posted on Friday, February 23, 2007 7:01 PM
by
admin
Response to a reader's questions on cervical stenosis
A comment was posted to my blog on "Cervical Stenosis" with some very good questions:
"I am wondering which Mckenzie neck excercises did you perform? All 7? 8 times a day? I am concerned about doing #2 and #7. I am in the same situation that you were in: I started with pain in my right side-arm and leg all the way to figres and toes with no neck pain. Neurosurgeons found formainal and moderate central stenosis at C4-5 and C5-7. They want to perform cervical discectomy and fusion. I want to try other avnues first. Thanks for the information."
Stenosis is quite a tricky syndrome. Many people with their MRI reporting stenotic findings have no stenotic symptoms, while others have the symptoms but not the MRI indication. Within the group that have the symptoms and the confirming MRI, there is a number of them that can be treated conservatively, and there is a number that can only be managed surgically. The McKenzie method for the neck is not merely the 7 or 8 exercises, but a comprehensive systematic methodology to solve orthopedic problems. Stenosis, like many other mechanical problems in the spine, will require a thorough McKenzie assessment to determine the extensiveness, in order for the most precise and appropriate therapy to be prescribed. If I were you, with symptoms you presented, I would not perform any of the 7 exercises without a McKenzie assessment by an experienced certified McKenzie therapist or diplomat. The McKenzie method is able to determine whether the patient can benefit from it or not. If your problem is beyond what conservative approach can offer, you may not want to waste too much time there.
In the meantime, my first recommendation for you would be: Let the symptoms guide you. This is one of the McKenzie principles to treatment. My MRI was extremely alarming and depressing a year ago. However, my symptoms were not constant nor severe. I had strong tingling and numbness only if I extended my neck--i.e. a movement to look up, or to lift one's head up above neutral position. So I avoided the activities and positions that would aggrevate any symptom.
Furthermore, the component of the stenosis in my case was the severe herniation toward the back--the nerve roots and spinal cord. Therefore, I also avoided flexion--the movement that brings the head down or forward. Please keep in mind though--for severe stenotic symptoms, many times it is only flexion that can alleviate symptoms. So this may seem contradicting, but indeed it is not. The need to see a certified McKenzie professional is in this--knowing in what direction to exercise and how far to go to reduce the mechanical problem, but don't go too far to worsen the symptoms. In my case, I performed retraction hourly as long as it did not provoke symptoms. But I would not tell all my stenosis patients to do the same thing.
Without knowing all the aspect of your symptom behavior, I cannot, and should not, tell you which exercise to do. I would urge you to consult a certified McKenzie professional (www.McKenzieMDT.org) to get the right exercises to do at the right time and with the right amount of intensity. Hope this helps and best of luck to you!
Irene Acevedo, PT, Cert MDT