Table 2.
Characteristics of included studies.
| Author (Year) | Groups Characteristic (Mean Age, Sex) | n | Interventions | Outcome Measures | Conclusions |
|---|---|---|---|---|---|
| Cervical radiculopathy | |||||
| Hassan et al. (2020) [34] | G1: 43.0 (14M, 6F) | G1: 20 | G1: Kaltenborn sustained stretch mobilization, TENS, hot packs | NPRS NDI ROM |
Both oscillatory and sustained stretch mobilization techniques are found to be effective in the management of cervical radiculopathy in terms of pain, range and disability. However, oscillatory mobilization is found to be superior in terms of functional ability and range of motion. |
| G2: 43.0 (13M, 7F) | G2: 20 | G2: Maitland oscillatory mobilization, TENS, hot packs | |||
| Young et al. (2019) [35] | G1: 48.8 (5M, 17F) G2: 43.1 (9M, 12F) |
G1: 22 G2: 21 |
G1: Thoracic spine manipulation G2: Sham thoracic spine manipulation |
NPRS NDI ROM |
One session of thoracic manipulation resulted in improvements in pain, disability, cervical ROM, and deep neck flexor endurance in patients with cervical radiculopathy. |
| Eldesoky et al. (2019) [36] | G1: 43.1 (13M, F12) G2: 43.9 (14M, 11F) |
G1: 25 G2: 25 |
G1: Maitland postero-anterior and rotation oscillatory mobilization techniques G2: Therapeutic ultrasonic and exercise program |
VAS NDI Somatosensory evoked potentials |
Cervical mobilization could be utilized as an effective physical therapy program design for patients with cervical radiculopathy for improvement of pain level, functional disability and nerve root function. |
| Afzal et al. (2019) [37] | G1: 42.1 (M, F) G2: 40.9 (M, F) G3: 42.5 (M, F) |
G1: 13 G2: 13 G3: 14 |
G1: Opening of intervertebral foramen technique G2: Manual cervical traction G3: Combined both above techniques |
NPRS NDI PSFS Active extension/extension Right/left side bending Right/left Rotation |
Manual intervertebral foramen opening technique, manual traction, and combination of both techniques were equally effective in decreasing pain, level of disability and improved cervical mobility in patients with cervical radiculopathy. |
| Ayub et al. (2019) [38] | G1: 21.9 (0M, 22F) G2: 23.1 (0M, 22F) |
G1: 22 G2: 22 |
G1: Cervical traction, Unilateral Posterior Anterior glide and passive upper extremity neural mobilization G2: Cervical traction, Unilateral Posterior Anterior glide and active upper extremity neural mobilization |
NPRS NDI ROM |
Both active and passive neural mobilization is effective in the management of cervical radiculopathy. One of the interventions is not superior to the other. |
| Ojoawo and Olabode (2018) [39] | G1: 51.4 (14M, 11F) G2: 55.7 (15M, 10F) G3: 59.5 (11M, 14F) |
G1: 25 G2: 25 G3: 25 |
G1: Cervical traction plus Exercise, massage, ice therapy G2: Transverse oscillatory pressure plus Exercise, massage, ice therapy G3: Exercise, massage, ice therapy only |
VAS NDI |
Transverse oscillatory pressure reduces the PI and disability of patients with cervical radiculopathy more quickly, compared to conventional therapy. |
| Song and Pan (2017) [40] | G1: 42.4 (7M, 12F) G2: 42.5 (7M, 13F) G3: 42.2 (8M, 12F) |
G1: 19 G2: 20 G3: 20 |
G1: Warm needling moxibustion G2: Warm needling moxibustion and Mulligan dynamic joint mobilization G3: Warm needling moxibustion and cervical traction |
ROM VAS |
Warm needling moxibustion plus Mulligan dynamic joint mobilization can effectively improve neck ROM and relieve pain in patients with cervical radiculopathy. |
| Rodríguez-Sanz et al. (2017) [41] | G1: 33.3 (14M, 11F) G2: 32.5 (12M, 15F) |
G1: 25 G2: 27 |
G1: Cervical lateral glide G2: Waiting list (without intervention) |
NPRS QuickDASH Ipsilateral cervical rotation |
Cervical lateral glide is superior to the absence of treatment in reducing pain and increasing the affected upper limb function of participants who suffer from cervicobrachial pain. |
| Cui et al. (2017) [42] | G1: 44.1 (45M, 128F) G2: 44.4 (35M, 141F) |
G1: 173 G2: 176 |
G1: Shi-style cervical manipulations G2: Mechanical cervical traction |
NDI VAS SF-36 |
Shi-style cervical manipulations could be a better option than mechanical cervical traction for the treatment of cervical radiculopathy-related pain and disability. |
