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Manual Therapy, Exercise, and Traction for Patients With Cervical Radiculopathy: A Randomized Clinical Trial

From: Phys Ther. 2009 May 21. [Epub ahead of print]

Optimal strategies for the management of patients with cervical radiculopathy remain elusive. Preliminary evidence suggests that a multimodal treatment program consisting of manual therapy, exercise, and cervical traction may result in positive outcomes for patients with cervical radiculopathy. However, limited evidence exists to support the use of mechanical cervical traction in patients with cervical radiculopathy. The purpose of this study was to examine the effects of manual therapy and exercise, with or without the addition of cervical traction, on pain, function, and disability in patients with cervical radiculopathy. Design This study was a multicenter randomized clinical trial. Setting The study was conducted in orthopedic physical therapy clinics. Patients Patients diagnosed with cervical radiculopathy (N=81) were randomly assigned to 1 of 2 groups: a group that received manual therapy, exercise, and intermittent cervical traction and a group that received manual therapy, exercise, and sham intermittent cervical traction. Intervention Patients were treated, on average, 2 times per week for an average of 4.2 weeks. Measurements Outcome measurements were collected at baseline and at 2 weeks and 4 weeks using the Numeric Pain Rating Scale, the Patient-Specific Functional Scale, and the Neck Disability Index.

There were no significant differences between the groups for any of the primary or secondary outcome measures at 2 weeks or 4 weeks. The effect size between groups for each of the primary outcomes was small. Limitations were the use of a nonvalidated clinical prediction rule to diagnose cervical radiculopathy and the lack of a control group without treatment. The results suggest that the addition of mechanical cervical traction to a multimodal treatment program of manual therapy and exercise yields no significant additional benefit to pain, function, or disability in patients with cervical radiculopathy.

Functional assessment of the cervical spine in F-16 pilots with and without neck pain

From: Aviat Space Environ Med. 2009 May;80(5):477-81

Spinal symptoms in fighter pilots are a serious aeromedical problem. The most common neck complaints are muscular pain and strain. The aim of the current study was to determine possible differences in the cervical range of motion, neck position sense, and neck muscle strength between pilots with and without neck pain. There were 90 male F-16 pilots who volunteered, of which 17 had experienced bilateral neck pain. A standardized questionnaire was used to collect personal information. The maximum isometric neck flexion/extension and lateral flexion strength, the neck position sense, and the cervical range of motion were measured.

There were no significant differences between healthy pilots and those with neck pain concerning neck muscle strength and neck position sense. The neck pain group had a limited cervical range of motion in the sagittal plane and in the transversal plane compared to the healthy pilots. In the current study the authors screened for different motor skills so that deficits could be detected and retraining programs could be implemented when necessary. According to their results, individual retraining programs might reduce neck pain and therefore a well-instructed training program to maintain a proper active cervical range of motion should be implemented. Future studies should investigate the effectiveness of this kind of program.

Retropharyngeal Tendinitis May be More Common Than We Think: A Report on 45 Cases Seen in Danish Chiropractic Clinics

From: J Manipulative Physiol Ther. 2009 May;32(4):315-20

This study presents information from 45 cases of retropharyngeal tendinitis that were collected in Danish chiropractic clinics. A practicing Danish chiropractor collected cases of retropharyngeal tendinitis from colleagues who were members of the Danish Society of Chiropractic and Clinical Biomechanics. Only cases where a patient history of acute severe neck pain, cervical stiffness, and dysphagia were considered, and these were supplemented with imaging in the form of x-rays, computed tomography, or magnetic resonance imaging scans. All cases were reviewed independently by the chiropractor and a medical radiologist with a specialty in musculoskeletal disorders before acceptance into this case series.

Forty-five cases fulfilled the inclusion criteria and were included in this review. Sixteen of these were recruited from a single chiropractic practice. Nineteen were males and 26 were females with an average age of 48 years. All but 2 patients had the characteristic depositions of calcium hydroxyapatite in the tendon of the longus colli muscle, and the average diameter of the retropharyngeal space was 8.1 mm. Patients presenting with a triad of acute severe neck pan, stiff neck, and dysphagia may have retropharyngeal tendinitis. This condition may be a more common than previously thought among patients presenting with acute neck pain in the primary health care sector.

Knowledge to Action: A Challenge for Neck Pain Treatment

From: J Orthop Sports Phys Ther. 2009 May;39(5):351-63

Neck pain causes significant impairment, second only to low back pain. In a recent best-evidence synthesis, the 12-month prevalence of neck pain varied from 30% to 50%, lifetime prevalence was approximately 70%, point prevalence was 22%, and the estimated incidence was 213 per 1000 person years. Sedentary lifestyles are contributing to the prevalence of neck pain. Occupational factors play a large role in the development of neck pain as one of the most frequent causes of long-term sickness absence. Some 25% of visits to chiropractors, 15% to hospital-based physiotherapists, 2% to family physicians, and 75% of musculoskeletal disease seen by rheumatologists relate to neck pain. Combined, low back pain and neck pain have cost an estimated $90 billion per year in the United States, a figure roughly equivalent to 1% of the 2004 gross domestic product. Given the burden of neck disorders for society and individuals, it is important to maximize effective strategies to treat and prevent neck pain. Equally important is for health providers to make evidence-based treatment decisions to optimize their delivery of care. There is a wide spectrum of treatments available to people with neck pain, not all of which are equally effective.

Systematic reviews can enhance incorporation into practice of the large volumes of information emerging from research on effectiveness and risks. But the authors believe that these reviews are most useful with simplified tools to facilitate translation of this knowledge into practice. They provide a “Neck Care Tool Kit” that gives a diagrammatic approach to prioritizing intervention. The evidence from a series of 11 systematic reviews by the Cervical Overview Group is depicted in decision flow-charts and tables to enhance clinical interpretation of the overview findings. On simple visual inspection of symbols in a table, the reader can establish where there is evidence of benefit or no benefit, the strength of the recommendation, and if these data represent short or long term findings. Where possible, they guide clinicians to dosage of specific neck pain treatment methods. There is no consensus as to which outcome measures to prioritize among the large number in use. This clinical commentary guides clinicians to view the evidence in enough detail to integrate it into their clinical practice environment. They conclude by delineating research gaps and proposing future research directions for neck pain treatment.

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