Ross A. Hauser, MD.
Recent research supports the use of exercise combined with manual therapy as one of the primary conservative treatments for cervical radiculopathy, although the optimal combination of techniques is still being studied. Some of the stronger evidence includes:
- An October 2025 systematic review and meta-analysis (101 randomized controlled trials): Multimodal treatment (manual therapy plus exercise) was the most effective approach for reducing neck pain and disability. Mobilization appeared more effective than manipulation alone for improving cervical motion. (1)
- An April 2025 systematic review of manual therapy in the Journal of pain research (2) : Manual therapy significantly improved neck pain and disability in patients with cervical radiculopathy. The review found no strong evidence that adding cervical traction consistently improved outcomes over manual therapy alone.
- A June 2024 systematic review in the journal Healthcare (3) found adding neural mobilization (nerve gliding exercises) to routine physical therapy improved cervical mobility, although pain relief was similar to routine physical therapy alone.
- An October 2025 study (4) on rehabilitation found individualized exercise programs combined with manual therapy to improve cervical mobility, reduce neuropathic pain, and improve function. The authors also note that more high-quality studies are needed to determine the best treatment protocols.
- A September 2017 study in the Journal of Back and Musculoskeletal Rehabilitation (5) found a favorable patient response after a 3-month program in pain and neck disability, better postural scores, handgrip, and SF-36 scores (A scoring system that measures pain, social interaction, and general health among other questions), improved. The researchers were able to conclude that stabilization exercise training could be an effective intervention for decreasing pain and improving quality of life and posture in patients with cervical radiculopathy.
Thrust manipulation for cervical radiculopathy
A case report of a 35-year-old man with cervical radiculopathy was presented in the September 2022 issue of the journal Physiotherapy Theory and Practice (6). In the introduction to this case, the presenters write: “the conservative management of cervical radiculopathy is supported by moderate evidence to include interventions such as manual therapy, traction, and therapeutic exercise. There is sparse evidence, however, to support specific manual therapy techniques, particularly thrust (high velocity) manipulation.”
The case of a 35-year-old male is given. The patient was suggested for physical therapy with a clinical diagnosis of cervical radiculopathy. He complained of neck and upper arm pain with 1st and 2nd digit paresthesias (numbness). “He was initially managed with repeated movements that restored the cervical range of motion and centralized neck and upper arm pain. Non-thrust upslope joint mobilizations resulted in improved sensation detection in the hand, but the paresthesias did not completely resolve. Immediately following cervical spine upslope thrust manipulation, symptoms fully resolved.” The attending specialists, in this case, concluded: “This case demonstrates the safe and effective utilization of cervical spine thrust manipulation and non-thrust mobilization in the management of a patient with cervical radiculopathy with lingering paresthesias in the distal upper extremity.”
A May 2019 paper published in The Journal of Orthopaedic and Sports Physical Therapy (7) wrote: “Thoracic spine thrust manipulation has been shown to improve patient-rated outcomes for individuals with neck pain. However, there is limited evidence of its effectiveness in patients with cervical radiculopathy. . . In this multicenter randomized controlled trial, participants with cervical radiculopathy were randomized to receive either manipulation (22 patients) or sham manipulation (21 patients) of the thoracic spine. Outcomes were measured at baseline, immediately after treatment, and at a follow-up 48 to 72 hours after manipulation.”
- Findings: One session of thoracic manipulation resulted in improvements in pain, disability, cervical ROM, and deep neck flexor endurance in patients with cervical radiculopathy. Patients treated with manipulation were more likely to report at least moderate change in their neck and upper extremity symptoms up to 48 to 72 hours following treatment.
Neck-specific exercises and prescribed physical therapy
A January 2023 study lead by Linköping University Hospital researchers in Sweden studied the effect of neck-specific exercises and prescribed physical therapy on headache and dizziness in individuals with cervical radiculopathy. The study appeared in the journal Physiotherapy theory and practice.(8)
The researchers found both activities were beneficial, one not more so than the other. Follow up was done at three months, six months, and twelve months. In the headache subgroup, significant within-group improvements were seen at all follow-ups for neck-specific exercises from baseline to 3 and at 12 months for physical therapy.
For dizziness, significant within-group improvements were seen from baseline to 3 months for neck-specific exercises and from baseline to 3 and 12 months for physical therapy. “Based on the participant’s symptoms, vestibular rehabilitation was included in the neck-specific exercise, aiming to reduce dizziness and improve balance. Vestibular rehabilitation consisted of voluntary eye movements and fixation, and neck and body movements when lying down, sitting, standing, and walking.” Physical therapy consisted of aerobic and/or muscular physical activity or training, and the general prescription consisted of at least 30 minutes of physical activity at moderate intensity three times per week.
Exercise will not work for everyone
November 2019: researchers writing in the journal Medicine (9) wrote that some studies have shown that exercise or exercise combined with other treatments can effectively decrease pain and improve functional status in patients with cervical radiculopathy. What they found was exercise alone or exercise plus other treatments (in this research medications) may be helpful to patients with cervical radiculopathy. However, the exercise option should be carefully considered for each patient with cervical radiculopathy in accordance with their different situations.
In other words, exercise will not work for everyone. We have found that the main reason is that for exercise to work, muscles need resistance. If the tendon attachments of the neck muscles and the cervical spinal ligaments are weakened or injured, they will not supply the resistance necessary to make exercise or physical therapy work.
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References
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