Authored by Ashitha Abdul Ashraf, Senior Consultant Physiotherapist – Incharge | Medically Reviewed by Dilshana Thasni T, Senior Consultant Physiotherapist | Last Reviewed: June 2026
Spondylosis is one of the most frequently mentioned diagnoses on MRI reports across Kerala. Patients hear the word, look it up, and come away alarmed. The combination of medical terminology and the word degeneration suggests something serious and progressive that requires significant intervention.
In most cases, it does not.
Spondylosis is age-related wear and tear of the spine. It is present to some degree in virtually everyone over 40 and in a significant proportion of people under 40 who have sedentary lifestyles, a history of spinal injury, or genetic predisposition. Most people with spondylosis on imaging have no significant pain. Many who do have pain recover fully with appropriate conservative treatment.
This guide explains what spondylosis is across different spinal regions, how it is properly managed without surgery, and when surgery becomes genuinely necessary.
What Spondylosis Actually Means
Spondylosis is a broad term describing degenerative changes in the spine. It encompasses:
Disc degeneration. Loss of disc height and water content. The discs lose their ability to absorb load effectively as they dehydrate.
Osteophyte formation. Bone spurs forming at the edges of vertebral bodies and facet joints. The body’s response to increased mechanical stress at degenerated spinal segments.
Facet joint arthritis. Osteoarthritic changes in the small joints between vertebrae. Cartilage thinning, joint space narrowing, and reactive bone formation.
Ligament changes. Thickening and calcification of spinal ligaments over time.
These changes occur throughout the spine — in the cervical (neck), thoracic (mid-back), and lumbar (lower back) regions — though they are most clinically significant in the cervical and lumbar spine where they are most likely to cause symptoms.
The important distinction is between spondylosis as a structural finding — which is extremely common and often asymptomatic — and spondylosis as a clinical condition producing symptoms that require treatment.
Lumbar Spondylosis
Lumbar spondylosis refers to degenerative changes in the lower five vertebrae — the most load-bearing region of the spine.
Who Gets It
Lumbar spondylosis is present in approximately 40% of people aged 40 and in over 80% of people over 60. Risk factors include sedentary lifestyle, obesity, previous lumbar injury, heavy occupational loading, and genetics.
Kerala’s combination of high rates of sedentary desk work, high obesity prevalence in urban areas, and a physically demanding agricultural and construction workforce creates a large population with lumbar spondylosis at varying stages.
Symptoms
Lumbar spondylosis without nerve compression produces:
- Lower back aching that worsens with prolonged sitting, standing, or activity
- Morning stiffness that eases within 30 minutes of movement
- Reduced lumbar range of motion — difficulty bending forward or backward fully
- Pain that is worse at the end of the day after sustained activity
When lumbar spondylosis produces foraminal stenosis — narrowing of the nerve exit channels — or central canal stenosis — narrowing of the spinal canal itself — nerve root symptoms develop:
- Leg pain, numbness, or tingling from nerve root compression
- Leg heaviness or weakness with walking that improves with sitting (neurogenic claudication from spinal stenosis)
- Sciatica when the L4, L5, or S1 nerve roots are compressed
Non-Surgical Treatment
Physiotherapy and spinal stabilisation exercise. The primary treatment for lumbar spondylosis at every stage. Strengthening the deep spinal stabilisers — multifidus and transverse abdominis — compensates for the reduced mechanical stability of degenerated spinal segments. Progressive lumbar strengthening, hip strengthening, and aerobic conditioning are the core components.
Manual therapy. Joint mobilisation of stiff lumbar segments reduces pain and improves range of motion. Soft tissue release addresses the paraspinal muscle guarding that develops around spondylotic levels.
Spinal Decompression Therapy. For lumbar spondylosis producing disc height loss and associated nerve root irritation, the KNX-7000 spinal decompression system creates negative intradiscal pressure — reducing nerve compression and drawing hydration back into degenerated discs. Available at all Maana Health clinics across Kerala.
A typical course of spinal decompression for lumbar spondylosis with nerve involvement is 15 to 20 sessions. Many patients with chronic pain from lumbar spondylosis that has not responded to basic physiotherapy experience significant improvement with decompression.
Lifestyle modification. Weight management, ergonomic correction for desk workers, activity modification to reduce high-load activities while maintaining aerobic fitness.
