Understanding and Managing Degenerative Cervical Myelopathy: A Physiotherapist’s Perspective

As a physiotherapist at Physio@Home, I frequently encounter clients with neck-related conditions, one of the more complex being Degenerative Cervical Myelopathy (DCM). This condition can significantly impact quality of life, but with early recognition and tailored management, individuals can maintain function and reduce symptoms. In this blog post, I’ll explain what DCM is, its signs and symptoms, and how we, as physiotherapists, can help manage it alongside medical interventions.

What is Degenerative Cervical Myelopathy?

Degenerative Cervical Myelopathy is a progressive condition caused by compression of the spinal cord in the cervical spine (neck). This compression often results from age-related degenerative changes, such as:

• Disc degeneration: Wear and tear of intervertebral discs.

• Osteophytes: Bone spurs that narrow the spinal canal.

• Ligament thickening: The ligamentum flavum or posterior longitudinal ligament may stiffen and encroach on the spinal cord.

• Spondylosis: General wear of the cervical spine structures.

These changes reduce the space available for the spinal cord, leading to neurological symptoms. DCM is most common in people over 50, but it can occur earlier in those with predisposing factors like previous spinal injuries or congenital spinal narrowing.

Signs and Symptoms of DCM

DCM symptoms develop gradually, which can make early detection challenging. As physiotherapists, we’re trained to spot these red flags during assessments. Common symptoms include:

• Neck pain and stiffness: Often an early complaint, though not always present.

• Numbness or tingling: Typically in the hands, arms, or legs, due to impaired nerve signaling.

• Weakness: Difficulty with fine motor tasks (e.g., buttoning a shirt) or general limb weakness.

• Balance and coordination issues: Clients may report unsteadiness when walking or frequent tripping.

• Reduced dexterity: Difficulty with tasks requiring precision, like writing or holding objects.

• Bladder or bowel dysfunction: In severe cases, indicating urgent medical attention is needed.

If you’re experiencing these symptoms, don’t ignore them. At Physio@Home, we can conduct a thorough assessment to identify potential DCM and guide you toward appropriate care.

Physiotherapy Management of DCM

As physiotherapists, our role in managing DCM focuses on maintaining function, reducing discomfort, and supporting overall well-being. While DCM often requires medical intervention, physiotherapy is a vital part of a holistic management plan.

1. Education and Self-Management

We empower clients with knowledge about DCM to help them understand their condition and avoid aggravating activities. For example:

• Posture correction: Teaching proper neck and shoulder alignment during daily tasks.

• Activity modification: Advising on how to avoid prolonged neck flexion (e.g., looking down at a phone for long periods).

2. Pain and Stiffness Management

• Manual therapy: Gentle mobilizations to improve cervical joint mobility, provided symptoms are stable and non-progressive.

• Soft tissue techniques: To relieve muscle tension in the neck and upper back.

• Heat or cold therapy: To ease discomfort and improve circulation.

3. Exercise Therapy

Exercise is tailored to the individual’s symptoms and severity. Our goals include strengthening supporting muscles and maintaining mobility:

• Neck and core strengthening: Gentle exercises to support the cervical spine, such as isometric neck exercises.

• Upper limb strengthening: To counteract weakness and maintain function.

• Balance training: For clients with gait or coordination issues, we incorporate exercises like tandem walking or standing on uneven surfaces.

• Flexibility exercises: Stretching to maintain range of motion in the neck and shoulders.

4. Functional Training

We focus on practical strategies to improve daily function. For example:

• Fine motor skills practice: Activities like picking up small objects to enhance dexterity.

• Gait retraining: To improve walking stability and reduce fall risk.

5. Collaboration with Multidisciplinary Teams

DCM often requires input from neurologists, orthopedic surgeons, or pain specialists. We liaise with your healthcare team to ensure physiotherapy complements medical management.

Medical Management of DCM

While physiotherapy plays a crucial role, DCM often requires medical oversight, especially in moderate to severe cases. Common medical interventions include:

• Conservative Management:

  • Medications: Pain relievers (e.g., paracetamol) or anti-inflammatories (e.g., ibuprofen) to manage symptoms.

  • Cervical collars: Used sparingly to limit neck movement, but prolonged use is avoided to prevent muscle weakening.

• Surgical Intervention:

  • Surgery is often recommended for progressive or severe DCM to decompress the spinal cord. Procedures include:

    • Anterior cervical discectomy and fusion (ACDF): Removes a disc and fuses vertebrae.

    • Laminectomy or laminoplasty: Widens the spinal canal.

  • Post-surgical physiotherapy is critical to restore mobility and strength, and we at Physio@Home specialize in home-based rehabilitation.

• Monitoring and Imaging:

  • MRI or CT scans are used to confirm diagnosis and monitor progression.

  • Regular follow-ups with a neurologist or spinal specialist ensure timely intervention.

Living with DCM: Tips from Physio@Home

• Stay active: Engage in low-impact activities like walking or swimming to maintain overall fitness.

• Prioritize ergonomics: Set up your workspace to support neutral neck posture.

• Monitor symptoms: Report any worsening symptoms, such as increased weakness or bladder issues, to your healthcare provider immediately.

• Seek support: DCM can be challenging emotionally. Consider joining support groups or speaking with a counselor.