Title: The Effect of Neural Mobilization with Cervical Traction in Cervical Radiculopathy Patients

Authors: Kattela Suneel Kumar, Achyutha Kiran Kumar, Thiruppathi Arjunan, SK Thoufiq

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i5.132

Abstract

 Background: Cervical Traction and Neural Mobilization both have been individually advocated for treatment of cervical radiculopathy due to their various effects. But the combined effect of these techniques applied simultaneously has not been explored in studies. Hence the purpose is to find the effect of simultaneous application of cervical traction and neural mobilization on improvement in neck pain, radicular symptoms and neck disability in subjects with Cervical Radiculopathy.

Methods: An experimental study design, 60 subjects with Unilateral Cervical Radiculopathy and ULTT1 (Upper Limb Tension Test) positive for median nerve bias, randomized 20 subjects each into three groups- Group A, B and C respectively. Group A received both Cervical Traction and Neural Mobilization. The Group B received only Mechanical Cervical Traction. The Group C received only Neural Mobilization. The duration of intervention was given 3 treatment sessions per week for four weeks. Outcome measures such as Numerical Pain Rating Scale, Global Rating of Change Scale, Neck Disability Index were measured before, at the end of 2nd and 4th week post treatment.

Results: Comparison of post intervention means at 2nd and 4th week of treatment there is a statistically significant (p<0.05) difference in improvement in outcome measures between three groups. Group A subjects shown greater percentage of improvement than Group B and Group C.

Conclusion: The present study concludes that simultaneous application of mechanical cervical traction with neural mobilization is more effective in improving pain, functional disability and severity of radicular symptoms than mechanical cervical traction and neural mobilization alone for subjects with unilateral cervical radiculopathy.

Keywords: Cervical Radiculopathy, Neck Pain, Median Nerve, Cervical Traction, Neural Mobilization, Pain, Neck Disability, Global Rating.

References

1.      Ian A. Young, Lori A. Michener, et al. Manual Therapy, Exercise, and Traction for Patients with cervical radiculopathy: A randomized clinical trial. American Physical Therapy Association. 2009; 89: 632-642.

2.      Cervical radiculopathy is a pathology of the cervical nerve root.16 It is frequently associated with cervical disc herniation or another space occupying lesion (such as osteophytes), which can cause nerve root impingement and inflammation. It mostly afflicts adults in their fourth and fif Joshua A. Cleland, Julie M. Whitman, Julie M. Fritz, Jessica A. Palmer, Manual physical therapy, Journala of orthopaedic and sports physical therapy. 2005; 35(12): 802-809

3.      Ellenberg MR,Honet JC,Treanor WJ.Cervical radiculopathy.Arch Phys Med Rehabil.1994;75:342-352.

4.      Farmer JC, Wisneski RJ. Cervical spine nerve root compression. An analysis of neuroforaminal pressures with varying head and arm positions. Spine. 1994; 19: 1850-158.

5.      Heckmann JG, Lang CJ, Zobelein I, et al. Hearniated cervical intervertebral dics with radiculopathy: J Spinal Disorder.1999; 12: 396-401.

6.      Muhle C, Bischoff L, Weinert D, et al. Exacerbated painin cervical radiculopathy at axial rotation, flexion,extension, and coupled motions of the cervical spine: evaluation by kinematic magnetic resonance imaging.Invest Radiol. 1998; 33: 279-288.

7.      Joshua A Cleland, Julie M Whitmann,Julie M Fritz, Jessica A Palmer. Manual physical Therapy, Cervical traction and Strengthening exercises in patients with cervical radiculopathy - a case series. Journal of orthopedic and sports physiotherapy.2005; 35: pp 802-811.

8.      Saal J S, Sall J A, Yurth E F. Non operative management of herniated cervical intervertebral radiculopathy. Spine 1996; 21(16): pp 1877-1883.

9.      Jason David Eubanks. Cervical radiculopathy : Nonoperative management of neck pain and radicular symptoms. American Family Physician. 2010; 81 (1): 33-40.

10.  Michal Dwornik, Dariusz Bialoszewski, Izabela korabiewska, Zbigniew Wronski. Principles of neuromobilization for treating musculoskeletal disease. Ortopedia traumatologia Rehabilitacja, 2007; 2(6); vol9, 111-121.

