Classification by pain pattern for patients with cervical spine radiculopathy

ABSTRACT

Objectives

A prospective observational cohort study was conducted to (1) report the prevalence of Mechanical Diagnosis and Therapy (MDT) classifications, Centralization (CEN), and Non-CEN among patients with Cervical Spine Radiculopathy (CSR), and (2) describe the association between classification via CEN and Non-CEN and clinical outcomes at follow-up.

Methods

Data were collected from 680 consecutive patients who presented to outpatient, orthopedic physical therapy clinics with primary complaints of neck pain with and without radiculopathy; thirty-nine patients (6%) met the physical examination inclusion criteria for CSR. First examination and follow-up data were completed by 19 patients.

Results

Seventy-nine percent of patients’ conditions were classified as Reducible Derangement at first examination and 21% were classified as either Irreducible Derangement, Entrapment, or Mechanically Inconclusive. The prevalence of CEN and Non-CEN was 36.8% and 47.4%, respectively. All patients treated via MDT methods made clinically significant improvements in disability, but not pain intensity, at follow-up. The magnitude of change in clinical outcomes was greatest for patients who exhibited CEN; however, the changes in disability and pain intensity at follow-up were not statistically significant compared to patients who exhibited Non-CEN at first examination. Patients who exhibited CEN were discharged, on average, ten days earlier and had one less treatment visit compared to patients who exhibited Non-CEN.

Discussion

The findings of this study show that patients with CSR can be classified and treated via MDT methods and experienced clinically significant improvements in disability, but not pain intensity, at follow-up. Providers should consider MDT classification and treatment to improve clinical outcomes for their patients affected by CSR.

KEYWORDS:

• Cervical spine
• cervical radiculopathy
• neck pain
• directional preference
• centralization
• McKenzie
• orthopedic
• musculoskeletal

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Richard Yarznbowicz

Richard Yarznbowicz obtained his doctor of physical therapy from the University of the Sciences in Philadelphia in 2010 before earning his diploma in Mechanical Diagnosis and Therapy in 2013. He is also a board certified Orthopedic Clinical Specialist. He has authored and co-authored several publications regarding the assessment and treatment of patients with musculoskeletal disorders.

Matt Wlodarski

Matt Wlodarski obtained his doctor of physical therapy from Northwestern University and a certification in Mechanical Diagnosis and Therapy in 2013. He enjoys treating patients in an outpatient setting and also programs healthcare technologies and data collection instruments to improve patient care. He has co-authored publications regarding Mechanical Diagnosis and Therapy on patients affected by spinal disorders.

Jonathan Dolutan

Jonathan Dolutan obtained his Master of Science in Rehabilitation Science-Physical Therapy in 2004 and his Doctorate in 2008 from the Medical University of South Carolina.  He was awarded his Diploma in Mechanical Diagnosis and Therapy in 2011.  Jonathan has special interest in research data collection related to physical therapy intervention and injury prevention.