Management Of Cervical Radiculopathy Research Articles

Simultaneous versus consecutive administration of cervical traction and neural mobilization in patients with cervical radiculopathy: A randomized controlled trial

Background & Objective: Cervical traction and neural mobilization are frequently utilized in the management of cervical radiculopathy. However, there is a paucity of literature concerning the best order of application of these techniques. The aim of this study was to compare the effects of simultaneous and consecutive administration of cervical traction and neural mobilization on pain and function in cervical radiculopathy. Methods: Thirty patients were randomly assigned to two equal groups: consecutive (CON) and simultaneous (SIM) cervical traction and neural mobilization in this single-blind randomized controlled trial. The inclusion criteria comprised age 20-60 years, unilateral cervical radiculopathy ≥ 6 months, and positive upper limb neural tension tests of radial, median or ulnar nerve, and positive Spurling test. Outcome measurement tools were numeric pain rating scale, cervical goniometry, neck disability index, and short-form health survey. Data was analyzed with SPSS 23. Results: Significant improvement was evident in all parameters in CON after 1-week rehabilitation (P≤0.001 for seven of the ten variables). Similarly, all parameters showed significant improvement in SIM (P≤0.001 for all variables except mental component score of SF-12 with P<0.05). After rehabilitation, SIM was significantly better with respect to pain (P<0.05), flexion-extension mobility (P<0.001), and quality of life (P<0.01). No differences were found in other variables. Conclusion: Simultaneous use of cervical traction and neural mobilization resulted in significantly better outcomes with regards to pain, flexion-extension mobility, and quality of life. The two groups performed similarly on other outcome measures.

Effect of Siravedha in the Management of Viswachi with special reference to Cervical Radiculopathy

Radiculopathy, commonly referred as pinched nerve, refers to a set of conditions in which one or more nerves are affected and their functioning is hampered. Cervical radiculopathy is a clinical condition resulting from compression of nerve roots due to disc herniation or degenerative stenosis which leads to neck pain, numbness and radiating arm pain in the distribution of the affected nerve root. Often this radicular pain is accompanied by motor or sensory disturbances also. The main treatments available are use of non-steroidal anti-inflammatory drugs, epidural steroid injection and surgery in the last stages. But the side effects of NSAID’s, incomplete neurologic recovery, loss of full cervical range of movement and surgical complications are the main hurdle in the management of cervical radiculopathy. In Ayurvedic classics, clinical picture of cervical radiculopathy can be explained under the heading of Viswachi. It is a Vatavyadhi mainly affecting the Kandaras leading to restricted movements and loss of function of upper limb. At present, there is no specific treatment procedure, which can offer quick relief of pain and other associated symptoms of cervical radiculopathy. Acharya Susruta mentioned Siravedha in the management of Viswachi. It is one of the most effective methods of Rakthamoksha by which vitiated Doshas can be eliminated in a faster way. In the present study, 150ml of blood was withdrawn from corresponding cephalic vein as a onetime procedure. Assessments were done before procedure, immediately after procedure, on 7th, 14th, 21st and 28th day after procedure. The results showed Siravedha is an effective treatment procedure in the management of Viswachi.

Management of cervical radiculopathy: Current systematic reviews

Management of cervical radiculopathy: Current systematic reviews

Ayurvedic management of Greevagatavata W.S.R.T. cervical radiculopathy: A case report

