TCM Views on Cervical Spondylosis

Author: Physician Niklas Seet | March 2021 | Zhongjing TCM 

What is cervical spondylosis (CS)?

Cervical spondylosis is one of the most common conditions afflicting many in the world today. It usually presents as neck pain and/or stiffness. In a 2010 study¹, it was found that it has a global prevalence of 4.9% and it ranks fourth in terms of disability. Based on an observational study done by the Department of Rehabilitative Services at Singapore Changi General Hospital², almost 80% of the 91 neck pain patients were between the ages of 35 and 65 years, with 70% of them suffering from chronic neck pain.

As a result of the modernisation of civilisation and technological improvements, most of us spend long hours in front of the computer each day. Other than office workers, students nowadays also spend more time on various devices for both education and leisure purposes. As a result, CS is becoming more prevalent in the younger population.

In the short run, this may seem harmless, with many of us experiencing some form of neck discomfort on a daily basis, which could be alleviated with rest or a good massage session. However, over a prolonged period of time, these symptoms may become more frequent due to the increased degeneration of our cervical spine.

Degeneration of the cervical spine may lead to growth of bone spurs or degeneration of the intervertebral discs. These will cause disequilibrium of the cervical spine, resulting in poor stability and changes to its structure and function. If these changes go on to affect the nerves and artery in the neck, we may observe symptoms such as radiating pain down the arm, tingling or numbness in the arm, giddiness or headaches, on top of the typical neck and shoulder stiffness and discomforts. In worse cases, this may slowly result in muscle atrophy in the affected arm, leading to weakness or even paralysis.

What is the medical (TCM/Western) understanding of the CS?

CS is a chronic condition that develops over many years. Injury to the neck is a common cause that can directly affect the spinal structure, thereby accelerating the degeneration of the cervical spine and causing CS.

In Chinese Medicine, the spleen governs the muscles in our body, the liver governs the ligaments and the kidney governs the bones. Our neck depends on these organs for proper function and movement. Various meridians, such as the Foot Tai Yang Bladder Meridian (足太阳膀胱经), are also distributed in the area to provide Qi, blood and nutrients to the structures.

When we are young, our bodies are strong and muscles are firm and plump. However, these structures as well as their corresponding organs may be affected from exposure to certain pathological factors. For example, if we were to consume cold foods or drinks in copious amounts, or are constantly exposed to cold environments without adequate protection, it may result in a rise in internal pathogenic cold and harm the spleen. This would cause changes to our Qi and Blood circulation, as well as causing our muscles to lose their source of nutrition and warmth. Over time, it can lead to obstruction in the meridians, and we start to experience discomfort or pain. In TCM, this is referred to as “pain due to obstruction 不通则痛”.

There can also be another cause for pain and this can occur due to aging. As we age naturally, some of our organs will become dysfunctional. As the functions of our kidneys and liver decline, their corresponding structures, the ligaments and bones in the neck, may slowly degenerate due to the loss of essence from their governing organs. This would result in some dull pain in the neck – this is referred to as “pain due to malnutrition 不荣则痛”. Furthermore, the cervical structure will become unstable, and constant use without care would cause the neck to undergo pathological changes, thus resulting in further pain.

Lifestyle habits, especially our posture, is another important risk factor for this condition. As mentioned, many of us are spending more time at our desks working or studying, with our necks bent down. Prolonged hours in this position causes neck muscles to stiffen and our cervical spinal column to remain in an anteflexed state, resulting in the loss of cervical lordosis (the natural curvature of the cervical spine). This would then cause the cervical spine to be in a state of disequilibrium.

A 2014 study³ found that the average human head weighs between 4.5 to 5.5kg and this is the weight borne by the neck in neutral position (at 0 degrees flexion or extension). However, this weight borne by the neck increases two-fold with a mere 15-degree forward bend, and five-fold with a 60-degree bend!  Another common type of poor neck posture is having the head lean forward, referred to as forward head posture. For every inch forward, the weight on the cervical spine increases by an additional 4.5kg. Thus we can see that improper posture puts a tremendous amount of stress on the cervical spine and neck muscles, especially in those with weaker neck muscles.

These additional stresses can then slowly lead to degeneration of the cervical spine, which may result in intervertebral disc degeneration or herniation, thickened ligaments or bone spurs. These changes do not necessarily result in symptoms. But if they start to affect surrounding bones, muscles, nerves or arteries, this could manifest in a myriad of symptoms, depending on the structure affected.

What are some stretching exercises that can be done to relieve the symptoms?

Regular stretching of the neck muscles can provide some relief from the pain and stiffness. Some muscles to focus on include the trapezius (back of the neck), scalene (sides of the neck), and sternocleidomastoid (front of the neck, next to the throat).

It is recommended to perform these stretches in a seated position, holding the stretch for 10 to 15 seconds, performing 3 to 5 sets at a time. Once you are familiar with the stretches, you may slowly increase the duration of the stretch at increments of 5 seconds, to a maximum of 30 seconds. The muscles might feel tight when you perform the stretches initially, proceed with the stretching gently and avoid forcing yourself to stretch beyond what is comfortable for you.

