Marma  

Krikatika Marma

●    Location- It is present over Atlanto - occipital articulation. Two in number in head region at the back. It is stimulated by folding both the hands and taken at the back of the head and pressed with the help of thinner eminence. 

Massage

●      Mahanarayana taila ( महानारायण तेल ) mild oil massage to the neck, shoulder and hands

●      Other oils like mustard, sesame or coconut oil can also be used

Prevention

●   Avoid high impact exercise (for e.g. running , jumping)

●  Maintain cervical ROM with daily ROM exercise' (The cervical spine's range of motion is approximately 80° to 90° of flexion, 70° of extension, 20° to 45° of lateral flexion, and up to 90° of rotation to both sides.) 

●    Maintain neck muscle strength, especially neck extensor strength.

●   Avoid holding the head in one position for long period (for example while driving or watching TV.)

●   Avoid prolong neck extension.

●   Be careful while performing physical activities that are done infrequently, such activities can trigger a flare in symptoms.

●       Sitting too much.

●       Holding the phone on the shoulder

●       Improper sleeping posture

●        Reading in bed.

●        Excessive texting

●       Slouching forward

●      Regular practice of yoga helps to prevent it

●      Correction of posture

●      Use proper angle chair for sitting

●      Use low pillow or towel  while sleeping or cervical pillow.

●   Strengthen your skeleton by drinking milk and eating other dairy products, green leafy vegetables and Ragi. They are all rich source of calcium that helps bones harden and become strong.

●    Avoid Knitting, needle work etc.

Treatment

Treatments for cervical spondylosis is focused on providing pain relief, lowering the risk of permanent damage, and helping you lead a normal life. Nonsurgical methods are usually very effective. In many cases, no specific treatment is required. If symptoms occur, treatments include medication, Corticosteroid injections, physiotherapy and sometimes surgery.

*    Home treatment options 

Take an Over the counter (O.T.C) pain reliever, such as Acetaminophen  (Tylenol) or an N.S.A.I.D, which includes Ibuprofen  (Advil) and  Naproxen sodium (Aleve).

Use a heating pad or a  cold pack on your neck to provide pain relief for sore muscles.

Exercise regularly to help you recover faster.

Wear a soft neck brace or soft collar to get temporary relief. However, you shouldn’t wear a neck brace or collar for long periods of time because that can make your muscles weaker.

Bed rest and analgesics in an acute painful stage.

Hot & Cold Fomentation.

  Painkillers :  Prescription Non Steroidal Anti-Inflammatory drugs (N.S.A.I.Ds ), such as 

Diclofenac (Voltaren-XR), to reduce inflammation

*      Tab Walagesic*      Tab Aceclofenac 100 mg with Paracetamol 500 mg
*       Tab Ibuprufen 400 mg BD
*       Tab Diclofenic 50 mg -100 mg BD
*       Tab Etodolac 8 - 16 mg BD
*       Tab Todolac 400 mg BD
*       Tab Larnoxicam 500 mg BD
*       Tab Zaltoprofen 80 mg BD
*       Tab Flupirtine 100 mg BD
*        Tab Etoricoxib 90 mg BD

For Spasticity  Tab  Tolperisone HCL (Tolperilas) 50 -100 mg BD
*        Tab Thiocolchicoside (Myoril) 4 -8 mg BD
*        Tab Methocarbamol 750 mg BD
*        Tab Chlorzoxazone 250 mg BD
Analgesics plus drugs for spasticity combination should be used.
*   Steroid injections, such as prednisone, to reduce tissue inflammation and subsequently lessen pain
*      Physiotherapy Lamp:
                                        

*       TENS (Trans electrical nerve stimulation) When associated with radicular pain in arm.
*       Surged faradic currents. 

*      Rest to affected arm in sling reduces radicular pain.

Advise
*     When pain and spasm  severe, total rest for the neck in a well fitting cervical collar.
*    When acuity has subsided - Physiotherapy:  Your doctor might send you to a physical therapist for treatment. Physical therapy helps you stretch your neck and shoulder muscles. This makes them stronger and ultimately helps to relieve pain.
*     Short wave diathermy to the neck.
*    Neck  traction : This involves using weights to increase the space between the cervical joints and relieve the pressure on the cervical discs and nerve roots.
●      Sedatives : Narcotics, such as hydrocodone (Norco), for pain relief
*      Inj pethidine, phenergan

●      Muscles relaxants :
*      Muscle relaxants, such as Cyclobenzaprine (Fexmid), to treat muscle spasms
*      Iodex, Move tube, Diclofenac gel locally

●      Neuro tonic Tab  Neurobion

●      Hot fomentation for 5-10 minutes twice a day

●      Infra-red rays five to ten minutes of exposure
●  Electro-therapy-Application of heating pads on the affected area relieves pain and stiffness in an easy way

●    Dry massage with hot sand kept in cotton cloth should be done for 30 minutes on cervical region

●     Ayurveda :

●      Massage Therapy :
                                              

             Application of Chinchadi Tailam every day.
●      Mahabrigraj tel is also useful for external application.

●      Internally Maharasnadi kshaya, Yograj Guggulu, Bala Tailam 101,  Dhanwantaram Tailam. Ghee like Tikta ghrita, Rasanadi ghrita is good. Special care should be taken to correct digestion, bowel movement, sleep etc.

●      Amalakanika Dhara  on the cervical region for 30 minutes (pouring of medicated warm water in the region).

● Patra Pinda Sweda It is the kind of massage done with the poultice made with Vata pacifying leaves like Nirgundi, Patra, Sigur Patra , cinch patra etc.

●      Pichu : This is a procedure in which a cloth soaked in warm medicated oil is placed on the affected part for about an hour This is a minor form of intensive oil therapy which can be performed easily at home.

●      Shashtica Saali  Pinda Sveda: This is a kind of massage done with a poultice made of sixty days old rice cooked in cow's milk and a decoction made of Vata pacifying drugs like Bala, sahacharadi, devadaru etc. This helps in nourishing the tissues in the affected area.

All the treatment are done in sitting position.

●      Panchakarma

a    Manya Basti- Medicated oil is poured over the neck region. It gives lubrication to the area and reduces inflammation.
                                                       

 b Nasya One drop of medicated oil is poured in both the nostril before sleeping. This procedure is good for all the diseases of a head to shoulder region.

●        Acupressure & Acupuncture therapy is very effective for cervical spondylitis. 

●      Massage From the base of the head to the shoulder area with warm mustard oil having garlic and methi in it  gives the relief of vertigo instantly.

●   Brahma Mudra Sitting in comfortable posture, and moving the head in different directions. It relieves the neck strain.

“ Most back pains can be effectively treated but the ruptured or slip disc often requires intensive medical care combined with adequate rest”

Link: https://madhuchhandacdmo.blogspot.com/2018/10/cervical-spondylitis-neck-stiffness.html

* Medicine as suggested above should only be taken under the consultation and supervision of registered medical practitioner.