| Kim et al. (2017) [43] | G1: 29.3 (5M, 10F) G2: 29.3 (6M, 9F) |
G1: 15 G2: 15 |
G1: Manual cervical traction G2: Manual cervical traction and neural mobilization |
NPRS NDI ROM Cranio-Cervical Flexion Test |
These results suggest that the neural mobilization can contribute to pain relief, recovery from neck disability, ROM, and deep flexor endurance for patients with cervical radiculopathy. |
| Khan et al. (2017) [44] | G1: 43.1 (16M, 4F) G2: 48.8 (16M, 4F) |
G1: 20 G2: 20 |
G1: Intermittent cervical traction in sitting position, TENS, hot pack G2: Intermittent cervical traction in supine position, TENS, hot pack |
NDI | Supine position is a better choice for applying cervical traction as compared to sitting position for the management of cervical radiculopathy when comparing post interventional NDI score |
| Savva et al. (2016) [45] | G1: 45.2 (8M, 13F) G2: 49.2 (8M, 13F) |
G1: 21 G2: 21 |
G1: Neural mobilization and intermittent cervical traction G2: Participants did not receive any type of treatment |
NPRS PSFS NDI Grip strength ROM |
Neural mobilization with simultaneous intermittent cervical traction can improve pain, function, disability, grip strength and cervical range of motion in people with cervical radiculopathy. |
| Khan et al. (2016) [46] | G1: 38.0 (25M, 25F) G2: 38.0 (25M, 25F) |
G1: 50 G2: 50 |
G1: Manual cervical traction and a combination of conventional exercises and modalities including TENS and superficial thermotherapy. G2: A combination of conventional exercises and modalities including TENS and superficial thermotherapy. |
VAS | Manual cervical traction when used with conventional exercises and modalities was an effective method for decreasing pain in cervical radiculopathy. |
| Waqas et al. (2016) [47] | G1: 47.0 (29M, 21F) G2: 47.0 (34M, 16F) |
G1: 50 G2: 50 |
G1: Maitland Thoracic spine manipulation G2: Maitland cervical spine mobilization |
NPRS NDI |
The result shows that Maitland Thoracic spine manipulation and Maitland cervical spine mobilization were effective techniques for pain reduction and functional abilities restoration. |
| Bukhari et al. (2016) [48] | G1: Not specified G2: Not specified |
G1: 21 G2: 15 |
G1: Segmental mobilization and exercise therapy and manual traction G2: Segmental mobilization and exercise therapy and mechanical traction |
NPRS NDI |
If cervical radiculopathy patients are treated with mechanical traction, segmental mobilization, and exercise therapy, pain and disability will be managed more effectively than when treated with manual traction, segmental mobilization, and exercise therapy. |
| Costello et al. (2016) [49] | G1: 46.2 (sex not specified) G2: 42.0 (sex not specified) |
G1: 12 G2: 11 |
G1: Soft tissue mobilization G2: Therapeutic Ultrasound |
NDI GROC PSFS NPRS ROM |
Patients with neck and arm pain demonstrated greater improvements in ROM, GROC, and PSFS, and pain following soft tissue mobilization than after receiving therapeutic ultrasounds. |
| Langevin et al. (2015) [50] | G1: 42.8 (6M, 12F) G2: 47.8 (6M, 12F) |
G1: 18 G2: 18 |
G1: Manual therapy and exercise program aimed at increasing the size of the intervertebral foramen G2: Manual therapy and exercise program without the specific goal of increasing the size of the intervertebral foramen |
NDI QuickDASH NPRS |
Results suggest that manual therapy and exercises are effective in reducing pain and functional limitations related to CR. The addition of techniques thought to increase the size of the intervertebral foramen of the affected nerve root yielded no significant additional benefits. |
| Fritz et al. (2014) [51] | G1: 44.9 (10M, 18F) G2: 48.1 (18M,13F) G3: 47.6 (12M, 15F) |
G1: 28 G2: 31 G3: 27 |
G1: Exercise alone G2: Exercise and mechanical traction G3: Exercise and over-door traction |
NDI VAS |
Adding mechanical traction to exercise for patients with cervical radiculopathy resulted in lower disability and pain, particularly at long-term follow-ups. |
| Jellad et al. (2009) [52] | G1: 38.5 (4M, 9F) G2: 44.2 (3M,10F) G3: 41.3 (2M, 11F) |
G1: 13 G2: 13 G3: 13 |
G1: Conventional rehabilitation with intermittent manual traction G2: Conventional rehabilitation with intermittent mechanical traction G3: Conventional rehabilitation alone |
