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ORIGINAL PAPER
Which is better to decompress the nerve roots in cervical radiculopathy: stretching or traction from foraminal opening position?
1
Department of Physical Therapy for Neuromuscular Disorder and Its Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
2
Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
Submission date: 2020-08-26
Acceptance date: 2020-12-23
Online publication date: 2024-08-29
Corresponding author
Abeer Farag Hanafy
Department of Biomechanics, Faculty of Physical Therapy, Cairo University, 7 Ahmed Ezzayyat Street, Bein Essarayat, Giza, Egypt
Department of Biomechanics, Faculty of Physical Therapy, Cairo University, 7 Ahmed Ezzayyat Street, Bein Essarayat, Giza, Egypt
Physiother Quart. 2024;32(3):52-62
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Cervical traction has long been used to relieve compression of nerve roots caused by intervertebral discs. Yet, there is lack of knowledge on comparing the effect of traction decompression with neck muscle stretching in patients with cervical radiculopathy (CR). This study investigated the effect of different angles of decompression on the flexor carpi radialis H-reflex, Neck Disability Index (NDI), and pain level (determined with the visual analogue scale) in patients with CR and compared the results with neck muscle stretching.
Methods:
Overall, 58 patients with CR were randomly assigned to 4 groups. Group A received a stretching protocol to the cervical musculature. Group B was treated with traction therapy from neutral position with rope angle 0°. Group C underwent traction therapy from 30° lateral bending toward the side opposite to radiculopathy. Group D was managed with traction from 15° flexion with 30° lateral bending to the side opposite to radiculopathy and 15° rotation toward the side of radiculopathy. All participants were assessed before and after 6 weeks of treatment.
Results:
Mixed design MANOVA revealed that the H-reflex increased significantly (p < 0.05) after treatment in groups A, B, and D. However, it increased non-significantly in patients within group C. NDI and pain scores decreased significantly after treatment in all tested groups.
Conclusions:
Decompression traction from retracted neutral position with 0° rope angle and foraminal opening directions is as effective as stretching of ipsilateral neck muscles in enhancing nerve root decompression and reducing pain in patients with CR.
Cervical traction has long been used to relieve compression of nerve roots caused by intervertebral discs. Yet, there is lack of knowledge on comparing the effect of traction decompression with neck muscle stretching in patients with cervical radiculopathy (CR). This study investigated the effect of different angles of decompression on the flexor carpi radialis H-reflex, Neck Disability Index (NDI), and pain level (determined with the visual analogue scale) in patients with CR and compared the results with neck muscle stretching.
Methods:
Overall, 58 patients with CR were randomly assigned to 4 groups. Group A received a stretching protocol to the cervical musculature. Group B was treated with traction therapy from neutral position with rope angle 0°. Group C underwent traction therapy from 30° lateral bending toward the side opposite to radiculopathy. Group D was managed with traction from 15° flexion with 30° lateral bending to the side opposite to radiculopathy and 15° rotation toward the side of radiculopathy. All participants were assessed before and after 6 weeks of treatment.
Results:
Mixed design MANOVA revealed that the H-reflex increased significantly (p < 0.05) after treatment in groups A, B, and D. However, it increased non-significantly in patients within group C. NDI and pain scores decreased significantly after treatment in all tested groups.
Conclusions:
Decompression traction from retracted neutral position with 0° rope angle and foraminal opening directions is as effective as stretching of ipsilateral neck muscles in enhancing nerve root decompression and reducing pain in patients with CR.
REFERENCES (37)
1.
Caridi JM, Pumberger M, Hughes AP. Cervical radiculopathy: a review. HSS J. 2011;7(3):265–72; doi: 10.1007/s11420-011-9218-z.
2.
Carragee EJ, Hurwitz EL, Cheng I, Carroll LJ, Nordin M, Guzman J, Peloso P, Holm LW, Côté P, Hogg-Johnson S, van der Velde G, Cassidy JD, Haldeman S; Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Treatment of neck pain: injections and surgical interventions: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine. 2008;33(Suppl. 4):153–69; doi: 10.1097/BRS.0b013e31816445ea.
3.
Graham N, Gross A, Goldsmith CH, Klaber Moffett J, Haines T, Burnie SJ. Mechanical traction for neck pain with or without radiculopathy. Cochrane Database Syst Rev. 2008;3:CD006408; doi: 10.1002/14651858.CD006408.pub2.
