Use of massage in cervical spondylosis

A) Characteristic signs and symptoms of cervical spondylosis:

1. It is a degenerative condition of cervical spine and is universal in elderly.
2. There is degeneration of inter-vertebral disc and secondary osteoarthrosis which is often asymptomatic, but may be associated with disc protrusion and bony overgrowth of adjacent vertebra, causing narrowing of spinal canal and inter-vertebral foramen with resultant compression of nerve roots, spinal cord or both.
3. Majority of patients experience pain in neck. Pain in upper limbs probably originates in disc and spine.
4. Compression of nerve roots occurs when disc prolapses laterally and radiating pain from neck to fingers is experienced. Range of movements is reduced and pain worsens with movement of neck, coughing, sneezing etc.
5. Signs of motor weakness and muscle wasting depend upon nerve roots compressed. Tingling sensation in upper limb is commonly observed.
6. Vertebro-basilar insufficiency may produce intermittent or perpetual vertigo. Neck movements may initiate or exacerbate vertigo.
7. Dorso-medial herniation of disc and development of post osteophytes may result in pressure over spinal cord and patient may present with progressive spastic paralysis, and sensory impairment within a level, bladder and bowel involvement developing at a later stage.
8. X-ray cervical spine shows reduced disc space, osteophyte formation. MRI shows

Nerve root involved.

B) Aim of massage:

1. To reduce pain sensation as massage stimulates body's natural painkillers.
2. To prevent further degenerative changes in inter-vertebral disc and cervical vertebrae as massage is a good source of nourishment with use of unctuous substance like oil, ghee etc.
3. To increase strength of cervical vertebrae and inter-vertebral disc as a result of improved nourishment to maintain their normal position and function and there by help to prevent prolaps disc, osteophyte formation etc.

C) Process of massage:

1. Body area to be massaged: From base of skull, neck region up to fingers of upper limb. If person does not experience any radiating pain in upper limb then only local massage over neck is sufficient.
2. Direction of massage movements: a) Massage movements should be directed from above downwards along the concerned muscles, ligaments etc right from neck to both shoulders up to fingers. b) Massage movements over cervical vertebrae and disc space between adjoining vertebrae should be circular.
3. Useful massage tips: a) In spondylosis, absorption and deep penetration of oil through skin is important to provide nourishment. Therefore massage movements should be slow but for longer time on a particular place like vertebrae etc rather than rapid movements with more pressure and friction. b) Circular action of thumb is useful for massage over vertebrae and disc space. c) Use of fingers and palm is useful while massaging upper limb. Individual muscles of neck and limb can be massaged with finger to help relaxation. d) Duration of massage as also its effect depends upon relief in pain and other symptoms. Reduced pain is an indicator of proper massage. Usually continuous massage for 25-30 minutes over a particular place like vertebrae etc will help oil reach up to bones. e) Daily massage preferably in early morning for some days is beneficial. f) Post massage, cold air and cold water bath should be avoided.

D) Use of different oils for massage:

1. Usually oil used for massage should be advised by concerned physician as some special medicinal oil that will reach up to bones and nourish them has to be used. Medicines that improve strength of bones like black sesame and milk etc should be added during preparation of oil.
2. Sesame oil, coconut oil, olive oil, sandalwood oil etc may be used.