{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T16:54:57Z","timestamp":1789750497061,"version":"4.0.1"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2021,8,11]],"date-time":"2021-08-11T00:00:00Z","timestamp":1628640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>Cervical radiculopathy is a relatively common and disabling condition involving local pain in the neck region and pain that radiates into the upper limb. Recent data suggest that cervical traction may effectively reduce disability and pain, with a dose-response relationship. The main aim of this study was therefore to evaluate the mid-term effect of an intensive cervical traction protocol for patients with cervical radiculopathy on disability, and to compare the effects with those reported by non-intensive protocols in the literature.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>We conducted a prospective open observational study of 36 patients referred by their general practitioner for symptoms suggestive of cervical radiculopathy. All patients underwent the same treatment: a 30-minute cervical traction protocol, twice a day, for five consecutive days. The main objective was the evaluation of disability at 3 months. We evaluated at baseline (D1), the end of the protocol (D5) and at mid-term (M3) disability, cervical pain, radiating pain, pain on motor imagery, presence of neuropathic pain and medication consumption. The primary outcome was the proportion of patients for whom the Neck Disability Index improved by more than the minimum clinically important difference of 7 points by M3.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>Thirty-six patients were included in this study. The Neck Disability Index improved by more than the minimum clinically important difference in 48.3% at M3. Mean Neck Disability Index (p &lt; .001), mean cervical VAS (p &lt; .001), mean radiating VAS (p &lt; .001), and mean VAS for imagined lateral flexion and rotation (p &lt; .002) improved significantly from D1 to D5 and from D1 to M3. Consumption of medication reduced at each time point. The proportion of patients with neuropathic pain reduced from 61.1% at D1 to 33.3% at D5 and 48.3% at M3.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusion<\/jats:title><jats:p>Disability reduced by more than the minimum clinically important difference in almost half of the participants following the intensive traction protocol. These results are encouraging and suggest that this complex condition can be treated with relatively simple methods.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0255998","type":"journal-article","created":{"date-parts":[[2021,8,11]],"date-time":"2021-08-11T17:29:17Z","timestamp":1628702957000},"page":"e0255998","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["Effect of an intensive cervical traction protocol on mid-term disability and pain in patients with cervical radiculopathy: An exploratory, prospective, observational pilot study"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2205-132X","authenticated-orcid":true,"given":"Thomas","family":"Rulleau","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Abeille","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lydie","family":"Pastor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucie","family":"Planche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascale","family":"Allary","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Chapeleau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chlo\u00e9","family":"Moreau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gr\u00e9goire","family":"Cormier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Caulier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,8,11]]},"reference":[{"key":"pone.0255998.ref001","doi-asserted-by":"crossref","first-page":"E251","DOI":"10.1097\/BSD.0000000000000284","article-title":"Cervical radiculopathy: epidemiology, etiology, diagnosis, and treatment","volume":"28","author":"BI Woods","year":"2015","journal-title":"J Spinal Disord Tech"},{"key":"pone.0255998.ref002","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1097\/00007632-200002010-00005","article-title":"The anatomic relation among the nerve roots, intervertebral foramina, and intervertebral discs of the cervical spine","volume":"25","author":"N Tanaka","year":"2000","journal-title":"Spine"},{"key":"pone.0255998.ref003","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1093\/physth\/pzy001","article-title":"Cervical radiculopathy: effectiveness of adding traction to physical therapy-a systematic review and meta-analysis of randomized controlled trials","volume":"98","author":"A Romeo","year":"2018","journal-title":"Phys Ther"},{"key":"pone.0255998.ref004","first-page":"325","article-title":"Epidemiology of cervical radiculopathyA population-based study from Rochester, Minnesota, 1976 through 1990","volume":"117","author":"K Radhakrishnan","year":"1994","journal-title":"Brain"},{"key":"pone.0255998.ref005","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1111\/j.1600-0404.1996.tb00196.x","article-title":"Prevalence of cervical spondylotic radiculopathy: a door-to-door survey in a Sicilian municipality","volume":"93","author":"G Salemi","year":"1996","journal-title":"Acta Neurol Scand"},{"key":"pone.0255998.ref006","doi-asserted-by":"crossref","first-page":"1781","DOI":"10.1016\/j.spinee.2014.02.032","article-title":"The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review of the literature","volume":"14","author":"JJ Wong","year":"2014","journal-title":"Spine J Off J North Am Spine