Effect of Cervical Traction and Exercise Therapy in the Management of Cervical Radiculopathy: A Case Study

Abstract

Background: Cervical radiculopathy is a clinical condition in which irritation or compression of a cervical nerve root produces neck pain with radiating arm pain, paraesthesia, sensory alteration, reflex change, or weakness in a myotomal pattern. It commonly arises from intervertebral disc protrusion, foraminal narrowing, spondylotic degeneration, or combined mechanical and inflammatory factors. Conservative physiotherapy is widely used when there is no progressive neurological deficit or red-flag pathology. Cervical traction is intended to reduce foraminal compression and nerve-root irritation, while exercise therapy aims to restore mobility, improve deep cervical and scapular muscle control, correct posture, and promote self-management. Clinical guidelines support a multimodal approach in chronic neck pain with radiating pain, including intermittent mechanical traction combined with stretching, strengthening, and mobilization-based exercise when clinically indicated.⁴

Presentation of Case: This case study describes a 38-year-old male office worker who presented with right-sided neck pain radiating to the lateral forearm and thumb for six weeks. Symptoms increased during prolonged computer work, mobile phone use, overhead activity, and sustained neck extension. The patient reported disturbed sleep, reduced work tolerance, difficulty driving for long periods, and fear of arm weakness. Examination suggested C6 nerve root involvement with restricted cervical range of motion, positive Spurling test, positive upper limb tension test, relief with cervical distraction, reduced biceps reflex, and mild weakness of wrist extensors. Magnetic resonance imaging showed posterolateral disc protrusion at C5-C6 with right foraminal narrowing. The patient was medically stable and suitable for conservative physiotherapy.

Intervention: The patient received a six-week physiotherapy programme consisting of intermittent mechanical cervical traction and progressive exercise therapy. Traction was administered in supine with cervical flexion of approximately 15 to 20 degrees, beginning with low to moderate pull and progressing according to symptom response. Exercise therapy included pain-free cervical mobility, chin tuck and deep cervical flexor activation, scapular setting, pectoral and upper trapezius stretching, thoracic extension mobility, median nerve sliding, isometric strengthening, resisted scapulothoracic training, postural correction, ergonomic education, and a structured home exercise schedule.

Outcome Measures: Outcome assessment included Numeric Pain Rating Scale, Neck Disability Index, cervical range of motion by goniometric estimation, upper limb tension test response, Spurling and distraction test response, grip strength, sleep disturbance, work tolerance, and Patient-Specific Functional Scale. The same measures were recorded at baseline, week three, and week six.

Results: The patient completed the treatment programme without adverse response. Neck pain reduced from 7/10 to 2/10, arm pain reduced from 8/10 to 1/10, and Neck Disability Index improved from 42% to 14%. Cervical rotation, lateral flexion, and extension improved, paraesthesia became occasional and mild, upper limb tension test irritability reduced, and functional tolerance for computer work, driving, and sleep improved. Grip strength and confidence in arm use also improved.

Conclusion: Cervical traction combined with exercise therapy produced clinically meaningful improvement in pain, disability, neural irritability, posture, and functional tolerance in this patient with cervical radiculopathy. The case supports individualized multimodal physiotherapy when red flags and progressive neurological deficit are absent.