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Cervical Spondylosis: Greeva graham

25 Apr 2016   Shanti Gowans
Spondylosis is a broad term that simply refers to a painful condition of the spine resulting from some degeneration of the intervertebral discs. Most often, the term is used to describe osteoarthritis of the spine, but it is also commonly used to describe any manner of spinal degeneration. Spondylosis changes in the spine are frequently referred to as osteoarthritis. For example, the phrase 'spondylosis of the lumbar spine' refers to degenerative changes such as osteoarthritis of the vertebral joints and degenerating intervertebral discs (degenerative disc disease) in the low back.

Cervical spondylosis is caused by degeneration of bones, discs (cartilage cushion between the neck bones) and joints of the neck.

This condition is commonly found in people of middle-age group, the elderly. Additionally, people who undergo excessive exertion, those with bad posture, and frequent travellers often end up with trauma to neck bones, leading to spondylosis. However, Cervical spondylitis is a health complaint which is increasing day by day in young adults. Lifestyle changes, altered food and habits, work exhaustion, improper sitting posture, excessive travelling and so on are the worsening factors for the disease. It is a wear and tear disease and is experienced as neck pain, stiffness, headache, numbness, and so on. As psychological factors are also involved in this complaint, it is wise to adopt some relaxing techniques to reduce the pain. The good news ia that this is one of the diseases wherein Ayurvedic treatment offers very good promise. 
 
The bony structure of the neck consists of cervical bones stacked one on top of the other, sandwitched with disc cartilage inbetween. The triangular circular aperture within these bones forms the way for the nerves from the brain to pass through. Branches of these nerves (the nerve roots) through the back and sides of these bones merge and divide, forming a complex arrangement of nerves, called the cervical plexus. These nerves spread on the sides to supply the neck, face, back of the head, ears, shoulder and the full length of the arms.
 
With age, the bones and cushioning cartilage discs lose their strength. This thins the soft cartilage causing it to expand, slip (called herniation of disc), touch and irritate the nerves.
 
The degenerating discs also become flat, with brittle edges, causing nerve irritation. Nerve irritation leads to symptoms such as pain, numbness and so on. The stiffness arises because of the lack of cushioning between the neck bones, causing friction whenever the neck is moved.
 
This condition is also called Cervical osteo arthritis. The term Cervical spondylitis is used, when the patient has active inflammation (redness, swelling, increase of temperature etc).
 
In Ayurveda, a condition called Greeva graham, a condition with cardinal feature of stiffness of the neck is explained, which exactly suits Cervical spondyslosis. Greeva means neck and Graha refers to stiffness. It is explained as a Vata condition. The inflammation in the ligaments and muscles surrounding the vertebrae classes this as a high Vata and Pitta disorder. Increase in Vata leads to depletion of body tissues. (For example, with ageing, Vata increases and body tissues start degenerating.) The dryness and degeneration caused by Vata leads to decrease of Kapha dosha, in particular, sleshaka kapha (synovial fluid), which is responsible for cushioning inbetween bone joints. Hence disc degeneration sets in leading to spondylosis.
 
Some compare this condition with another disease called Vishwachi  / Apabahuka.
 
Causative factors for Cervical spondylosis, greevagraha 
- Food habits that increase vata dosha, such as intake of dry, cold/frozen and light food
- Fasting for long period. This leads to depleted nourishment and increase of vata dosha.
- Untimely intake of food
- Junk food
- Fizzy drinks and Sodas
- Less intake of water/liquids
- Excess intake of curried food etc
 
Bad habits, viharaja
- Night awakening
- Day sleep
- Heavy exercise
- Suppression of the natural urges
- Weight bearing in the head, shoulder or neck
- Walking for long distances
- Bike riding for long distances.
 
Psychological factors, manasika hetu 
- Stress
- Grief
- Anger
- Fear
- Loss of interest in work etc
 
Clinical features and symptoms of Cervical spondylosis, greevagraha
Most commonly, cervical vertebrae are affected. Thee is pain in the neck that might radiate towards the hands and fingers. Paoin may also felt in the back near the scapular region. Tingling and numbness to the hands is very common. Vertigo after bending the neck may also be present.
 
- Pain in the neck
- Difficulty in the usual functions of the neck, such as rotation, flexion, extension etc
- Radiating pain to the shoulder, forearm or arm
- Muscular spasm
- Numbness
- Joint stiffness
- Fatigue
- Headache
- Tingling sensation, numbness, weakness in the arms
- Difficulty in walking, lack of co-ordination
 
Treatment of Cervical spondylosis, greevagraha
 
DIET AND HABITS
 
Unwholesome diet and habits 
All causative factors mentioned above should be avoided.
 
Wholesome diet and habits in Cervical spondylosis, greevagraha 
- Red rice, rakta shali
- Wheat, godhuma
- Milk, ksheera
- Ghee, ghrita
- Butter, navaneeta
- Warm water, ushna jala
- Rest, vishrama.
- Proper position (sukha asana) while sitting, writing, typing, driving a car etc. and lying down (shavasana), etc
- Forward bending of the neck should be avoided
- While sleeping, care should be taken that the pillow is not too thick, because with a larger the pillow, the neck remains more in the forward bending position, which increases the problem.
 