TENS and electrotherapy. For pain management during rehabilitation — reducing pain enough to allow the exercise program to proceed.
Cervical Spondylosis
Cervical spondylosis — degenerative changes in the neck — is covered in detail in our cervical spondylosis guide. The key points for this guide:
Cervical spondylosis is extremely common in Kerala’s desk worker population. Forward head posture from screen work accelerates degeneration of the cervical discs and facet joints.
The clinical spectrum ranges from axial neck pain and stiffness through to cervical radiculopathy — arm pain, numbness, and weakness from nerve root compression — and in severe cases, cervical myelopathy — spinal cord compression producing progressive weakness and coordination problems in the limbs.
Non-surgical treatment is appropriate for the vast majority of cervical spondylosis cases:
Cervical physiotherapy. Manual therapy, deep neck flexor strengthening, postural retraining.
Cervical spinal decompression. For radiculopathy from foraminal stenosis — targeted traction at the specific cervical level compressing the nerve root.
Ergonomic correction. Screen at eye level is the single most important intervention for desk workers with cervical spondylosis.
Myelopathy — progressive spinal cord compression — is the exception. This requires urgent surgical assessment.
Thoracic Spondylosis
Thoracic spondylosis is less commonly symptomatic than cervical or lumbar spondylosis. The thoracic spine is stabilised by the rib cage, which limits the movement and therefore the mechanical stress that drives symptomatic degeneration.
When thoracic spondylosis does cause symptoms:
- Mid-back aching between the shoulder blades
- Thoracic stiffness — reduced ability to rotate the upper body
- Occasionally, radicular symptoms wrapping around the chest wall from thoracic nerve root compression
Treatment for symptomatic thoracic spondylosis:
Thoracic manual therapy. Joint mobilisation of stiff thoracic segments is one of the most effective treatments for mid-back pain and thoracic stiffness. The thoracic spine responds well to mobilisation — often producing immediate improvement in range of motion and pain.
Thoracic extension exercises. Counteract the thoracic kyphosis (forward rounding) that both causes and is caused by thoracic spondylosis. Extension over a foam roller or a rolled towel, thoracic extension over a chair back.
Postural training. Strengthening the thoracic extensor muscles and scapular stabilisers improves thoracic posture and reduces the compressive loading that drives spondylotic progression.
Multilevel Spondylosis: What It Means
Many MRI reports in Kerala describe spondylosis at multiple spinal levels — C3-4, C4-5, C5-6 in the cervical spine, or L3-4, L4-5, L5-S1 in the lumbar spine.
Multilevel spondylosis sounds more serious than single-level spondylosis. Clinically, it is not necessarily so. Multiple levels of structural change does not mean multiple levels of clinically significant pathology.
The physiotherapist’s assessment identifies which level, if any, is producing the patient’s symptoms. Treatment is targeted to that level. The other levels may show spondylosis on imaging but require no specific intervention.
The mistake made when treating multilevel spondylosis is attempting to treat every level simultaneously. This diffuses treatment and reduces effectiveness. Targeted treatment of the clinically relevant level produces better outcomes than broad, unfocused management.
Spondylosis vs Spondylolysis vs Spondylolisthesis
These three terms are frequently confused. They are different conditions.
Spondylosis. Degenerative wear and tear changes in the disc and facet joints. Age-related. Very common.
Spondylolysis. A stress fracture in the pars interarticularis — a specific part of the vertebral arch. Most common in young athletes — gymnasts, fast bowlers in cricket, divers — who perform repeated lumbar hyperextension. Not a degenerative condition. Produces lower back pain in a young athletic population.
Spondylolisthesis. One vertebra slips forward over the vertebra below it. Can be caused by spondylolysis (isthmic spondylolisthesis), by degenerative facet joint disease (degenerative spondylolisthesis), or by congenital factors. Causes chronic lower back pain and sometimes nerve root symptoms if the slippage narrows the spinal canal.
Degenerative spondylolisthesis is common in patients over 50 and is often associated with lumbar spondylosis. It is almost always managed conservatively with physiotherapy. Surgery — spinal fusion — is reserved for cases with progressive neurological deficit or severe functional limitation that has not responded to conservative treatment.
