Multimodal Treatment Program Comparing 2 Different Traction Approaches for Patients With Discogenic Cervical Radiculopathy: A Randomized Controlled Trial

Abstract

Objective: The purpose of this study was to investigate the immediate and long-term effects of a 1-year multimodal program with the addition of 2 different traction approaches on the pain, function, disability, and nerve root function in patients with discogenic cervical radiculopathy (CR). This study also attempted to identify the optimal traction angle based on the maximum recovery of the peak-to-peak amplitude of the flexor carpi radialis (FCR) H-reflex. Methods: This randomized clinical trial with one-year follow-up included a total of 216 (101 female) patients with unilateral lower discogenic CR were randomly assigned to 1 of 3 groups. The standard care group (C) received the multimodal program (pain relief methods, muscle strengthening, and thoracic spine manipulation). The ventroflexion traction group (A) received the same multimodal program as group C, with added traditional ventroflexion traction. The novel traction group (B) received the same multimodal program as group C in addition to a flexor carpi radialis (FCR) H-reflex-based traction method. Primary outcomes were the Neck Disability Index (NDI) and secondary outcomes included neck pain, arm pain, and the amplitude and latency of the H-reflex. Patients were assessed at 3 intervals (pre-treatment, 4 weeks post-treatment, and the 1-year follow-up). Results: The mixed linear model with repeated measures indicated a significant group × time effect in favor of the novel cervical traction group (B) for measures of NDI (F = 412.6, P b .0005), neck pain (F = 108.9, P b .0005), arm pain (F = 91.3, P b .0005), H-reflex amplitude (F = 207.7, P b .0005), and H-reflex latency (F = 58.9 P b .0005). We found that the extension position of cervical spine (5°extension) was the position that achieved the maximum improvement in the novel cervical traction method. Conclusions: This preliminary study showed that a multimodal program with a novel cervical traction method added improved NDI, neck pain, arm pain, and the amplitude and latency of FCR H-reflex for a group of patients with chronic discogenic CR.

Increased Telomere Length and Improvements in Dysautonomia, Quality of Life, and Neck and Back Pain Following Correction of Sagittal Cervical Alignment Using Chiropractic BioPhysics® Technique: a Case Study

“…This increased tension provides resistance against the necessary shortening and swelling of nerve fibers that accompany an action potential. This tension can give rise to local and distant signs and symptoms including neuralgias, spasticity, dizziness, bladder dysfunction, cervical and lumbar spondylosis, disk hernias, trauma to the spinal cord, and autoimmune disorders [23][24][25][26]32,33,47]. This serves as a proposed mechanism for the source of this patient's health conditions due to their resolution following sagittal cervical spinal correction.…”

“…Chiropractic BioPhysics® (CBP®) technique is a full-spine and posture rehabilitation approach to correcting poor posture, deviation of normal spinal alignment and subluxation through incorporating mirror image® exercise, adjustments, and traction procedures [27][28][29][30][31]. CBP® has an extensive amount of quality scientific evidence supporting reliable correction of spinal and postural misalignment yielding improvements in concomitant neurological, musculoskeletal symptoms, spine movement, and patient disability levels [20,[23][24][25][26]32,33]. It seems logical to propose that improvements in spinal and neurological health may have a beneficial impact on TL.…”

Development of an attention-touch control for manual cervical distraction: a pilot randomized clinical trial for patients with neck pain

“…Of note, the improvements in PROs reported in this study were achieved in a pilot RCT that was only two weeks in duration. Future RCTs that evaluate MCD might extend the course of care to four or six weeks, as is delivered in clinical practice [ 34 ] and in recent clinical trials of traction-based therapies which demonstrated both short-term and longer term improvements in neck pain intensity and disability following four weeks of treatment [ 24 , 85 ].…”

H-reflex latency changes after combined application of traction and neural mobilization in cervical radiculopathy

“…Each patient had strengthening exercises of deep neck flexors through tucking the chin in from supine lying position with the head in contact with the plinth without any pillow [29]. This exercise was frequently performed for 3 sets of 10 repetitions and the holding time of exercise was 5 or 6 s.…”