Effectiveness of manual therapy for cervical radiculopathy, a review
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REVIEW
Open Access
Effectiveness of manual therapy for cervical radiculopathy, a review E. J. Thoomes
Abstract Manual therapy is often used for patients with neck pain with or without radicular symptoms. There is sparse evidence on the effectiveness in cervical radiculopathy. The aim of this study was to assess current levels of evidence on the effectiveness of manual therapy interventions for patients with cervical radiculopathy. Electronic data bases were systematically searched for clinical guidelines, reviews and randomised clinical trials (RCTs) reporting on the effectiveness of manual therapy for patients with cervical radiculopathy. Eight relevant reviews, two guidelines and two recent RCTs, that had not yet been included in either, were retrieved. The overall quality of the evidence of included studies was evaluated using the GRADE method. Most interventions were only studied in one single RCT. There is low level evidence that cervical manipulation and mobilisation as unimodal interventions are effective on pain and range of motion at the immediate follow up, but no evidence on the effectiveness of thoracic manipulation or mobilisation as unimodal interventions. There is low level evidence that a combination of spinal mobilisation and motor control exercises is more effective on pain and activity limitations than separate interventions or a wait-and-see policy. There is low level evidence of the effectiveness of cervical mobilisation with a neurodynamical intent as unimodal intervention, on the effectiveness of a multimodal intervention with neurodynamic intent on pain activity limitations and global perceived effect compared to a wait-and-see policy. There is also low level evidence that a multimodal intervention consisting of spinal and neurodynamic mobilisations and specific exercises is effective on pain in patients with CR. There is low level evidence that traction is no more effective than placebo traction.
Background Cervical radiculopathy (CR) is a term used to describe radiating pain in the arm with motor, reflex and/or sensory changes (such as paraesthesiae or numbness), provoked by neck posture(s) and/or movement(s) [1, 2]. It is most commonly caused by a cervical disc herniation or spondylotic changes such as bone spurs, resulting in nerve root compression and /or inflammation [1, 3]. There is sparse epidemiological data on the incidence and prevalence of CR. An annual age-adjusted incidence rate of 83.2 per 100,000 persons (107.3 for men and 63.5 for women) with a peak incidence in the 5th and 6th decade in both genders has been reported [4]. Little is known about the natural course of CR. A recent systematic review reported that patients with CR due to a cervical disc herniation substantially improved on levels of Correspondence: [email protected] Fysio-Experts Physical Therapy Clinic, Hazerswoude, The Netherlands
pain and activity within the first 4 to 6 months and were able to return to their normal activities after 24 to 36 months [5]. As surgery is associated with a small but defi
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