Manual Therapy as a Management of Cervical Radiculopathy: A Systematic Review

Table 2

Study characteristics.

Study	Subjects, no. (M/F); [Age range]	Selection criteria	Intervention	Protocol	Outcomes	Main results
Afzal (2019)	40 (17/23)	Unilateral pain in upper limb, paraesthesia w/o numbness. RMN; 3 of 4 items +: Spurling, facet distraction, ULTT1, ipsilateral; EMG/ENG: no	G1: openings; G2: manual cervical traction; G3:	Treatment: 3 ssn/3 weeks; G1: 10 reps/3 series; G2:10 sec traction/5 sec rest (10 min); All: 15 min heat before; Follow-up: ending	NDI; NPRS; Cervical ROM; Patient-specific PSFS	Statistically significant improvement in the 3 groups in all the outcomes
Bukhari (2016)	42 (-); [20-70]	“Evident symptoms of cervical radiculopathy”; EMG/ENG: no	G1: mechanical traction; G2: manual traction; Both: segment mobilisation & exercises	Treatment: 3 ssn/6 weeks; G1: 10 sec traction/5 sec rest (10 min); G2: 10 sec traction/5 sec rest (10 reps); Anteroposterior mobilisation: 5 sec/10 reps; Follow-up: ending	NPRS; NDI	Significant changes in both groups; , no comparison between groups
Cui (2017)	359 (25%/75%); [18-65]	Neurologist diagnosis. Pain in 1 or more dermatomes, weakness, & hyporeflexia; EMG/ENG: No	G1: mobilisation plus Shi-style cervical manipulation; G2: mechanical cervical traction	Treatment: 6 ssn in 2 weeks; Mobilisation plus Shi-style cervical manipulation: neck, back, thoracic massage, & UL movement (30 sec/point); Mechanical cervical traction: 20 min; Follow-up: ending, weeks 2, 10, & 22 postfinal Tx	NDI; VAS; SF-36	Statistically significant improvement in both groups, G1 > G2 in VAS & NDI; NDI difference disappears at 22 weeks; VAS: difference disappears at 10 weeks
Eldesoky (2019)	50 (-); [18-60]	Unilateral hernia diagnosis in C5 or C6 confirmed using RMN; Pain, paraesthesia, or numbness in the C6 or C7 dermatome. Cervical or periscapular pain, cervical rigidity, alteration in dermatome sensitivity, weakness, & muscular atrophy in myotome. Lack of tendon reflexes for more than 3 months	G1: (MC); G2: conventional Tx	Treatment: 3ss/4 weeks; Conventional Tx: ultrasound & strengthening; MC: posteroanterior & oscillatory rotations in C6 & C7 (10 reps/30 sec/technique); Follow-up: upon ending Tx & at 4 weeks post-Tx	VAS; NDI; SEP	Both groups: statistically significant improvement in all the outcomes; G1 statistically superior
Hassan (2020)	40 (27/13); [30-70]	Neck pain less than 8 on NPRS & numbness/paraesthesia and/or pain in the arm or the hand. Positive findings of cervical radiculopathy on X-rays; 3 of 4 items +: Spurling, facet distraction, ULTT1, ipsilateral; EMG/ENG: no	G1: (Maitland); G2: of static stretching (Kaltenborn)	Treatment: 7 ssn/2 weeks; G1: ( reps); G2: mobilisation (3 series); Follow-up: ending	NPRS; NDI; Cervical ROM	Significant improvements in all variables in both groups; : significant differences for all the outcomes except for NPRS & inclinations
Ibrahim (2019)	40 (-); [20–40]	Radiated pain in 1 of the arms; 3 of 4 items +: Spurling, facet distraction, ULTT1, ipsilateral; EMG/ENG: no	G1: conventional Tx; G2:	Treatment: 3 ssn/3 weeks; Conventional Tx: Neurodynamic Tx: ULTT gliding (10 reps) + ULTT tensioning (10 sec) x 2; Follow-up: ending	VAS; Pressure strength	Statistically significant changes in both groups, without significant differences between them
Khan (2016)	100 (50/50); [25-55]	Cervical radiculopathy neurologist’s diagnosis; 3 of 4 items plus: Spurling, facet distraction, ULTT1, ipsilateral; EMG/ENG: no	G1: conventional Tx; G2:	Treatment: 6 ss/week. 12ss; Conventional Tx: exercises (25 reps/twice a day); Continuous TENS (20 min); Heat; Cervical traction: 10 sec/5 sec rest (20 min); Follow-up: ending	VAS	in VAS
Kim (2017)	30; [25-60]	Pain radiation in 1 of the ULs; 3 of 4 items +: Spurling, facet distraction, ULTT1, ipsilateral; EMG/ENG: no	G1: G2: manual cervical traction	Treatment: 3 ss/8 weeks; Both: heat (20 min) & TENS (15 min); Cervical traction: 1 min/30 sec rest (10 min); Neural mobilisation: median gliding exercises (combines flexion-extension in wrist & elbow) (10 min); Follow-up: weeks 4 & 8 post-Tx	NPRS; NDI; ROM; FME	Statistically significant improvement in the 2 groups. statistically significant in all the outcomes