4.
Boyles R, Toy P, Mellon J Jr, Hayes M, Hammer B. Effectiveness of manual physical therapy in the treatment of cervical radiculopathy: a systematic review. J Man Manip Ther. 2011;19(3):135–42; doi: 10.1179/2042618611Y.0000000011.
5.
Wong JJ, Côté P, Quesnele JJ, Stern PJ. The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review of the literature. Spine J. 2014;14(8):1781–9; doi: 10.1016/j.spinee.2014.02.032.
6.
Carlsson AM. Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain. 1983;16(1):87–101; doi: 10.1016/0304-3959(83)90088-X.
7.
Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1991;14(7):409–15.
8.
Christie AD, Inglis JG, Boucher JP, Gabriel DA. Reliability of the FCR H-reflex. J Clin Neurophysiol. 2005;22(3):204–9; doi: 10.1097/01.WNP.0000162376.16773.A8.
9.
Khan RR, Awan WA, Rashid S, Masood T. A randomized controlled trial of intermittent cervical traction in sitting vs. supine position for the management of cervical radiculopathy. Pak J Med Sci. 2017;33(6):1333–8; doi: 10.12669/pjms.336.13851.
10.
Liu J, Ebraheim NA, Sanford CG Jr, Patil V, Elsamaloty H, Treuhaft K, Farrell S. Quantitative changes in the cervical neural foramen resulting from axial traction: in vivo imaging study. Spine J. 2008;8(4):619–23; doi: 10.1016/j.spinee.2007.04.016.
11.
Muhle C, Resnick D, Ahn JM, Südmeyer M, Heller M. In vivo changes in the neuroforaminal size at flexion-extension and axial rotation of the cervical spine in healthy persons examined using kinematic magnetic resonance imaging. Spine. 2001;26(13):287–93; doi: 10.1097/00007632-200107010-00013.
12.
Wong AM, Leong CP, Chen CM. The traction angle and cervical intervertebral separation. Spine. 1992;17(2):136–8; doi: 10.1097/00007632-199202000-00003.
13.
Hseuh TC, Ju MS, Chou YL. Evaluation of the effects of pulling angle and force on intermittent cervical traction with the Saunder’s halter [in Chinese]. J Formos Med Assoc. 1991;90(12):1234–9.
14.
Breig A. Adverse mechanical tension in the central nervous system: an analysis of cause and effect: relief by functional neurosurgery. New York: John Wiley and Sons; 1978.
15.
Vaughn HT, Having KM, Rogers JL. Radiographic analysis of intervertebral separation with a 0 degrees and 30 degrees rope angle using the Saunders cervical traction device. Spine. 2006;31(2):39–43; doi: 10.1097/01.brs.0000194840.42792.f2.
16.
Abdulwahab SS, Sabbahi M. Neck retractions, cervical root decompression, and radicular pain. J Orthop Sports Phys Ther. 2000;30(1):4–9; doi: 10.2519/jospt.2000.30.1.4.
17.
Harrison DE, Cailliet R, Harrison DD, Troyanovich SJ, Harrison SO. A review of biomechanics of the central nervous system. Part III: spinal cord stresses from postural loads and their neurologic effects. J Manipulative Physiol Ther. 1999;22(6):399–410; doi: 10.1016/s0161-4754(99)70086-2.
18.
Morishita Y, Naito M, Hymanson H, Miyazaki M, Wu G, Wang JC. The relationship between the cervical spinal canal diameter and the pathological changes in the cervical spine. Eur Spine J. 2009;18(6):877–83; doi: 10.1007/s00586-009-0968-y.
19.
Chen Y-S, Zhou S, Cartwright C, Crowley Z, Baglin R, Wang F. Test-retest reliability of the soleus H-reflex is affected by joint positions and muscle force levels. J Electromyogr Kinesiol. 2010;20(5):980–7; doi: 10.1016/j.jelekin.2009.11.003.
20.
Zheng C, Zhu Y, Lv F, Ma X, Xia X, Wang L, Jin X, Weber R, Jiang J, Anuvat K. Abnormal flexor carpi radialis H-reflex as a specific indicator of C7 as compared with C6 radiculopathy. J Clin Neurophysiol. 2014;31(6):529–34; doi: 10.1097/WNP.0000000000000104.
