The Value of Traction in the Treatment of Cervical Radiculopathy

Cervical traction is an intervention frequently recommended for the treatment of patients
with neck pain. Systematic reviews have not endorsed the use of mechanical traction for
patients with neck pain, however these reviews note the poor methodological quality of
available research. Trials that have been performed have examined heterogeneous samples of
patients with neck pain. It may be that cervical traction has not shown to be effective
because only a specific subgroup may benefit from it. Most experts believe that traction is
most beneficial for individuals with neck pain extending into the upper extremity who have
signs of nerve root compression. Randomized clinical trials examining the effectiveness of
traction for patients with these specific characteristics have not been performed.
Preliminary studies support the hypothesis that there exists a specific subgroup of patients
with neck pain likely to benefit from traction

The current study will address 3 important questions:

1. Will the existence of a more specific subgroup of patients who benefit from traction
along with a standard exercise program be validated in a second sample of patients?

2. Is cervical traction a critical component of the treatment necessary to maximize
outcomes for patients in this subgroup?

3. Do two commonly used traction protocols differ in their effectiveness for patients in
this subgroup? (Specifically, we study will compare supine mechanical traction to
over-the-door traction.)

Inclusion Criteria:

1. Primary complaint of neck pain with symptoms (pain and/or numbness) extending distal
to the acromioclavicular joint or caudal to the superior border of the scapula (may
be unilateral or bilateral).

2. Age between 18-70 years old

3. Neck Disability Score score >10 points

Exclusion Criteria:

1. Red flags indicative of a serious or non-musculoskeletal condition (i.e. tumor,
fracture, metabolic diseases, RA, osteoporosis, prolonged history of steroid use,
etc.)

2. Diagnosis of cervical spinal stenosis based on CT or MRI imaging

3. Evidence of cervical myelopathy or central nervous system involvement, (e.g.,
hyperreflexia, intrinsic muscle wasting of the hands, unsteadiness during gait,
nystagmus, loss of visual acuity, impaired sensation of the face, altered taste,
presence of pathologic reflexes (i.e. positive Hoffman's or Babinski reflex).

4. Prior surgery to the neck or thoracic spine

5. Inability to comply with treatment and follow-up schedule