What components and formats of rehabilitation interventions are more effective to reduce pain in patients with cervical radiculopathy? A Systematic review and component network meta-analysis

Abstract

Objectives

To estimate the comparative efficacy of rehabilitation interventions for pain reduction in cervical radiculopathy and evaluate the individual components of combined treatments to support clinical decision-making.

Data sources

A systematic search was conducted across the Cochrane, PubMed, Scopus, WOS, and PEDro databases up to 1 July 2025, for randomized controlled trials comparing rehabilitation interventions against no intervention or other rehabilitation approaches for cervical radiculopathy-related pain.

Review methods

We conducted a frequentist random effects network meta-analysis and a component network meta-analysis to isolate the effects of individual treatment components. We used CINeMA software to assess the confidence in our estimates.

Results

We included 36 trials comparing 25 interventions composed by eight active components. The components associated with a decrease in pain were neurodynamic techniques (SMD = -1.45; 95%CI: −1.88 to −1.02), cervical traction(SMD = -0.66; 95%CI: −1.08 to −0.25), articular treatment (SMD = -0.72; 95%CI:-1.29 to −0.15), and dry needling(SMD = -3.40; 95%CI: −5.40 to −1.39). The most promising interventions for reducing pain in cervical radiculopathy patients were a combination of the above components (except dry needling) with analgesic electrotherapy and strengthening exercises with a moderate confidence rating.

Conclusions

A combination of articular treatment, analgesic electrotherapy neurodynamic techniques strengthening exercises and cervical traction appears to offer the most effective pain relief for patients with cervical radiculopathy, with a moderate confidence rating. Individually, neurodynamic techniques, cervical traction, and articular treatment were the components associated with a significant reduction in pain. Although dry needling showed encouraging results, its limited presence in the network prevents drawing firm conclusions about its effectiveness.