Aly MM1, Hanafy AF2, Hassan SH3, Elhafez SM2, Abdelmageed SM3
1Faculty of Physical Therapy - Cairo University, Physical Therapy for Neuromuscular Disorders, Cairo, Egypt, 2Faculty of Physical Therapy - Cairo University, Biomechanics, Giza, Egypt, 3Faculty of Physical Therapy - Cairo University, Physical Therapy for Neurological Disorders, Giza, Egypt
Background: Cervical traction has long been defined as a distracting force that separate the cervical segments and relieve nerve roots compression. Yet, there is lack of knowledge that reports the effects of different traction decompression angles and determines the proper angle of pull among different angles of decompression system.
Purpose: The purpose of this study was to investigate the effect of different angles of decompression and comparing them with neck muscles stretching on flexor carpi radialis (FCR) H-reflex, neck disability index (NDI), and pain level (Visual Analogue Scale VAS) in patients with cervical radiculopathy.
Methods: Fifty-eight patients with cervical radiculopathy caused by cervical paramedian disc protrusion at C5-C6 or C6-C7 levels participated in the study. Their mean ± SD age, body mass, and height were 35.05 ± 7.43 years, 72.84 ± 12.14 kg and 169.32 ± 10.35 cm respectively. They were randomly assigned into four groups;
Group (A) received stretching protocols to the cervical musculature at the side of symptoms.
Group (B) was treated with traction therapy from neutral position with rope angle (0º).
Group (C) was treated with traction therapy from (30º) lateral bending toward the opposite side of radiculopathy.
Group (D) was treated by traction from (15º) flexion with lateral bending (30º) to the opposite side of radiculopathy and (15º) rotation toward the same side of radiculopathy.
All patients underwent initial pre-treatment and post-treatment measurements (after 6 weeks) of FCR H-reflex, VAS pain score, and NDI score.
Results: Mixed design MANOVA revealed that the H-Reflex increased significantly (p 0.05) after treatment in Group (A), (B) and (D). However, the H-reflex post-treatment values increased non-significantly (p > 0.05) in patients within group (C). The NDI and VAS pain scores decreased significantly after treatment in all tested groups. There were non-significant differences in VAS, NDI, or H-reflex between the traction decompression groups (B), (C), (D) and the stretching group (A).
Conclusion(s): Applying traction decompression from foraminal opening positions has a significant effect on reduction of symptoms of cervical radiculopathy appeared in an improvement of FCR H-reflex amplitude, VAS as well as improvement of NDI score. Stretching of cervical muscles produced significant improvement similar to the effect of applying traction from neutral retracted neck position with rope angle 0 degree and traction from triaxial position.
Implications: Decompression traction from retracted neutral position with (0º) rope angle and foraminal opening directions either uniaxial or multiaxial is as effective as stretching of the ipsilateral neck muscles in enhancing nerve roots decompression and reducing pain in patients with cervical radiculopathy.
Keywords: Cervical radiculopathy, Traction decompression, Ipsilateral Stretching
Funding acknowledgements: No fund
Purpose: The purpose of this study was to investigate the effect of different angles of decompression and comparing them with neck muscles stretching on flexor carpi radialis (FCR) H-reflex, neck disability index (NDI), and pain level (Visual Analogue Scale VAS) in patients with cervical radiculopathy.
Methods: Fifty-eight patients with cervical radiculopathy caused by cervical paramedian disc protrusion at C5-C6 or C6-C7 levels participated in the study. Their mean ± SD age, body mass, and height were 35.05 ± 7.43 years, 72.84 ± 12.14 kg and 169.32 ± 10.35 cm respectively. They were randomly assigned into four groups;
Group (A) received stretching protocols to the cervical musculature at the side of symptoms.
Group (B) was treated with traction therapy from neutral position with rope angle (0º).
Group (C) was treated with traction therapy from (30º) lateral bending toward the opposite side of radiculopathy.
Group (D) was treated by traction from (15º) flexion with lateral bending (30º) to the opposite side of radiculopathy and (15º) rotation toward the same side of radiculopathy.
All patients underwent initial pre-treatment and post-treatment measurements (after 6 weeks) of FCR H-reflex, VAS pain score, and NDI score.
Results: Mixed design MANOVA revealed that the H-Reflex increased significantly (p 0.05) after treatment in Group (A), (B) and (D). However, the H-reflex post-treatment values increased non-significantly (p > 0.05) in patients within group (C). The NDI and VAS pain scores decreased significantly after treatment in all tested groups. There were non-significant differences in VAS, NDI, or H-reflex between the traction decompression groups (B), (C), (D) and the stretching group (A).
Conclusion(s): Applying traction decompression from foraminal opening positions has a significant effect on reduction of symptoms of cervical radiculopathy appeared in an improvement of FCR H-reflex amplitude, VAS as well as improvement of NDI score. Stretching of cervical muscles produced significant improvement similar to the effect of applying traction from neutral retracted neck position with rope angle 0 degree and traction from triaxial position.
Implications: Decompression traction from retracted neutral position with (0º) rope angle and foraminal opening directions either uniaxial or multiaxial is as effective as stretching of the ipsilateral neck muscles in enhancing nerve roots decompression and reducing pain in patients with cervical radiculopathy.
Keywords: Cervical radiculopathy, Traction decompression, Ipsilateral Stretching
Funding acknowledgements: No fund
Topic: Musculoskeletal: spine
Ethics approval required: Yes
Institution: Faculty of Physical Therapy, Cairo University, Egypt
Ethics committee: Ethical Committee of Faculty of Physical Therapy
Ethics number: P.T. REC/012/001780
All authors, affiliations and abstracts have been published as submitted.
