Other risk factors include:
You can manage cervical stenosis by (8, 9):
Spinal stenosis most often affects the lower (lumbar) spine but it can also occur in the cervical spine and rarely in the thoracic spine (mid-back). For this piece, we will concentrate on cervical stenosis.
Cervical (neck) stenosis means narrowing of the central tunnel (spinal canal) that the spinal cord runs through. This can also occur where nerves branch off the spinal cord (nerve roots) and exit through a gap at the side of the vertebrae (foramina). This narrowing can cause compression on the spinal cord and/or nerve roots affecting their function. This can cause symptoms of cervical myelopathy (spinal cord) or cervical radiculopathy (nerve roots).
Cervical radiculopathy is due to compression or irritation of the sensory and motor roots of a cervical nerve at one or multiple cervical spinal levels. This can be caused by disc herniation, osteophyte formation and others structures causing the nerve to be compressed. This can result in symptoms such as arm pain, weakness, sensory loss, with or without neck pain (4).
Cervical myelopathy is compression on the spinal cord which cause its dysfunction. It is commonly caused by disc herniation, spondylosis and congenital stenosis. The symptoms can include weakness or altered sensation in upper and lower limbs, as well as symptoms such as clumsiness of the hands and feet, decreased manual dexterity and unsteady walking (3).
The process of cervical stenosis does not necessarily cause symptoms. If symptoms are present, they will mainly be due to cervical radiculopathy or myelopathy. The progression of symptoms usually varies in the following ways: a slow and steady decline, progression to a certain level and then stabilising or they can rapidly decline (2,5,6).
The potential symptoms include (2,4):
The narrowing of the structures that contain the spinal cord and nerve roots causes compression; this can then cause damage to the cord and nerve roots. It is thought that the compression can cause the spinal cord/nerve to be damaged due to a lack of blood supply to the nerve cells (ischemia) (2).
The narrowing can happen due to one or a combination of the reasons below:
Cervical stenosis is most commonly caused by degenerative osteoarthritis (2). Other factors that could increase the likelihood of someone developing cervical spinal stenosis are listed below (3). It does not mean everyone with these risk factors will develop symptoms.
It has been found that approximately 5% of people have cervical stenosis in the adult population (1). As previously mentioned, stenosis can be asymptomatic and it is the result of its impact on the nerve cells that determine the extent of damage, not the narrowing itself. Cervical radiculopathy is estimated to affect 0.06% of women and 0.1% of men. Cervical myelopathy being caused by stenosis is very rare and is estimated to affect 0.004% of people (4).
Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.
Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments of your treatment to be made.
Imaging studies like magnetic resonance imaging (MRI) can determine the level of spinal canal or foramina narrowing on the spinal cord and nerve roots. However, the degree of stenosis does not always equate to symptoms and therefore, it is not used in all cases of stenosis, mainly just when surgery is being considered or symptoms are severe.
If you are reporting signs and symptoms that involve coordination problems, gross weakness or bladder and bowel control issues, your physiotherapist may be required to make an urgent referral to a specialist to check the cause of these symptoms.
As part of your treatment, your musculoskeletal physiotherapist will help you understand the condition and what needs to be implemented to effectively manage your neck and other symptoms. This will include activity modification strategies as well as other useful treatments aimed at reducing discomfort. Regular adherence to a specific rehabilitation programme is important in the management of this condition. It should be noted that rehabilitation exercises are not always a quick fix but, if adhered to on a consistent basis (weeks to months), over time they have been shown to yield positive outcomes.
Most cases of cervical spinal stenosis are successfully treated with non-surgical techniques such as pain and anti-inflammatory medications (6). Depending on the extent of nerve involvement, some patients may need to temporarily restrict their activities for a time. However, most patients only need to rest for a brief time. Your musculoskeletal physiotherapist will prescribe exercise to help strengthen and stabilise the neck as well as build endurance and increase flexibility.
Below are three rehabilitation programmes created by our specialist physiotherapists targeted at addressing cervical stenosis. In some instances, a one-to-one assessment is appropriate to individually tailor targeted rehabilitation. However, these programmes provide an excellent starting point as well as clearly highlighting exercise progression.
This plan focuses on range of movement of the neck and shoulders to try and reduce the sensitivity of the condition. Pain should not exceed 3/10 on your self-perceived pain scale whilst completing this exercise programme.
This plan continues to work on increasing the movement of the neck whilst adding exercises that help to improve the strength and stability of the neck and shoulder region. Pain should not exceed 3/10 on your self-perceived pain scale whilst completing this exercise programme.
This plan provides a gentle progression of the exercises from the intermediate plan still aiming to improve strength and movement of the neck and shoulder region. Pain should not exceed 3/10 on your self-perceived pain scale whilst completing this exercise programme.
For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.
As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering you might benefit from a further assessment to ensure you are making progress and establish the appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future re-occurrence.
An epidural injection in which a liquid is injected into space around your spinal cord can ease symptoms of stenosis. This is used to allow the person to commence with rehabilitation. They contain two types of medicine – a local anaesthetic (which numbs the pain) and a steroid (which helps to reduce swelling and inflammation). They are also called epidural steroid injections.
Surgery is only for those who have failed non-operative management such as physiotherapy, analgesics or steroid epidurals (4). Most patients can begin getting out of bed on the same-day surgery is performed. Activity is gradually increased and patients are typically able to go home within a few days after their procedure, depending on the extent of the surgery. Once returned home, patients will need to continue to rest. They will be instructed on how to gradually increase their activity and may still need to take the pain medications for a while. However, pain and discomfort should begin to reduce within a week or two after surgery.
Types of surgery include:
Please book an appointment with one of our physiotherapists if you think you are suffering from this condition and would like to find out more.
We have Pure Physiotherapy clinics across the country including Norwich, Dereham, Bolton, Manchester, Rochdale, Sheffield and Barnsley. Please view our clinics to find the closest physiotherapy clinic for you.
An injury which typically occurs following a road traffic collision, often affecting the soft tissues of the neck.
Pain or discomfort in the neck and/or shoulder girdle, with or without pain referred to the arms.
A condition presenting with pain in the arm as a result of compression of structures around the neck/shoulder.
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