LONG-TERM EFFECT OF STRENGTHENING EXERCISE VERSUS STRETCHING EXERCISE COMBINED WITH SHOCK WAVE THERAPY ON PAIN AND DISABILITY IN PATIENTS WITH CERVICAL RADICULOPATHY: A 12-MONTH FOLLOW-UP RANDOMIZED CONTROLLED TRIAL

Abstract

Background: Cervical radiculopathy (CR) is diagnostically distinct from non-specific mechanical neck pain, has
a dual mechanical-chemical physiopathology, and a natural history that is longer and more prone to recurrence
than commonly assumed. No previous trial had directly compared strengthening versus stretching exercise with a
constant background of extracorporeal shock wave therapy (ESWT) in a diagnostically confirmed population of
radicular patients over a clinically relevant time period.
Objective: To compare the long-term effect of strengthening exercise compared to stretching exercise and both in
combination with ESWT for reducing pain intensity and disability in patients with cervical radiculopathy over 12
months.
Methods: A Prospective, randomized, parallel group, assessor-blinded, two arm RCT was conducted in the
Department of Physiotherapy with the Department of Orthopaedics teaching hospital at Malwanchal University,
Indore. Two hundred patients aged 25–55 years with physician-diagnosed cervical radiculopathy were randomly
assigned to Group A (strengthening + ESWT, n=100) and Group B (stretching + ESWT, n=100) with equal
ESWT protocol and exercise dosage for 8 weeks supervised phase.
Outcome measures: Numeric Pain Rating Scale (NPRS) and Neck Disability Index (NDI) recorded at baseline,
at end of intervention and at 3, 6, and 12 months.
Results: There were no significant differences between the groups at baseline. Mean NPRS at 12 months was 1.39
± 0.6 in Group A versus 5.1 ± 0.79 in Group B (p<0.001). Mean NDI at 12 months was 12.13 ± 3.7% versus 42.97
± 5.2% (p<0.001). Group A continued to improve over time, while Group B improved during active treatment, but
regressed to near-baseline values over time.
Conclusion: Strengthening exercise combined with ESWT produces significantly better and more durable pain
and disability outcomes than stretching exercise combined with ESWT over 12 months in cervical radiculopathy.