Soc"},{"key":"pone.0255998.ref007","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1097\/BRS.0000000000002983","article-title":"What Are the Costs of Cervical Radiculopathy Prior to Surgical Treatment?","volume":"44","author":"C Barton","year":"2019","journal-title":"Spine"},{"key":"pone.0255998.ref008","doi-asserted-by":"crossref","first-page":"2030","DOI":"10.1097\/01.BRS.0000083325.27357.39","article-title":"Impact of neck and arm pain on overall health status","volume":"28","author":"SD Daffner","year":"2003","journal-title":"Spine"},{"key":"pone.0255998.ref009","first-page":"CD001466","article-title":"Surgery for cervical radiculopathy or myelopathy","author":"I Nikolaidis","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"pone.0255998.ref010","first-page":"746","article-title":"Nonoperative Management of Cervical Radiculopathy","volume":"93","author":"MA Childress","year":"2016","journal-title":"Am Fam Physician"},{"key":"pone.0255998.ref011","doi-asserted-by":"crossref","first-page":"1658","DOI":"10.1097\/BRS.0b013e3181a9c304","article-title":"The Influence of Cervical Traction, Compression, and Spurling Test on Cervical Intervertebral Foramen Size","volume":"34","author":"H Takasaki","year":"2009","journal-title":"Spine"},{"key":"pone.0255998.ref012","first-page":"1237","article-title":"Comparison between Manual Traction, Manual Opening technique and Combination in Patients with cervical radiculopathy: Randomized Control Trial","volume":"69","author":"R Afzal","year":"2019","journal-title":"JPMA J Pak Med Assoc"},{"key":"pone.0255998.ref013","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1080\/09593980802511896","article-title":"Comparison of cervical vertebral separation in the supine and seated positions using home traction units","volume":"24","author":"DCW Fater","year":"2008","journal-title":"Physiother Theory Pract"},{"key":"pone.0255998.ref014","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1016\/j.rhum.2008.07.002","article-title":"R\u00e9\u00e9ducation dans les cervicalgies communes: ce que je fais, ce que je discute et pourquoi ? Fondement sur les preuves et strat\u00e9gies du clinicien","volume":"75","author":"M Jousse","year":"2008","journal-title":"Rev Rhum"},{"key":"pone.0255998.ref015","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1097\/00007632-199202000-00003","article-title":"The traction angle and cervical intervertebral separation","volume":"17","author":"AM Wong","year":"1992","journal-title":"Spine"},{"key":"pone.0255998.ref016","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/0304-3959(76)90113-5","article-title":"Graphic representation of pain","volume":"2","author":"J Scott","year":"1976","journal-title":"Pain"},{"key":"pone.0255998.ref017","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1016\/j.rhum.2004.05.009","article-title":"Traitements physiques et cervicalgies communes","volume":"71","author":"V Tiffreau","year":"2004","journal-title":"Rev Rhum"},{"key":"pone.0255998.ref018","unstructured":"Rulleau, Rivette C, Toussaint L. Le massage, approche bas\u00e9e sur les preuves. Encycl M\u00e9d-Chir Kin\u00e9sith\u00e9rapie M\u00e9decine Phys. 2017."},{"key":"pone.0255998.ref019","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1097\/01.brs.0000201241.90914.22","article-title":"The reliability and construct validity of the Neck Disability Index and patient specific functional scale in patients with cervical radiculopathy","volume":"31","author":"JA Cleland","year":"2006","journal-title":"Spine"},{"key":"pone.0255998.ref020","doi-asserted-by":"crossref","first-page":"400","DOI":"10.2519\/jospt.2009.2930","article-title":"Measurement properties of the neck disability index: a systematic review","volume":"39","author":"JC MacDermid","year":"2009","journal-title":"J Orthop Sports Phys Ther"},{"key":"pone.0255998.ref021","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1016\/j.jmpt.2008.08.006","article-title":"The Neck Disability Index: state-of-the-art, 1991\u20132008","volume":"31","author":"H Vernon","year":"2008","journal-title":"J Manipulative Physiol Ther"},{"issue":"Suppl 11","key":"pone.0255998.ref022","doi-asserted-by":"crossref","first-page":"S240","DOI":"10.1002\/acr.20543","article-title":"Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP)","volume":"63","author":"GA Hawker","year":"2011","journal-title":"Arthritis Care Res"},{"key":"pone.0255998.ref023","doi-asserted-by":"crossref","first-page":"1644","DOI":"10.1212\/01.WNL.0000123019.13575.5E","article-title":"Imagined movements cause pain and swelling in a patient with complex regional pain syndrome","volume":"62","author":"Moseley","year":"2004","journal-title":"Neurology"},{"key":"pone.0255998.ref024","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1002\/art.23580","article-title":"Thinking about movement hurts: The effect of motor imagery on pain and swelling in people with chronic arm pain","volume":"59","author":"GL Moseley","year":"2008","journal-title":"Arthritis Care Res"},{"key":"pone.0255998.ref025","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.pain.2004.12.010","article-title":"Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4)","volume":"114","author":"D Bouhassira","year":"2005","journal-title":"Pain"},{"key":"pone.0255998.ref026","doi-asserted-by":"crossref","unstructured":"Cleland. Examen clinique de l\u2019appareil locomoteur: Tests, \u00e9valuations et niveaux de preuve. 