Addition of McKenzie Exercises to a Multimodal Physical Therapy Approach for Cervical Radiculopathy: A Case Report

Abstract

Cervical radiculopathy is a common subset of neck pain involving cervical nerve root irritation potentially resulting in numbness, radicular pain, and/or upper extremity weakness. The Neck Pain Clinical Practice Guidelines published by the American Physical Therapy Association does not support McKenzie exercises in isolation when treating cervical radiculopathy, but endorses a multimodal physical therapy approach for the management of cervical radiculopathy. The purpose of this case report is to exemplify the treatment of a patient with cervical radiculopathy utilizing McKenzie centralization exercises within a multimodal physical therapy approach for improved patient outcomes. The patient was a 49-year-old female with a past medical history of type 1 diabetes mellitus with a history of subacute cervical pain with left upper extremity radicular symptoms for four months consistent with cervical radiculopathy. Interventions included a multimodal physical therapy approach consisting of McKenzie cervical retraction exercises, thoracic manipulation, rib mobilizations, manual cervical traction, peripheral nerve mobilization, and scapular retraction with postural exercises. The patient received four visits over a five-week period with an emphasis on patient education and independence. Although McKenzie centralization exercises are not supported by the Neck Pain Clinical Practice Guideline (CPG) in isolation, adding these exercises to the supported recommendation of a multimodal physical therapy approach for cervical radiculopathy has promise.

The McKenzie Method Is an Effective Rehabilitation Paradigm for Treating Adults With Moderate-to-Severe Neck Pain: A Systematic Review With Meta-Analysis

“…As the McKenzie MMDT is an approach, rather than a simple technique, there are inherent limitations in comparing individual utilization of the McKenzie MMDT. As the literature supports multimodal physical therapy treatments, there may be value in adding the McKenzie MMDT to a more comprehensive treatment approach rather than in isolation [ 1 , 2 ]. The McKenzie MMDT offers an approach that can treat many different spinal syndromes, such as neck pain with radiating pain; however, this study only examined patients who exclusively had non-specific neck pain and was not specific for neck pain primarily due to stiffness or cervical radiculopathy [ 1 , 2 ].…”

“…As the literature supports multimodal physical therapy treatments, there may be value in adding the McKenzie MMDT to a more comprehensive treatment approach rather than in isolation [ 1 , 2 ]. The McKenzie MMDT offers an approach that can treat many different spinal syndromes, such as neck pain with radiating pain; however, this study only examined patients who exclusively had non-specific neck pain and was not specific for neck pain primarily due to stiffness or cervical radiculopathy [ 1 , 2 ]. The effectiveness of the McKenzie MMDT could vary depending on the different subsets of neck pain; however, the findings of this study are not able to comment on this limitation.…”

“…Neck pain is a common musculoskeletal condition often treated conservatively in various ways in the outpatient setting [1][2][3]. An estimated 70% of people will have neck pain at some point in their lives with 54% of individuals having neck pain within the last six months [1,4].…”