Kumar (2010)	30 (10/20); [25-68]	Diagnosis by neurologist or traumatologist; Spontaneous pain in the neck, with radiation in the arm, forearm, hand; EMG/ENG: no	G1: McKenzie mobilisation; G2: neural mobilisation; G3: diathermia & mechanical cervical traction	Treatment: 10 sessions in 3 weeks; G1: 10-15 openings (1 rep/5 sec); G2: 100 Hz/50 μs/30 min; G3: 6-8 sec/rep, 5 reps (flexion, extension, inclination, rotation); Heat: 20-25 min cervical posterior; Follow-up: weeks 3 & 6 post-Tx	VAS; Cervical ROM: scalar method	VAS: all with statistically significant reduction (); ROM: improvement in the 3; Adverse effects: not reported
Langevin (2014)	36; [18-65]	Pain in superior or periscapular limb, paraesthesia or meses; 3 of 4 items +: Spurling, facet distraction, ULTT1, ipsilateral; EMG/ENG: no	G1: TM & exercise to open intervertebral foramen; G2: TM & exercise	Treatment: 8 ss in 4 weeks; G1: MT 10 reps/30 sec→+ at-home exercise; G2: equal to G1 without foramen opening objective; Follow-up: weeks 4 & 8	NDI; NPRS; QuickDASH	Statistically significant difference in both groups in the 3 outcomes. No differences between groups
Ojo Ojoawo (2016)	25 (15/12); [-]	Traumatologist diagnosis; EMG/ENG: no	G1: G2: conventional Tx	Treatment: 3ss/4 weeks.; Conventional Tx: TOP: 20 sec/3 reps; Follow-up: weeks 2 & 4	VAS; NDI	Significant improvement in both groups. statistically significant in VAS
Ojo Ojoawo (2018)	75 (40/35); [-]	Cervical pain radiated in the arm.; Positive test in: Pinched nerve, posteroanterior pressure, Spurling test & positive Valsalva; EMG/ENG: No	G1: cervical traction (CT); G2: transversal oscillatory pressure (TOP); G3: exercise + cryotherapy	Treatment: 2 ss/week/6 weeks; G1: TC 15 min; G2: TOP 20 sec/3 reps; G3: 3 ss/week/6 weeks; Follow-up: weeks 3 & 6 Tx	VAS; NDI	Statistically significant improvements in all groups; VAS: G2 change quicker (weeks) & greater at 6 weeks; NDI: no statistically significant differences; yes, greater percentage of change in G1 & G3
Prabhakar (2011)	75 (48%/52%); [20–50]	Diagnosis of cervical spondylosis with subacute radiated pain in upper limb; EMG/ENG: no	G1: G2: G3:	Treatment: 10 sessions in 3 weeks; G1: 10-15 (1rep/5 sec); G2: 100 Hz/50 μs/30 min; G3: 6-8 sec/rep, 5 reps (flexion, extension, inclination, rotation); Heat: 20-25 min cervical posterior; Follow-up: weeks 3 & 6 post-Tx	VAS; ROM elbow extension in median NDT; NPQ; NPS; SF-MPQ	G1 & G2: statistically significant improvement in all the outcomes; NPQ, SF-MPQ: in 3 weeks. (reduced radicular pain & functional improvement); Adverse effects: not reported
Savva (2020)	66 (32/34); [20-75]	Unilateral pain in upper limbs, together with sensory and/or motor symptoms; 3 of 4 items +: Spurling, facet distraction, ULTT1, ipsilateral; EMG/ENG: no	G1: G2: neural mobilisation; G3: control	Treatment: 3 ss/week/4 weeks; G1: 12-15 min;  sec, rest 30; G2: 12-15 min;  sec, rest 30; G3: no; Follow-up: ending	NDI; NPRS; PSFS; Pressure strength; Cervical ROM	Statistically significant improvement of the groups in all the outcomes except for pressure strength, active flexion, & inclinations; : NDI, NPRS, & contralateral rotation; : NPRS
Shafique (2019)	31 (12/19); [20-60]	3 de 4 items +: Spurling, facet distraction, ULTT1, ipsilateral; EMG/ENG: no	G1: spinal mobilisation with movement of Tx; G2: conventional Tx:	Treatment: 2 ss/3 weeks; G1: cervical mobilisation-transversal gliding (10 reps in 1^st ssn) (30 reps/3 series in following ssn); G2: conventional Tx: (6-10 sec/20 reps); Neurodynamics: 10 gliding exercises/ssn; Manual traction: 10 sec/5 sec rest (10 min); Follow-up: finalisation	NPRS; NDI; ROM	in the 3 variables. Statistically significant
Waqas (2016)	100 (63/37); [20-60]	Referred by surgeon or traumatologist for unilateral cervical radiculopathy, due to a disk prolapse. Spurling test, ULTT, cervical distraction, & positive evocation tests; EMG/ENG: no	G1: thoracic manipulation; G2: cervical mobilisation; Both: cervical traction & exercises	Treatment: 3 ss/4 weeks; G1: no specific dose; G2: no specific dose; Cervical traction: 10 min; Follow-up: weeks 2 & 4	NDI; NPRS	Both groups experience statistically significant improvement in the 2 outcomes. G1 obtained better, statistically significant results
Young (2019)	43; [18-65]	3 de 4 items +: Spurling, facet distraction, ULTT1, ipsilateral; EMG/ENG: no	G1: thoracic manipulation; G2: placebo manipulation	Treatment: 1 ssn; Follow-up: finalisation & 48/72 h post-Tx	NPRS; NDI; ROM; FME; GROC	neck NPRS not in arm; in NDI, FME, GROC & ROM except inclination to asymptomatic side