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Anandkumar S. The effect of sustained natural apophyseal glide (SNAG) combined with neurodynamics in the management of a patient with cervical radiculopathy: a case report. Physiother Theory Pract 2014; 31:140-5. [PMID: 25329587 DOI: 10.3109/09593985.2014.971922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This case report describes a 47-year-old female who presented with complaints of pain in the right elbow radiating down to the thumb. Physical examination revealed symptom reproduction with Spurling A test, upper limb neurodynamic testing-1 and right cervical rotation along with reduced symptoms with neck distraction. Clinical diagnosis of cervical radiculopathy (CR) was made based on a clinical prediction rule. This case report speculates a potentially first-time description of successful conservative management of CR in a patient utilizing simultaneous combination of sustained natural apophyseal glide and neurodynamic mobilization. Immediate improvements were seen in pain, cervical range of motion and functional abilities. The patient was discharged from physical therapy by the second week after four treatment sessions with complete pain resolution maintained at a four-month follow-up period.
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Moustafa IM, Diab AA. Multimodal treatment program comparing 2 different traction approaches for patients with discogenic cervical radiculopathy: a randomized controlled trial. J Chiropr Med 2014; 13:157-67. [PMID: 25225464 DOI: 10.1016/j.jcm.2014.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 06/17/2014] [Accepted: 06/19/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the immediate and long-term effects of a 1-year multimodal program with the addition of 2 different traction approaches on the pain, function, disability, and nerve root function in patients with discogenic cervical radiculopathy (CR). This study also attempted to identify the optimal traction angle based on the maximum recovery of the peak-to-peak amplitude of the flexor carpi radialis (FCR) H-reflex. METHODS This randomized clinical trial with one-year follow-up included a total of 216 (101 female) patients with unilateral lower discogenic CR were randomly assigned to 1 of 3 groups. The standard care group (C) received the multimodal program (pain relief methods, muscle strengthening, and thoracic spine manipulation). The ventroflexion traction group (A) received the same multimodal program as group C, with added traditional ventroflexion traction. The novel traction group (B) received the same multimodal program as group C in addition to a flexor carpi radialis (FCR) H-reflex-based traction method. Primary outcomes were the Neck Disability Index (NDI) and secondary outcomes included neck pain, arm pain, and the amplitude and latency of the H-reflex. Patients were assessed at 3 intervals (pre-treatment, 4 weeks post-treatment, and the 1-year follow-up). RESULTS The mixed linear model with repeated measures indicated a significant group × time effect in favor of the novel cervical traction group (B) for measures of NDI (F = 412.6, P < .0005), neck pain (F = 108.9, P < .0005), arm pain (F = 91.3, P < .0005), H- reflex amplitude (F = 207.7, P < .0005), and H-reflex latency (F = 58.9 P < .0005). We found that the extension position of cervical spine (5° extension) was the position that achieved the maximum improvement in the novel cervical traction method. CONCLUSIONS This preliminary study showed that a multimodal program with a novel cervical traction method added improved NDI, neck pain, arm pain, and the amplitude and latency of FCR H-reflex for a group of patients with chronic discogenic CR.
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Affiliation(s)
- Ibrahim M Moustafa
- Assistant Professor, Basic Science Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Aliaa A Diab
- Assistant Professor, Basic Science Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Dedering Å, Halvorsen M, Cleland J, Svensson M, Peolsson A. Neck-specific training with a cognitive behavioural approach compared with prescribed physical activity in patients with cervical radiculopathy: a protocol of a prospective randomised clinical trial. BMC Musculoskelet Disord 2014; 15:274. [PMID: 25115308 PMCID: PMC4243421 DOI: 10.1186/1471-2474-15-274] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 07/30/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with cervical radiculopathy often have neck- and arm pain, neurological changes, activity limitations and difficulties in returning to work. Most patients are not candidates for surgery but are often treated with different conservative approaches and may be sick-listed for long periods. The purpose of the current study is to compare the effectiveness of neck-specific training versus prescribed physical activity. METHODS/DESIGN The current protocol is a two armed intervention randomised clinical trial comparing the outcomes of patients receiving neck specific training or prescribed physical activity. A total of 144 patients with cervical radiculopathy will be randomly allocated to either of the two interventions. The interventions will be delivered by experienced physiotherapists and last 14 weeks. The primary outcome variable is neck- and arm pain intensity measured with a Visual Analogue Scale accompanied with secondary outcome measures of impairments and subjective health measurements collected before intervention and at 3, 6, 12 and 24 months after base-line assessment. DISCUSSION We anticipate that the results of this study will provide evidence to support recommendations as to the effectiveness of conservative interventions for patients with cervical radiculopathy. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01831271.
