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Jellad A, Kalai A, Chaabeni A, Nasrallah CB, Nsir AB, Jguirim M, Sriha AB, Frih ZBS, Bedoui MH. Effect of cervical traction on cervicogenic headache in patients with cervical radiculopathy: a preliminary randomized controlled trial. BMC Musculoskelet Disord 2024; 25:842. [PMID: 39448969 PMCID: PMC11515553 DOI: 10.1186/s12891-024-07930-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 10/08/2024] [Indexed: 10/26/2024] Open
Abstract
BACKGROUND Cervical radiculopathy (CR) is a common condition, often associated with cervicogenic headache (CGH), a secondary headache arising from cervical spine disorders. Mechanical intermittent cervical traction (MICT) is frequently prescribed to treat CR symptoms. The purpose of the study was to make a preliminary estimate of efficacy of adding MICT to conventional rehabilitation on CGH in patients with cervical radiculopathy. METHODS A total of 36 CR patients with CGH were randomly allocated to 3 equally sized groups (A, B and C). The treatment consisted of twelve sessions of conventional rehabilitation (4 weeks) combined with MICT (2 kg for group A, 8 kg for group B and 12 kg for group C). Primary outcomes were CGH intensity (visual analog scale) and frequency (days per week). Secondary outcomes were radicular pain intensity (visual analog scale), cervical range of motion (cervical range of motion instrument), proprioception (cervical range of motion instrument) and muscle strength (MicroFET2 dynamometer), handgrip strength (handheld dynamometer), function (Neck Disability Index), kinesiophobia (Tampa Scale for KInesiophobia), anxiety and depression (Hospital Anxiety and Depresion questionnaire), and quality of life (World Health Organization Quality of Life). Patients were assessed at baseline, one, three and six months after the beginning of treatment. The post hoc Dunn testing was used to determine which traction load had the better effect on CGH symptoms. RESULTS At one, three and six months follow-ups, Group C exhibited the highest improvement in CGH intensity and frequency compared to the other groups (p = 0.021 and p = 0.023; p = 0.012 and p = 0.01; p = 0.005 and p = 0.005). Both groups C and B showed a significant improvement in radicular pain compared to group A at one month follow-up (p = 0.05).The improvement in group C was significantly better in terms of function (p = 0.049) and anxiety (p = 0.011) at three months and quality of life at six months (Psychological p = 0.046 and Environment p = 0.006). CONCLUSIONS The blend of conventional rehabilitation alongside 12 kg MICT seems to be efficacious in diminishing both the intensity and frequency of CGH in patients with CR. These advantages appear to last for up to six months following the treatment period, potentially leading to decreased CGH severity and occurrence rates, heightened functionality, reduced anxiety levels, and an overall enhancement in quality of life. These findings are preliminary and require confirmation in larger trials. TRIAL REGISTRATION The study protocol was retrospectively registered at the Pan African Clinical Trial Registry (PACTR202401838955948). Date of registration is 16/01/2024.
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Affiliation(s)
- Anis Jellad
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Monastir, Rue Avicenne, Monastir, 5000, Tunisia.
- Laboratory of Technology and Medical Imaging - LR12ES06, Center for Musculoskeletal Biomechanics Research, Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia.
| | - Amine Kalai
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Monastir, Rue Avicenne, Monastir, 5000, Tunisia
- Laboratory of Technology and Medical Imaging - LR12ES06, Center for Musculoskeletal Biomechanics Research, Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Amr Chaabeni
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Monastir, Rue Avicenne, Monastir, 5000, Tunisia
| | - Cyrine Ben Nasrallah
- Department of Preventive Medicine, Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Atef Ben Nsir
- Department of Neurosurgery, Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Mahbouba Jguirim
- Department of Rheumatology, Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Asma Belguith Sriha
- Department of Preventive Medicine, Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Zohra Ben Salah Frih
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Monastir, Rue Avicenne, Monastir, 5000, Tunisia
| | - Mohamed Hedi Bedoui
- Laboratory of Technology and Medical Imaging - LR12ES06, Center for Musculoskeletal Biomechanics Research, Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
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Hutchins J, Lagerstrand K, Stävlid E, Svensson PA, Rennerfelt K, Hebelka H, Brisby H. MRI evaluation of foraminal changes in the cervical spine with assistance of a novel compression device. Sci Rep 2023; 13:11508. [PMID: 37460649 DOI: 10.1038/s41598-023-38401-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023] Open
Abstract
Standard supine Magnetic Resonance Imaging (MRI) does not acquire images in a position where most patients with intermittent arm radiculopathy have symptoms. The aim of this study was to test the feasibility of a new compression device and to evaluate image quality and foraminal properties during a Spurling test under MRI acquisition. Ten asymptomatic individuals were included in the study (6 men and 4 women; age range 27 to 55 years). First, the subjects were positioned in the cervical compression device in a 3 T MRI scanner, and a volume T2 weighted (T2w) sequence was acquired in a relaxed supine position (3 min). Thereafter, the position and compressive forces on the patient's neck (provocation position) were changed by maneuvering the device from the control room, with the aim to simulate a Spurling test, causing a mild foraminal compression, followed by a repeated image acquisition (3 min). A radiologist measured the blinded investigations evaluating cervical lordosis (C3-C7), foraminal area on oblique sagittal images and foraminal cross-distance in