The Most Effective Rehabilitation for Cervical Radiculopathy

With 83 out of 100,000 adults affected each year, cervical radiculopathy has a lower prevalence than mechanical neck pain, but generally leads to more severe pain.1,2 Consensus holds that CR results from impingement and inflammation of a nerve root.3 Pain results near the scapula, in the upper limb, and in the neck. Other symptoms may include neurological signs such as sensory disturbance, weakness, and reduced reflexes among tendons fed by the affected nerve root.4

 

While ample evidence demonstrates the effectiveness of rehabilitation for CR in general,3,5-8 the comparative value of different rehabilitation approaches remains a subject of research. Physiotherapists employ a variety of treatments in the rehabilitation of cervical radiculopathy: strengthening and stretching exercises for the cervical and thoracic spine, manual therapy techniques, cervical traction, postural education, etc. Studies find that active rehabilitation gets better results than wait-and-see or advice to remain active.5,6 Ragonese and colleagues find that combined manual therapy and exercise therapy achieve greater results than manual or exercise therapies alone.7 There is conflicting evidence on whether cervical traction adds to the benefits available through physiotherapy,8 but the term “cervical traction” refers to a diverse category of treatment approaches. Most studies show a 40% to 50% improvement in pain scales at four to six weeks. 

 

A multi-center, randomised, double-blinded trial recently published by Langevin and colleagues connected their rehabilitation protocol for CR with 60% improvement in pain at four weeks and an 88% improvement in pain at eight weeks. Treatment plans sometimes include techniques designed to increase the size of the intervertebral foramen (IVF). Langevin and colleagues compared two rehabilitation plans: one with manual therapy to increase the IVF and one without. All patients received eight physiotherapy visits spread over four weeks. All treatments included cervical and thoracic mobilisations as well as stabilisation and mobility exercises. The experimental group

received the same rehabilitation plus manual therapy designed to increase IVF space. Both groups achieved highly favorable, clinically significant improvement in pain, disability, and patient-perceived improvement. While the IVF group trended toward better outcomes in nine of eleven outcomes, there were no statistically significant differences between the treatment protocols. However, the magnitude of the aggregated results, especially when compared to previous studies, leaves open the possibility that treatments designed to increase the size of the IVF may add to the overall effectiveness of rehabilitation programs. 

 

The current evidence regarding rehabilitation for cervical radiculopathy offers two take away messages. One, treatment plans within the physiotherapy scope of practice offer levels of improvement not available through wait-and-see or advice to stay active. Two, different physiotherapy practices are likely implementing different rehabilitation protocols and getting varying levels of success (even if all are successful in general). At Advanced Physiotherapy, we stay abreast of the latest science in rehabilitation and practice multimodal approaches any time that may benefit your patients.

References

 

1. Radhakrishnan K, Litchy W, O’Fallon W, Kurland L. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain. 1994; 117 (2): 325-335. 2. Manchikanti L, Boswell M, Sing V, et al. Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician. 2009; 12: 699802. 3. Langevin P, Desmeules F, Lamothe M, et al. Comparison of 2 manual therapy and exercise protocols for cervical radiculopathy: a randomized clinical trial evaluating short-term effects. Journal of Orthopaedic & Sports Physical Therapy. 2015; 45 (1): 4-17. 4. Bogduk N. The anatomy and pathophysiology of neck pain. Phys Med Rehabil Clin N Am. 2003; 14: 455-472. 5. Kuliper B, Tans J, Beelen A, et al. Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy: randomised trial. BMJ. 2009; 339: b3883. 6. Nee R, Vicenzino B, Jull G, et al. Neural tissue management provides immediate clinically relevant benefits without harmful effects for patients with nerve related neck and arm pain: a randomised trial. J Physiother. 2012; 58: 23-31. 7. Ragonese J. A randomized trial comparing manual physical therapy to therapeutic exercises, to a combination of therapies, for the treatment of cervical radiculopathy. Orthop Phys Ther Pract. 2009; 21: 71-76. 8. Young I, Michener L, Cleland J. Manual therapy, exercise, and traction for patients with cervical radiculopathy: a randomized clinical trial. Physical therapy. 2009; 89 (7): 632-42.