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Affiliation(s)
- Åsa Dedering
- />Department of Physical Therapy, Karolinska University Hospital, 171 76 Stockholm, Sweden
- />Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Marie Halvorsen
- />Department of Physical Therapy, Karolinska University Hospital, 171 76 Stockholm, Sweden
- />Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | | | - Mikael Svensson
- />Department of Department of Clinical NeuroscienceKarolinska Instiutet, Karolinska Institutet, Stockholm, Sweden
- />Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Anneli Peolsson
- />Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Linköping University, Stockholm, Sweden
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Use of thoracic spine thrust manipulation for neck pain and headache in a patient following multiple-level anterior cervical discectomy and fusion: a case report. J Orthop Sports Phys Ther 2014; 44:440-9. [PMID: 24816502 DOI: 10.2519/jospt.2014.5026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Case report. BACKGROUND Thoracic spine thrust manipulation has been shown to be an effective intervention for individuals experiencing mechanical neck pain. CASE DESCRIPTION The patient was a 46-year-old woman referred to outpatient physical therapy 2 months following multiple-level anterior cervical discectomy and fusion. At initial evaluation, primary symptoms consisted of frequent headaches, neck pain, intermittent referred right elbow pain, and muscle fatigue localized to the right cervical and upper thoracic spine regions. Initial examination findings included decreased passive joint mobility of the thoracic spine, limited cervical range of motion, and limited right shoulder strength. Outcome measures consisted of the numeric pain rating scale, the Neck Disability Index, and the global rating of change scale. Treatment consisted of a combination of manual therapy techniques aimed at the thoracic spine, therapeutic exercises for the upper quarter, and patient education, including a home exercise program, over a 6-week episode of care. OUTCOMES Immediate reductions in cervical-region pain (mean ± SD, 2.0 ± 1.1) and headache (2.0 ± 1.3) intensity were reported every treatment session immediately following thoracic spine thrust manipulation. At discharge, the patient reported 0/10 cervical pain and headache symptoms during all work-related activities. From initial assessment to discharge, Neck Disability Index scores improved from 46% to 16%, with an associated global rating of change scale score of +7 ("a very great deal better"). DISCUSSION This case report describes the immediate and short-term clinical outcomes for a patient presenting with symptoms of neck pain and headache following anterior cervical discectomy and fusion surgical intervention. Clinical rationale and patient preference aided the decision to incorporate thoracic spine thrust manipulation as a treatment for this patient. Level of Evidence Therapy, level 4.
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Shin JH, Jun SL, Lee YJ, Kim JH, Hwang SY, Ahn SH. Effects of intermittent traction therapy in an experimental spinal column model. J Acupunct Meridian Stud 2014; 7:83-91. [PMID: 24745867 DOI: 10.1016/j.jams.2013.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 12/21/2012] [Accepted: 12/27/2012] [Indexed: 11/28/2022] Open
Abstract
Traction therapy, which is known to be a treatment method for scoliosis, one of many muscles disease, has been used since Hippocrates introduced it. However, the effects of traction therapy are still not clear. In addition, the meridian sinew theory, which is related to muscle treatment and is mentioned in the book on meridian sinews in the Miraculous Pivot of Huangdi's Internal Classic, has not been the subject of much study. For these reasons, experimental spinal models were made for this study to observe and analyze the lengths of vertebral interspaces after intermittent traction therapy, which is known to be excellent among muscle treatment methods, with various tensile forces. The results showed that the effects of intermittent traction therapy were unclear and that it might be harmful, especially when the pain was induced by muscle weakness. Because the results of this study on intermittent traction therapy were different from those expected from osteopathy or craniosacral theory, better studies of the subject are necessary.