Cervical radiculopathy refers to pain that travels from neck towards arm. Cervical radiculopathy most often occurs when a herniated disk or an overgrowth of bone puts pressure on part of the nerve. Herniated disc is common cause of cervical radiculopathy. In this condition patient experiences maximum pain in unilateral direction, which gets aggravated with improper posture of neck or cervical extension. The distribution of pain in the upper extremities is dependent on site of nerve compression but feels relief while at rest. According to Ayurveda, based on resembling clinical manifestation this condition can be co-related with Greevagatavata. Aim: To understand the efficacy of Ayurveda treatment protocol in the management of Cervical radiculopathy (Greevagatavata). Materials and Method: A 38 years old female suffering from complaints of Greevashoola (neck pain), radiating to right upper limb, which increased while working on laptop/mobile, while reading and while lifting heavy weights since past 2-3years on and off, presented in the OPD of SDACH, Chandigarh. The above complaints exasperated over the last 1 month. Based on clinical presentation and X-RAY findings the condition was diagnosed as cervical radiculopathy (Greevagata vata). A multimodal therapeutic intervention as per Ayurveda with greeva basti, nadi swedan, basti, nasya, were prescribed. Clinical assessment was done before and after treatment based on Neck disability index/questionnaire. Observation and Results: Before treatment Neck disability index score was 28 and after the complete treatment patient reported relief in symptoms of Ruk (pain), Stambha (stiffness), Spandan (cramping), distribution of pain significantly reduced and score was only 5. Conclusion: The present case study revealed that the multiple Ayurveda treatment modalities including Shaman and Shodhan Chikitsa (palliative and purification therapies) were effective in the management of Cervical radiculopathy.

Comparative Effects of Sustained Natural Apophyseal Glides and Mechanical Traction in the Management of Cervical Radiculopathy: A Randomized Control Study

Cervical radiculopathy can lead to severe pain and disability. The study compared the effects of sustained natural apophyseal glides (SNAG) and mechanical cervical traction (MCT) in the management of patients with cervical radiculopathy.

Manual Therapy as a Management of Cervical Radiculopathy: A Systematic Review.

Background Cervical radiculopathy is defined as a disorder involving dysfunction of the cervical nerve roots characterised by pain radiating and/or loss of motor and sensory function towards the root affected. There is no consensus on a good definition of the term. In addition, the evidence regarding the effectiveness of manual therapy in radiculopathy is contradictory. Objective To assess the effectiveness of manual therapy in improving pain, functional capacity, and range of motion in treating cervical radiculopathy with and without confirmation of altered nerve conduction. Methods Systematic review of randomised clinical trials on cervical radiculopathy and manual therapy, in PubMed, Web of Science, Scopus, PEDro, and Cochrane Library Plus databases. The PRISMA checklist was followed. Methodological quality was evaluated using the PEDro scale and RoB 2.0. tool. Results 17 clinical trials published in the past 10 years were selected. Manual therapy was effective in the treatment of symptoms related to cervical radiculopathy in all studies, regardless of the type of technique and dose applied. Conclusions This systematic review did not establish which manual therapy techniques are the most effective for cervical radiculopathy with electrophysiological confirmation of altered nerve conduction. Without this confirmation, the application of manual therapy, regardless of the protocol applied and the manual therapy technique selected, appears to be effective in reducing chronic cervical pain and decreasing the index of cervical disability in cervical radiculopathy in the short term. However, it would be necessary to agree on a definition and diagnostic criteria of radiculopathy, as well as the definition and standardisation of manual techniques, to analyse the effectiveness of manual therapy in cervical radiculopathy in depth.

Comparing Mulligan Mobilization and Neural Mobilization Effects in Patients with Cervical Radiculopathy

Background Mulligan mobilization and neural mobilization have already made a mark and have been found effective in reducing pain disability and in improving range of motion in patients with cervical radiculopathy. Objective The present study was intended to compare the effects of Mulligan mobilization versus neural mobilization in cervical radiculopathy.Methods Thirty patients with cervical radiculopathy were conveniently assigned to two groups ndash Group A n15 were treated with Mulligan mobilization while Group B n15 were treated with neural mobilization. Intermittent cervical traction was used as a common treatment for both the groups. Treatment dosage for both groups was seven sessions or one week. Neck disability functional level and range of motion before and after the treatment program were evaluated by using Neck Disability Index questionnaire Patient Specific Functional Scale questionnaire and Goniometer respectively.Results In Group A amp Group B significant improvement in condition existed within the groups. There was a significant reduction in neck disability increase in functional level and increase in ROM following Mulligan and neural mobilizations. Though patients who received neural mobilization did better than patients who received Mulligan there was no significant difference between the groups. PSFS p0.572NS NDI p0.269NS ROM Flexion p0.776NS extension p0.302NS lateral flexion ndash right p0.282NS lateral flexion ndash left p0.877NS side rotation ndash left p0.72NS were noted.Conclusion Neural mobilization showed better results than Mulligan mobilization in the management of cervical radiculopathy. However there was no significant difference between the groups.Keywords Cervical radiculopathy Mulligan mobilization Neural mobilization Neck disability Functional level.

