Effect of nerve mobilization with intermittent cervical segment traction on pain, range of motion, endurance, and disability of cervical radiculopathy원문보기
Yun, Young-Ho
(Department of Physical Therapy, College of Medical Science, Konyang University)
,
Lee, Byoung-Kwon
(Department of Physical Therapy, College of Medical Science, Konyang University)
,
Yi, Jae-Hoon
(Department of Smart Rehabilitation Care, Pyeongtaek University)
,
Seo, Dong-Kwon
(Department of Physical Therapy, College of Medical Science, Konyang University)
Objective: This study aimed to evaluate the effects of the Kaltenborn-Evjenth concept of nerve mobilization combined with intermittent cervical segment traction (ICST) on pain, Neck Disability Index (NDI) scores, range of motion (ROM) and endurance in persons with cervical radiculopathy (CR). Design...
Objective: This study aimed to evaluate the effects of the Kaltenborn-Evjenth concept of nerve mobilization combined with intermittent cervical segment traction (ICST) on pain, Neck Disability Index (NDI) scores, range of motion (ROM) and endurance in persons with cervical radiculopathy (CR). Design: Two-group pretest-posttest design. Methods: Thirty subjects participated in this study and were randomly assigned to two groups. The ICST group (n=15) was performed simultaneously with nerve mobilization and cervical traction for the segment with cervical pain at the same time. The intermittent cervical total traction (ICTT) group (n=15) performed nerve mobilization and cervical traction for the whole cervical area at the same time. In this study, outcome measures such as the Visual Analog Scale (VAS), NDI, ROM, endurance (cranio-cervical flexion test), and passive intervertebral motion performed before and 4 weeks after the experiment were compared to investigate the effects of each intervention. Results: In both groups, there were significant differences in the VAS, NDI scores, and endurance, and there were significant differences between the two groups except for endurance (p<0.05). In the ICST group, significant differences were found in all ROM, and in the ICTT group, significant differences were found in only extension, and there were significant differences between the two groups (p<0.05). Conclusions: The ICST group showed more improvement than the ICTT group in pain, NDI scores and ROM. Moreover, our findings show that the ICST could be used as a new strategy for manual therapy in persons with CR.
Objective: This study aimed to evaluate the effects of the Kaltenborn-Evjenth concept of nerve mobilization combined with intermittent cervical segment traction (ICST) on pain, Neck Disability Index (NDI) scores, range of motion (ROM) and endurance in persons with cervical radiculopathy (CR). Design: Two-group pretest-posttest design. Methods: Thirty subjects participated in this study and were randomly assigned to two groups. The ICST group (n=15) was performed simultaneously with nerve mobilization and cervical traction for the segment with cervical pain at the same time. The intermittent cervical total traction (ICTT) group (n=15) performed nerve mobilization and cervical traction for the whole cervical area at the same time. In this study, outcome measures such as the Visual Analog Scale (VAS), NDI, ROM, endurance (cranio-cervical flexion test), and passive intervertebral motion performed before and 4 weeks after the experiment were compared to investigate the effects of each intervention. Results: In both groups, there were significant differences in the VAS, NDI scores, and endurance, and there were significant differences between the two groups except for endurance (p<0.05). In the ICST group, significant differences were found in all ROM, and in the ICTT group, significant differences were found in only extension, and there were significant differences between the two groups (p<0.05). Conclusions: The ICST group showed more improvement than the ICTT group in pain, NDI scores and ROM. Moreover, our findings show that the ICST could be used as a new strategy for manual therapy in persons with CR.
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문제 정의
[15] showed an improvement in the function disability index of patients with an intervention method combining cervical traction and muscle strengthening exercises for CR. This is a study of a complex treatment method along with cervical traction. It was confirmed that the disability index was significantly reduced in the group with nerve mobilization with cervical traction.
This study aimed to investigate the effects of the Kaltenborn-Evjenth (K-E) concept of nerve mobilization combined with intermittent cervical segment traction (ICST) on pain, joint ROM, neck disability index (NDI) scores, and craniocervical flexion test (CCFT) in patients with CR. When nerve root compression and inflammation occur by applying mechanical and chemical irritation to the vertebral foramen where the cervical nerve root exits, it causes neuritis, edema, fibrosis, and reduces nerve mobility [5].
제안 방법
The arbitration time of each group was conducted three times a week for a total of 50 minutes/day, and the ICST and ICTT groups were composed of seven sets (1-minute treatment, 1-minute rest) and 35 minutes of conservative physical therapy were applied. All subjects underwent conservative physical therapy three times a week for 4 weeks, which included superficial heat treatment for 20 minutes followed by transcutaneous electrical nerve stimulation. The frequency was set at 60 HZ applied for 15 minutes.
Afterwards, VAS, neck disability, joint ROM and deep flexor muscle endurance tests were assessed after 4 weeks. Each group was treated for 4 weeks by a physical therapist with a musculoskeletal K-E orthopaedic manual therapy qualification and more than 10 years of treatment and evaluation experience before the experiment. Each examination was conducted by a physical therapist with more than 7 years of experience in musculoskeletal treatment and evaluation who did not participate in the experiment.
