The Older Neck: Cervical Stenosis Explained By Peter Pfeiffer

Why does neck pain seem to affect so many of us today? Whether it’s long hours at a desk, years of wear and tear, or simply the passage of time, neck discomfort is becoming increasingly common. Two frequent culprits are cervical stenosis and cervical disc injury. Understanding these conditions is the first step towards managing them confidently and safely.

What Is Cervical Stenosis?

Cervical stenosis is a degenerative condition in which the spinal canal of the neck becomes narrowed. This narrowing can press on the spinal cord or nearby nerves, leading to pain, weakness, or changes in sensation in the arms, shoulders, or neck. The areas most often affected are the C5 - C6 and C6 - C7 levels - the lower part of the cervical spine where much of our movement and load-bearing occurs.

As we age, the tissues around the spine gradually stiffen and thicken. Small bony outgrowths (osteophytes) may develop, and the ligaments that stabilise the spine can lose flexibility, all contributing to reduced space for the spinal cord.

How Common Is It?

Cervical stenosis affects around 5% of adults, and its prevalence rises sharply with age - nearly 1 in 10 people over 70 experience it (Battié, Joshi & Gibbons, 2019). Men are slightly more affected, and symptoms often appear after the age of 50. While most cases remain mild and manageable with physiotherapy and exercise, studies suggest that up to 75% of individuals may notice gradual neurological changes over time if left untreated.

What Causes Cervical Stenosis?

This condition rarely stems from a single event. Instead, it develops over years of gradual change. Common contributing factors include:

• Bony overgrowths and ligament thickening; which reduce space around the spinal cord.

• Disc herniation or bulging; pressing on nerve roots.

• Genetic predisposition; influencing spinal shape or tissue resilience.

• Postural strain; such as extended computer use or repetitive neck movements.

• Trauma; such as whiplash from a previous motor vehicle accident

These mechanical and biological factors combine to produce the characteristic narrowing seen on imaging. In Imaging could include: X-rays, MRI (Magnetic Resonance Imaging), CT scans (Computed Tomography), Ultrasound, PET scans (Positron Emission Tomography), Mammography, Fluoroscopy or Nuclear medicine imaging.

Recognising the Symptoms

The signs of cervical stenosis can vary widely - from mild stiffness to significant nerve involvement. Common symptoms include:

• Persistent neck pain radiating into the shoulders or arms.

• Tingling, numbness, or “electric shock” sensations down the arms or spine.

• Hand weakness or loss of dexterity (difficulty with buttons or writing).

• Balance problems or unsteady walking.

• Headaches and neck stiffness, often worse with looking up or prolonged standing.

Interestingly, some people show clear narrowing on MRI but have few or no symptoms - a reminder that structure and pain do not always correlate directly (Schmid et al., 2008).

Getting the Right Diagnosis

A thorough assessment by a physiotherapist is essential. Diagnosis involves:

• Clinical examination to assess strength, reflexes, and coordination.

• Functional assessment tools, such as the Neck Disability Index (NDI), to measure how symptoms affect daily life.

An MRI scan, which remains the gold standard for visualising canal narrowing or disc changes. A referral from a specialist is needed for an MRI.

Importantly, imaging findings should always be interpreted alongside a person’s symptoms and physical presentation - not in isolation.

Managing and Treating Cervical Stenosis

Most cases can be treated conservatively. Physiotherapy plays a central role in:

• Improving mobility and posture to reduce mechanical strain.

• Strengthening deep neck flexors and scapular stabilisers to support spinal alignment.

• Manual therapy techniques, which may influence both mechanical and central nervous system responses to pain (Schmid et al., 2008).

• Breathing and relaxation exercises, which research suggests can improve overall pain control and muscle function (Simoni et al., 2020).

Surgery is reserved for cases where severe compression causes significant weakness, loss of coordination, or bladder/bowel changes.

Living Well With Cervical Stenosis

The good news is that many people live active, comfortable lives with this diagnosis. With professional guidance and consistent exercise, symptoms can be managed and often improved. Recovery is gradual - some changes are structural, but the body’s adaptability and resilience are remarkable.

Take care not to be discouraged by fluctuations in symptoms. Progress is rarely linear, and even small improvements in strength, flexibility, and confidence can make a meaningful difference.

If you’d like some help getting started, call Debbie Cameron Physiotherapy on 031 765 88 98. We would love to support you with managing this condition.

References (Harvard Style)

• Battié, M.C., Joshi, A.B. & Gibbons, L.E. (2019) ‘Degenerative Disc Disease: What is in a Name?’, Spine, 44(21), pp. 1523–1529.

• Schmid, A., Brunner, F., Wright, A. & Bachmann, L.M. (2008) ‘Paradigm Shift in Manual Therapy? Evidence for a Central Nervous System Component in the Response to Passive Cervical Joint Mobilisation’, Manual Therapy, 13(5), pp. 387–396.

• Simoni, G. et al. (2020) ‘Effect of Standard Cervical Physiotherapy Plus Diaphragm Manual Therapy on Pain in Patients with Chronic Neck Pain: A Randomized Controlled Trial’, Physiotherapy Theory and Practice, 48(4), pp. 387–396.