Q: I am a 35 years old woman having cervical spondylosis, stiff joints and severe pain in neck and right arm. My right eye is also getting smaller and pains a lot. Please advise me some medication and exercises.

A:Few of your complaints are a little concerning like severe neck pain with arm pain as well as right eye getting smaller. This usually occurs if the sympathetic nerve around the neck is being compressed due to any reason. If the symptoms continue, you should seek medical help and an MRI might be required to further define the lesion. I am giving you a brief summary of cervical spondylosis and its treatment so that you can educate yourself and benefit from it:

1. Mild cases of cervical spondylosis may respond to -
   • Wearing a neck brace (cervical collar) during the day to help limit neck motion and reduce nerve irritation.
   • Taking non-steroidal anti-inflammatory drugs such as Brufen, Voveran etc just for a short period
   • Doing exercises prescribed by a physical therapist to strengthen neck muscles and stretch the neck and shoulders. Low-impact aerobic exercise, such as walking or water aerobics, also may help.
2. For more severe cases, non-surgical treatment may include -
   • Hospitalisation with bed rest and traction on the neck for a week or two to completely immobilize the cervical spine and reduce the pressure on spinal nerves.
   • Taking muscle relaxants, such as methocarbamol (Robaxin) or cyclobenzaprine (Flexeril), particularly if neck muscle spasms occur, and taking narcotic medications to relieve severe pain.
   • Injecting corticosteroid medications into the joints between the vertebrae (facet joints). The injection combines corticosteroid medication with local anesthetic to reduce pain and inflammation.
3. Surgery - Your doctor may recommend surgery to relieve compression of spinal nerves or the spinal cord if you have severe pain that doesn't improve with more conservative treatment or if your neurological symptoms, such as weakness in your arms or legs, are getting worse.

Call your doctor if -

• You have neck pain that doesn't respond to over-the-counter pain medications and is increasing in intensity and is worsening.
• You develop numbness in your arms or legs.

I am including neck exercises that might benefit you: In an isometric exercise, a force is applied against a resistant object, so that even though tension builds in a specific muscle, there is no movement. You can do isometric exercises to strengthen the muscles of your neck. For each exercise, keep your neck straight and look straight ahead.

• To exercise muscles at the right side of the neck, put your right hand against the right side or your head above your ear. As you press against the side of your head with your hand, also press your head back against your hand. You should feel the muscles at the side of your neck tighten, but your head should not move to either side. Hold for about 4 seconds, rest a few seconds, then repeat.
• To exercise muscles at the left side of the neck, do the same steps as in the exercise above, but press your left hand against the left side of your head.
• To exercise muscles at the back of the neck and upper back, lace your fingers or put one hand over the other and place your hands at the back of your head. Press your hands against your head at the same time you press your head straight back against your hands. Do not tip your head back. Hold for about 4 seconds, rest a few seconds, then repeat.
• To exercise muscles at the front of the neck, put the heels of both hands against your forehead just above your eyebrows. Press your hands against your forehead at the same time you press your head against your hands. Do not tip your head forward. Hold for about 4 seconds, rest a few seconds, then repeat.
• Repeat each exercise 6 to 10 times, 3 to 5 times each day.

Talk with your doctor or physical therapist if you have questions about how to do this.