Clinical evaluation of the effect of Ayurvedic oil enema therapy in the management of Cervical Radiculopathy

Cervical Radiculopathy (CR), a common cause due to nerve compression. CR occurs when one or more nerves are impaired. When the motor nerves are compressed, it causes pain in the arms. In the cervical radiculopathy, the problem occurs at the brachial plexuses; it also affects the cervical area of the spinal cord. However, the symptoms related to the cervical radiculopathy are radiated and expressed in arms. The treatment is available for cervical radiculopathy, but the medicine is not satisfactory. Hence, we prepared medicated oil with the help of some nerve nourishing herbs, and we used this oil through Ayurvedic medicated enema therapy (Matra basti) for the cervical radiculopathy. Enema of medicated oil (Matrabasti) was administered for 21 days. The treatment was also validated. The nerve conduction was taken as a tool and the changes observed were confirmed. The observed result showed the scale of pain reduced from 7.55 to 1.12 among the CR patients. Motor nerve conduction parameter like latency, amplitude and Conduction velocity was 6.46, 3.95, 47.07 ms in the cervical radiculopathy patients. With the treatment of the medicated oil enema, it was 6.75, 6.97 and 60.41 ms respectively, which is a phenomenal increase. We concluded that, in the pain scale, it reduced which was 85.16%. In this study of 21 days, the Conduction velocity parameters, which was used to assess patients, showed considerable improvement. This study attempts to ascertain cervical radiculopathy may be successfully managed through the medicated oil enema (Matrabasti).

Evidence for acupotomology in the management of cervical radiculopathy: A protocol for systematic review and meta-analysis.

Background:Cervical radiculopathy (CR) describes compression or stimulation secondary to the cervical nerve root, 1 or 2 types of upper limb pain, and/or with neck. In clinical practice, both acupotomology and acupuncture are very widely and popular for the management of CR. So, we conducted a systematic review and meta-analysis to explore the efficacy, safety of acupotomology in the treatment of CR.Methods:We will search the following databases from inception to the September 2019 : MEDLINE(PubMed), Web of Science(Thomson Reuters), Cochrane Library, Embase (Ovid, Elsevier), SinoMed, Clinical Trials. gov, the China National Knowledge Infrastructure, Wanfang database, and VIP database. We will apply no language restrictions. We will not use a randomized controlled trial filter in EMBASE, as the set of intervention terms will limit the results sufficiently. The randomised controlled trials of acupotomology versus acupuncture for CR; two independent researchers will use the bias risk tool provided by the Cochrane Collaboration to evaluate the quality of the literature using RevMan 5.3 software (Copenhagen, The Nordic Cochrane Centre, The Cochrane Collaboration, 2014).Results:This systematic review and meta-analysis will provide a synthesis of existing evidence-based medical evidence for acupotomology/ acupotomy/needle knife in the treatment of CR.Conclusion:The conclusions of this systematic review and meta-analysis will provide evidence to evaluate the effectiveness of acupotomology/ acupotomy/needle knife for CR and further guide clinical decision-making.Ethics and Dissemination:This study is based on literature and therefore does not require ethical approval or patient consent. The study will be published in a peer-reviewed journal.PROSPERO registration number:CRD42020172274

Effects of oscillatory mobilization as compared to sustained stretch mobilization in the management of cervical radiculopathy: A randomized controlled trial.

