Cervical osteoarthritis

If you're reading this, you're probably familiar with that neck stiffness. The kind that prevents you from turning your head. That morning pain that takes time to fade. Or that worry after reading a report mentioning "osteoarthritis." As physiotherapists, we see patients every day who fear their neck is worn out for good.

Neck pain is very common. It is estimated that between 22% and 70% of people will experience it at some point in their lives. Neck pain is part of the ordinary human experience.

You are not alone. Signs of wear and degeneration on MRI scans are very common, and they increase with age. By age 20, about 37% of people already have disc wear without any pain. By age 80, that proportion reaches 96%. In other words, seeing cervical osteoarthritis on imaging does not mean you have neck pain: these signs are part of normal aging. Wear and tear is not entirely unrelated to pain. On imaging, these signs are slightly more common in people who have pain than in those who do not. The link exists; it’s just much weaker than is often thought.

• The presence of osteoarthritis does not necessarily mean pain; 98% show signs on an MRI, but most feel no pain.¹
• Wear and tear affects the entire joint. Cartilage, bone, ligaments, discs, and muscles can all be affected.³
• Movement is the best treatment. Your joints are nourished and strengthened through movement.
• Symptoms can be treated. Even with visible osteoarthritis, you can regain a pain-free neck.

This guide will help you understand your condition and get back to your activities. For an overview, consult our complete guide to neck pain.

What Is Cervical Osteoarthritis?

Cervical osteoarthritis is the normal wear and tear of the joints in the neck vertebrae. It affects the cartilage, bone, ligaments, discs, and muscles; it is a natural part of the aging process, not a serious disease.

We often talk about cartilage wear between the vertebrae. Cartilage acts like a cushion between the surfaces of your vertebrae. It allows your vertebrae to glide and move smoothly.

Over time, this cartilage wears down. All the structures of the joint can be affected.

Cervical osteoarthritis affects the entire joint, not just the cartilage.

What Are the Symptoms of Cervical Osteoarthritis?

Main symptoms include neck pain, morning stiffness, reduced flexibility, and creaking or cracking sounds with movement. However, cervical osteoarthritis doesn't always cause symptoms.

Many people live with osteoarthritis without experiencing any symptoms—a surprisingly common occurrence.

Morning stiffness is common with neck osteoarthritis, but it usually goes away once you start moving. That's a good reason not to stay still.

If you experience headaches along with your neck pain, read our article on cervicogenic headaches.

We frequently address this issue in physical therapy.

Neck pain can be persistent. About 37% of people who experience it report that their symptoms last at least 12 months.

What are the causes and risk factors?

Aging is the main cause of cervical osteoarthritis. By age 50, almost everyone has it. Risk factors include past neck injuries, being female, obesity, a sedentary lifestyle, and jobs requiring prolonged static postures.

Osteoarthritis does not develop overnight, but gradually over several years—a normal and natural process.

Osteoarthritis can sometimes cause cervical stenosis, which is a narrowing of the spinal canal. This is rare. Consult a professional if your symptoms change or worsen.

How is cervical osteoarthritis diagnosed?

Diagnosis relies on your symptom history and a clinical examination. An X-ray can confirm osteoarthritis, but it's not always necessary. Imaging results don't always correspond to the symptoms you experience.

What an X-ray or MRI shows isn't always relevant to your symptoms.

In most cases, the exact cause of neck pain cannot be pinpointed. It is clearly identified in only about 10 percent of cases.

Your symptoms and the physical exam are often more important than the imaging results. Don't be alarmed if a report mentions osteoarthritis—it's to be expected and is normal.

An X-ray or MRI is not necessary to diagnose osteoarthritis. The British NICE clinical practice guidelines recommend diagnosing osteoarthritis based on a clinical examination, without imaging.

When to consult a physiotherapist?

See a physical therapist when pain or stiffness prevents you from performing your daily activities. For example, if you have trouble checking your blind spots while driving or tilting your head. You don't need to see a doctor first.