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Affiliation(s)
- Jeong-Hun Shin
- Department of Bio-nano Chemistry, Wonkwang University, Iksan, Republic of Korea
| | - Seung-lyul Jun
- Korea Trade-Investment Promotion Agency, Seoul, Republic of Korea
| | - Young-Jun Lee
- Lee Young Jun Korean Medicine Clinic, Cheonan, Republic of Korea
| | - Jae-Hyo Kim
- Department of Meridians and Acupoints, College of Oriental Medicine, Wonkwang University, Iksan, Republic of Korea
| | | | - Seong-Hun Ahn
- Department of Meridians and Acupoints, College of Oriental Medicine, Wonkwang University, Iksan, Republic of Korea.
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Savva C, Giakas G, Efstathiou M, Karagiannis C. Test-retest reliability of handgrip strength measurement using a hydraulic hand dynamometer in patients with cervical radiculopathy. J Manipulative Physiol Ther 2014; 37:206-10. [PMID: 24630769 DOI: 10.1016/j.jmpt.2014.02.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 12/30/2013] [Accepted: 01/09/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the test-retest reliability of handgrip strength measurement using a hydraulic hand dynamometer in patients with cervical radiculopathy (CR). METHODS A convenience sample of 19 participants (14 men and 5 women; mean ± SD age, 50.5 ± 12 years) with CR was measured using a Jamar hydraulic hand dynamometer by the same rater on 2 different testing sessions with an interval of 7 days between sessions. Data collection procedures followed standardized grip strength testing guidelines established by the American Society of Hand Therapists. During the repeated measures, patients were advised to rest their upper limb in the standardized arm position and encouraged to exert 3 maximum gripping efforts. The mean value of the 3 efforts (measured in kilogram force [Kgf]) was used for data analysis. The intraclass correlation coefficient, SEM, and the Bland-Altman plot were used to estimate test-retest reliability and measurement precision. RESULTS Grip strength measurement in CR demonstrated an intraclass correlation coefficient of 0.976, suggesting excellent test-retest reliability. The small SEM in both testing sessions (SEM1, 2.41 Kgf; SEM2, 2.51 Kgf) as well as the narrow width of the 95% limits of agreements (95% limits of agreement, -4.9 to 4.4 Kgf) in the Bland-Altman plot reflected precise measurements of grip strength in both occasions. CONCLUSIONS Excellent test-retest reliability for grip strength measurement was measured in patients with CR, demonstrating that a hydraulic hand dynamometer could be used as an outcome measure for these patients.
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Affiliation(s)
- Christos Savva
- Clinical Trainer, Department of Health Science, Diogenous 6, Engomi, European University, Nicosia, Cyprus.
| | - Giannis Giakas
- Senior Lecturer in Biomechanics, Department of Physical Education and Sport Science, University of Thessaly, Volos, Greece
| | - Michalis Efstathiou
- Clinical Trainer, Department of Health Science, Diogenous 6, Engomi, European University, Nicosia, Cyprus
| | - Christos Karagiannis
- Clinical Trainer, Department of Health Science, Diogenous 6, Engomi, European University, Nicosia, Cyprus
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Exercise only, exercise with mechanical traction, or exercise with over-door traction for patients with cervical radiculopathy, with or without consideration of status on a previously described subgrouping rule: a randomized clinical trial. J Orthop Sports Phys Ther 2014; 44:45-57. [PMID: 24405257 DOI: 10.2519/jospt.2014.5065] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Randomized clinical trial. OBJECTIVES To examine the effectiveness of cervical traction in addition to exercise for specific subgroups of patients with neck pain. BACKGROUND Cervical traction is frequently used, but its effectiveness has not been adequately examined. Existing studies have failed to target patients most likely to respond. Traction is typically recommended