Cervical radiculopathy is a relatively common musculoskeletal disorder resulting in a significant social and occupational impact. Manual therapy is thought to provide relief in cervical radiculopathy; however, evidence is lacking regarding the comparison of different manual therapy concepts. To determine the effects of Maitland's oscillatory mobilization as compared to Kaltenborn's sustained stretch mobilization in the management of cervical radiculopathy. A randomized controlled trial was conducted at Fauji Foundation Hospital comprising of 46 patients randomized into oscillatory and sustained stretch mobilization groups. Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI) and cervical range of motion (ROM) were used as outcome variables. No significant differences were observed at base line between the two groups (P> 0.05) except for ROM in extension and left side bending (P< 0.05). In terms of pre and post treatment comparison, P value of less than 0.05 was observed for both groups, indicating both treatments to be effective in isolation. However, post treatment comparison between both groups showed oscillatory mobilization to be superior to sustained stretch mobilization (P< 0.05) in the management of cervical radiculopathy except for the outcomes of pain and side bending. Both oscillatory and sustained stretch mobilization techniques are found to be effective in the management of cervical radiculopathy in terms of pain, range and disability. However, oscillatory mobilization is found to be superior in terms of functional ability and range of motion.

Economic and Outcomes Analysis of Recalcitrant Cervical Radiculopathy: Is Nonsurgical Management or Surgery More Cost-Effective?

This study directly compares the economical and clinical effectiveness of the use of cervical epidural injections and continued physical therapy versus surgical management in cases of cervical radiculopathy that have failed 6 weeks of conservative management. A theoretical cohort of patients with cervical radiculopathy resistant to 6 weeks of noninvasive conservative management were simulated to treatment with either anterior cervical diskectomy and fusion (ACDF) or cervical epidural injections and continued physical therapy and analyzed with Markov chain decision tree Monte Carlo simulation. The average incremental cost-effectiveness ratio associated with ACDF was $6,768 per quality-adjusted life year over the lifetime of the patient, whereas the incremental cost-effectiveness ratio associated with cervical injections ranged from $9,033 to $4,044 per quality-adjusted life year based on the success rate. Our study suggests that for the management of recalcitrant cervical radiculopathy, ACDF remains the dominant strategy compared with cervical epidural injections if the surgical avoidance rate of such injections is less than 50%. If there is a greater than 50% surgery avoidance rate with injections, then cervical epidural injections would be considered a cost-effective strategy with a role in the management of cervical radiculopathy before surgery.

A randomised controlled trial of multimodal physiotherapy versus advice for recent onset, painful cervical radiculopathy \u2013 the PACeR trial protocol

BackgroundA research gap exists for optimal management of cervical radiculopathy in the first 12 weeks and short term natural history of the condition is somewhat unclear, although thought to be favourable. The primary aim of this assessor blinded, superiority, 2 parallel group randomised controlled trial is to investigate the effects of a 4 week physiotherapy programme (6–8 sessions) of manual therapy, exercise and upper limb neural unloading tape, compared to a control of weekly phone advice; on disability, pain and selected biopsychosocial measures, in acute and sub-acute cervical radiculopathy patients. A secondary aim is to identify whether any baseline variables, symptom duration or group allocation can predict outcome.MethodsParticipants are recruited from GP referrals in an urban setting, from a neurosurgery non-urgent waiting list and from self-referral through Facebook advertising. Eligible participants (n = 64) are diagnosed with radiculopathy based on a clinical prediction rule and must have symptoms of unilateral, single level, radiculopathy for between 2 and 12 weeks, without having yet received physiotherapy. Random 1:1 group allocation (using variable block sizes), allocation concealment, blinded assessment and intention to treat analysis are being employed. Treatment is provided by clinical specialist physiotherapists in primary and secondary care settings. Outcomes are measured at baseline, 4 (primary endpoint) and 12 weeks. Participants’ report of pain, disability and their rating of recovery is also recorded by telephone interview at 6 months. Statistical analysis of between group differences will be performed with ANOVAs and MANOVAs, and multivariable regression analysis will be undertaken to explore predictor variables. Ethical approval for this study has been received from the Beaumont Hospital and Irish College of General Practitioners Research Ethics Committees. The trial is registered at ClinicalTrials.gov (NCT02449200).DiscussionAn internal pilot study to test retention and recruitment strategies led to trial expansion and this is now a multi centre trial involving 5 clinical sites.Trial registrationNCT02449200. Registered 20/05/15.