the axial plane. A total of three levels (C4-C7) were measured on the right side on each individual. Measurements were compared between the compressed and relaxed state. Reliability tests for inter- and intraclass correlation were performed. The device was feasible to use and well tolerated by all investigated individuals. Images of adequate quality was obtained in all patients. A significant increase (mean 9.4, p = 0.013) in the cervical lordosis and a decreased foraminal cross-distance (mean 32%, p < 0.001) was found, during the simulated Spurling test. The area change on oblique sagittal images did not reach a statistically significant change. The reliability tests on the quantitative measures demonstrated excellent intraobserver reliability and moderate to good interobserver reliability. Applying an individualized provocation test on the cervical spine, which simulates a Spurling test, during MRI acquisition was feasible with the novel device and provided images of satisfactory quality. MRI images acquired with and without compression showed changes in cervical lordosis and foraminal cross distance indicating the possibility of detecting changes of the foraminal properties. As a next step, the method is to be tested on symptomatic patients.
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Affiliation(s)
- J Hutchins
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - K Lagerstrand
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering Physics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - E Stävlid
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - P-A Svensson
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - K Rennerfelt
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - H Hebelka
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - H Brisby
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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Swanson BT, Creighton D. Cervical disc degeneration: important considerations for the manual therapist. J Man Manip Ther 2021; 30:139-153. [PMID: 34821212 DOI: 10.1080/10669817.2021.2000089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Cervical disc degeneration (CDD) is a progressive, age-related occurrence that is frequently associated with neck pain and radiculopathy. Consistent with the majority of published clinical practice guidelines (CPG) for neck pain, the 2017 American Physical Therapy Association Neck Pain CPG recommends cervical manipulation as an intervention to address acute, subacute, and chronic symptoms in the 'Neck Pain With Mobility Deficits' category as well for individuals with 'Chronic Neck Pain With Radiating Pain'. While CPGs are evidence-informed statements intended to help optimize care while considering the relative risks and benefits, these guidelines generally do not discuss the mechanical consequences of underlying cervical pathology nor do they recommend specific manipulation techniques, with selection left to the practitioner's discretion. From a biomechanical perspective, disc degeneration represents the loss of structural integrity/failure of the intervertebral disc. The sequelae of CDD include posterior neck pain, segmental hypermobility/instability, radicular symptoms, myelopathic disturbance, and potential vascular compromise. In this narrative review, we consider the mechanical, neurological, and vascular consequences of CDD, including information on the anatomy of the cervical disc and the mechanics of discogenic instability, the anatomic and mechanical basis of radiculitis, radiculopathy, changes to the intervertebral foramen, the importance of Modic changes, and the effect of spondylotic hypertrophy on the central spinal canal, spinal cord, and vertebral artery. The pathoanatomical and biomechanical consequences of CDD are discussed, along with suggestions which may enhance patient safety.
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Affiliation(s)
- Brian T Swanson
- Department of Rehabilitation Sciences University of Hartford, West Hartford, CT, USA
| | - Douglas Creighton
- Human Movement Science Department Oakland University, Rochester, MI, USA
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Xiao LX, Liu CS, Zhong SZ, Huang WH. Effect of a Traction Exercise Neck Brace on Cervical Spondylopathy Radiculopathy: A Clinical Study and Finite Element Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:8825150. [PMID: 33936246 PMCID: PMC8060117 DOI: 10.1155/2021/8825150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 11/17/2022]
Abstract
Traction of cervical spine is an effective method for the treatment of cervical spondylotic radiculopathy (CSR). In this study, a cervical tractor named traction exercise neck brace (TENB) was used to evaluate its effect on the patients with CSR. Forty CSR volunteers were recruited and randomly divided into two groups. One group was subjected to cervical muscle exercise with TENB under static traction condition. Another group was subjected to (JOBT) as controls. Symptoms of CSR were evaluated by the visual analogue scale (VAS) and neck disability index (NDI). Imaging characteristics were assessed by curvature of the cervical spine and size of the intervertebral foramen. A finite element (FE) analysis model of cervical spine was established by 3D reconstruction to simulate the TENB traction, which evaluates the biomechanical performance. Results showed that TENB significantly reduced scores of VAS and NDI in subjects, and this improved effect on symptoms of pain and radiculopathy is better than that of JOBT. TENB also improved the cervical curvature and enlarged intervertebral foramen at the C4-C6 level. Moreover, FE analysis found that simulated TENB traction increased the spacing of intervertebral foramen, intervertebral disc, and zygapophyseal and uncovertebral joints and changed the stress distribution on the facet joints and nucleus pulposus. This study demonstrates that TENB relieves the symptoms of CSR by adjusting structure of cervical vertebra and restoring its biomechanical performance, which may be a promising instrument in the treatment of CSR.
