Physiotherapy for Painful Radiculopathies

Jesson physiotherapy for radicular pain

Jesson et al (2020)

Peripheral neuropathic pain is common with an estimated population prevalence of 6.9%-10%. Currently, treatment of this condition largely depends on pharmacology, however with modest effects. This narrative review aimed to describe the current evidence for physical therapy in patients with chemotherapy-induced peripheral neuropathy (CIPN) and radicular pain.

Physiotherapy for Chemotherapy-Induced Peripheral Neuropathy

Key mechanisms in developing CIPN include microtubule disruption, mitotoxicity, and the neuroimmune response. They experience pain or a combination of numbness, tingling, or hot or cold sensations. This review described the aforementioned symptoms with the umbrella term “CIPN pain”.

Prevention of CIPN

Several studies investigated the preventative effect of predominantly exercise. However, no meaningful effects to this date were found.

Treatment of CIPN

Some studies suggest an easing of symptoms due to exercise. Studies were small and had a modest to high risk of bias, meaning further research is required to confirm this hypothesis.

Effects of QOL

Effects look similar to those of the treatment of CIPN. Although even more research is required in this field.

Physiotherapy for Radicular Pain

The underlying mechanism of radicular pain is caused by mechanical or chemical irritation of spinal nerves or nerve roots, mostly cervical and lumbar. Natural history is favorable in two-thirds of patients. Common causes are disk herniations, spinal canal stenosis, and spondylolisthesis. One would think symptoms would occur in the corresponding dermatome, yet extradermatomal pain is more often the rule, rather than the exception.

Stabilization and Motor Control

When compared to no or minimal care (such as TENS), spinal stabilization and/or motor control exercises provide some benefit. Although most trials report the aforementioned benefit, this clinically meaningful difference disappeared in the only trial with a low risk of bias (Hahne et al 2017).

Fig1 jesson radicular pain
From: Jesson et al (2020), Pain Reports

When stabilization and motor control exercises are compared to more substantial care (such as general exercises), there’s no evidence to suggest one is superior to the other.

Fig2 jesson radicular pain
From: Jesson et al (2020), Pain Reports

Interventions Directed at Neural Mechanosensitivity

“Physiotherapeutic techniques addressing neural mechanosensitivity include specific movements of peripheral nerves in relation to their surrounding tissues (neural sliders and tensioners) of interface techniques that are directed at the tissue surrounding the nerve.”

Fig3 jesson radicular pain
From: Jesson et al (2020), Pain Reports

Similar to stabilization and motor control exercises, these techniques provided additional benefit compared to no or minimal care. When compared to substantial treatment, results were mixed with a large range of plausible outcomes. This conclusion is in conjunction with a recent systematic review (Su and Lim 2016).

Fig4 jesson radicular pain
From: Jesson et al (2020), Pain Reports

Effects of Physiotherapy on Disability for Radicular Pain

Trends for the effectiveness of physiotherapy on pain and disability were similar although disability decreased to a lesser extent. When disability is improved, pain improves as well. When pain improved, disability wasn’t necessarily better.

References:

Jesson et al (2020): https://pubmed.ncbi.nlm.nih.gov/33490836/

Hahne et al (2017): https://pubmed.ncbi.nlm.nih.gov/27765714/

Su et al (2016): https://pubmed.ncbi.nlm.nih.gov/26710222/

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