Can physical therapy help with acute cervical radiculopathy?

Physical Therapy for Acute Cervical Radiculopathy

Physical therapy is recommended as part of the initial non-operative management of acute cervical radiculopathy, with studies showing that 75-90% of patients achieve symptomatic improvement with conservative treatment approaches. 1

Effectiveness of Physical Therapy

• Non-operative management, including physical therapy, is the mainstay treatment in the acute phase of cervical radiculopathy, with success rates averaging 90% 2
• Physical therapy has demonstrated statistically significant clinical improvement after treatment for patients with cervical radiculopathy 2
• At 12 months, physical therapy can achieve comparable clinical improvements to surgical interventions, though surgical approaches may provide more rapid relief (within 3-4 months) 2

Evidence-Based Physical Therapy Approaches

• A multimodal physical therapy approach has shown effectiveness in treating cervical radiculopathy 3:

  • Manual physical therapy techniques 4
  • Cervical traction to temporarily decompress nerve impingement 5
  • Strengthening exercises focusing on deep neck flexors and scapulothoracic muscles 4
  • Postural education and exercises 3

• In one case series, 91% of patients with cervical radiculopathy demonstrated clinically meaningful improvement in pain and function following an average of 7.1 physical therapy visits 4

Specific Therapeutic Interventions

• Manual intermittent cervical longitudinal mobilization has shown effectiveness in reducing pain and disability in acute, subacute, and chronic radiculopathy cases 6
• Therapeutic modalities such as Microwave Diathermy and transcutaneous electrical nerve stimulation may help alleviate symptoms 6
• McKenzie centralization exercises, when added to a multimodal physical therapy approach, show promise for improved outcomes 3
• Cervical collars may be used for short-term immobilization during the acute phase 5

Outcome Measures

• Valid and reliable outcome measures for assessing physical therapy effectiveness include 2:
  • The Patient-Specific Functional Scale (PSFS)
  • The cervical North American Spine Society (NASS) questionnaire
  • Neck Disability Index (NDI)
  • Numeric Pain Rating Scale (NPRS)

Considerations and Limitations

• While physical therapy is effective for many patients, those with significant functional deficits impacting quality of life may eventually require surgical intervention 1
• Surgical approaches like anterior cervical decompression may provide more rapid relief (within 3-4 months) of arm/neck pain, weakness, and sensory loss compared to physical therapy 2
• The effectiveness of individual physical therapy treatments may be controversial, but a multimodal approach generally benefits patients with cervical radiculopathy 5

Treatment Algorithm

1. Begin with physical therapy utilizing manual techniques, cervical traction, and targeted strengthening exercises 4, 5
2. Incorporate postural education and home exercise program for patient self-management 3
3. Monitor progress using validated outcome measures like NDI and NPRS 6
4. If symptoms persist beyond 3-4 months with minimal improvement, consider surgical consultation 2
5. For patients responding to physical therapy, continue with progressive strengthening and functional training for long-term management 4