Manual therapy in cervical radiculopathy

• General information about cervical radiculopathy
  
• Symptoms of cervical radiculopathy caused by a herniated disc
• What is manual therapy?
• Case study. Selection criteria
• Results and discussion

General information about cervical radiculopathy

Cervical radiculopathy (CR) is a term used to describe radiating arm pain with motor, reflex, and/or sensory changes (such as paresthesia or numbness), provoked by neck posture(s) and/or movement(s). It is most commonly caused by a herniated cervical disc or by spondylotic changes, such as bone spurs, which result in the compression and/or inflammation of the nerves. 

When an intervertebral disc herniates in the neck, its contents can leak into the spinal canal or into the nerve root tunnel and can affect the nerve root exiting the spine. Disc herniations in the neck occur most often in people between 30 and 50 years of age. Cervical radiculopathy caused by a herniated disc is usually treated non-surgically until the symptoms finally improve, and may even disappear completely. Surgical intervention is rarely considered, except in cases where the symptoms progressively worsen or do not go away.

Symptoms of cervical radiculopathy caused by a herniated disc

When cervical radiculopathy is caused by a herniated disc, the pain can be even more intense than that caused by cervical osteophytes (bone spurs) or excessive bone tissue growth, because the inner layer (nucleus pulposus) of the disc contains inflammatory proteins that can leak onto the sensitive nerve root when a disc herniates. The chemical reaction created when these proteins leak onto the nerve root can cause both pain and damage.

Symptoms of cervical radiculopathy can radiate to any area, from the neck down to the fingers, and may include any of the following:

• Pain similar to an electric shock or a burning sensation
• Tingling, pins and needles
• Numbness, which may or may not include tingling
• Weakness that can affect the strength of the shoulder, arm, and/or hand

The location of cervical radiculopathy symptoms will depend on the herniated cervical disc and the affected nerve root. For example, radiculopathy at the C6 level may cause symptoms to radiate along the arm to the thumb and index finger, while radiculopathy at the C8 level may cause symptoms to radiate to the little finger.

What is manual therapy?

Manual therapy is a technique used to treat almost any type of musculoskeletal problem using only the therapist's hands. The treatment involves mobilizing joints and muscles in specific directions, at different speeds (HVLA – high velocity, low amplitude) in order to regain mobility (mobilizations and manipulations), to reduce pain, and to restore normal function to the tissues and joints. The main manual therapy methods are: mobilization, traction, muscle relaxation, myofascial release, and intermittent manipulation. 

Because surgery is associated with a higher risk, conservative management is a suggested first-line treatment choice in the absence of severe neurological deficits. Manual therapy is a cautious form of treatment, provided by specialized therapists. It is considered to produce a variety of effects, including better tissue elasticity and a wider range of movement, relaxation, changes in muscle function, reduced pain, and reduced swelling and inflammation of the soft tissues. A recent systematic review reported that patients with cervical radiculopathy, caused by a herniated cervical disc, substantially improved their pain and activity levels within the first 4-6 months.

Case study. Selection criteria

The population studied in order to create this article had to consist of patients with cervical radiculopathy who had received manual therapy as an intervention. Studies were included that used at least one of the primary measures considered to be the most important, namely: pain intensity, perceived overall effect (for example, the proportion of recovered patients, subjective improvement of symptoms), disability (for example, the neck disability index), return to work (for example, days off work) or quality of life, and the results of physical examinations (for example, range of motion, spinal flexibility).

Results and discussion

It was concluded that manual therapy techniques combined with specific exercises were effective in improving function, active range of motion, and in reducing pain and activity restrictions.

Centrokinetic is the place where you will find answers and clear solutions for your movement problems. The clinic dedicated to osteoarticular conditions is divided into the following specialized departments:

• Orthopedics, a department made up of a highly experienced team of orthopedic doctors, led by Dr. Andrei Ioan Bogdan, senior physician in orthopedics-traumatology, with surgical activity at  Medlife Orthopedic Hospital, specialized in sports traumatology and in ankle and foot surgery.
• Pediatric orthopedics, where children's sports conditions (ligament and meniscus injuries), spinal deformities (scoliosis, kyphosis, hyperlordosis), and foot deformities (hallux valgus, hallux rigidus, clubfoot, flat valgus foot, cavus foot) are treated.
• Neurology,  which has a state-of-the-art department, where consultations, electroencephalograms (EEG), and electromyographies (EMG) are performed. 
• Medical recovery for adults and children, a department specialized in the recovery of performance athletes, in spinal conditions, in the recovery of children with neurological and traumatic conditions. Our experience is extremely extensive, having treated over 5000 performance athletes.
• Medical imaging, the clinic being equipped with ultrasound and MRI, high-performance devices dedicated to musculoskeletal conditions, and complemented by an experienced team of radiologists: Dr. Sorin Ghiea and Dr. Cosmin Pantu, specialized in musculoskeletal imaging.

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