• Difficulty checking your blind spots while driving
• Difficulty tilting the head
• Stiffness limiting your daily movements
• Pain lasting several weeks

You don't need to see a doctor before consulting a physiotherapist. If necessary, the physiotherapist will refer you to one.

What physiotherapy treatments are available?

Movement is the best treatment for cervical osteoarthritis. The physiotherapist assesses your mobility, nerve glide, postural habits, movement quality, and strength. This assessment allows them to create a personalized treatment plan.

For more details, consult our guide on physiotherapy for neck pain.

• Joint Mobilization Reduces Pain and Improves Movement
• Home Exercises Address the Cause, Not Just the Symptoms
• Dosage Education: Adjust Your Activities to Optimize Recovery
• Posture Tips Help Prevent Recurrences

For persistent neck pain, exercise can help. Strength training, motor control exercises, and approaches such as yoga, Pilates, or tai chi all appear to be equally effective. There isn't just one right type of exercise.

Physiotherapy doesn't cure osteoarthritis; wear and tear cannot be reversed. However, treatment can completely eliminate symptoms, even if the osteoarthritis remains present.

You can regain a pain-free neck even if osteoarthritis is visible on imaging.

Staying physically active helps manage chronic pain and should be a central part of the treatment plan for neck osteoarthritis.

What to do at home?

Stay active. If you have a sedentary lifestyle, start with walks and neck mobility exercises. If you're already active, continue your activities while listening to your body.

• Regular walks
• Neck and shoulder mobility exercises
• Respect your pain (a little is okay, not too much)

• Continue activities that don't cause too much pain
• Listen to your body

• Painful movements: Stop temporarily, then resume gradually
• Static Postures: Avoid staying in the same position for more than an hour. Move your neck and shoulders regularly.
• Pillow: Choose a pillow that you find comfortable
• Sleeping Position: Avoid sleeping on your stomach if you experience morning stiffness

How to prevent or slow down cervical osteoarthritis?

Regular physical activity prevents and slows down cervical osteoarthritis. Your joints are nourished by movement. Aim for 150 minutes of cardio activity per week, strength training twice a week, and maintain a healthy weight.

Your joints get stronger through movement, just like caring for a plant: regular care makes all the difference.

• Healthy Weight: Varies from person to person
• Preventing Repeated Injuries: Sprains, fractures, and surgeries accelerate wear and tear
• Healthy Eating: Consult a nutritionist or Canada's Food Guide

These tips can help you no matter your age. Regular activity reduces your chances of experiencing symptoms, even if you already have osteoarthritis.

Need professional advice?

If your neck pain persists, our physiotherapists can help. Contact Physioactif for a personalized assessment.

Visit our neck pain page to book an appointment.

Listen to the podcast "Parle-moi de santé" by Alexis Gougeon, a physiotherapist at Physioactif. Episode #15 discusses osteoarthritis in an easy-to-understand way.

Available on Spotify, Apple Podcast, and Google Podcasts.

References

1. Okada E, Matsumoto M, Fujiwara H, Toyama Y. Disc degeneration of cervical spine on MRI in patients with lumbar disc herniation: comparison study with asymptomatic volunteers. Eur Spine J. 2011;20(4):585-91.
2. Musumeci G, Aiello FC, Szychlinska MA, Di Rosa M, Castrogiovanni P, Mobasheri A. Osteoarthritis in the XXIst century: risk factors and behaviours that influence disease onset and progression. Int J Mol Sci. 2015;16(3):6093-112.
3. Gellhorn AC, Katz JN, Suri P. Osteoarthritis of the spine: the facet joints. Nat Rev Rheumatol. 2013;9(4):216-24.
4. Canadian Society for Exercise Physiology. Canadian 24-Hour Movement Guidelines for Adults ages 18-64 years. 2021. Available from: https://csepguidelines.ca/adults-18-64/