Borrella-Andrés, Sergio et al. “Manual Therapy as a Management of Cervical Radiculopathy: A Systematic Review.” BioMed research international vol. 2021 9936981. 3 Jun. 2021, doi:10.1155/2021/9936981
Submitted by Peter Schoch, Diploma MDT & MIA Faculty
Background & Objective
Cervical radiculopathy is defined as a disorder involving dysfunction of the cervical nerve roots characterised by pain radiating and/or loss of motor and sensory function towards the root affected. There is no consensus on a good definition of the term. In addition, the evidence regarding the effectiveness of manual therapy in radiculopathy is contradictory. This systematic review aimed to assess the effectiveness of manual therapy in improving pain, functional capacity, and range of motion in treating cervical radiculopathy with and without confirmation of altered nerve conduction.
Methods
Systematic review of randomised clinical trials on cervical radiculopathy and manual therapy, in PubMed, Web of Science, Scopus, PEDro, and Cochrane Library Plus databases. The PRISMA checklist was followed. Methodological quality was evaluated using the PEDro scale and RoB 2.0. tool.
Results
17 clinical trials published in the past 10 years were selected. Manual therapy was effective in the treatment of symptoms related to cervical radiculopathy in all studies, regardless of the type of technique and dose applied.
Clinical Implications
This systematic review illustrates the difficulties of drawing firm conclusions about ‘treatment techniques’ when the published evidence is heterogeneous, i.e. patient subgroups and definitions of clinical presentations are described and applied inconsistently, and, treatment protocols are incompletely outlined. That said, this study suggests that virtually any kind of ‘manual therapy’ may have positive short-term effects for patients who present with cervical radicular symptoms. The study does not attempt to draw conclusions about the mechanisms underlying the treatment responses observed in the trials included in the review.
With these limitations in mind, one of the major benefits of assessing patients with ‘radicular symptoms’ using the MDT system is our ability to consistently classify patients into a subgroup such as derangement syndrome, adherent nerve root, mechanically unresponsive radicular syndrome (MUR) or foraminal stenosis. This can help us recognise patients who are potentially rapid responders, slow responders or non-responders and adapt our management strategies accordingly. Our emphasis on patients’ actively self-managing and the selective or judicious use of ‘manual therapy’ within the MDT ‘progressions of force’, means we have a multitude of (clinically reasoned) management ‘tools’ at our disposal, regardless of the patient presentation and underlying pathology.