School

School of Health Sciences and Human Performance

Department

Physical Therapy

Abstract

Background and Purpose: Conservative treatments aimed at treating neck related conditions, such as cervical radiculopathy, vary greatly between physical therapists with the majority of the evidence suggesting the use of traction, manual therapy, strengthening and repeated movement exercises. However, there is limited evidence examining the combined use of both traction and repeated movements for neck related conditions. The objective of this case report is to show the results of the combined use on pain and disability in a patient experiencing chronic cervical radiculopathy.

Case Description: The patient in this case report is a 43-year-old male, manual laborer, who presents with bilateral elbow, forearm and wrist pain for the past 6 years with no history of neck pain, surgeries nor prior treatments. Interventions included the use of traction, manual therapy, exercise and neural-mobilization, which relieved symptoms temporarily (less than 1 hour). However, with the addition of repeated movements combined with the traction, symptom relief was prolonged immediately (4-5 hours).

Outcomes: The patient subjectively reported increased function at work (with minimal flare-ups) and overall decreased stress levels within 2 sessions with the addition of repeated movements. Minimal clinically important difference (MCID) was achieved for the Disabilities of the Arm, Shoulder and Hand (DASH) and Numerical Pain Rating Scale (NPRS) score after 7 total sessions. At discharge, the patient was able to independently manage symptoms and was 0/10 on a NPRS scale.

Discussion: Although there is limited evidence examining the combined use of the McKenzie Method of Mechanical Diagnosis and Therapy (MDT) repeated movements and traction, the result for this patient’s case was positive on pain and disability, which may merit further research to explore the potential benefits of the combined interventions.

Reference:

  1. Caridi MJ, Pumberger M, Hughes, AP. Cervical Radiculopathy: A Review. HSS J. 2011 Oct; 7(3): 265–272.
  2. Thoomes EJ, Scholten-Peeters W, Koes B, et al. The effectiveness of conservative treatment for patients with cervical radiculopathy: a systematic review. Clin J Pain. 2013;29(12):1073–1086.
  3. Woods BI and Hilibrand AS. Cervical radiculopathy: epidemiology, etiology, diagnosis, and treatment. J Spinal Disord Tech. 2015; 28: E251–259.
  4. Blanpied PR, Gross AR, Elliott JM, et al. Neck Pain: Revision 2017 Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2017;47(7):A1–A83.
  5. Yarznbowicz R, Wlodarski M, Dolutan J. Classification by pain pattern for patients with cervical spine radiculopathy. J Man Manip Ther. 2019 May 2:1-10.
  6. Spanos G, Zounis M, Natsika M, May S. The application of Mechanical Diagnosis and Therapy and changes on MRI findings in a patient with cervical radiculopathy. Man Ther. 2013 Dec;18(6):606-10.
  7. Romeo A, Vanti C, Boldrini V, et al. Cervical Radiculopathy: Effectiveness of Adding Traction to Physical Therapy-A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Phys Ther. 2018 Apr 1;98(4):231-242.
  8. May S, Runge N, Aina A. Centralization and directional preference: An updated systematic review with synthesis of previous evidence. Musculoskelet Sci Pract. 2018 Dec;38:53-62.
  9. Desai MJ, Padmanabhan G, Simbasivan A, et al. Directional preference following epidural steroid injection in three patients with acute cervical radiculopathy. Pain Pract. 2013 Sep;13(7):559-65.

Document Type

Poster

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The Combined Use of Traction and Repeated Movement for Cervical Radiculopathy: A Case Report

Background and Purpose: Conservative treatments aimed at treating neck related conditions, such as cervical radiculopathy, vary greatly between physical therapists with the majority of the evidence suggesting the use of traction, manual therapy, strengthening and repeated movement exercises. However, there is limited evidence examining the combined use of both traction and repeated movements for neck related conditions. The objective of this case report is to show the results of the combined use on pain and disability in a patient experiencing chronic cervical radiculopathy.

Case Description: The patient in this case report is a 43-year-old male, manual laborer, who presents with bilateral elbow, forearm and wrist pain for the past 6 years with no history of neck pain, surgeries nor prior treatments. Interventions included the use of traction, manual therapy, exercise and neural-mobilization, which relieved symptoms temporarily (less than 1 hour). However, with the addition of repeated movements combined with the traction, symptom relief was prolonged immediately (4-5 hours).

Outcomes: The patient subjectively reported increased function at work (with minimal flare-ups) and overall decreased stress levels within 2 sessions with the addition of repeated movements. Minimal clinically important difference (MCID) was achieved for the Disabilities of the Arm, Shoulder and Hand (DASH) and Numerical Pain Rating Scale (NPRS) score after 7 total sessions. At discharge, the patient was able to independently manage symptoms and was 0/10 on a NPRS scale.

Discussion: Although there is limited evidence examining the combined use of the McKenzie Method of Mechanical Diagnosis and Therapy (MDT) repeated movements and traction, the result for this patient’s case was positive on pain and disability, which may merit further research to explore the potential benefits of the combined interventions.

Reference:

  1. Caridi MJ, Pumberger M, Hughes, AP. Cervical Radiculopathy: A Review. HSS J. 2011 Oct; 7(3): 265–272.
  2. Thoomes EJ, Scholten-Peeters W, Koes B, et al. The effectiveness of conservative treatment for patients with cervical radiculopathy: a systematic review. Clin J Pain. 2013;29(12):1073–1086.
  3. Woods BI and Hilibrand AS. Cervical radiculopathy: epidemiology, etiology, diagnosis, and treatment. J Spinal Disord Tech. 2015; 28: E251–259.
  4. Blanpied PR, Gross AR, Elliott JM, et al. Neck Pain: Revision 2017 Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2017;47(7):A1–A83.
  5. Yarznbowicz R, Wlodarski M, Dolutan J. Classification by pain pattern for patients with cervical spine radiculopathy. J Man Manip Ther. 2019 May 2:1-10.
  6. Spanos G, Zounis M, Natsika M, May S. The application of Mechanical Diagnosis and Therapy and changes on MRI findings in a patient with cervical radiculopathy. Man Ther. 2013 Dec;18(6):606-10.
  7. Romeo A, Vanti C, Boldrini V, et al. Cervical Radiculopathy: Effectiveness of Adding Traction to Physical Therapy-A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Phys Ther. 2018 Apr 1;98(4):231-242.
  8. May S, Runge N, Aina A. Centralization and directional preference: An updated systematic review with synthesis of previous evidence. Musculoskelet Sci Pract. 2018 Dec;38:53-62.
  9. Desai MJ, Padmanabhan G, Simbasivan A, et al. Directional preference following epidural steroid injection in three patients with acute cervical radiculopathy. Pain Pract. 2013 Sep;13(7):559-65.

 

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