for patients with cervical radiculopathy. A prediction rule has been described to identify a narrower subgroup of patients likely to respond to cervical traction. METHODS Patients with neck pain and signs of radiculopathy were randomized to 4 weeks of treatment with exercise, exercise with mechanical traction, or exercise with over-door traction. Baseline assessment included subgrouping-rule status. The primary outcome measure (Neck Disability Index, scored 0-100) and secondary outcome measure (neck and arm pain intensity) were assessed at 4 weeks, 6 months, and 12 months after enrollment. The primary analyses examined 2-way treatment-by-time interactions. Secondary analyses examined validity of the subgrouping rule by adding 3-way interactions. RESULTS Eighty-six patients (53.5% female; mean age, 46.9 years) were enrolled in the study. Intention-to-treat analysis found lower Neck Disability Index scores at 6 months in the mechanical traction group compared to the exercise group (mean difference between groups, 13.3; 95% confidence interval: 5.6, 21.0) and over-door traction group (mean difference between groups, 8.1; 95% confidence interval: 0.8, 15.3), and at 12 months in the mechanical traction group compared to the exercise group (mean difference between groups, 9.8; 95% confidence interval: 0.2, 19.4). Secondary outcomes favored mechanical traction at several time points. The validity of the subgrouping rule was supported on the Neck Disability Index at the 6-month time point only. CONCLUSION Adding mechanical traction to exercise for patients with cervical radiculopathy resulted in lower disability and pain, particularly at long-term follow-ups. The study protocol was registered at http://clinicaltrials.gov (NCT00979108).
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The effect of cervical traction combined with neural mobilization on pain and disability in cervical radiculopathy. A case report. ACTA ACUST UNITED AC 2013; 18:443-6. [DOI: 10.1016/j.math.2012.06.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 06/27/2012] [Accepted: 06/29/2012] [Indexed: 11/21/2022]
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Lehtola V, Kaksonen A, Luomajoki H, Leinonen V, Gibbons S, Airaksinen O. Content validity and responsiveness of a Finnish version of the Patient-Specific Functional Scale. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2013. [DOI: 10.3109/21679169.2013.828243] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Intradiscal Pressure Changes during Manual Cervical Distraction: A Cadaveric Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:954134. [PMID: 24023587 PMCID: PMC3762077 DOI: 10.1155/2013/954134] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 07/02/2013] [Accepted: 07/06/2013] [Indexed: 11/18/2022]
Abstract
The objective of this study was to measure intradiscal pressure (IDP) changes in the lower cervical spine during a manual cervical distraction (MCD) procedure. Incisions were made anteriorly, and pressure transducers were inserted into each nucleus at lower cervical discs. Four skilled doctors of chiropractic (DCs) performed MCD procedure on nine specimens in prone position with contacts at C5 or at C6 vertebrae with the headpiece in different positions. IDP changes, traction forces, and manually applied posterior-to-anterior forces were analyzed using descriptive statistics. IDP decreases were observed during MCD procedure at all lower cervical levels C4-C5, C5-C6, and C6-C7. The mean IDP decreases were as high as 168.7 KPa. Mean traction forces were as high as 119.2 N. Posterior-to-anterior forces applied during manual traction were as high as 82.6 N. Intraclinician reliability for IDP decrease was high for all four DCs. While two DCs had high intraclinician reliability for applied traction force, the other two DCs demonstrated only moderate reliability. IDP decreases were greatest during moving flexion and traction. They were progressevely less pronouced with neutral traction, fixed flexion and traction, and generalized traction.