Effects of Sustained Natural Apophyseal Glides in the Management of Cervical Radiculopathy

The study examined the effects of Sustained Natural Apophyseal Glides (SNAGS) on pain intensity (PI), neck functional disability (NFD) and range of motion (ROM) in patients with cervical radiculopathy (CR). Sixty seven patients (male: n = 34, female: n = 33) with cervical radiculopathy were purposively recruited from the Outpatient Physiotherapy Department of the Usman Dan fodio University Teaching Hospital, Sokoto for the study. Each subjects was treated with cryotherapy for seven minutes and sustained natural apophyseal glides was administered twice weekly for six weeks. Visual analogue scale, neck disability index questionnaires and inclinometer were used to assess the pain intensity, disability and cervical range of motion respectively pre-treatment, 3rd and 6th week of treatment session. Descriptive and inferential statistics were used to analyze the data with alpha level at 0.05 Result showed that there was a significant difference in pain intensity (F = 521.35, p< 0.001), neck disability (F = 102.55, p< 0.001) and right side flexion ((F = 16.86; p< 0.001) in 3rd week and 6th week when compared with pretreatment pain intensity Therefore, it can be concluded from the study that SNAGS is effective in the management on cervical radiculopathy

Comparative effectiveness of transverse oscillatory pressure and cervical traction in the management of cervical radiculopathy: A randomized controlled study.

Background:Radiating neck pain is one of the major symptoms of cervical radiculopathy (CR).Objective:This study compared the effects of cervical traction (CT) and transverse oscillatory pressure (TOP) in management of CR.Methods:Seventy-five participants with unilateral radiating neck pain were randomly allocated into three groups, 25 (14 males, 11 females) for CT, 25 (15 males and 10 females) for TOP and 25 (11 males and 14 females) control (Cnt) group. All participants received massage, cryotherapy and active exercises three times in a week for six weeks. CT was administered to CT group, TOP to TOP group while the third group served as control. Pain intensity (PI) and neck functional disability (NFD) were assessed pretreatment, 3rd and 6th week of intervention. Data were analyzed using descriptive and inferential statistics.Results:There was a significant reduction in PI and NFD between pretreatment and 6th week in all the groups (). The effect size of PI (, ) and disability index (, ) in CT group were significantly lower than that of TOP group at 3rd week. PI of TOP was significantly () lower than that of CT and Cnt groups at the 6th week.Conclusion:TOP reduces the PI and disability of patients with CR faster compared to CT.

Morphometric changes of the cervical intervertebral foramen: A comparative analysis of pre-manipulative positioning and physiological axial rotation

BackgroundCervical foraminal impingement has been described as a source of radicular pain. Clinical tests and head motions have been reported for affecting the intervertebral foramen (IVF) dimensions. Although manual approaches are proposed in the management of cervical radiculopathy, their influence on the foraminal dimensions remains unclear. ObjectivesTo investigate the influence of pre-manipulative positioning versus cervical axial rotation on the foraminal dimensions of the lower cervical spine. MethodsThirty asymptomatic volunteers underwent CT scan imaging in neutral position and axial rotation or pre-manipulative positioning. The manipulation task was performed at C4-C5 following a multiple components procedure. 3D kinematics and IVF (height, width and area) were computed for each cervical segment. ResultsThe results showed that foraminal changes are dependent on motion types and cervical levels. With reference to head rotation, IVF opening occurred on the ipsilateral side during pre-manipulative positioning while axial rotation involved the contralateral side. Regardless of the side considered, magnitudes of opening were similar between both attitudes while narrowing was lower at the target and adjacent levels during the pre-manipulative positioning. Some associations between segmental motion and IVF changes were observed for the target level and the overlying level. ConclusionsThe present study demonstrated that pre-manipulative positioning targeting C4-C5 modified IVF dimensions differently than the passive axial rotation. The findings suggest that techniques which incorporate combined movement positioning influence segmental motion and IVF dimensions differently at the target segment, compared to unconstrained rotation. Further investigations are needed to determine the clinical outcomes of such an approach.

