INTRODUCTION
Cervical radiculopathy (CR) is a condition caused by the compression or irritation of cervical nerve roots, leading to symptoms such as pain, numbness, and motor dysfunction in the upper extremities. Types of CR are categorized based on the affected nerve roots:
- C5 Nerve Root: Weakness in deltoid and biceps muscles, diminished biceps reflex.
- C6 Nerve Root: Pain radiating to the thumb, weakness in wrist extensors, diminished brachioradialis reflex.
- C7 Nerve Root: Pain in the middle finger, weakness in triceps, diminished triceps reflex.
- C8 Nerve Root: Pain in the little finger, weakness in finger flexors.
Traditional rehabilitation strategies, particularly cervical strengthening exercises, aim to restore muscle function and reduce symptoms. However, neural mobilization techniques, which involve the application of controlled movements to improve nerve glide and reduce mechanical tension, may provide more direct relief by addressing nerve dysfunction.
This study seeks to investigate the relative effectiveness of neural mobilization and cervical strengthening exercises in managing CR, focusing on pain reduction, functional improvements, and ROM enhancements.
AIMS & OBJECTIVES
1. To evaluate the effectiveness of neural mobilization in the treatment of cervical radiculopathy (C6-C8).
2. To compare the effects of neural mobilization and cervical strengthening exercises on pain reduction and functional recovery.
3. To assess the safety and tolerability of neural mobilization as a therapeutic approach for cervical radiculopathy.
MATERIAL & METHOD
- Study Design: A randomized controlled trial was conducted over 12 weeks.
- Participants: Sixty patients, aged 30-60, diagnosed with cervical radiculopathy were recruited. Participants were randomly assigned into two groups (30 in each group).
- Group A (Neural Mobilization): Received neural mobilization techniques focusing on mobilizing cervical nerve roots (C6-C8). Techniques included:
- Median Nerve Glide
- Radial Nerve Glide
- Ulnar Nerve Glide
- Group B (Cervical Strengthening): Engaged in a program of cervical strengthening exercises designed to enhance neck muscle function and reduce nerve root compression. Patients engaged in a cervical strengthening program including:
- Isometric Neck Exercises: Static contractions to strengthen cervical muscles.
- Progressive Isotonic Exercises: Targeting neck flexors, extensors, and lateral flexors.
- Dynamic Stretching: To improve cervical flexibility and range of motion.
- Supportive Treatments: Both groups received adjunct therapies like moist heat application, ergonomic advice, and postural correction.
- Outcome Measures:
- Pain: Assessed using the Visual Analog Scale (VAS).
- Disability: Evaluated using the Neck Disability Index (NDI).
- Function: Measured using the Patient-Specific Functional Scale (PSFS).
- ROM: Range of motion was assessed using a goniometer. Goniometric assessment of cervical flexion, extension, lateral flexion, and rotation.
- Data Collection Intervals: Assessments were conducted at baseline, and at 4, 8, and 12 weeks after initiating the interventions.
Statistical Analysis:
Paired t-tests and repeated measures ANOVA were used to analyze the differences in pain reduction, functional improvements, and ROM between the two groups at different time points. A p-value of less than 0.05 was considered statistically significant.
- Demographic Data of Participants:
Group A (Neural Mobilization) |
Group B (Conservative Treatment) |
Total |
|
Number of Participants |
30 |
30 |
60 |
Age (Mean ± SD) |
35.4 ± 8.2 years |
36.1 ± 7.9 years |
35.8 ± 8.0 years |
Gender (M/F) |
18/12 |
16/14 |
34/26 |
Occupation |
|||
Desk Job (%) |
60% (18) |
55% (16) |
57% (34) |
Manual Labor (%) |
20% (6) |
25% (8) |
22% (14) |
Others (%) |
20% (6) |
20% (6) |
20% (12) |
Duration of Symptoms |
|||
3-6 months (%) |
30% (9) |
35% (10) |
32% (19) |
6-12 months (%) |
40% (12) |
35% (10) |
38% (22) |
>12 months (%) |
30% (9) |
30% (9) |
30% (18) |
RESULT
Pain Scores Over Time (VAS):
Time Point |
Neural Mobilization (Mean ± SD) |
Conservative Treatment (Mean ± SD) |
p-value |
Baseline |
7.8 ± 1.2 |
7.6 ± 1.3 |
0.45 |
Immediately Post |
4.2 ± 1.5 |
5.6 ± 1.7 |
<0.001 |
4 Weeks Follow-Up |
3.8 ± 1.4 |
5.2 ± 1.6 |
<0.001 |
8 Weeks Follow-Up |
3.2 ± 1.3 |
4.8 ± 1.5 |
<0.001 |
12 Weeks Follow-Up |
2.8 ± 1.2 |
4.5 ± 1.4 |
<0.001 |
Range of Motion (ROM) Improvements:
Movement |
Baseline Neural Mobilization |
Baseline Conservative |
12 Weeks Neural Mobilization |
12 Weeks Conservative |
p-value |
Flexion (degrees) |
30.5 ± 5.2 |
31.0 ± 5.0 |
40.2 ± 5.5 |
36.5 ± 5.3 |
<0.001 |
Extension (degrees) |
40.2 ± 6.1 |
39.5 ± 6.4 |
50.8 ± 5.8 |
44.7 ± 6.0 |
<0.001 |
Lateral Flexion |
25.3 ± 4.8 |
25.7 ± 4.6 |
34.6 ± 5.2 |
30.4 ± 5.0 |
<0.001 |
Rotation (degrees) |
45.8 ± 6.5 |
46.2 ± 6.7 |
56.4 ± 6.9 |
50.8 ± 7.0 |
<0.001 |
Functional Scale Scores (PSFS):
Time Point |
Neural Mobilization (Mean ± SD) |
Conservative Treatment (Mean ± SD) |
p-value |
Baseline |
4.5 ± 1.0 |
4.4 ± 1.1 |
0.72 |
Immediately Post |
6.8 ± 1.3 |
5.7 ± 1.5 |
<0.001 |
4 Weeks Follow-Up |
7.2 ± 1.4 |
6.1 ± 1.4 |
<0.001 |
8 Weeks Follow-Up |
7.8 ± 1.5 |
6.5 ± 1.6 |
<0.001 |
12 Weeks Follow-Up |
8.2 ± 1.6 |
6.9 ± 1.7 |
<0.001 |