The effect of neural mobilization with cervical traction in cervical radiculopathy patients

Transcutaneous Electrical Nerve Stimulation (TENS) is the application of electrical stimulation to the skin via surface electrodes to stimulate nerve fibers, primarily used for relief of pain. The gate control theory of pain asserts that non-painful input closes the nerve "gates" to painful input, which prevents pain sensation from traveling to the central nervous system. Neurodynamics or Neural mobilization, refers to the communication between different parts of the nervous system and to the nervous systems relationship to the musculoskeletal system. It has been shown that the nerves move independently from other tissues. The term Neurodynamics first made an appearance in 1989 and has since been further developed over the last 30 years. Neurodynamics is now seen as an important part of injury assessment and treatment. Spondylosis, or spinal arthritis, is a medical term for the normal wear and tear that occurs in the joints and bones of the spine as people get older. Cervical spondylosis refers to these age related changes that occur in the neck (the cervical spine). Cervical radiculopathy (CR) is a symptom complex of neck pain and radiating arm pain due to compression of one or more cervical nerve roots. The impingement is caused by spondylotic narrowing of the intervertebral foramina, by intervertebral disc herniation or by both. Cervical radiculopathy typically manifests as pain radiating from the neck into the distribution of the affected root. The exact location and pattern of pain may vary widely, and a classic dermatomal distribution of pain is not always present. Associated sensory, motor, and reflex disturbances may or may not be present. Because acute cervical radiculopathy generally has a self-limited clinical course, nonsurgical treatment is the appropriate initial approach for most patients. Surgical treatment may be considered when nonsurgical treatment fails and in the patient with a significant neurologic deficit. Methods: Experimental study design, 60 subjects with Unilateral Cervical Radiculopathy and ULTT-1 positive for median nerve bias, randomized 20 subjects each into three groups - Group A, B and C respectively. Group A received both Cervical Traction and Neural Mobilization. The Group B received only Mechanical Cervical Traction. The Group C received only Neural Mobilization. The duration of intervention was given 3 treatment sessions per week for four weeks. Outcome measures such as Numerical Pain Rating Scale, Global Rating of Change Scale, and Neck Disability Index were measured before, at the end of 2nd and 4th week post treatment. Conclusion: The present study concludes that simultaneous application of mechanical cervical traction with neural mobilization is more effective in improving pain, functional disability and severity of radicular symptoms than mechanical cervical traction and neural mobilization alone for subjects with unilateral cervical radiculopathy.