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Manual Physical Therapy, Cervical Traction, and Strengthening Exercises in Patients With Cervical Radiculopathy: A Case Series
Manual Physical Therapy, Cervical Traction, and Strengthening Exercises in Patients With Cervical Radiculopathy: A Case Series
Manual Physical Therapy, Cervical Traction, and Strengthening Exercises in Patients With Cervical Radiculopathy: A Case Series
Official Publication of the Orthopaedic and Sports Physical Therapy Sections of the American Physical Therapy Association
C
Study Design: A case series of consecutive patients with cervical radiculopathy. ervical radiculopathy
Background: A multitude of physical therapy interventions have been proposed to be effective in is a common clinical
the management of cervical radiculopathy. However, outcome studies using consistent treatment diagnosis classified as
approaches on a well-defined sample of patients are lacking. The purpose of this case series is to
a disorder of a nerve
describe the outcomes of a consecutive series of patients presenting to physical therapy with
cervical radiculopathy and managed with the use of manual physical therapy, cervical traction,
root and most often
and strengthening exercises. is the result of a compres-
Case Description: Eleven consecutive patients (mean age, 51.7 years; SD, 8.2) who presented sive or inflammatory pathology
with cervical radiculopathy on the initial examination were treated with a standardized approach, from a space-occupying lesion
including manual physical therapy, cervical traction, and strengthening exercises of the deep neck such as a disc herniation,
flexors and scapulothoracic muscles. At the initial evaluation all patients completed self-report spondylitic spur, or cervical osteo-
measures of pain and function, including a numeric pain rating scale (NPRS), the Neck Disability phyte.11,13,17,28,39,43 The average
Index (NDI), and the Patient-Specific Functional Scale (PSFS). All patients again completed the annual incidence rate of cervical
outcome measures, in addition to the global rating of change (GROC), at the time of discharge radiculopathy is 83 per 100 000 for
from therapy and at a 6-month follow-up session. the population in its entirety, with
Outcomes: Ten of the 11 patients (91%) demonstrated a clinically meaningful improvement in
an increased prevalence occurring
pain and function following a mean of 7.1 (SD, 1.5) physical therapy visits and at the 6-month
follow-up.
in the fifth decade of life (203 per
Discussion: Ninety-one percent (10 of 11) of patients with cervical radiculopathy in this case 100 000).33
series improved, as defined by the patients classifying their level of improvement as at least ‘‘quite The location and pattern of
a bit better’’ on the GROC. However, because a cause-and-effect relationship cannot be inferred symptoms will vary, depending on
from a case series, follow-up randomized clinical trials should be performed to further investigate the nerve root level affected, and
the effectiveness of manual physical therapy, cervical traction, and strengthening exercises in a can include sensory and/or motor
homogeneous group of patients with cervical radiculopathy. J Orthop Sports Phys Ther alterations if the dorsal and/or
2005;35:802-811. ventral nerve root is involved.4,5,36
Although patients with cervical
Key Words: cervical spine, manipulation, mobilization, thoracic spine radiculopathy may have complaints
of neck pain, the most frequent
reason for seeking medical assist-
1
Assistant Professor, Department of Physical Therapy, Franklin Pierce College, Concord, NH; Physical ance is arm pain.5,10,18,43 Patients
Therapist, Rehabilitation Services of Concord Hospital, Concord, NH; Fellow, Manual Physical Therapy usually present with complaints of
Fellowship Program, Regis University, Denver, CO. pain, numbness, tingling, and
2
Assistant Faculty, Department of Physical Therapy, Regis University, Denver, CO
3
Assistant Professor, Division of Physical Therapy, University of Utah, Salt Lake City, UT; Clinical weakness in the upper extremity,
Outcomes Research Scientist, Intermountain Health Care, Salt Lake City, UT. which often result in significant
4
Physical Therapist, Rehabilitation Services of Concord Hospital, Concord, NH. functional limitations and disabil-
This case series received exempt status from the Institutional Review Boards at Concord Hospital,
Concord, NH and approval from the Institutional Review Board at Franklin Pierce College, Concord, NH. ity.35
Address correspondence to Joshua A. Cleland, Assistant Professor, Physical Therapy Program, Franklin Physical therapists often treat
Pierce College, 5 Chenell Drive, Concord, NH 03301. E-mail: clelandj@fpc.edu patients with cervical radiculop-
DISCUSSION
CONCLUSION
While recent research has identified accurate meth-
ods for clinical diagnosis of cervical radiculopathy,42 In this case series, 91% (10 of 11) of patients with
identification of appropriate conservative manage- cervical radiculopathy treated with the multimodal
ment strategies appears to remain a clinical enigma. treatment approach of manual physical therapy,
While other studies21,27 have investigated the effec- strengthening exercises, and intermittent cervical
tiveness of physical therapy in patients with expected traction exhibited reduced pain and improved func-
cervical radiculopathy, we believe that our case series tion at the time of discharge and at a 6-month
is the first to do so in a specific series of patients with follow-up. Although we cannot suggest a cause-and-
cervical radiculopathy, as identified by clinical exami- effect relationship from a case series, this report
nation techniques demonstrated to exhibit strong allows for initial hypothesis development that this
diagnostic utility.42 The purpose of our case series was approach may have clinical merit. Future studies in
to describe the outcomes in a homogeneous group of the form of well-designed, randomized clinical trials
patients with cervical radiculopathy who underwent a should be performed to evaluate the effectiveness of
standardized physical therapy treatment regimen, in- this approach in patients with cervical radiculopathy.
cluding manual physical therapy interventions,
strengthening exercises, and intermittent cervical ACKNOWLEDGMENTS
traction. Although a cause-and-effect relationship can-
The authors would like to thank Frank ‘‘Chip’’
not be inferred from a case series, our results suggest
Carson, PTA and Valerie Brunell, PTA for assisting
that this particular treatment approach may be ben-
with the treatment of patients in this case series. In
eficial in improving self-reported outcomes in pa-
CASE REPORT
CASE REPORT
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CASE REPORT