1e \u00e9dition. Elsevier Masson; 2007.","DOI":"10.1016\/B978-2-294-06818-8.50001-2"},{"key":"pone.0255998.ref027","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1097\/00007632-200301010-00014","article-title":"Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy","volume":"28","author":"RS Wainner","year":"2003","journal-title":"Spine"},{"key":"pone.0255998.ref028","doi-asserted-by":"crossref","first-page":"45","DOI":"10.2519\/jospt.2014.5065","article-title":"Exercise only, exercise with mechanical traction, or exercise with over-door traction for patients with cervical radiculopathy, with or without consideration of status on a previously described subgrouping rule: a randomized clinical trial","volume":"44","author":"JM Fritz","year":"2014","journal-title":"J Orthop Sports Phys Ther"},{"key":"pone.0255998.ref029","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1016\/j.rehab.2009.07.035","article-title":"The value of intermittent cervical traction in recent cervical radiculopathy","volume":"52","author":"A Jellad","year":"2009","journal-title":"Ann Phys Rehabil Med"},{"key":"pone.0255998.ref030","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.jcm.2014.07.003","article-title":"Multimodal Treatment Program Comparing 2 Different Traction Approaches for Patients With Discogenic Cervical Radiculopathy: A Randomized Controlled Trial","volume":"13","author":"IM Moustafa","year":"2014","journal-title":"J Chiropr Med"},{"key":"pone.0255998.ref031","doi-asserted-by":"crossref","first-page":"632","DOI":"10.2522\/ptj.20080283","article-title":"Manual therapy, exercise, and traction for patients with cervical radiculopathy: a randomized clinical trial","volume":"89","author":"IA Young","year":"2009","journal-title":"Phys Ther"},{"key":"pone.0255998.ref032","doi-asserted-by":"crossref","first-page":"227","DOI":"10.3171\/2017.5.SPINE1732","article-title":"Validation of the Visual Analogue Scale in the Cervical Spine","volume":"28","author":"A MacDowall","year":"2018","journal-title":"J Eurosurgery Spine"},{"key":"pone.0255998.ref033","article-title":"Cervical Intermittent Traction: Does it Really Work in Cervical Radiculopathy Due to Herniated Disc?","author":"Yazicioglu Aydin","year":"2012","journal-title":"Turk Fiz Tip Ve Rehabil Derg"},{"key":"pone.0255998.ref034","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/j.ejpain.2004.11.001","article-title":"Human brain mechanisms of pain perception and regulation in health and disease","volume":"9","author":"AV Apkarian","year":"2005","journal-title":"Eur J Pain Lond Engl"},{"key":"pone.0255998.ref035","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.pain.2005.05.034","article-title":"Functional connectivity and pain: how effectively connected is your brain","volume":"116","author":"I Tracey","year":"2005","journal-title":"Pain"},{"key":"pone.0255998.ref036","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.math.2011.10.002","article-title":"Self-reported pain severity, quality of life, disability, anxiety and depression in patients classified with \u201cnociceptive\u201d, \u201cperipheral neuropathic\u201d and \u201ccentral sensitisation\u201d pain. The discriminant validity of mechanisms-based classifications of low back (\u00b1leg) pain","volume":"17","author":"KM Smart","year":"2012","journal-title":"Man Ther"},{"key":"pone.0255998.ref037","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/S0004-9514(05)70053-2","article-title":"Widespread brain activity during an abdominal task markedly reduced after pain physiology education: fMRI evaluation of a single patient with chronic low back pain","volume":"51","author":"GL Moseley","year":"2005","journal-title":"Aust J Physiother"},{"key":"pone.0255998.ref038","doi-asserted-by":"crossref","first-page":"7540","DOI":"10.1523\/JNEUROSCI.5280-10.2011","article-title":"Effective treatment of chronic low back pain in humans reverses abnormal brain anatomy and function","volume":"31","author":"DA Seminowicz","year":"2011","journal-title":"J Neurosci Off J Soc Neurosci"},{"key":"pone.0255998.ref039","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1016\/j.jclinepi.2015.03.010","article-title":"Neuropathic pain screening questionnaires have limited measurement properties. A systematic review","volume":"68","author":"S Mathieson","year":"2015","journal-title":"J Clin Epidemiol"},{"key":"pone.0255998.ref040","first-page":"33","article-title":"The neuropathic pain: An overview of the current treatment and future therapeutic approaches","author":"E Cavalli","year":"2019","journal-title":"Int J Immunopathol Pharmacol"},{"key":"pone.0255998.ref041","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1197\/j.jht.2005.02.010","article-title":"Upper limb neural tension testing and mobilization. Fact, fiction, and a practical approach","volume":"18","author":"MT Walsh","year":"2005","journal-title":"J Hand Ther Off J Am Soc Hand Ther"},{"key":"pone.0255998.ref042","unstructured":"Zimmerman B, Hubbard JB. Deep Tendon Reflexes. StatPearls. Treasure Island (FL): StatPearls Publishing; 2020. Available: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK531502\/"},{"key":"pone.0255998.ref043","doi-asserted-by":"crossref","first-page":"455","DOI":"10.2217\/pmt.15.39","article-title":"What effect can manual therapy have on a patient\u2019s pain experience?","volume":"5","author":"MD Bishop","year":"2015","journal-title":"Pain Manag"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0255998","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,7]],"date-time":"2023-01-07T04:37:15Z","timestamp":1673066235000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0255998"}},"subtitle":[],"editor":[{"given":"Panagiotis","family":"Kerezoudis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,8,11]]},"references-count":43,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0255998","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,11]]}}}