*It is important to note that safety is of the utmost priority when performing these stretches. You may choose to do your own variation of the recommended stretches. However, please note that if you have any physical limitations in carrying out the stretches, or if you experience any discomfort or abnormal sensation while performing the stretches, please stop immediately and seek advice from a trusted medical practitioner.

Scalene Stretch

1. Tilt your head gently to the right and bring your right ear towards your right shoulder until a comfortable stretch is felt on the left side of your neck. 

2. Once you have reached your limit, place your right hand on the upper left side of your head.

3. While maintaining the position of your hand, push against your hand with your head and hold this position for 10-15 seconds. You should feel the stretch intensify. (Your hand should not be exerting any strength to push down on your head throughout the stretch.

4. Relax and slowly bring your head back into the neutral position, looking forward. Repeat on the opposite side. Perform 3-5 sets on each side, 2-3 times a day.

Trapezius Stretch

1. Bring your chin close to your chest and tilt your head gently to the right, bringing your right ear towards your right collar bone, until a comfortable stretch is felt on the left side of your neck and left shoulder.

2. Once you have reached your limit, place your right hand on the left of the back of your head.

3. While maintaining the position of your hand, push against your hand with your head and hold this position for 10-15 seconds. You should feel the stretch intensify. (Your hand should not be exerting any strength to push down on your head throughout the stretch.)

4. Relax and slowly bring your head back into the neutral position, looking forward. Repeat on the opposite side. Perform 3-5 sets on each side, 2-3 times a day.

Sternocleidomastoid (SCM) Stretch

1. Tilt your head upwards and look towards the ceiling until you feel a comfortable stretch in the front of your neck and the sides of your throat. Maintain in this position for 10 seconds.

2. While still looking upwards, tilt your head gently towards the left, as if trying to reach the left ear to the shoulder. Hold this position for 10 seconds. You should feel the stretch on the right side of your neck intensify.

3. Then tilt your head gently towards the right while still looking upwards and hold this position for another 10 seconds. You should now feel the stretch on the left side of your neck intensify.

4. Relax and slowly bring your head back into the neutral position, looking forward. Perform 3-5 repetitions, 2-3 times a day.

Squeezing on the SCM muscle lightly from time to time can also be a good way to loosen it. To identify the muscle, simply look towards your right shoulder and you should be able to feel a thick rod-like muscle band on the left of your neck, beside your throat. Pinch on this muscle using your thumb and index finger and slowly turn your head to look towards the left. You should feel the muscle relax and become easier to pinch. Grasp the muscle gently and massage along the muscle, beginning from the bottom (collar bone) and moving towards the bottom of the ear. It can feel slightly uncomfortable at first, so work gently and stop if you notice any pain.

Is there any food I can take to relieve the symptoms?

Two herbs commonly used clinically for the relief of neck pain are Ge Gen 葛根 (Pueraria) and Chuan Xiong 川芎. When used together, these herbs help to relax the muscles and increase blood circulation to the muscles, thereby relieving muscular tension. Please note that as these herbs increase blood circulation, females who are pregnant or intending to conceive should avoid taking following recipes.

Soup Recipe

Porridge Recipe

What are some other exercises I can do?

Based on the natural range of motion of the neck, neck exercises should cover the 8 major directions. One way to accomplish this would be to draw the Chinese 米 character using the head. Perform this exercise in a seated position.

Look towards the ceiling as far as you can while bringing the head back, and hold the position for 5 seconds. Look downwards, bringing the chin closer to the chest, and hold the position for 5 seconds. Return to the neutral position, looking forward. Look to the left over your left shoulder, and hold the position for 5 seconds. Look to the right over your right shoulder, and hold the position for 5 seconds.  Return to the neutral position, looking forward. Continue this exercise with the four diagonal directions, and hold for 5 seconds at each maximum point. You can proceed in this sequence: upper left diagonal, bottom right diagonal, upper right diagonal and lower left diagonal. Perform the entire set 3 times and repeat them 3 times a day.

Other things to note

Everyone’s cervical spine will show a certain degree of degeneration. It is the natural wear-and-tear that happens as we age. While we cannot prevent degeneration, we can definitely slow down the process by practising good habits. This includes having proper posture, sufficient rest, good physical training and regular stretching. It is up to us to take charge of our physical well-being, so that we can continue to do the things we love.

It may be difficult to start making these lifestyle changes as habits do take time to cultivate. However, once you establish these habits into your daily routine, these may help with neck discomfort, or even prevent it in the future.

References

1. Damian Hoy, L. M. et al. The global burden of neck pain: estimates from the global burden of disease 2010 study. Annals of the rheumatic diseases 73, 1309–1315 (2014).

2. Praveen, J. J., Lim, T. J., & O’Brien, A. (2014). Neck Pain in Changi General Hospital: An Observational Study. Proceedings of Singapore Healthcare, 23(3), 209–217.

3. Hansraj KK. Assessment of stresses in the cervical spine caused by posture and position of the head. Surg Technol Int. 2014 Nov;25:277-9.