Ayurvedic Medicines
Triphala guggul or Mahayogaraj guggul: 2 tablest x 3 times a day, with
Maharasanadi decoction. 15ml. x 3 times a day
for fifteen days, is ideal for relieving pain.
 
Main Procedures
Four basic procedures form the basis of treatment. These procedures help to normalise the movement of Vata in proper direction. They are:
1. Oleation, snehana. Both internal and external oleation (vishagarbha oil) are beneficial.
 
2. Sudation, swedana. Mild to moderate sudation can be carried out. External application of vishagarbha oil should be followed by nadi sweda fomentation with the mixture of water and a few drops of eucalyptus oil or leaves of nirgundi.
 
3. Mild purgation, mridu shodhana, with Castor oil mixed with milk, or the fruit pulp of Cassia fistula, aragwadha phala majja. Here is a suggested recipe. Take the following mixture for three weeks on an empty stomach, early in the morning:
2tsf. Castor oil,
2 tsf fresh juice of ginger
1/4 teaspoon lemon juice
1 teaspoon ghee
 
4. Retaining medication in the nape of the neck, greeva basti
In this procedure, a dam is created around the back of the neck with black gram paste. Medicated oil (Vishagarbha, or Ksheerabala oil or Bala Ashwagandhadi oil etc) is heated and is retained within the dam for a few minutes. The heated oil helps to improve the space between the neck bones, leading to relief from disc herniation. The oil, along with oral medicines help to improve nourishment of disc cartilage and bone, reversing the degeneration process.
 
Secondary procedures 
Additionally, many secondary procedures such as
- Shirodhara, oil drip to the forehead
- Abhyanga, massage
- Patrapinda sweda, medicated leaves to induce sweating
- Shastika Sali Pinda Swedam/ Navarakizhi, herb bundles
- Pizhichil, medicated oil bath and so on, 
are administered to relieve pain, inflammation of muscles and ligaments, and to improve the flexibility of neck bone joints.
 
Oils for external application
- Vishagarbha taila
- Mahanarayana taila
- Mahamasha taila 
- Sahacharadi taila
- Bala taila
- Pure Shanti taila.
 
Adjuncts that can assist
 
Cervical collars
Cervical collars help by restricting the movements of the neck. Lesser neck movements helps to reduce inflammation, pain and heal the ligaments faster. They also tend to increase the space between each neck bone, thereby, reducing the extent of disc prolapse (herniation). Lesser the disc herniation, lesser the irritation the displaced disc causes to the nerve, lesser the pain and discomfort. You can wear the neck collar at least for 2- 4 hours a day. It is not recommended that you use it for very long hours or throughout the day.
 
Cervical pillow
A cervical pillow can keep the neck in a comfortable position while you sleep.
 
Cervical traction kit with sand bag
This is advanced equipment and needs expert supervision. It helps to widen the gap between the neck bones, thereby replacing the disc in its normal position. It can be used for a period of 1 – 2 weeks. Seek medical advice for more information.
 
Yoga sanas for cervical spondylosis:
- In the early stages, practice Gardhanasana, the Yoga exercises to strengthen your neck muscles and ligaments. 
- Asanas such as Sun salutation, surya namaskara, Cobra, bhujangasana, makarasanaardha naukasana and marjariasana can help. You will have to seek expert guidance for following them. The benefits would double if you apply pain relieving oil such as Mahanarayana taila, 10 minutes before practicing Asanas.
 
Ayurvedic vata pacifying herbs useful in cervical spondylosis:
Castor root, ricinus communis
Rasna, pluchea lanceolata
Bala, sida cardifolia
Atibala, abutilon indicum
Prishniparni, uraria picta
Shalaparni, desmodium gangeticum
Gambhari, gmelina arborea
Amalaki, emblica officinalis
Ashwagandha, withania somnifera
Sahachara, barleria prionitis
Guggulu, commiphora mukul
Shallaki, boswelia serrata
Shunthi, ginger, and so  on
 
Ayurvedic medicines for cervical spondylosis:
- Rasnairandadi kashaya. Used more commonly in South Indian Ayurveda practice for backache, low back pain, pain in flanks and locked jaw. 
- Sahacharadi kashaya. Relieves pain associated with neck, hip and low back.
- Rasna saptaka kashaya
- Yogaraja guggulu. Widely used in the Ayurvedic treatment for various types of arthritis
- Mahayogaraja guggulu. Widely used in the Ayurvedic treatment of joint diseases, skin diseases, piles, sprue, diabetes, gout, fistula, bloating, emaciation, low digestion power, etc
- Ksheerabala (Avartita). Useful in reversing tissue deneration.
- Trayodashanaga guggulu. Widely used in the Ayurvedic treatment of joint pain related disorders.
- Dashamoola rasayana. Relieves pain and inflammation
- Rasnadi guggulu.
 
 

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