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Affiliation(s)
- Liang-Xing Xiao
- School of Basic Medical Sciences, Southern Medical University, Guangzhou 510515, China
- Foshan Yitai Medical Supplies Co., Ltd, Foshan 528200, China
| | - Chang-Shun Liu
- Foshan Yitai Medical Supplies Co., Ltd, Foshan 528200, China
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, China
| | - Shi-Zhen Zhong
- School of Basic Medical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Wen-Hua Huang
- School of Basic Medical Sciences, Southern Medical University, Guangzhou 510515, China
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Dugailly PM, Beyer B, Salem W, Feipel V. Morphometric changes of the cervical intervertebral foramen: A comparative analysis of pre-manipulative positioning and physiological axial rotation. Musculoskelet Sci Pract 2018; 34:97-102. [PMID: 29414758 DOI: 10.1016/j.msksp.2018.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 01/19/2018] [Accepted: 01/21/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cervical 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. OBJECTIVES To investigate the influence of pre-manipulative positioning versus cervical axial rotation on the foraminal dimensions of the lower cervical spine. METHODS Thirty 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. RESULTS The 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. CONCLUSIONS The 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.
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Affiliation(s)
- Pierre-Michel Dugailly
- Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Benoît Beyer
- Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium; Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Walid Salem
- Research Unit in Osteopathy, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Véronique Feipel
- Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium; Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Wang K, Wang H, Deng Z, Li Z, Zhan H, Niu W. Cervical traction therapy with and without neck support: A finite element analysis. Musculoskelet Sci Pract 2017; 28:1-9. [PMID: 28171773 DOI: 10.1016/j.msksp.2017.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 01/02/2017] [Accepted: 01/08/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cervical traction is commonly used for treating neck pain. However, few studies have investigated the biomechanical impact such traction has on soft tissues. OBJECTIVES To analyze the biomechanics of cervical traction therapy in a supine position with and without neck support (NS and non-NS). METHODS A finite element model of the cervical spine was constructed to investigate the mechanism behind cervical traction therapy. An axial traction force of 100-N was loaded on the upper surface of C0 to simulate traction weight. Neck support traction was simulated by additionally constraining anterior-posterior motion of the surface of the C4 vertebral lamina. The average von Mises stress, tensile force and motions of related tissues were calculated and compared between the two conditions. Stress in the posterior annulus fibers under flexion was also recorded for comparison. RESULTS At the C4-C5 and C5-C6 levels, NS traction resulted in less of a decrease in the lordotic angle. At these levels, the highest average stress was distributed in the posterior annulus fibers with non-NS traction and both traction therapies produced greater stress on the posterior annulus fibers than physical flexion. The intradiscal pressure in all intervertebral discs between C4-T1 decreased during both traction therapies. CONCLUSION Neck support traction therapy produced less tension on the posterior annulus fibers and ligaments posterior to it at the C4-C5 and C5-C6 levels. In order to minimize the potential harm to soft tissue in clinical practice, it may be beneficial to use a neck support according to the targeted level.
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Affiliation(s)
- Kuan Wang
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai 201203, China; Institute of Traumatology, Shanghai Academy of TCM, Shanghai 201203, China
| | - Huihao Wang
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai 201203, China; Institute of Traumatology, Shanghai Academy of TCM, Shanghai 201203, China
| | - Zhen Deng
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai 201203, China; Institute of Traumatology, Shanghai Academy of TCM, Shanghai 201203, China
| | - Zhengyan Li
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai 201203, China; Institute of Traumatology, Shanghai Academy of TCM, Shanghai 201203, China
| | - Hongsheng Zhan
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai 201203, China; Institute of Traumatology, Shanghai Academy of TCM, Shanghai 201203, China.
| | - Wenxin Niu
- Department of Rehabilitation Sciences, Tongji University School of Medicine, Shanghai 200092, China; Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Centre), Shanghai 201619, China.
