The Bottom Line
The Bottom Line is a translation of study findings for application to clinical practice. It is not intended
to substitute for a critical reading of the research article. Summaries are written by invitation of the
Editor in Chief.
[Young IA, Michener LA, Cleland JA, Aguilera AJ, Snyder AR. Manual therapy, exercise, and traction for patients with cervical
radiculopathy: a randomized clinical trial. Phys Ther. 2009;89:632–642.]
What problems did the research-
ers set out to study, and why?
Cervical radiculopathy (CR) can be
a disabling condition as patients
experience pain in the neck and
into the arm or hand. Patients with
CR have several treatment options
available, ranging from surgical
procedures to conservative inter-
ventions. Investigations into the
optimal conservative intervention
are few, and current approaches
to the physical therapist manage-
ment of CR are based on incom-
plete evidence and expert opinion.
Thus, the authors set out to per-
form a randomized clinical trial
to assess the effect of intermittent
cervical traction, a commonly used
intervention for CR, as part of a
multimodal treatment program for
patients with CR.
Who participated in this study?
81 participants. To be included,
participants were required to dem-
onstrate signs and symptoms con-
sistent with CR (pain in the hand
or arm with or without neck pain)
and meet 3 out of 4 criteria (a
positive Spurling’s Test, a positive
Distraction Test, a positive Upper
Limb Tension Test 1, and ipsilateral
neck rotation <65°) on a previously
established clinical prediction rule
that has been shown to identify
patients with CR. Exclusion criteria
consisted of a history of cervical
or thoracic spine surgery, bilateral
upper-extremity symptoms, medi-
cal red flags, or the use of steroidal
medication or injection within the
past 2 weeks.
■ Physical Therapy
What new information does this who collected self-reported out-
study offer? come measures were blinded to
group assignment.
The addition of supine intermittent
cervical traction to a multimodal How might the results be applied
treatment program for CR did not to physical therapist practice?
produce an added treatment ben-
efit. The results of this trial suggest that
there is no additional benefit to
What new information does this adding supine intermittent cervi-
study offer for patients? cal traction to a multimodal treat-
ment approach for patients who
This trial is another example of have CR.
research demonstrating that more
treatment is not always better. In What are the limitations of the
this case, adding traction to a phys- study, and what further research is
ical therapy program consisting of needed?
postural education, manual thera-
The researchers acknowledged
py, and exercise did not provide
several limitations to this trial. First,
an additional benefit. The baseline
the clinical prediction rule used to
care was sufficient. This is an im-
identify eligible participants has
portant result because, in some set-
not been validated. Second, the ef-
tings, adding another treatment to
fectiveness of subject blinding was
a physical therapy program means
the patient will incur additional not assessed, and this is important
in a trial where the primary out-
charges.
comes are self-reported. Future
How did the researchers go about studies should investigate different
this study? dosages of cervical traction. More
research is required to determine
Participants were randomly as- the optimal combination of inter-
signed to either (1) a multimodal ventions for CR.
treatment group and sham trac-
tion or (2) a multimodal treatment Eric K Robertson
group plus traction. The multimod-
EK Robertson, PT, DPT, OCS, is Assistant
al treatment consisted of 4 weeks Professor, Department of Physical Therapy,
Medical College of Georgia.
of thrust and non-thrust manipu-
lation to the cervical and thoracic
regions, therapeutic exercise, and
postural correction. The traction
intervention consisted of supine
intermittent cervical traction begin-
ning at 20 lb or 10% of the patient’s
body weight and was progressed
to a maximum of 35 lb. The par-
ticipants and clinical support staff
©2009 American Physical Therapy Association