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Sato T, Masui K. Morphologic Differences in Intervertebral Foramina: A Radiographic Study of Cervical Spine Positions in Asymptomatic Men. J Manipulative Physiol Ther 2013; 36:327-32. [DOI: 10.1016/j.jmpt.2013.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Revised: 09/23/2012] [Accepted: 10/07/2012] [Indexed: 01/12/2023]
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Cervical Foraminal Versus Interlaminar Epidurals: Risks, Benefits, and Alternatives. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2013. [DOI: 10.1007/s40141-013-0013-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Physical function outcome in cervical radiculopathy patients after physiotherapy alone compared with anterior surgery followed by physiotherapy: a prospective randomized study with a 2-year follow-up. Spine (Phila Pa 1976) 2013; 38:300-7. [PMID: 23407407 DOI: 10.1097/brs.0b013e31826d2cbb] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective randomized study. OBJECTIVE To investigate differences in physical functional outcome in patients with radiculopathy due to cervical disc disease, after structured physiotherapy alone (consisting of neck-specific exercises with a cognitive-behavioral approach) versus after anterior cervical decompression and fusion (ACDF) followed by the same structured physiotherapy program. SUMMARY OF BACKGROUND DATA No earlier studies have evaluated the effectiveness of a structured physiotherapy program or postoperative physical rehabilitation after ACDF for patients with magnetic resonance imaging-verified nerve compression due to cervical disc disease. METHODS Our prospective randomized study included 63 patients with radiculopathy and magnetic resonance imaging-verified nerve root compression, who were randomized to receive either ACDF in combination with physiotherapy or physiotherapy alone. For 49 of these patients, an independent examiner measured functional outcomes, including active range of neck motion, neck muscle endurance, and hand-related functioning before treatment and at 3-, 6-, 12-, and 24-month follow-ups. RESULTS There were no significant differences between the 2 treatment alternatives in any of the measurements performed (P = 0.17-0.91). Both groups showed improvements over time in neck muscle endurance (P ≤ 0.01), manual dexterity (P ≤ 0.03), and right-handgrip strength (P = 0.01). CONCLUSION Compared with a structured physiotherapy program alone, ACDF followed by physiotherapy did not result in additional improvements in neck active range of motion, neck muscle endurance, or hand-related function in patients with radiculopathy. We suggest that a structured physiotherapy program should precede a decision for ACDF intervention in patients with radiculopathy, to reduce the need for surgery. LEVEL OF EVIDENCE 2.
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Hegedus EJ, Stern B, Reiman MP, Tarara D, Wright AA. A suggested model for physical examination and conservative treatment of athletic pubalgia. Phys Ther Sport 2013; 14:3-16. [DOI: 10.1016/j.ptsp.2012.04.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 03/12/2012] [Accepted: 04/06/2012] [Indexed: 12/14/2022]
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Boyles R, Toy P, Mellon J, Hayes M, Hammer B. Effectiveness of manual physical therapy in the treatment of cervical radiculopathy: a systematic review. J Man Manip Ther 2012; 19:135-42. [PMID: 22851876 DOI: 10.1179/2042618611y.0000000011] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
STUDY DESIGN Systematic review of randomized clinical trials. OBJECTIVE Review of current literature regarding the effectiveness of manual therapy in the treatment of cervical radiculopathy. BACKGROUND Cervical radiculopathy (CR) is a clinical condition frequently encountered in the physical therapy clinic. Cervical radiculopathy is a result of space occupying lesions in the cervical spine: either cervical disc herniations, spondylosis, or osteophytosis. These affect the pain generators of bony and ligamentous tissues, producing radicular symptoms (i.e. pain, numbness, weakness, paresthesia) observed in the upper extremity of patients with cervical nerve root pathology. Cervical radiculopathy has a reported annual incidence of 83·2 per 100 000 and an increased prevalence in the fifth decade of life among the general population. RESULTS Medline and CINAHL via EBSCO, Cochrane Library, and Google Scholar were used to retrieve the randomized clinical trial studies for this review between the years of 1995 and February of 2011. Four studies met inclusion criteria and were considered to be high quality (PEDro scores of ⩾5). Manual therapy techniques included muscle energy techniques, non-thrust/thrust manipulation/mobilization of the cervical and/or thoracic spine, soft-tissue mobilization, and neural mobilization. In each study, manual therapy was either a stand-alone intervention or part of a multimodal approach which included therapeutic exercise and often some form of cervical traction. Although no clear cause and effect relationship can be established between improvement in radicular symptoms and manual therapy, results are generally promising. CONCLUSION Although a definitive treatment progression for treating CR has not been developed a general consensus exists within the literature that using manual therapy techniques in conjunction with therapeutic exercise is effective in regard to increasing function, as well as AROM, while decreasing levels of pain and disability. High quality RCTs featuring control groups are necessary to establish clear and effective protocols in the treatment of CR.
