Protocol for the treatment of Radiculopathy with the Stimpod NMS460
Radiculopathy, also commonly referred to as pinched nerve, refers to a set of conditions in which one or more nerves are affected and do not work properly (a neuropathy). This can result in pain (radicular pain), weakness, numbness, or difficulty controlling specific muscles.
In a radiculopathy, the problem occurs at or near the root of the nerve, shortly after its exit from the spinal cord. However, the pain or other symptoms often radiate to the part of the body served by that nerve. For example, a nerve root impingement in the neck can produce pain and weakness in the forearm. Likewise, an impingement in the lower back or lumbar-sacral spine can be manifested with symptoms in the foot.
Mid to lower cervical radiculopathy may involve cervical joints C5, C6 and C7. Radiculopathy from a slipped disc may cause nerve compression of the involved nerve roots as they exit the cervical foramina (facet joints).
The symptoms may involve radiating pain, paraesthesia such as pins and needles, tingling and or numbness in the dermatomal representation of the nerve root compression. Weakness may be consistent with the specific nerve root involved. Pain is usually referred into the arm but may also exist in the neck/cervical region itself with possible reduced mobility of extension, flexion, rotation and or lateral flexion when the particular nerve root is further compressed with movement.
Treatment Protocol with the Stimpod NMS460
Suggested protocol for the use of the Stimpod NMS460 for the relief of pain, paraesthesia and even weakness:
Area of Rx: Brachial plexus, bilaterally
Duration: 5mins each
Repetition: 3 Rx
The brachial plexus (BP) is accessed superior or inferior to the clavicle. The Stimpod NMS460 is applied as usual with the reflexive electrode placed on the opposite side of the body on a muscular region (e.g. middle trapezius) and the treatment probe is then applied to the specific brachial plexus region that is most appropriate for the patient. A conductive gel is applied to enable a comfortable penetration of the current from the treatment probe.
It may be possible to change the above symptoms and yet may not create and even prevent irritation. It may also demonstrate which level of the cervical spine is most affected. Very often the Stimpod NMS460 may become a diagnostic tool. The patient may indicate that the stimulation from the probe radiates into the affected region.
Area of Rx: C5/6; C6/7; C7/T1; as nerve root exits the foramen (uni/bilaterally)
Duration: 5 minutes at each level
Repetition: 3-6 Rx
Pain reduction is usually evident and the paraesthesia and or weakness may also change or disappear.
Area of Rx: In the arm and hand. Unilaterally.
Duration: 5 minutes at each affected region where the nerve demonstrates changes (pain, paraesthesia weakness, or reduced reflexes)
Repetition: 3-6 Rx
Select the area where the nerve is most exposed e.g. for C7/T1 at the lateral/ulna aspect of the wrist, in the lateral elbow where the nerve exits superior to the olecranon or use the appropriate acupuncture points.
Click on the images for larger versions
Representation of the anterolateral aspect of the neck, shoulder, and upper limb. The thick yellow line represents the sharp, radiating pain, which often has a dermatomal pattern. Yellow lines indicate sharp pain with a C8 radiculopathy, which is on the inner aspects of the arm and forearm.
The diffused yellow areas represent the poorly localised dull ache. A dull ache medial to the shoulder blade is a common complaint in all cervical radiculopathies and has no localizing value. The area covered by light yellow indicates the location of paraesthesia and sensory impairment.
Most patients respond within 3 treatments with relief of pain and other symptoms and 3 further treatments may be necessary to relieve all symptoms.
Commence with treatment of the brachial plexus and continue if relief is achieved. If there is no change or minimal changes after 2-3 treatments, then add treatment at the cervical facet joint as mentioned above. If treatment has improved the condition but there are still some areas of discomfort, then proceed to treat the arm and hand. The Stimpod NMS460 can also be applied to appropriate acupuncture points on the cervical spine, arm and or hand.
Treatment may be given once or twice weekly. If acute, the condition may be treated daily for 3 treatments. The treatment itself has llong-term effects and therefore if a patient is unable to attend more than once weekly positive effects will continue to be effective and resolve the condition.
About the author
Professor Phyllis Berger is Adjunct Professor at the School of Therapeutic Sciences, Faculty of Health Sciences at the Department of Physiotherapy at the University of the Witwatersrand. She holds a BSc Physiotherapy degree and is also the Chairperson of the Acupuncture Group South African Society of Physiotherapy.
Professor Berger has been using the Stimpod NMS460’s non-interventional pulsed radio frequency technology for the treatment of neuropathic pain and symptoms emanating from different aetiologies since 2009. Prof Berger has also used the Stimpod for neurogenic conditions caused by degeneration, inflammation or injury to nerve tissue.