Comment : Here is a good article advocating for multiple treatment choices when it comes to injuries of the spine – such as cervical radiculopathy.
At the clinic, we adopt an evidence informed and multi-modal treatment plan for spinal complaints that our skill set can impact positively.
Effectiveness of manual therapy for cervical radiculopathy, a review. By E. J. Thoomes
Chiropractic & Manual Therapies201624:45. DOI: 10.1186/s12998-016-0126-7
What is a cervical radiculopathy ?
A cervical radiculopathy often presents to the clinic with the patient suffering from neck pain with a peripheralising symptom into the arm that could include pain, numbness, tingling, change in muscle strength (or reflex change on examination). These symptoms or signs are influenced on positional changes of the neck and/or body to enhance or reduce symptoms.
In a recent review of the literature by E. J. Thomas on the effectiveness of the chiropractors role in managing neck pain with radiating pain into the arm, we learnt more about the role and effectiveness of the skill set that chiropractor’s lead the health care system; manual therapy.
Although more study is required in this important clinical presentation in clinic, it is accepted that multimodal treatment choices are best used in management strategies that could include manual therapy for cervical radiculopathy.
The review demonstrated the following conclusions:
“There is low level evidence that cervical manipulation and mobilisation as unimodal interventions are effective on pain and range of motion at the immediate follow up, but no evidence on the effectiveness of thoracic manipulation or mobilisation as unimodal interventions. There is low level evidence that a combination of spinal mobilisation and motor control exercises is more effective on pain and activity limitations than separate interventions or a wait-and-see policy. There is low level evidence of the effectiveness of cervical mobilisation with a neurodynamical intent as unimodal intervention, on the effectiveness of a multimodal intervention with neurodynamic intent on pain activity limitations and global perceived effect compared to a wait-and-see policy. There is also low level evidence that a multimodal intervention consisting of spinal and neurodynamic mobilisations and specific exercises is effective on pain in patients with CR. There is low level evidence that traction is no more effective than placebo traction.”
The take home point from this article was summed up in the discussion as follows:
“This study aimed to assess the effectiveness of manual therapy interventions for patients with cervical radiculopathy in comparison to other conservative treatments, placebo interventions or a wait-and-see policy. The overall level of evidence for any intervention is low. This is mainly due to the fact that most interventions have only been evaluated in one single study and some of these were of low quality, which seriously impedes the firm drawing of conclusions.
There is a paucity of evidence for individual interventions or for combinations of interventions. From the few studies that were conducted, it would seem that multimodal management strategies are generally more effective than unimodal interventions. Several reviews and guidelines also conclude that a multimodal management strategy, comprising of spinal and neurodynamic mobilisation and specific exercises is the more effective conservative treatment for patients with cervical radiculopathy”