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Affiliation(s)
- Robert Boyles
- Program of Physical Therapy, University of Puget Sound, Tacoma, WA, USA
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Effectiveness of the gaze direction recognition task for chronic neck pain and cervical range of motion: a randomized controlled pilot study. Rehabil Res Pract 2012; 2012:570387. [PMID: 22645685 PMCID: PMC3356945 DOI: 10.1155/2012/570387] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 01/26/2012] [Indexed: 11/18/2022] Open
Abstract
We developed a mental task with gaze direction recognition (GDR) by which subjects observed neck rotation of another individual from behind and attempted to recognize the direction of gaze. A randomized controlled trial was performed in test (n = 9) and control (n = 8) groups of subjects with chronic neck pain undergoing physical therapy either with or without the GDR task carried out over 12 sessions during a three-week period. Primary outcome measures were defined as the active range of motion and pain on rotation of the neck. Secondary outcome measures were reaction time (RT) and response accuracy in the GDR task group. ANOVA indicated a main effect for task session and group, and interaction of session. Post hoc testing showed that the GDR task group exhibited a significant simple main effect upon session, and significant sequential improvement of neck motion and relief of neck pain. Rapid effectiveness was significant in both groups. The GDR task group had a significant session-to-session reduction of RTs in correct responses. In conclusion, the GDR task we developed provides a promising rehabilitation measure for chronic neck pain.
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Lack of uniform diagnostic criteria for cervical radiculopathy in conservative intervention studies: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 21:1459-70. [PMID: 22531897 PMCID: PMC3535232 DOI: 10.1007/s00586-012-2297-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 02/03/2012] [Accepted: 03/29/2012] [Indexed: 11/03/2022]
Abstract
PURPOSE Cervical radiculopathy (CR) is a common diagnosis. It is unclear if intervention studies use uniform definitions and criteria for patient selection. Our objective was to assess the uniformity of diagnostic criteria and definitions used in intervention studies to select patients with CR. METHODS We electronically searched the Cochrane Controlled Trials Register, MEDLINE, EMBASE and CINAHL. Studies were included when evaluating conservative interventions in randomised clinical trials (RCTs) in patients with CR. Selection criteria and definitions for patients with CR were extracted and evaluated on their uniformity. RESULTS Thirteen RCTs were included. Pain was used as an inclusion criterion in 11 studies. Inclusion based on the duration and location of pain varied between studies. Five studies used sensory symptoms in the arm as inclusion criterion. Four studies used cervical range of motion and motor disturbances as inclusion criteria, while reflex changes were used in two studies. Three studies included patients with a positive Spurling's test and two studies used it within a cluster of provocation tests. CONCLUSIONS Criteria used to select patients with CR vary widely between different intervention studies. Selection criteria and test methods used are poorly described. There is consensus on the presence of pain, but not on the exact location of pain.