21.
Hopkins JT, Ingersoll CD, Cordova ML, Edwards JE. Intrasession and intersession reliability of the soleus H-reflex in supine and standing positions. Electromyogr Clin Neurophysiol. 2000;40(2):89–94.
22.
Mynark RG. Reliability of the soleus H-reflex from supine to standing in young and elderly. Clin Neurophysiol. 2005;116(6):1400–4; doi: 10.1016/j.clinph.2005.02.001.
23.
Chen Y-S, Zhou S. Soleus H-reflex and its relation to static postural control. Gait Posture. 2011;33(2):169–78; doi: 10.1016/j.gaitpost.2010.12.008.
24.
Wainner RS, Gill H. Diagnosis and nonoperative management of cervical radiculopathy. J Orthop Sports Phys Ther. 2000;30(12):728–44; doi: 10.2519/jospt.2000.30.12.728.
25.
Sari H, Akarirmak Ü, Karacan I, Akman H. Evaluation of effects of cervical traction on spinal structures by computerized tomography. Adv Physiother. 2003;5(3):114–21; doi: 10.1080/14038190310016517.
26.
Humphreys SC, Chase J, Patwardhan A, Shuster J, Lomasney L, Hodges SD. Flexion and traction effect on C5–C6 foraminal space. Arch Phys Med Rehabil. 1998;79(9):1105–9; doi: 10.1016/s0003-9993(98)90179-4.
27.
Humphreys SC, Hodges SD, Patwardhan A, Eck JC, Covington LA, Sartori M. The natural history of the cervical foramen in symptomatic and asymptomatic individuals aged 20–60 years as measured by magnetic resonance imaging. A descriptive approach. Spine. 1998;23(20):2180–4; doi: 10.1097/00007632-199810150-00007.
28.
Jellad A, Salah ZB, Boudokhane S, Migaou H, Bahri I, Rejeb N. The value of intermittent cervical traction in recent cervical radiculopathy. Ann Phys Rehabil Med. 2009;52(9):638–52; doi: 10.1016/j.rehab.2009.07.035.
29.
Fater DCW, Kernozek TW. Comparison of cervical vertebral separation in the supine and seated positions using home traction units. Physiother Theory Pract. 2008;24(6):430–6; doi: 10.1080/09593980802511896.
30.
Sahasrabudhe A, Eapen C, Zulfeequer CP. Comparison of efficacy of mechanical intermittent Kaltenborn cervical traction mobilization with belt in radiating neck pain: a randomized clinical trial. J Musculoskelet Res. 2017;20(4):1750023; doi: 10.1142/S0218957717500233.
31.
Rai SC, Ajith S, Bhagavan KR, Pinto D. Cervical traction reduces pain and disability in patients with unilateral cervical radiculopathy. Int J Curr Res Rev. 2013;5(7):33–40.
32.
Reddy RSY, Eapen C, Kumar SP. Efficacy of intermittent cervical traction in the treatment of cervical radiculopathy. A randomized controlled study. J Ind Assoc Physiother. 2008;4(1):5–9.
33.
Ylinen J, Häkkinen A, Nykänen M, Kautiainen H, Takala E-P. Neck muscle training in the treatment of chronic neck pain: a three-year follow-up study. Eura Medicophys. 2007;43(2):161–9.
34.
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(5):327–32; doi: 10.1016/j.jmpt.2013.05.006.
35.
Nagib SH, Karkousha RN, El Nahas EM. Effect of stretching exercises vs. Kinesio Taping on postoperative neck discomfort following total thyroidectomy in postmenopausal women. Physiother Quart. 2019;27(4):21–5; doi: 10.5114/pq.2019.89463.
36.
Izzo R, Guarnieri G, Guglielmi G, Muto M. Biomechanics of the spine. Part I: Spinal stability. Eur J Radiol. 2013;82(1):118–26; doi: 10.1016/j.ejrad.2012.07.024.
37.
Izzo R, Guarnieri G, Guglielmi G, Muto M. Biomechanics of the spine. Part II: Spinal instability. Eur J Radiol. 2013;82(1):127–38; doi: 10.1016/j.ejrad.2012.07.023.
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