Manual Therapy in Cervical and Lumbar Radiculopathy: A Systematic Review of the Literature

Abstract

The aim of this study was to describe and update current knowledge of manual therapy accuracy in treating cervical and lumbar radiculopathy, to identify the limitations in current studies, and to suggest areas for future research. The study was conducted according to PRISMA guidelines for systematic reviews. A comprehensive literature review was conducted using PubMed and Web of Science databases up to April 2020. The following inclusion criteria were used: (1) presence of radiculopathy; (2) treatment defined as manual therapy (i.e., traction, manipulation, mobilization); and (3) publication defined as a Randomized Controlled Trial. The electronic literature search resulted in 473 potentially relevant articles. Finally, 27 articles were accepted: 21 on cervical (CR) and 6 in lumbar radiculopathy (LR). The mean PEDro score for CR was 6.6 (SD 1.3), and for LR 6.7 (SD 1.6). Traction-oriented techniques are the most frequently chosen treatment form for CR and are efficient in reducing pain and improving functional outcomes. In LR, each of the included publications used a different form of manual therapy, which makes it challenging to summarize knowledge in this group. Of included publications, 93% were either of moderate or low quality, which indicates that quality improvement is necessary for this type of research.

Effects of Neurodynamic Mobilization on Health-Related Quality of Life and Cervical Deep Flexors Endurance in Patients of Cervical Radiculopathy: A Randomized Trial

“…With advancement in health care, more attention has been given to conservative or nondrug treatment of cervical radiculopathy. Studies show that a multimodal approach may be more beneficial in alleviating these symptoms [ 5 , 19 ].…”

A Case of Brachioradial Pruritus Treated with Chiropractic and Acupuncture

“…Cervical radiculopathy results from various pathologies, most commonly herniated intervertebral discs and degenerative disc disease, which may result in nerve root compression and inflammation. Motor and/or sensory fibers can be affected, resulting in pain, paresthesia, or motor weakness in the corresponding dermatome [ 6 , 7 ]. The second is thought to be a contributing factor to BRP because excessive exposure to UVR can cause damage to and cause a reduction in a subset of histamine-sensitive C-fibers which are responsible for the transmission of pruritus.…”

“…Although no particular manual therapy has been found to be superior for cervical radiculopathy, traction is the most frequently used. The purpose of joint-oriented techniques is to treat joint dysfunction and relieve nerve root compression, thus centralizing the symptoms [ 6 , 13 ]. The mechanism by which acupuncture is thought to work is such that microtrauma created by the needle puncture deforms connective tissues and alters fibroblastic structures, resulting in the release of ATP.…”

The Efficacy of Cervical Lordosis Rehabilitation for Nerve Root Function and Pain in Cervical Spondylotic Radiculopathy: A Randomized Trial with 2-Year Follow-Up

“…CSR incidence increases with age and has an estimated frequency of 0.35% in the fifth to sixth decade of life [ 2 ]. Recently, multiple systematic literature reviews have been published seeking to understand the complexities of CSM and its natural history, conservative management strategies, and the need for surgical interventions [ 2 , 8 , 9 , 10 , 11 , 12 , 13 ]. For patients with intractable pain and with motor loss of less than three out of five, surgical intervention is warranted [ 2 ].…”

“…For patients with intractable pain and with motor loss of less than three out of five, surgical intervention is warranted [ 2 ]. However, in comparison between conservative and surgical management trials, the long-term outcomes at 1–2 years generally show conservative care to be equally effective for less severe CSM patients [ 2 , 8 , 9 , 10 , 11 , 12 ].…”