Effectiveness of manipulative physiotherapy for the treatment of cervicobrachial pain syndrome: a single case study

Cowell, I.M., Phillips, D.R. and Hurley, M.V. (2002) Effectiveness of manipulative physiotherapy for the treatment of cervicobrachial pain syndrome: a single case study. [in special issue: British Society for Rheumatology XIX Annual General Meeting 23-26 April 2002, Brighton UK] Rheumatology, 41, supplement 2, 82. (doi:10.1093/rheumatology/41.suppl_2.80).

Abstract

Background: Chronic shoulder and neck pain is a very common and costly condition, for which manipulative physiotherapy is frequently recommended, although evidence to support its use is limited. This study examined the effectiveness of a scheme of manipulative physiotherapy examination and treatment in the management of a subject with neurogenic cervicobrachial pain.

Methods: A single case study ABC design was used to evaluate the effectiveness of manipulative physiotherapy. The patient was a 44-year old woman with an eight-month history of left-sided neurogenic cervicobrachial pain. Clinical examination demonstrated signs of upper quadrant neural tissue mechanosensitivity suggesting that neural tissue was the origin of the subject's complaint of pain. Corroborative magnetic resonance imaging verified that the cause for the patient's radicular signs and symptoms was discal pathology at the C5/6 intersegmental level. The study involved three phases Phase A was a four-week pre-assessment phase; Phase B was a four-week treatment phase; Phase C was a two-week home exercise phase. Before phase A and at the end of each phase the patient's function (Northwick Park Neck Pain Questionnaire), pain (Short Form McGill Pain Questionnaire or SF-MPQ) and cervical and left shoulder abduction range of motion were measured. Manipulative physiotherapy treatment consisted of a lateral glide mobilisation technique of C5 on C6 towards the right side, performed by a physiotherapist with a postgraduate qualification in manipulative physiotherapy. Treatment was 3 sessions per week for 2 weeks and 2 sessions per week for 2 weeks. The two-week home exercise phase consisted of the patient performing an active cervical right side flexion movement.

Results: From the end of Phase A to the 1 month follow-up there was a 42% improvement in functional disability; there was a 70% reduction in pain level recorded in the VAS aspect of the SF-MPQ; shoulder abduction increased from 280 to 1400 and cervical right side flexion increased from 180 to 520. Because of the controversy regarding performing statistical tests on single case studies, and because there was obvious clinical improvement, no statistical tests were performed on the results.

Conclusion: This treatment protocol produced beneficial effects on functional disability, pain and cervical and shoulder mobility in a patient with chronic cervicobrachial pain. These improvements were maintained until a one-month follow-up. The single case design of the study limits generalisation of the findings, but the results give further impetus for a clinical trial.

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