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Langevin P, Roy JS, Desmeules F. Cervical radiculopathy: study protocol of a randomised clinical trial evaluating the effect of mobilisations and exercises targeting the opening of intervertebral foramen [NCT01500044]. BMC Musculoskelet Disord 2012; 13:10. [PMID: 22293092 PMCID: PMC3299659 DOI: 10.1186/1471-2474-13-10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 01/31/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervical radiculopathy is a common form of neck pain and has been shown to lead to severe disability. Clinical rehabilitation approaches for cervical radiculopathies commonly include exercise and manual therapy interventions targeting the opening of intervertebral foramen, but evidence regarding their effectiveness is scarce. The primary objective of this randomised clinical trial is to compare, in terms of pain and disability, a rehabilitation program targeting the opening of intervertebral foramen to a conventional rehabilitation program, for patients presenting acute or subacute cervical radiculopathies. The hypothesis is that the rehabilitation program targeting the opening of intervertebral foramen will be significantly more effective in reducing pain and disability than the conventional rehabilitation program. METHODS/DESIGN This study is a double-blind (participants and evaluators blinded) randomised clinical trial that will allow the comparison of patients with a cervical radiculopathy randomly assigned to one of two groups: one group will receive a 4-week rehabilitation program targeting the opening of intervertebral foramen, and the second group will receive a 4-week conventional rehabilitation program. Thirty-six subjects with cervical radiculopathy will be recruited from participating medical and physiotherapy clinics and will be evaluated at baseline, at the end of the 4-week program and four weeks following the end of the program. The primary outcome measure will be the validated Neck Disability Index questionnaire. Secondary outcome measures will include the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire, a numerical pain rating scale, cervicothoracic mobility and patients' perceived global rating of change. During the 4-week rehabilitation program, each participant will take part in eight physiotherapy treatment sessions (2 session/week) and will perform a home exercise program. A mixed-model, 2-way ANOVA will be used to analyze the effects of the rehabilitation programs. DISCUSSION Control trials are needed to define ideal intervention approaches in rehabilitation for this population. This randomised clinical trial will be the first study that directly compares a rehabilitation program targeting the opening of intervertebral foramen to a conventional rehabilitation program for patients with cervical radiculopathy. The results of this study may help to establish best clinical practice guidelines for this patient population. TRIAL REGISTRATION ClinicalTrials.gov: NCT01500044.
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Affiliation(s)
- Pierre Langevin
- Physio interactive Clinics, 3520, rue de l'Hêtrière, Saint-Augustin-de-Desmaures, (QC), Canada, G3A 0B4
- Department of Rehabilitation, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry, 1050, avenue de la Médecine, Quebec City (QC), Canada, G1R 1P5
| | - Jean-Sébastien Roy
- Department of Rehabilitation, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry, 1050, avenue de la Médecine, Quebec City (QC), Canada, G1R 1P5
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute, 525, Boulevard Wilfrid Hamel, Quebec City (QC), Canada, G1M 2S8
| | - François Desmeules
- School of Rehabilitation, University of Montreal, CP 6128 Succursale Centre-Ville, Montreal (QC), Canada, H3C 3J7
- Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, 5415, Boulevard l'Assomption, Montreal (QC), Canada, H1T 2M4
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69
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The patient-specific functional scale: psychometrics, clinimetrics, and application as a clinical outcome measure. J Orthop Sports Phys Ther 2012; 42:30-42. [PMID: 22031594 DOI: 10.2519/jospt.2012.3727] [Citation(s) in RCA: 242] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Systematic review of the literature. OBJECTIVE To summarize peer-reviewed literature on the reliability, validity, and responsiveness of the Patient-Specific Functional Scale (PSFS), and to identify its use as an outcome measure. METHODS Searches were performed of several electronic databases from 1995 to May 2010. Studies included were published articles containing (1) primary research investigating the psychometric and clinimetrics of the PSFS or (2) the implementation of the PSFS as an outcome measure. We assessed the methodological quality of studies included in the first category. RESULTS Two hundred forty-two articles published from 1994 to May 2010 were identified. Of these, 66 met the inclusion criteria for this review, with 13 reporting the measurement properties of the PSFS, 55 implementing the PSFS as an outcome measure, and 2 doing both of the above. The PSFS was reported to be valid, reliable, and responsive in populations with knee dysfunction, cervical radiculopathy, acute low back pain, mechanical low back pain, and neck dysfunction. The PSFS was found to be reliable and responsive in populations with chronic low back pain. The PSFS was also reported to be valid, reliable, or responsive in individuals with a limited number of acute, subacute, and chronic conditions. This review found that the PSFS is also being used as an outcome measure in many other conditions, despite a lack of published evidence supporting its validity in these conditions. CONCLUSION Although the use of the PSFS as an outcome measure is increasing in physiotherapy practice, there are gaps in the research literature regarding its validity, reliability, and responsiveness in many health conditions.
