Mechanical cervical traction in cervical radiculopathy.
I believe it can worsen the situation. Manual traction of just few minutes a day is beneficial. I am not talking about the worst last stage of cervical radiculopathy where surgery may be required.
As we all know: Cervical radiculopathy is severe arm pain originating from a pinched nerve inthe neck. Cervical radiculopathy leads to neck and radiating arm pain or numbness in the distribution of a specific nerve root. Often this radicular pain is accompanied by motor or sensory disturbances. There are various causes of radiculopathy, such as acute disk herniation; cervical spondylosis; and foraminal narrowing.
First of all you should set the precise diagnosis. Cervical traction should not be done in cases with sequestrated nucleus pulposus herniation, because it can worsen the neurological state. In cases with disc protrusions, spondylosis, spondylarthritis, cervical muscle blockage, etc. cervical traction works well. We recommend it for short periods - 15 - 20 minutes per day with traction force according to patient body weight (usually 1/10 of the body weight) in combination with massage and ultrasound. Cervical brace for 4-6 weeks is also worn. This treatment triad works well but shoud be supervised by an experienced kinesiotherapist.
If its a cervical brace/ collar, I trust that it has to be rigid/ hard brace (where patient is not able to turn the head), to stabilize the cervical vertebrae.
In turn the soft brace might worsen the situation, since it would allow the patient to turn the neck with strain.
Dr. Menezes, with the regard to the rigidity of the cervical collar you are right. However, once again I would make my decision for treatment (incl. cervical orthosis) individually, from case to case.
I do agree with you Dr. Panayot it has to be individualized!
Cercial traction can be used for rediculopathies..
If redicular symptomes are originating from upper cervical region then with cervical spine in extension position, if from mid cervical then neutral spine, if lower cervical region then cervical extension..
Either in suipne or sitting positions..
Either static if condition is acute or intermittent if condition is subacute/ chronic
Either hold n rest time 5-5 sec for soft tissue conditions or 20-20 sec for disc related & degenerative condition..
Duration is 20-40min.. More then 40 min of traction wont have any additional efffects..
Hi..
Using a rigid orthosis for prolonged time may lead to core muscle weakness .. Which would create new issues once you discard it..
Espcially if one is having cervical rediculopathy I would prefer PT Mx rather then going for immobilization..
My experience with mechanical traction, seated position, makes this my first choice for not only common cervicobrachialgia but for some neck pain as well. We always try a comprehensive rehabilitation process together, but essentially it's a mechanical traction as suggested above, 10 minutes a day, for no more than 10 days. With exercises and muscle relaxation and strengthening the results are, in general, very good. Our next step for severe pain due to disc or even stenosis would be foraminal injection. Surgery is done for classical indications.
@ Dr. Chavda, you are right a rigid orthosis for prolonged time may be harmful. A short time (1-2 weeks) bracing comes in consideration after mechanical traction. In fact, bracing and orthosis rigidity depend on the individual case, as it is mentioned above.
@ Dr. Vialle, I agree with you entirely. Your conservative approach corresponds to mine.On the other hand, surgery should be done for classical indications.
Dear Pranayot, Dhara and Luiz- I am sure in this process of discussion you are making way for getting rid of most of the misconceptions in the treatment of cervical radiculopathy.
I guess if the Physiotherapist is not dictated terms and given the freedom to put his/ her experience into practice, they would give their 100% into the work in hand. This is my personal experience of an Ortho Clinic which has self motivated Physiotherapists.
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