Current trends: Operative Strategy for the Management of Cervical Radiculopathy

Current trends: Operative Strategy for the Management of Cervical Radiculopathy

Transverse oscillatory pressure (TOP) in the management of cervical radiculopathy using visual analogue scale and neck disability index as outcome measures

Transverse oscillatory pressure (TOP) in the management of cervical radiculopathy using visual analogue scale and neck disability index as outcome measures

Effectiveness of Neurodynamics in Comparison to Manual Traction in the Management of Cervical Radiculopathy

Effectiveness of Neurodynamics in Comparison to Manual Traction in the Management of Cervical Radiculopathy

Effectiveness of neural mobilization with intermittent cervical traction in the management of cervical radiculopathy: A randomized controlled trial

BackgroundThe effectiveness of both neural mobilization and intermittent cervical traction (ICT) has been previously explored in some studies of generally low methodological quality. However, the effect of simultaneous application of these techniques in people with cervical radiculopathy (CR) has not been previously investigated. AimTo investigate the effect of neural mobilization with simultaneously applied ICT on pain, disability, function, grip strength and cervical range of motion in patients with CR. DesignRandomized, controlled, assessor-blinded, clinical trial. MethodsParticipants (n = 42) diagnosed with unilateral CR were randomly allocated to intervention (neural mobilization combined with ICT, n = 21) or control (n = 21) groups. Participants in the intervention group were asked to attend for 12 treatment sessions to receive 6 sets of 60s grade II–IV ICT with simultaneously applied ‘slider’ neural mobilizations with median nerve bias. Participants randomized to the control group did not receive any type of treatment and were asked to avoid prescription or over-the-counter analgesia or anti-inflammatory medication. The Neck Disability Index (NDI), the Patient-Specific Functional Scale (PSFS), the Numeric Pain Rating Scale (NPRS), and measures of grip strength (GS) and cervical spine active range of motion (CSAROM) were administered at baseline and at 4-weeks. ResultsThe intervention group demonstrated significant improvements in NDI scores (mean difference = −16.95; 95% CI = −22.47 to −11.43, ES = 0.42), PSFS scores (mean difference = 2.88; 95% CI = 2.33 to 3.43, ES = 0.66), NPRS scores (mean difference = −3.74; 95% CI = −4.92 to −2.96, ES = 0.37), GS (mean difference = 1.87 kg; 95% CI = 0.51 to 3.23; ES = 0.07), and CSAROM (except for lateral flexion), compared to the control group where significant changes were not detected. ConclusionNeural mobilization with simultaneous ICT can improve, pain, function, disability, grip strength and cervical range of motion in people with CR. Further clinical trials comparing neural mobilization with cervical traction to other standard interventions are justified.

Transverse oscillatory pressure in management of cervical radiculopathy: A randomised controlled study.

Background:Cervical radiculopathy is an important subgroup of neck disorders causing severe pain and disability.Objectives:The study assessed the effect of transverse oscillatory pressure (TOP) on pain intensity and functional disability of patients with cervical radiculopathy.Methods:Twenty-six individuals with unilateral radiating neck pain were randomly allocated into Group A (8 males and 5 females) and Group B (6 males and 7 females). Participants in the two groups received kneading massage, cryotherapy, and active isometric exercises to the posterior paraspinal muscles, trapezuis, and sternomastoid muscles. TOP was administered to Group A, whereas Group B served as control. Treatment was applied three times per week for 4 weeks, making 12 treatment sessions for each participant. Visual analogue scale and Neck Disability Index were used to assess pain intensity and neck disability, respectively, at baseline, 2 weeks, and 4 weeks. Data were analysed using repeated-measures analysis of variance.Results:There was a significant improvement in pain intensity and neck functional disability of patients between baseline, 2nd week, and 4th week of treatment sessions in Groups A and B (p < 0.05). There was a significant reduction in pain intensity in Group A (f = 7.08, p < 0.05) at the 2nd week and 4th week compared with Group B.Conclusion:It can be concluded that TOP reduces pain faster in patients with cervical radiculopathy.