The Spondylosis Diagnosis: What to Do Next
If you have received a diagnosis of spondylosis — whether from an MRI report, an X-ray, or a doctor’s assessment — the appropriate next steps are:
Step 1. Get a physiotherapy assessment.
An MRI showing spondylosis tells you what structural changes are present. A physiotherapy assessment tells you which of those changes, if any, are causing your symptoms and what treatment will address them.
Many patients with spondylosis on imaging are managed for the wrong structure. Neck pain attributed to cervical spondylosis may actually be from a muscle trigger point or a stiff thoracic segment. Lower back pain attributed to lumbar spondylosis may actually be from the sacroiliac joint. Treatment follows assessment, not imaging reports.
Step 2. Start physiotherapy promptly.
The earlier physiotherapy begins for spondylosis, the better the outcome. Prolonged inactivity allows muscle weakness to progress, posture to worsen, and the pain sensitisation that turns acute pain into chronic pain.
Step 3. Commit to the exercise program.
Spondylosis is a chronic condition. The muscles that compensate for reduced disc and facet joint function need to be maintained consistently. A 12-week physiotherapy program followed by no ongoing exercise produces temporary improvement that fades. An ongoing exercise program produces durable long-term function.
Step 4. Address modifiable risk factors.
Weight management, ergonomic correction, activity modification, and smoking cessation are modifiable factors that directly affect the rate of spondylotic progression and the severity of symptoms. Conservative treatment that does not address these factors produces less durable results.
When Surgery Is Considered for Spondylosis
Surgery for spondylosis is appropriate in a small proportion of cases. The indications are specific.
Cervical myelopathy. Progressive spinal cord compression from cervical spondylosis producing worsening hand weakness, coordination problems, balance difficulties, or bladder involvement. This requires surgical decompression. Physiotherapy alone cannot reverse spinal cord compression from severe structural stenosis.
Progressive neurological deficit. Worsening leg weakness, spreading numbness, or progressive motor deficit from lumbar or cervical nerve root compression that is not improving with conservative treatment.
Cauda equina syndrome. Bladder and bowel involvement — a surgical emergency regardless of the cause.
Failed conservative treatment. A genuine 12-week structured physiotherapy program — including spinal decompression where appropriate — that has not produced adequate improvement in a patient with significant functional limitation.
For the vast majority of spondylosis patients in Kerala, these criteria do not apply. Conservative management is the appropriate and most evidence-based treatment.
Frequently Asked Questions
Is spondylosis the same as arthritis of the spine?
They overlap. Facet joint spondylosis involves osteoarthritic changes in the spinal facet joints. Disc degeneration is a separate but related process. The term spondylosis encompasses both, along with osteophyte formation. It is more accurate to say that spondylosis includes arthritic changes in the spine rather than that they are identical.
Will spondylosis keep getting worse?
Structurally, some progression is part of normal ageing. Clinically, symptoms do not necessarily worsen with structural progression. Many patients with significant spondylosis on imaging have stable or improving symptoms with appropriate management. Modifiable factors — weight, posture, activity level, smoking — directly influence the rate of progression.
Can I exercise with spondylosis?
Yes — and you must. Exercise is the primary treatment for spondylosis. The muscles surrounding the spine compensate for reduced disc and facet joint stability. Without consistent exercise, this compensation fails and symptoms worsen. The exercise prescription for spondylosis is specific — not all exercise is appropriate. A physiotherapy assessment determines the right program for your spinal level and symptom pattern.
My MRI shows spondylosis at multiple levels. Do I need surgery?
Almost certainly not, unless you have neurological deficit or myelopathy. Multilevel spondylosis on MRI without significant neurological involvement is a conservative management problem, not a surgical one. Multiple levels of structural change does not mean multiple levels requiring surgical intervention.
How long does physiotherapy take for spondylosis?
For axial pain without nerve involvement, 8 to 12 sessions typically produces significant improvement. For nerve root symptoms, 12 to 20 sessions including spinal decompression is a reasonable course. Ongoing maintenance exercise is needed long-term — spondylosis is a chronic condition, not an acute one.
Maana Health treats cervical, thoracic, and lumbar spondylosis across five clinics in Kerala — Kochi, Calicut, Perinthalmanna, Aluva, and Trivandrum. If you have been told you have spondylosis and want a clear, honest assessment of your treatment options, book a free assessment today.