Objective: To determine if combining intermittent cervical traction with conventional physical therapy methods is more effective than using conventional approaches alone in the improvement of the grip strength and treatment of the patients with unilateral cervical 7 (C7) radiculopathy.
Design: Randomized controlled trial (RCT).
Setting: An outpatient physical therapy clinic, University of Social Welfare and Rehabilitation Science, Iran.
Patients: A sample of convenience of 30 patients with unilateral C7 radiculopathy participated in this study. Patients were assigned randomly to a control (N=15, mean age=46.939 ±5.32) and an experimental group (N=15, mean age=47.53 ±5.6).
Interventions: Electrotherapyu/exercise treatment for control group and combined cervical traction and electrotherapyu/exercise for experimental group. Ten physical therapy sessions, three times a week for each group.
Main outcome measures: Grip strength as an appropriate objective parameter was measured before treatment and after 5 and 10 treatment sessions.
Results: Statistical analysis (paired t-test) revealed significant increase in grip strength after 10 treatment sessions in control (p<0.01) and experimental group (p<0.01) compared with pretreatment score. In the ANCOVA, controlling for pretest scores, no significant difference was found between the two groups in the after 10 treatment sessions grip score (p=0.65). However, the change in grip strength after five sessions was significantly greater for the experimental group than for the control group (P=0.04).
Conclusions: The application of cervical traction combined with electrotherapy and exercise produced an immediate improvement in the hand grip function in patients with cervical radiculopathy.
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References
1.
1 Kondo K, Molgaard CA, Kurland LT, Onofrio BM. Protruded intervertebral cervical disc: incidence and affected cervical level in Rochester, Minnesota, 1950 through 1974. Minn Med1981; 64: 751-753.
2.
2 Hult L. The Munksfors investigation. Acta Orthop Scand Suppl1954; 16:1-76.
3.
3 Garvey TA, Eismont FJ. Diagnosis and treatment of cervical radiculopathy and myelopathy. Orthop Rev1991; 10: 595-603.
4.
4 Hunt WE, Miller CA. Management of cervical radiculopathy. Clin Neurosurg1986; 33: 485-502.
5.
5 Yu Yl, Woo E, Huang CY. Cervical spondylotic myelopathy and radiculopathy. Acta Neurol Scand1987; 75: 367-373.
6.
6 Henderson C, Hennessy R. Posterolateral foraminotomy as an exclusive operative technique for cervical radiuclopathy: a review of 846 consecutively operated cases. Neurosurgery1983; 13: 504-504.
7.
7 Radhakrishan K, Litchy WJ, O'Fallon WM et al. Epidemiology of cervical radiculopathy. A population based study from Rochester, Minnesota, 1976 through 1990. Brain1994; 117: 325-335.
8.
8 Benini A. Clinical features of cervical root compression C5-C8 and their variation. Neuro Orthop1987; 4:74-88.
10 Norkin CC, Leavngie PK. Joint structure and function. A comprehensive analysis, second edition. Philadelphia: FA Davis, 1992.
11.
11 Brouillette DL, Gurske DT. Chiropractic treatment of cervical radiculopathy caused by a herniated cervical disc. J Manipulative Physiol Ther1994; 17: 119-123.
12.
12 Hubka MJ, Phelan SP, Delaney PM et al. Rotary manipulation for cervical radiculopathy: observation on the importance of the direction of the trust. J Manipulative Physiol Ther1997; 20: 622-627.
13.
13 Goldie I, Landquist A. Evaluation of the effects of different forms of physiotherapy in the cervical pain. Scand J Rehabil Med1970; 2: 117-121.
14.
14 Tan JC, Nordin M. Role of physical therapy in the treatment of cervical disc disease. Orthop Clin North Am1992; 23: 435-449.
15.
15 Saal JS, Saal JA, Yurth EF. Nonoperative management of herniated cervical intervertebral disc with radiculopathy. Spine1996; 21: 1877-1883.
16.
16 Abdulwahab S. The effect of reading and traction on patients with cervical radiculopathy based on electrodiagnostic testing. J Neuromusculoskeletal Syst1999; 7:91-96.
17.
17 Constantoyannis C, Konstantinou D, Kourtopoulos H et al. Intermittent cervical traction for cervical radiculopathy caused by large-volume herniated disks. J Manipulative Physiol Ther2002; 25: 188-192.
18.
18 Olivero WC, Dulebohn SC. Results of halter cervical traction for the treatment of cervical radiculopathy: retrospective review of 81 patients. Neurosurg Focus2002; 12: clinical part 1.
19.
19 Moeti P, Marchetti G. Clinical outcome from mechanical intermittent cervical traction for the treatment of cervical radiculopathy: a case series. J Orthop Sports Phys Ther2001; 31: 207-213.
20.
20 Bland JH. Disorders of the cervical spine. Diagnosis and medical management. Philadelphia: WB Saunders, 1994.
21.
21 Colachis SC, Strohm BR. A study of tractive forces and angle of pull on vertebral interspaces in the cervical psine. Arch Phys Med Rehabil1965; 46: 820-830.
22.
22 Saunders DH. Use of spinal traction in the treatment of neck and back conditions. Clin Orthop1983; 179:31-38.
24 Myers CRGrennan DM, Palmer DG. Hand grip function in patients with rheumatoid arthritis. Arch Phys Med Rehabil1980; 61: 369-372.
25.
25 Culjak M, Skreb-Rakijasic N, Strizrep T. Measurement of motor strength of the hand using the Martin Vigorometer in evaluating the success of physical therapy in arthritis of the thumb. Rheumatizam1993; 40:21-23.
26.
26 Viikari-Juntura E, Porras M, Laasonen EM. Validity of clinical tests in the diagnosis of root compression in cervical disc disease. Spine1989; 14: 253-257.
27.
27 Jordan A, Bendix T, Nielson H et al. Intensive training, physiotherapy, or manipulation for patients with chronic neck pain: a prospective, single-blinded, randomized clinical trial. Spine1998; 23: 311-319.
28.
28 Desrosiers J, Bravo G, Hebert R, Dutil E. Normative data for grip strength of elderly men and women. Am J Occup Ther1995; 49: 637-644.
29.
29 Shrout PE, Fleiss JL. Intraclass correlation: Use in assessing rater reliability. Psychol Bull1979; 86: 420-428.
30.
30 Martin GM, Corbin KB. An evaluation of conservative treatment for patients with cervical disc syndrome. Staff Meet Mayo Clin1954; 29: 324-326.
31.
31 Hattori M, Shiari Y, Aoki T. Research on the effectiveness of intermittent cervical traction therapy, using short-latency somatosensory evoked potentials. J Orthop Sci2002; 7: 208-216.
32.
32 Erhard RE. Manual therapy in the cervical spine. HSC 96. The cervical spine. La Crosse, WI: APTA, 1996.
33.
33 Chung TS, Lee YJ, Kang SW, Park CJ, Kang WS, Shim YW. Reducibility of cervical disk herniation: Evaluation at MR imaging during traction with a nonmagnetic tration device. Radiology2002; 225: 895-900.
34.
34 Andersson GBJ, Schultz AB, Nachemson AL. Intervertebral disc pressures during traction. Scand J Rehabil Med Suppl1983; 9:88-91.