Moreover, the patient’s age range was narrow and the number of participants was small. In addition, objective measures were not made to determine whether it is applicable to patients with acute and bilateral CR, muscle weakness, dysesthesia, and radiation pain of the upper extremity. Objective measurement of the instability segment of the cervical spine was not possible, and muscle power for the deep flexors was not measured.
In this study, cervical traction was applied to increase the spacing of the vertebral body that can directly apply mechanical pressure to the nerve when the nerve is moving in patients with chronic CR, while simultaneously improving the nutrient supply and normal length and mobility of the nervous system. The effect of applying a slider technique that does not cause stress due to stretching of the nerve during nerve mobilization has been confirmed [13].
It was created based on the Oswestry index’s 10-question questionnaire, which evaluates daily life limitations related to back pain, pain intensity, daily life, lifting, reading, headache, concentration, work, driving, sleep, and leisure, selected from one of six items for each of the 10 items (0-5).
Urbaniak and Scott Plous, Lancaster, PA, USA), two random groups were formed, and 15 people in the ICST group were randomly assigned to experimental group 1, while 15 people in the ICTT group were randomly assigned to experimental group 2. The arbitration time of each group was conducted three times a week for a total of 50 minutes/day, and the ICST and ICTT groups were composed of seven sets (1-minute treatment, 1-minute rest) and 35 minutes of conservative physical therapy were applied. All subjects underwent conservative physical therapy three times a week for 4 weeks, which included superficial heat treatment for 20 minutes followed by transcutaneous electrical nerve stimulation.
The study variables were the participants’ pain index (assessed using the visual analog scale, VAS), NDI, ROM, and deep flexor muscle CCFT was tested before the treatment.
In addition, the neck position was set so that there was 0 degrees of flexion, lateral flexion, and rotation. The therapist stood on the cranial side, placing the radial side of both index fingers from the posterior arch of the vertebra to the left and right surfaces of the spinous process, and the index finger formed an angle of 45 degrees from the treatment table. The therapist’s index finger held the posterior arch of the vertebra, below which the traction occurred.
When nerve root compression and inflammation occur by applying mechanical and chemical irritation to the vertebral foramen where the cervical nerve root exits, it causes neuritis, edema, fibrosis, and reduces nerve mobility [5]. Therefore, this study intended to identify the effects of ICST on pain, NDI scores, ROM, CCFT, and passive intervertebral motion, in order to provide patients with CR with the appropriate treatment methods, as well as to investigate for the difference between the K-E ICST group and the intermittent cervical total traction with nerve mobilization (ICTT) group.
93 [10]. To measure the ROM of the neck, a joint ROM instrument was used, and the parameters were measured in degrees of ervical flexion and extension, left and right lateral flexion, and left and right rotation. Subjects were comfortably seated in a chair and started at the front for measurement.
대상 데이터
Thirty-five patients who were treated for CR at the Madu Orthopedic hospital in Gyeonggi-do were recruited for this study. Of these 35 patients, 30 had satisfied with the selection conditions, understood the purpose of the study, and voluntarily signed the consent form.
데이터처리
The Shapiro-Wilk test was used to test the normality of every group variable, and the normal distribution was confirmed. The Chi-squared test and independent t-test were used to compare the general characteristics of the subjects, and there was no significant difference as a result of using the independent sample t-test to test the homogeneity of the pre-dependent variables of each group. The data appeared to be homogeneous.
이론/모형
, Armonk, NY, USA) was used. The Shapiro-Wilk test was used to test the normality of every group variable, and the normal distribution was confirmed. The Chi-squared test and independent t-test were used to compare the general characteristics of the subjects, and there was no significant difference as a result of using the independent sample t-test to test the homogeneity of the pre-dependent variables of each group.
성능/효과
As the results of this study suggested, the ICST group showed more improvement than the ICTT group in pain, NDI scores and ROM. Moreover, our findings show that ICST could be used as a new strategy for manual therapy in patients with CR.
In both groups, the paired t-test revealed significant differences in VAS, NDI, and endurance and there were significant differences between the two groups except for endurance (p<0.05; Table 2).
In this study, both groups showed an increase in deep flexor endurance, but there was no significant difference when comparing the changes between the two groups (p<0.05).
In this study, it was confirmed that the ICST group that included the combination of the two treatment methods showed a significant increase in cervical flexion and extension ROM, left and right side-bending, and left and right rotation than the ICTT group (p<0.05).
In this study, subjects in the cervical segment traction with nerve mobilization group showed greater reduction of pain than the subjects in the total traction with nerve mobilization group (p<0.05).
In this study, there was a greater significant decrease in NDI scores in the ICST group than the ICTT group (p<0.05).
This is a study of a complex treatment method along with cervical traction. It was confirmed that the disability index was significantly reduced in the group with nerve mobilization with cervical traction. In this study, there was a greater significant decrease in NDI scores in the ICST group than the ICTT group (p<0.
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