Expert: J.R. Strecker, B.S., D.C. - 2/24/2008

Question
"I recently had an MRI on my neck due to pain in the lower neck and shoulder region. The results from the MRI were;
Minimal narrowing of the right C4-5 neural foramen. Significant narrowing of the right C5-6 neural foramen which appears to be associated within an uncovertebral osteophyte.
My neurologist suggests Physiotherapy. What would you suggest?"


Answer
Hello D.,

First off, thanks for trusting me with your health.  To start, as a disclaimer, please do not substitute my advice with the advice of your doctor, as there is no way I can thoroughly assess your situation and evaluate you.

As a chiropractor, this is one of the most common things I see.  What you have is basically degeneration (arthritis) in your neck.  There are a variety of things that can help with degenerating necks.  There are also a variety of conditions that can cause degeneration in the first place.  For example, a prior history of trauma 15-25 years earlier is one of the most common causes for degeneration to show up later in life.  So if you were in a bad car accident many years ago with a bad whiplash, or if you played a lot of college or high school football, these factors can lead to degenerating joints later in life.  Sometimes degeneration can also occur from poor posture.  If you lose the normal curves of your spine, you stress the joints improperly with day-to-day motions, and after years of chronic improper biomechanics, degeneration occurs.  So if your arthritis is secondary to poor postural or biomechanical habits, certain exercises that either a physical therapist, chiropractor, or orthopedist can teach you will help you to focus your body to move the proper way and be more aware of poor posture, thus, decelerating the rate of future degeneration.  This is important because if degeneration continues to occur, you may not only begin to experience pain in your lower neck, but actually start to have the “uncovertebral osteophytes” grow even larger and begin to pierce the nerves that travel from the spinal cord to the arm.  When this occurs, you’ll notice a numb, shooting, electrical sensation down the arm, similar to your hand falling asleep, but with more pain and duration.  If it becomes serious enough, surgery can sometimes be the only option for eliminating this symptom.  Because of this, I would advise you to get under the care of a knowledgeable doctor.  An orthopedist is typically going to refer you to a physical therapist to manage your case, or a chiropractic doctor is going to manage your case his/herself.  Either way, it doesn’t matter much where you go.  But what is important is finding a good physical therapist or chiropractor who knows what he/she is doing.  I always tell my patients, there are amazing chiropractors out there (that practice scientific, evidence-based procedures and protocols) and there are terrible chiropractors out there.  Just the same, there are amazing physical therapists out there, and there are terrible physical therapists out there.  So it is important to notice improvement with whichever practitioner you decide to go see.  If you are going to work with a physical therapist, my recommendation would be to look for a D.P.T. (Doctor of Physical Therapy).  If you don’t know where to find a good chiropractor, try to look for one with the initials of F.A.C.O or D.A.C.B.O. after their D.C. title.  All of these types of doctors will have additional training for your condition.  The chiropractic initials mentioned above pertain to chiropractors that have additional training and certification in orthopedics.  However, like I said, you never know what you’re going to get, so at the very least, keep shopping for a doctor that seems to be helping your situation and pain the most.  I would focus on having your doctor train you with certain rehabilitative exercises and stretches to help fight the degenerative posture, along with other therapeutic procedures, such as ultrasound therapy if needed.  One nice thing about seeing a chiropractor is that they will be able to provide adjustments.  After all, that is what chiropractors do.  However, some D.P.T. programs are now training physical therapists in the art of manipulation, though not all will practice this since manipulation and spinal adjusting is a practiced, skilled art.  Nonetheless, these are great therapies for degenerating spines.  Some PTs or chiropractors might even use some traction on your neck, which is also great for degenerating necks.  Though traction is used a lot for disc problems, it is also very beneficial and really great for alleviating pain from arthritic necks.  Most patients feel it is a very comfortable and soothing procedure, so check into this as well.  If pain continues to persist, you may have some muscular pains from trigger points, so a knowledgeable practitioner that does trigger point therapy or acupressure may provide additional pain relief.

Lastly, I would recommend getting on a glucosamine chondroitin product.  And the rule of thumb is you usually get what you pay for when it comes to buying a glucosamine product.  This is about the only supplement that is specifically for degenerating joints (from worn down cartilage).  Glucosamine basically repairs the worn down cartilage, helps to rebuild it, and thus, prevents the acceleration of further degeneration.  Some good products out there are Cosamine and a liquid type by the Zand brand.  Like I said you get what you pay for, and these can be quite costly.  They can also sometimes take a few months to work, so you have to give it some time and be very patient.  You’ll even find some doctors tell you it’s a waste of money, but I’ve seen objective case studies showing dramatic results.  And if you find noticeable improvements even after 6 months, you should continue the product the rest of your life if you want to keep your neck in tip-top shape.  Sometimes its effect is so dramatic some patients will no longer need ongoing treatment.

I hope my references to a “degenerating, arthritic neck” are not too alarming to you.  We all tend to get some degeneration eventually in our life.  The best thing you can do is what you are doing – research your options and find a knowledgeable doctor that clearly knows what he/she is doing and also one who takes time to help you.  If your treatments sounds like a canned sales pitch or your therapists are a bit on the lazy side, you might want to keep shopping for a practitioner that seems knowledgeable and caring for your condition.

I hope this helps.  Best of luck!!

Dr. J.R. Strecker, D.C.