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Physiotherapy for CSM

Interview with a Physiotherapist

Dr. Sukhvinder Kalsi-Ryan, BScPT, MSc, PhD, 10 December 2015


​I am a physiotherapist in Ontario, Canada. I have practiced in all aspects of spine care, acute and chronic. I have a special interest in CSM as I see a large number of individuals who suffer from this disease. Currently I am a scientist who spends time studying in detail this disease and how it impacts people’s ability to live their life on a daily basis.

​What is the role of physiotherapy in CSM?

For patients with mild CSM that are likely to be managed without surgery the role of Physiotherapy has two goals:

  1. reduction of pain in the neck and other body parts
  2. improving the cervical alignment and strength.

A caveat is that mild CSM is often not recognised and sometimes even misdiagnosed. Patients that suffer from neck pain and associated symptoms such as radiculopathy of impaired upper limb function can benefit from a neck conditioning and postural education program.

Can physiotherapy avoid the need for surgery?

Lady undergoing rehab exercise

The changes that occur and cause CSM are structural and are not treatable without surgery. The structural pressure cannot be removed by any other means. However, if the pressure is related to poor posture and cervical dysfunction, then cervical conditioning and postural education can relieve the symptoms of CSM, however, not remove or relieve the structural pressure. If one does have a very positive response to physiotherapy it is likely that the CSM is not the primary cause of pressure on the spinal cord. 

Therefore, for those patients who have mild CSM a course of conservative management can help in determining how necessary surgery is.

Which patients benefit most from physiotherapy?

Ideally patients with very mild degenerative changes can benefit from cervical conditioning and postural education. Often Physiotherapy is quite effective for a period of time. Both pain and symptoms can be reduced.

What can patients expect to get out of physiotherapy?

Patients can expect a reduction in neck and limb pain and a reduction in neurological symptoms such as numbness. However, complete resolution is not expected. 

When is physiotherapy not recommended?

Physiotherapy is not recommended when the CSM has become moderate and severe, here the degeneration is frank and compression on the cord is not questionable. Some general exercise for fitness is harmless, however, excessive manipulation and movement in the cervical spine can be damaging.

Unfortunately, CSM is often diagnosed late, at a stage where the role of physiotherapy is limited.

How do you approach a CSM patient?

One should always perform cervical screening. This involves testing the integrity of the cervical ligaments, segmental mobility, and neurological function. If imaging is available, it should definitely be reviewed. The therapy should be activity based and not involve manipulation or traction. The aims include cervical core stabilisation, flexibility and postural education.

What are your treatment aims?

​Pain reduction, symptom relief and improving neck posture.

How long do you treat patients for?

There is no recommended course that fits all patients. Physiotherapy should be personalised to each individual patient. In my practice, I see most mild CSM patients 1 to 2 times a week for the first few weeks, followed by one visit a week for another 2 to 3 weeks, followed by once every two weeks prior to a recommended independent program.

Dr. Sukhvinder Kalsi-Ryan - Biography

Dr. Kalsi-Ryan is a physiotherapist with a special interest in spinal disease, working for the last 15 years with patients at the Toronto Western Hospital. Her research interests include outcome measures in spinal cord injury. She has developed an assessment of upper limb function called the GRASP test, establishing its psychometric properties and utility within the field of spinal cord injury. Dr. Kalsi-Ryan continues to work on a number of clinical studies: she is currently leading the GRASSP Longitudinal Study and developing an objective measurement protocol specific for Cervical Spondylotic Myelopathy.

Watch the CSM and Physiotherapy Q/A Session (21st September)