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70
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Pangarkar S, Lee PC. Conservative treatment for neck pain: medications, physical therapy, and exercise. Phys Med Rehabil Clin N Am 2011; 22:503-20, ix. [PMID: 21824590 DOI: 10.1016/j.pmr.2011.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This article offers conservative treatment strategies for patients suffering from musculoskeletal causes of neck pain. Basic pharmacology is reviewed, including that of opioids, nonsteroidal anti-inflammatory drugs, adjuvants, and topical analgesics. Moreover, indications for therapeutic exercise, manual therapy, and modalities are reviewed, along with any supporting literature. Treatment considerations with each category of medication and physical therapy are discussed. This article is meant to serve as a resource for physicians to tailor conservative treatment options to their individual patients.
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Affiliation(s)
- Sanjog Pangarkar
- Inpatient Pain Service, Veterans Health Service Greater Los Angeles, David Geffen School of Medicine at UCLA, Los Angeles, CA 90073, USA
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71
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Chiu TTW, Ng JKF, Walther-Zhang B, Lin RJH, Ortelli L, Chua SK. A randomized controlled trial on the efficacy of intermittent cervical traction for patients with chronic neck pain. Clin Rehabil 2011; 25:814-22. [DOI: 10.1177/0269215511399590] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To investigate the efficacy of intermittent cervical traction in the treatment of chronic neck pain over a 12-week follow-up. Design: A randomized controlled trial. Setting: Hospital-based outpatient practice. Subjects: Seventy-nine patients with chronic neck pain. Interventions: Subjects were randomly assigned to either experimental group ( n = 39, mean age = 50.5 ± 9.8) or control group ( n = 40, mean age = 48.8 ± 9.1). Experimental group received intermittent cervical traction and control group received infrared irradiation alone; twice a week over a period of six weeks. Outcome measurements: The values of Chinese version of the Northwick Park Neck Pain Questionnaire (NPQ), verbal numerical pain scale (VNPS), and cervical active range of motion (AROM) were measured at baseline, six-week and 12-week follow-up. Results: No significant differences were found between the two groups in the NPQ ( P > 0.05), VNPS ( P > 0.05) and AROM ( P > 0.05).
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Affiliation(s)
- Thomas TW Chiu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Joseph Kim-Fai Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Barbro Walther-Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Rex JH Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Luc Ortelli
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Siew Kuan Chua
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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72
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A systematic literature review on the effectiveness of non-invasive therapy for cervicobrachial pain. ACTA ACUST UNITED AC 2011; 16:53-65. [DOI: 10.1016/j.math.2010.09.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 09/03/2010] [Accepted: 09/24/2010] [Indexed: 11/24/2022]
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73
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Leininger B, Bronfort G, Evans R, Reiter T. Spinal manipulation or mobilization for radiculopathy: a systematic review. Phys Med Rehabil Clin N Am 2010; 22:105-25. [PMID: 21292148 DOI: 10.1016/j.pmr.2010.11.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In this systematic review, we present a comprehensive and up-to-date systematic review of the literature as it relates to the efficacy and effectiveness of spinal manipulation or mobilization in the management of cervical, thoracic, and lumbar-related extremity pain. There is moderate quality evidence that spinal manipulation is effective for the treatment of acute lumbar radiculopathy. The quality of evidence for chronic lumbar spine-related extremity symptoms and cervical spine-related extremity symptoms of any duration is low or very low. At present, no evidence exists for the treatment of thoracic radiculopathy. Future high-quality studies should address these conditions.
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Affiliation(s)
- Brent Leininger
- Wolfe-Harris Center for Clinical Studies, Northwestern Health Sciences University, 2501 West 84th Street, Bloomington, MN 55431, USA.
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Young IA, Cleland JA, Michener LA, Brown C. Reliability, Construct Validity, and Responsiveness of the Neck Disability Index, Patient-Specific Functional Scale, and Numeric Pain Rating Scale in Patients with Cervical Radiculopathy. Am J Phys Med Rehabil 2010; 89:831-9. [DOI: 10.1097/phm.0b013e3181ec98e6] [Citation(s) in RCA: 171] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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On "Manual therapy, exercise, and traction for patients with cervical radiculopathy..." Young IA, et al.Phys Ther. 2009;89:632-642. Phys Ther 2009; 89:1253; author reply 1253. [PMID: 19884641 DOI: 10.2522/ptj.2009.89.11.1253.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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