Effectiveness of simultaneous application of cervical traction and neural mobilization on pain and disability in patients with cervical radiculopathy: A systematic review and meta-analysis.

Abstract

ObjectiveThe primary objective of this systematic review was to evaluate the effectiveness of the simultaneous combination of neural mobilization and traction therapy (SNMCT) in reducing pain and disability for patients with cervical radiculopathy.MethodsWe conducted a systematic review with meta-analysis using the randomized controlled trials (RCTs) articles published in PubMed, Cochrane Library, CINAHL Complete, EMBASE, CNKI from 01 January 2013 to 05 March 2025. Randomized controlled trials (RCTs) comparing SNMCT with on intervention and other interventions were included. Risk of bias was evaluated using the RoB 2 and the quality of evidence was systematically appraised by the GRADE approach.ResultsThis study included seven RCTs (n = 288). For the primary outcomes of pain and disability, there is moderate-quality of evidence that SNMCT provides statistically significant difference on pain relief (MD: -3.29, 95% CI: -4.08 to -2.49, p < 0.05) and disability (MD: -15.90, 95% CI: -21.34 to -10.45, p < 0.05) than waitlist group. SNMCT provides statistically significant difference than other interventions on pain relief (MD: -0.92, 95% CI: -1.13 to -0.71, p < 0.05) and disability (MD: -3.60, 95% CI: -4.65 to -2.54, p < 0.05) with low-quality of evidence. For the secondary outcomes (hand grip strength and cervical range of motion), SNMCT significantly improved range of motion compared to waitlist controls for both flexion (MD = -5.81, 95% CI: -9.45 to -2.17, p < 0.01) and extension (MD: -7.22, 95%CI: -13.63 to -0.80, p = 0.03), but no difference statistically significant on hand grip strength (MD: 0.39, 95% CI: -3.61 to 4.40, p = 0.85). Based on very low-quality evidence, SNMCT appears to enhance cervical flexion (MD: -4.18, 95%CI: -6.59 to -1.77, p < 0.01; I²=0%) and extension (MD: -4.96, 95%CI: -7.59 to -2.33, p < 0.01; I²=0%), while demonstrating no significant effect on hand grip strength improvement. There were no statistically significant differences were observed between the SNMCT and CNMCT groups regarding pain relief and disability improvement (MD: -0.90, 95%CI: -1.92 to 0.12, p = 0.09; MD: -8.70, 95%CI: -17.62 to -0.22, p = 0.06; respectively) after the treatment. However, the SNMCT group showed significantly better outcomes in cervical range of motion, particularly in flexion (MD: -17.20, 95%CI -24.88 to -9.52, p < 0.01) and extension (MD: -10.60, 95%CI -14.50 to -6.70, p < 0.01). Furthermore, cervical segment traction combined with nerve mobilization is superior to cervical total traction in reducing pain intensity, disability, and cervical range of motion (MD: -1.80, 95% CI: -2.76 to -0.84; MD: -6.07, 95% CI: -9.57 to -2.57; SMD: 3.85, 95% CI: 3.02 to 4.67; respectively).ConclusionThe current findings of this systematic review suggest that SNMCT may be considered an effective intervention for cervical radiculopathy.