Cervical radiculopathy (CR) is an affection of the cervical nerve root (CNR) that is commonly caused by a cervical disk pathology, spondylosis, and spinal stenosis leading to nerve root inflammation and impingement and hence chronic pain and disability [1]. The annual incidence rate of CR in the USA is roughly 83 per 100,000, and patients in the fifth decade of life (203 per 100,000) are commonly affected [2].
Symptoms of CR are different from one patient to another and this variation of symptoms is due to the level of nerve root affected. Symptoms are sensory like pain, numbness, and tingling sensation and motor such as muscle weakness and hyporeflexia leading to significant disability [3].
Spinal traction and neural mobilization are forms of physical therapy that have been individually used for treatment of CR due to their various benefits [4].
Neural tissue mobilization techniques (NMTs) are methods that induce neural tension by mobilizing nerves through passive or active movements by using tensioning, gliding, and individualized joint movement [5]. NMTs help to reduce nerve adhesion, improve nerve gliding, and decrease neural mechanosensitivity and thus the CNR’s structure and function are enhanced in patients with CR [6].
Current evidence for the effect of NMTs for patients with CR is limited [7,8,9,10,11,12]. There was a lack of randomized controlled trials (RCTs) that study the efficacy of the sole application of median nerve neural mobilization (MNNM) on patients with CR. All trials used a combination of MNNM with other physical therapy modalities MNNM in treatment of CR [13].
Cervical traction is a force applied to increase the space between the cervical segments and decompress nerve roots [14]. Although there were no evidence-based parameters for intermittent traction, many studies showed a significant effect of it in reducing pain intensity and enhancing functional ability for patients with CR [15, 16]. It is theorized that intermittent traction unloads the spine by stretching muscles and ligaments causing separation between articular surfaces leading to improvements in patient symptoms [17].
There were few RCTs [16, 18] that studied the combined effect of cervical traction either manually or mechanically and neural mobilization on improving neck pain, neck disability, radicular symptoms, cervical spine movements, and grip strength; but to our knowledge, there were no trials that studied the effect of simultaneous application of intermittent cervical traction with MNNN on H-reflex latency of median nerve recorded from flexor carpi radialis (FCR) muscle.
Subjects
Fifteen male and female patients with unilateral CR, with their age from 30 to 50 years included in this trial in the outpatient clinic of faculty of physical therapy, Cairo University from May 2018 till March 2019. Informed written consent was obtained from participants and the study was approved by the physical therapy faculty ethical committee (No. P.T.RE-012-001589).
Inclusion criteria and subject selection
Patients from both genders with age group from 30 to 50 years [2, 13, 19,20,21] with unilateral C5-6 or C6-7 disk protrusion as shown in Fig. 1, numbness along C6-C7 nerve root persisted for more than 3 months and positive provocative test for cervical radiculopathy (Spurling’s test, shoulder abduction test, Valsalva maneuver, neck distraction test, and upper limb tension test 1 (Median nerve)) were included in this study [22, 23].
Exclusion criteria
Patients with C3–C5 lesions, sensory loss or motor weakness, bilateral radiculopathy, shoulder disorders or had cervical surgeries were excluded.
Patients received combined intermittent cervical traction and MNNM. Also, patients received strengthening exercises for deep neck flexors and upper back extensor muscles. Six sessions were given day by day. Patients were evaluated pretreatment and post-treatment for H-reflex latency of the median nerve recorded from FCR muscle.