What is the initial management for a patient with spondylosis?

From the Research

The initial management for a patient with spondylosis should focus on conservative approaches to relieve pain and improve function, as recommended by the most recent guidelines 1. The management of spondylosis involves a combination of physical therapy, pain management, and lifestyle modifications.

• Physical therapy should emphasize exercises to strengthen core and back muscles, improve flexibility, and correct posture.
• Over-the-counter pain medications such as acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (250-500mg twice daily with food) can be recommended for pain relief 1.
• Application of heat or cold packs for 15-20 minutes several times daily can help manage localized pain.
• Activity modification is important—advise patients to avoid activities that worsen symptoms while maintaining general activity levels to prevent deconditioning.
• For persistent pain, consider referral for physical modalities such as massage therapy, acupuncture, or chiropractic care.
• If conservative measures fail after 4-6 weeks, consider prescription medications like muscle relaxants (cyclobenzaprine 5-10mg at bedtime) or referral for interventional procedures such as epidural steroid injections 1. This stepwise approach addresses both pain management and functional improvement while targeting the underlying degenerative process and associated muscle tension that characterizes spondylosis. It is essential to prioritize conservative management, as surgical intervention is generally reserved for patients who have failed conservative treatment or have severe or progressive neurologic deficits 2. A recent study on physiotherapy for ankylosing spondylitis, a related condition, also supports the use of exercise programs and patient education in improving outcomes 3. However, the primary focus should be on the most recent and highest-quality evidence available, which supports a conservative approach to managing spondylosis 1.