Effects of Cyriax Manipulation in Cervical Discogenic Pain

Cervical disc displacement is a significant cause of neck and arm pain and disability in majority of individuals. It causes a great burden on physical, social and emotional quality of life of patients. The cervical disc herniation is characterized by prolapsed nucleus pulposus material through the annulus into the spinal canal. The local mechanical or chemical irritation of neural structures typically leads to symptoms of radiculopathy, head and neck pain or myelopathy. The disc bulge may be postero-central to compress the dura matter, causing multi segmental pain and affect the scapular area. It can also be postero-lateral causing the root signs, that have dermatomal behavior and affect the upper limb in specific pattern. Postero-central bulge can also shift to postero-lateral with symptoms shifting from centralization to radiculopathy.

The State of U.S. Health: Burden of Diseases, Injuries and Risk Factors describes cervical pain among 5 most contributing factor in causing years lived in disability. the ratio tremendously increases after 40 years. Studies describing impact of chronic neck pain on general health care reveals 14% of patients reports grade II to grade IV neck pain with high pain intensity and disability.

Disc displacement disorders are included among the mechanical causes of neck pain. Symptomatic disc displacements can occur at any age but have different clinical features depending on the age group. In young adults nucleus pulposus can involve which is rare in old age. Diagnoses can be established on clinical findings along with patient's history and the functional examination. Disc displacement can occur in postero-central and Postero- lateral displacement. Movement of the disc posteriorly causes stress on the posterior longitudinal ligament and also on the anterior part of the Dura mater. As a result of this the pain travels in more than one segment with dural reference. Pain occurs in trapezius and scapular area. This typical poster central displacement causes the pain symptoms centrally and bilaterally. Poster lateral movement of disc tissue inserts force on the nerve root, which causes a Segmental pain or root pain and Segmental paraesthesia. Disc displacement may be primary or secondary. Secondary poster lateral displacement is more common type of displacement. Patient previously having pain in different segments like neck, trapezius and scapular region now feels pain in the upper limb area. It occurs due to the lateral shifting of disc tissues.

The goal of treatment in discogenic problems is to stop the conflict between the displaced disc material and affecting sensitive structure. Disc fragment may affect the Dura matter, nerve roots and intervertebral joints. Manipulations and traction brings back the disc material to its place. The choice depends on the displacement. Nuclear displacements are treated by traction while annular ones are by manipulations. Injection usually is done to help pain less spontaneous recovery. If there is too much postero-central displacement that it compresses the spinal cord then surgery usually is done.

Physiotherapy Treatment protocol for cervical discogenic pain include muscle strengthening and to relieve stress on muscles. Cyriax manipulation is a systematic technique of manipulation for the disc prolapse. this study hypothesize that there is a difference between the effects of traditional physical therapy and cyriax manipulation for the discogenic problems. The objecvtive of this study is to find the effects of cyriax manipulation and to compare it with traditional physical therapy treatment in patients with cervical discogenic pain.