Top 5 Fridays! 5 Treatments That Help With Cervical "Radiculopathies" | Modern Manual Therapy Blog

Top 5 Fridays! 5 Treatments That Help With Cervical "Radiculopathies"


Another reader request, thank you! Here are 5 Treatments That Help With "Radiculopathies." The quotes are because that is too pathoanatomical for me, and I just consider things radiating or referred pain, regardless of the structure involved. But, you already knew that!

1) Repeated spinal movements - start centrally first
  • centralization is a predictor of excellent outcomes
  • start with cervical retraction, then if centralization occurs, but does not remain better, add patient generated overpressure
  • if this increases, peripheralizes, and remains worse, or no worse as a result, move onto cervical retraction with SB OP toward the involved side UE
image from Mulligan Concept Website

2) Functional Mobilization with UE Movements
  • pt may be in sitting or supine
  • if the UE is very sensitive to movements, often increasing and/or worsening their radiating complaints, this may be indicated
  • start at the level of the nerve root that may be indicated, or realistically, start at the middle of the cervical spine
    • gapping the ipsilateral side works best as a pattern
  • give a light unilateral P/A or gapping technique and have them move their arm in the direction that previously increased or peripheralized their complaints
  • hold the spinal mob, and have them perform the UE movement to decrease the threat

3) Neurodynamics
  • also use these sensitizing maneuvers for chronic tendinopathies or chronic UE pain in general
  • median
  • radial
  • ulnar
  • start with sliders vs tensioners, most clinicians want to "stretch" everything, but these test/movements can be very uncomfortable
  • if you want to decrease the threat and show the CNS it is ok to move, make the movements comfortable rather than increasing or reproducing paraesthesia or pain
4) IASTM

  • my preference for treating the neural container
  • often you will have a moderate to severe limitation that reproduces or increases the pt's complaints with neurodynamic biased movements
  • if you lightly perform IASTM along the path of the limited nerve - medial upper arm and anterior upper arm for median nerve for example
  • then retest, the movement is often nearly Sx free and full, all without the threat of a tensioner
  • the pt can then comfortably perform a neurodynamic HEP within a near full and comfortable ROM

5) Kinesiotaping
  • another way to lock in the improvements with IASTM is to use kinesiotape (preferably RockTape) along the path of the neural container
  • this makes for a comfortable movements in general for ADLs
  • make sure to properly clean the area with alcohol if you previously performed IASTM along the neural container
Remember, while these treatments may absolutely help with centralization, the patient specific mode of homework and education is what maintains it!

Keeping it Eclectic...

3 comments:

  1. Thanks, Dr. E.


    Haven't ever tried the MWM with UE movement. Always just did it with the C/S movement. Will have to try it.

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  2. Hi, always great post, thank you Dr. E. What about Traction Mobilizations with or without belt? and/or Lateral Glide Mob as well?

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  3. Sure those help as well! I just listed 5 but there are many! I haven't used the belt in quite a while, as I have been using EDGE Mobility bands for upglide like pull, and lateral glides on the ipsilateral side seem to work best for me.

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