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Savva C, Giakas G, Efstathiou M, Karagiannis C, Mamais I. Effectiveness of neural mobilization with intermittent cervical traction in the management of cervical radiculopathy: A randomized controlled trial. INT J OSTEOPATH MED 2016. [DOI: 10.1016/j.ijosm.2016.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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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: 1.3] [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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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: 1.9] [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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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: 1.0] [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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Sebastian D. T2 radiculopathy: A differential screen for upper extremity radicular pain. Physiother Theory Pract 2012; 29:75-85. [DOI: 10.3109/09593985.2012.700001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Anderst WJ. Automated measurement of neural foramen cross-sectional area during in vivo functional movement. Comput Methods Biomech Biomed Engin 2011; 15:1313-21. [PMID: 21736429 DOI: 10.1080/10255842.2011.590450] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
An automated technique to measure neural foramen cross-sectional area during in vivo, multi-planar movements is presented. This method combines three-dimensional (3D) models of each vertebra obtained from CT scans with in vivo movement data collected using high-speed biplane radiography. A novel computer algorithm that automatically traces a path around the bony boundary that defines the neural foramen at every frame of X-ray data is described. After identifying the neural foramen boundary, the cross-sectional area is calculated. The technique is demonstrated using data collected from a patient with cervical radiculopathy who is tested before and after conservative treatment. The technique presented here can be applied when 3D, dynamic, functional movements are performed. Neural foramen cross-sectional area can be quantified at specific angles of intervertebral rotation, allowing for matched comparisons between two trials or two test sessions. The present technique is ideal for longitudinal studies involving subjects who receive conservative or surgical treatments that may affect spine motion.
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Affiliation(s)
- William J Anderst
- Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, University of Pittsburgh, 3820 South Water Street, Pittsburgh, PA 15203, USA.
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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: 1.5] [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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Souza RBD, Lavado EL, Medola FO, Blanco DH, Blanco JHD. Efeito da tração manual sobre o comprimento da coluna cervical em indivíduos assintomáticos: estudo randomizado controlado. FISIOTERAPIA E PESQUISA 2011. [DOI: 10.1590/s1809-29502011000100011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Os objetivos do estudo foram o de mensurar o comprimento da coluna cervical quando submetida à tração manual, e o de verificar as alterações da cervical após um período de 10 sessões consecutivas. Trata-se de estudo randomizado controlado, no qual 64 participantes foram submetidos a dois procedimentos radiológicos, antes e durante a tração. As distâncias das bordas anteriores e posteriores do corpo vertebral C2 até as do corpo vertebral de C7 foram mensuradas e comparadas. Na primeira etapa as medidas das bordas anteriores foi de 8,40 para 8,50 cm (P<0,001) e nas posteriores foi de 8,35 para 8,50 cm (P<0,001). Para a segunda etapa, os indivíduos foram aleatorizados em grupo controle (n=31) e intervenção (n=33), o qual recebeu dez sessões tração cervical. Após as sessões, as distâncias anterior e posterior do grupo intervenção aumentaram significativamente de 8,40 para 8,90 cm (P<0,001) e de 8,40 para 8,65 cm (P<0,001), respectivamente. Após as trações, todos os participantes repetiram os mesmos procedimentos radiológicos, as mensurações e as comparações das distâncias vertebrais. Quando os dois grupos foram comparados após as trações, houve diferença estatisticamente significante entre as distâncias anteriores e posteriores, de 8,20 e 8,90 cm (P=0,015) e de 8,30 e 8,65cm (P=0,030), respectivamente. Portanto, a tração aumentou o comprimento da coluna cervical. Após um período de aplicação das sessões, ocorreu aumento significativo das medidas entre as vértebras.