11.  Mortimer A J and Dyson M. The effect of therapeutic ultrasound on calcium Uptake in  fibroblasts. US Med Biol. 1988; 14:499-506.

12.  Mark I Johnson, Chazala Tabasam. An investigation into the analgesics effect of IFC and TENS on experimentally induced ischemic pain in otherwise pain free volunteers. Physical Therapy. 2003 Mar; 83: No 3.

13.  Jason M. Beneciuk, Mark D. Bishop, Steven Z George. Effects of upper extremity neural mobilization on thermal pain sensitivity: A sham-controlled study in asymptomatic participants. Journal of orthopaedic and sports physical therapy. 2009; 39 (6): 428-438.

14.  Christopher R Showalter, Eric Van Doorne. The role of neurodynamics in carpel tunnel syndrome with double crush syndrome. Maitland Australian Physiotherapy Seminar.

15.  David S. Butler, Mobilisation of the nervous system.  Churchill livingstone. 1991; Ch 13: 231-246.

16.  Dox I, Melloni BJ, Eisner GM. Melloni’s Illustrated Medical Dictionary. Baltimore, Md : Williams & Wilkins Company; 1979.

17.  Wainner, R.S., Gill, H. Diagnosis and non-operative management of cervical radiculopathy. Journal of orthopaedics and sports physical therapy. 2000; 30: 728-744.

18.  Radhakrishnan. K., Litchy, W.J., O’Fallon, W.M., Kurland, L.T. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain. 1987; 117: 325-335.

19.  Benini A. Clinical features of cervical root compression C5-C8 and their variations. Neuro-Orthopedics.1987; 4 :74– 88.

20.  Honet J, Puri K. Cervical radiculitis: treatment and results in 82 patients. Arch Phys Med Rehabil. 1976; 57: 12– 16.

21.  Caplan L. Management of cervical radiculopathy. Eur Neurol.1995; 35: 309– 320.

22.  Sampath P, Bendebba M, Davis JD, et al. Outcome in patients with cervical radiculopathy: prospective, multicenter study with independent clinical review. Spine. 1999; 24: 591– 597.

23.  Hult L. Frequency of symptoms of different age groups and professions. In: Hirsch C, Zotterman Y, editors. Cervical pain. New York: Pergamon Press; 1971. 17-20.

24.  Mohammad Taghi Joghataei, Amir Massoud Arab, Hossein Khaksar. The effect of cervical traction combined with conventional therapy on grip strength on patients with cervical radiculopathy. Clinical Rehabilitation. 2004; 18: 879-887.

25.  Nanno M.Effects of intermittent cervical traction on muscle pain. Flow metric and electromyography studies of the cervical para spinal muscles. Nippon Ika Daigaku Zasshi. 1994; 61 (2): 137-47.

26.  Ibrahim M. Elnaggar, Hala R. Elhabashy, Enas M. Abd El-Menam. Influence of spinal traction in treatment of cervical radiculopathy. Egypt J. Neurol. Psychiat. Neursurg. 2009; 46 (2): 455-460.

27.  Prabhakar Ronald, Ramteke G. J. Cervical spinal mobilization versus TENS in the management of cervical radiculopathy: A comparative, experimental and randomized controlled trial. Indian Journal of Physio-therapy and occupational Therapy – An International journal. 2011; 5 (1): 95-99.

28.  Mark I Johnson, Chazala Tabasam. An investigation into the analgesics effect of IFC and TENS on experimentally induced ischemic pain in otherwise pain free volunteers. Physical Therapy. 2003 Mar; 83:No 3.

29.  Mark T. Walsh. Upper limb neural tension testing and mobilization. Journal of Hand Therapy. 2005; 18 (2): 241-258.

30.  Hunt C. Peripheral nerve biomechanics- application to neural mobilization approach. Physical therapy reviews.2002; (7): 111-121

31.  Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med. 2001; 8 (12): 1153-7.

32.  Vernon H, Mior S. Neck disability index- a study of reliability and validity. Journal of manipulative physiological therapeutics. 1991; 14(7): 409-415.

33.  Steven L. Wolf, Meryl R. Gersh, Vaddadi R. Rao. Examination of electrode placements and stimulating parameters in treating chronic pain with conventional transcutaneous electric nerve stimulation (TENS). Pain. 1981; vol 11 (1): 37- 47.

Corresponding Author

Kattela Suneel Kumar