Physiotherapy in North America for Upper Back and Neck

Q: My physiotherapist was doing joint mobilizations and traction on me for a pinched nerve on the left side of my neck. But a new study showed that it didn't really help, so we've stopped using it. I definitely feel a difference without it. Should I say something?

A: Yes! Although the study you mentioned showed no difference in results for patients receiving manual therapy with and without traction, there were quite a few yes buts expressed by the authors.

First, they used 15 minutes of intermittent (on/off) traction. They started with a traction force (generated by the machine) of 10 per cent of the person's body weight. The treatment was delivered twice a week for four weeks.

It's possible that a different setting/dosage of traction might work better over a longer period of time. The results of this study don't really support doing away with traction altogether. More study is needed before that recommendation would be made. The patients received the traction lying down on their backs with their heads in a position of slight flexion. It's possible that a different head and neck angle would yield better results.

Second, it's possible that the tests used to measure results might not be the best ones for this condition treated with this treatment. They used the Numeric Pain Rating Scale (pain), Patient Specific Functional Scale (function), and Neck Disability Index (disability). Other tests administered included grip strength, patient satisfaction with treatment, and fear avoidance beliefs.

Third, the comparison group received a sham (pretend) traction of five pounds of force. This subtherapeutic weight still applied some force to the head and neck and could have had a positive treatment effect. And finally, without a control group (patients who received no treatment), there's no way to know if everyone would have gotten better after four weeks without treatment anyway.

Future studies are needed to follow-up the findings of this study. Because cervical radiculopathy can be so painful, limiting, and disabling, it is important to make sure patients are identified early and receive the most effective treatment. Physiotherapists will continue comparing treatment methods until its clear what works best for each group of patients.

Reference: Ian S. Young, PT, MS, OCS, SCS, Cert MDT, et al. Manual Therapy, Exercise, and Traction for Patients with Cervical Radiculopathy: A Randomized Clinical Trial. In Physiotherapy. July 2009. Vol. 89. No. 7. Pp. 632-642.