VAS | Manual or mechanical cervical traction appears to be a major contribution in the rehabilitation of cervical radiculopathy particularly if it is included in a multimodal approach to rehabilitation. |
| Young et al. (2009) [53] | G1: 47.8 (14M, 31F) G2: 46.2 (12M, 24F) |
G1: 45 G2: 36 |
G1: Manual therapy, exercise, and intermittent cervical traction G2: Manual therapy, exercise, and sham intermittent cervical traction |
NDI NPRS PSFS |
The results suggest that the addition of mechanical cervical traction to a multimodal treatment program of manual therapy and exercise yields no significant additional benefit to pain, function, or disability in patients with cervical radiculopathy. |
| Joghataei et al. (2004) [54] | G1: 47.5 (8M, 7F) G2: 46.3 (7M, 8F) |
G1: 15 G2: 15 |
G1: Cervical traction and electrotherapy/exercise G2: Electrotherapy/exercise treatment |
Grip strength | The application of cervical traction combined with electrotherapy and exercise produced an immediate improvement in the hand grip function in patients with cervical radiculopathy. |
| Lumbar radiculopathy | |||||
| Plaza-Manzano et al. (2019) [55] | G1: 47.0 (8M,8F) G2: 45.5 (8M, 8F) |
G1: 16 G2: 16 |
G1: Neurodynamic mobilization plus motor control exercises G2: Motor control exercises |
NPRS PLE PPT RMQ |
The addition of neurodynamic mobilization to a motor control exercise program led to reductions in neuropathic symptoms and mechanical sensitivity, but did not result in greater changes of pain. |
| Satpute et al. (2018) [56] | G1: 49.9 (14M, 16F) G2: 42.3 (20M, 10F) |
G1: 30 G2: 30 |
G1: Spinal mobilization with leg movement, exercise and electrotherapy G2: Exercise and electrotherapy alone |
VAS ODI GROC SLR ROM |
In patients with lumbar radiculopathy, the addition of spinal mobilization with leg movement, exercise and electrotherapy provided significantly improved benefits in leg and back pain, disability, SLR ROM, and patient satisfaction in the short and long term. |
| Tambekar et al. (2015) [57] | G1: 34.1 (8M, 8F) G2: 32.3 (7M, 8F) |
G1: 16 G2: 15 |
G1: Mulligan bent leg raise G2: Butler’s neural tissue mobilization |
VAS SLR ROM |
The study showed that both techniques produce immediate improvement in pain and SLR range, but this effect was not maintained during the follow up period. |
| Moustafa et al. (2013) [58] | G1: 43.9 (19M, 13F) G2: 43.2 (17M, 15F) |
G1: 32 G2: 32 |
G1: Lumbar extension traction in addition to hot packs and interferential therapy G2: Hot packs and interferential therapy |
Lumbar lordotic angle NPRS ODI Modified Schober test EMG |
The traction group receiving lumbar extension traction in addition to hot packs and interferential therapy experienced better effects than the control group with regard to pain, disability, H-reflex parameters and segmental intervertebral movements. |
| McMorland et al. (2010) [59] | G1: 41.5 (6M, 7F) G2: 42.4 (2M, 9F) |
G1: 13 G2: 11 |
G1: Microdiscectomy G2: Spinal manipulation |
MGP RMQ SF-36 |
Sixty percent of patients with sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention. Of 40% left unsatisfied, subsequent surgical intervention confers excellent outcome. Patients with symptomatic LDH failing medical management should consider spinal manipulation followed by surgery if warranted. |
| Gudavalli et al. (2006) [60] | G1: 42.2 (81M, 42F) G2: 40.9 (66M, 46F) |
G1: 123 G2: 112 |
G1: Flexion-distraction G2: Active trunk exercise program |
VAS RMQ SF-36 |
Subgroup analysis indicated that subjects categorized as chronic, with moderate to severe symptoms, and those with radiculopathy, improved most with flexion-distraction. Subjects categorized with recurrent pain and moderate to severe symptoms improved most with an active trunk exercise program. |
G1: group 1; G2: group 2; G3: group 3; VAS: Visual Analogue Scale; ODI: Oswestry Disability Index; GROC: Global Rating Of Change; SLR: Straight Leg Raise; ROM: Range Of Motion; RMQ: Roland Morris Questionnaire; MGP: Mcgill Pain Questionnaire; SF-36: The Short Form Health Survey; NPRS: Numerical Pain Rating Scale; NDI: Neck Disability Index; PSFS: Patient-Specific Functional Scale; GRC: Global Rating Of Change; PPT: pressure pain threshold.