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Enhanced external counterpulsation and traction therapy ameliorates rotational vertebral artery flow insufficiency resulting from cervical spondylosis. Spine (Phila Pa 1976) 2010; 35:1415-22. [PMID: 20098348 DOI: 10.1097/brs.0b013e3181c62956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Clinical trial of patients with rotational vertebrobasilar insufficiency (VBI) resulting from cervical spondylosis. OBJECTIVE To investigate the effectiveness of enhanced external counterpulsation (EECP) and traction therapy for these patients. SUMMARY OF BACKGROUND DATA EECP would reduce arterial stiffness and vascular resistance, and increase regional blood flow of vertebral arteries, thus may ameliorate symptoms in these patients. METHODS One hundred sixty-three patients who were clinically suspected rotational VBI caused by cervical spondylosis were enrolled in this study. They were randomly allocated into 3 groups: EECP + traction, EECP, and traction group. All patients and 50 healthy volunteers received transcranial color Doppler examination of the vertebral artery and basilar artery in both a neutral cervical spine position and a rotational position. RESULTS Within 3 days after treatment, 47 (84%) patients in EECP + traction group, 32 (61%) patients in EECP group, and 8 (15%) patients in traction group achieved successful outcomes, while at 3 months' follow-up, 45 (80%) patients in EECP + traction group, 34 (64%) in EECP group, and 3 (6%) in traction group achieved successful outcomes. With head rotation, the percentage of reduction of blood flow velocities of the vertebrobasilar artery (VBA) in patients was much greater than that of the healthy volunteers (P < 0.01). After treatment, rotational blood flow velocity reduction percentage of VBA in each treatment group was much lower than that of each group before treatment. EECP + traction group experienced the greatest decrease of rotational blood flow velocity reduction percentage of VBA, while EECP group experienced second greatest. CONCLUSION EECP and traction therapy can relieve the symptoms of rotational VBI, improve the rotational reduction of vertebrobasilar blood flow, and reduce the increased arterial impedance.
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Jellad A, Ben Salah Z, Boudokhane S, Migaou H, Bahri I, Rejeb N. The value of intermittent cervical traction in recent cervical radiculopathy. Ann Phys Rehabil Med 2009; 52:638-52. [PMID: 19846359 DOI: 10.1016/j.rehab.2009.07.035] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 07/20/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Our objective is to assess the effect of mechanical and manual intermittent cervical traction on pain, use of analgesics and disability during the recent cervical radiculopathy (CR). METHODS We made a prospective randomized study including patients sent for rehabilitation between April 2005 and October 2006. Thirty-nine patients were divided into three groups of 13 patients each. A group (A) treated by conventional rehabilitation with manual traction, a group (B) treated with conventional rehabilitation with intermittent mechanical traction and a third group (C) treated with conventional rehabilitation alone. We evaluated cervical pain, radicular pain, disability and the use of analgesics at baseline, at the end and at 1, 3 and 6 months after treatment. RESULTS At the end of treatment improving of cervical pain, radicular pain and disability is significantly better in groups A and B compared to group C. The decrease in consumption of analgesics is comparable in the three groups. At 6 months improving of cervical and radicular pain and disability is still significant compared to baseline in both groups A and B. The gain in consumption of analgesics is significant in the three groups: A, B and C. CONCLUSION Manual or mechanical cervical traction appears to be a major contribution in the rehabilitation of CR particularly if it is included in a multimodal approach of rehabilitation.
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Affiliation(s)
- A Jellad
- Service de médecine physique et réadaptation, CHU F. Bourguiba, Monastir, Tunisia.
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Chung CT, Tsai SW, Chen CJ, Wu TC, Wang D, Lan HCH, Wu SK. Comparison of the intervertebral disc spaces between axial and anterior lean cervical traction. 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 2009; 18:1669-76. [PMID: 19533177 DOI: 10.1007/s00586-009-1072-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 04/05/2009] [Accepted: 06/01/2009] [Indexed: 11/25/2022]
Abstract
The insufficient investigations on the changes of spinal structures during traction prevent further exploring the possible therapeutic mechanism of cervical traction. A blind randomized crossover-design study was conducted to quantitatively compare the intervertebral disc spaces between axial and anterior lean cervical traction in sitting position. A total of 96 radiographic images from the baseline measurements, axial and anterior lean tractions in 32 asymptomatic subjects were digitized for further analysis. The intra- and inter-examiner reliabilities for measuring the intervertebral disc spaces were in good ranges (ICCs = 0.928-0.942). With the application of anterior lean traction, the statistical increases were detected both in anterior and in posterior disc spaces compared to the baseline (0.29 mm and 0.24 mm; both P < 0.01) and axial traction (0.16 mm and 0.35 mm; both P < 0.01). The greater intervertebral disc spaces obtained during anterior lean traction might be associated with the more even distribution of traction forces over the anterior and posterior neck structures. The neck extension moment through mandible that generally occurred in the axial traction could be counteracted by the downward force of head weight during anterior lean traction. This study quantitatively demonstrated that anterior lean traction in sitting position provided more intervertebral disc space enlargements in both anterior and posterior aspects than axial traction did. These findings may serve as a therapeutic reference when cervical traction is suggested.
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Affiliation(s)
- Chin-Teng Chung
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan
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