The prevalence of cervical spondylosis in Muslim community with special reference to Namaz in Agra

Introductıon Degenerative process of the spine is an inevitable consequence of ageing. Cervical spondylosis is one of the common chronic degenerative conditions of the neck involving the vertebral bodies (osteophyte formation), intervertebral discs (deformation, disc herniation) and adjacent ligament.1 Radiological evidence of degenerative changes in the cervical spine is noted in 80-90% of the individuals >50 years of age.1 Namaz, an Urdu word for prayer, is a form of ritualistic prayer performed by Muslims 5 times a day. The 5 daily namaz are as follows: 1. Fajr: Early morning just before sunrise. It consists of 4 rakats. 2. Zuhr: Afternoon prayers after Zawaal (when sun is perpendicular to earth). It consists of 12 rakats. 3. Asr: Postnoon and before sunset. It consists of 8 rakats. 4. Maghrib: Just after sunset. It consists of 7 rakats. 5. Isha: Late evening after completing sunset and darkness. It consists of 17 rakats.


Introductıon
Degenerative process of the spine is an inevitable consequence of ageing.Cervical spondylosis is one of the common chronic degenerative conditions of the neck involving the vertebral bodies (osteophyte formation), intervertebral discs (deformation, disc herniation) and adjacent ligament. 1Radiological evidence of degenerative changes in the cervical spine is noted in 80-90% of the individuals >50 years of age. 1 Namaz, an Urdu word for prayer, is a form of ritualistic prayer performed by Muslims 5 times a day.The 5 daily namaz are as follows: 1. Fajr: Early morning just before sunrise.It  Each rakat consists of various steps, of which sajdah and sala'm are thought to be protective against the development of cervical spondylosis.
Thus, a namazi, offering namaz 5 times a day, will be performing sajdah and sala'm 48 times per day.

Sajdah
Sajdah helps to make the neck muscles stronger and the forward bending position is a good spinal exercise.In particular, the active movement of the neck and the facial muscles, when the head is being lifted approximately one inch above the ground, exerts a tense pressure on the neck muscles.Stronger cervical muscles protect the cervical vertebrae.Strength of cervical muscles is important as the head rests upon cervical vertebrae supported by cervical musculature. 2,3 a'm Sala'm is turning the head towards shoulders so that the side face of the namazi can be seen by the person sitting behind.This complete movement is excellent neck exercise in which the cervical vertebre rotate one on the other and neck muscles (Sterno-Cleido-Mastoid/ Trapezius) are stretched.This in turn exerts a squeezing and twisting pressure on the carotid arteries and veins.
The bilateral movement of both eyeballs focusing on the shoulders is also highly beneficial. 2 The main objective of the present study was to estimate the prevalence of cervical spondylosis among Muslim population in Agra who performed namaz four times a day or more, and those who performed namaz infrequently (<3/week).The study also evaluated whether early regular neck muscles exercise has any preventive effect on cervical spondylosis.

Materials and methods
The cross-sectional study was carried out at Postgraduate Department of Medicine, S.N.Medical College, Agra, India for a period of one and half years.Two hundred study participants were selected from Muslim inhabitant areas by simple random sampling.The study was approved by the institutional ethical committee.The subjects were categorized into two groups, group A: Muslim male between the age group 40-60 years who performed namaz four times a day or more, and group B: Muslim male between the age group 40-60 years who performed namaz infrequently (<3/wk).Collection of detailed history and thorough clinical examination were carried out for all the participants after obtaining informed consent.The study was pretested on 10% of total population size.
The inclusion criteria considered were: Muslim males between the age group 40-60 years who performed namaz four times a day or more, and the same age group subjects who performed the prayer infrequently (<3/wk.).
The subjects were cooperative.The exclusion criteria were: non-cooperative persons, individuals with a history of neck trauma, heavy weight bearing/occupation-related cervical spondylosis, any other type of arthritis or diabetes mellitus.
The diagnostic criteria for cervical spondylosis were: clinical manifestations, pain on extension of neck, and positive Spurling's sign.The data analysis was performed using Chi-square test.P <0.05 was considered to be statistically significant.

Results
The Frequency of various symptoms related to cervical spondylosis in regular namazi and infrequent namazi population was compared.Difference in frequency of most of the symptoms and signs were statistically significant, except for pain with movement of neck, burning sensation on outer aspect of hand, and various neurological deficits (P >0.05) (Table 2).
Out of the 118 males who performed regular namaz, only 17 had cervical spondylosis, while among the 82 males who performed irregular namaz, 30 had cervical spondylosis (P<0.05).This showed that namaz has preventive role in development of cervical spondylosis (Table 3).
The study population was sub-classified into various age groups such as: 40-45 yrs, 46-50 yrs, 51-55 yrs, and 56-60 yrs.The estimation of percentage prevalence of cervical spondylosis in each group showed that the value was significant in the first 3 sub-groups and insignificant in 56-60 yrs group (Table 4).
Overall percent prevalence of the disease noted was 23.5%.The prevalence noted after excluding persons who exercised regularly was 27.647%.
Difference in percentage prevalence of the disease in the study population was statistically significant even after excluding persons who exercised regularly (18.478% and 38.462%, P 0.0036%) in regular and infrequent namazi groups respectively.

Discussion
Cervical spondylosis is a degenerative disc disease usually In summary, the present study findings corroborate the assumption that religious meditation and prayers could be beneficial in improving the overall health and wellbeing.These results also reiterate the need to consider the beneficial effects of such routine prayers beyond its religious aspect.

Conclusion
Life style changes, in the form of mild regular neck muscle exercise may assist in reducing the prevalence of cervical spondylosis, thereby contributing to improve the quality of life.Research and evidence to establish relationship between cervical spondylosis and exercise are sparse and more studies with larger sample size are needed to establish preventive role of early regular neck muscle exercise on decreasing the burden of cervical spondylosis.
study included 200 Muslim namazi males of the age group between 40 and 60.Evaluation of medical history and clinical examinations were carried out for all the enrolled participants.Out of the 200 subjects, the number of namazis enrolled under different age groups 40-45, 46-50, 51-55 and 56-60 were 45, 65, 47 and 43 respectively.The corresponding number of regular and infrequent namazis recruited in the aforementioned age groups were 26 and 19, 43 and 22, 27 and 20, and 22 and 21 respectively.The distribution of the subjects across all the age groups was uniform and the variation according to the age was statistically non-significant (ᵡ 2 = 2.54, P=0.47).Comparison of the subjects on the basis of exercise demonstrated that 30 persons were doing regular exercises and none of them developed cervical spondylosis (P <0.05) (Table1).This showed that regular exercises have some preventive role in development of cervical spondylosis.Out of 62 subjects who drank milk regularly, 11 developed cervical spondylosis.Whereas, among the 138 persons who did not drink milk regularly, 36 developed cervical spondylosis (P <0.05).

Table 5 : Prevalence of cervical spondylosis among regular namazi and infrequent namazi
Cervical spondylosis is a degenerative disc disease usually causing intermittent neck pain in middle-aged and elderly patients.Performing regular namaz may assist in preventing cervical spondylosis, as the practice consists of several postures including stretching, bending and kneeling.This religious practice assists in strengthening neck muscles.The study bySayeed et al.substantiate the present study findings.The researchers have stated that "it is uncommon to find a person offering regular Salah prostrating at least 34 times a day to suffer from cervical spondylosis or myalgias".Similarly, a case study by Badsha et al. has reported that the spinal mobility has been significantly improved in a 35-year-old patient suffering from ankylosing spondylosis after following an intensive regimen of Islamic prayer, for ~2 hours daily for one month.