Cervical RadiculopathyNCT07375823
Effects of Exercises and Electrical Current Application Aiming to Strengthen Neck and Shoulder Blades Muscles on Symptoms of a Pinched Nerve in the Neck
A study testing Exercise Therapy and Superimposition of electrical muscle stimulation on active movement in people with Cervical Radiculopathy and Cervical Radicular Pain, run by European University of Lefke at 1 site in Cyprus.
Trial summary
Cervical Radiculopathy (CR) is an objective loss of sensory and/or motor function as a result of compression or irritation of the cervical spinal nerve root. The individuals with CR present with findings indicating an altered neural control of the neck musculature, leaving the cervical spine vulnerable to reactive… Read more about this study
- Who is it for?
- Ages 18 to 29 years
- Conditions the study is for
- Cervical Radiculopathy, Cervical Radicular Pain, Neck Pain
- What is being tested?
- Exercise Therapy and Superimposition of electrical muscle stimulation on active movement
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 50 participants
- Where
- 1 siteCyprus
- Study dates
- 1 Dec 2025to 23 Mar 2026
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 29 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Student must be enrolled in the last 2 years of Bachelor degree or in Master's degree in one of the healthcare - related programs at the European University of Lefke;
- Age 18 - 29 years old;
- Neck pain of minimum 4 or more on numerical rating scale (0 - 10);
- Duration of symptoms 3 < months < 6, i.e. subacute symptoms with chronic/stable presentation;
- Has 1 or more of the following symptoms: paresthesia of 1 or both upper extremities at the level below elbow; pain radiating from neck to shoulder/arm/below elbow; feeling of weakness in 1 or both of the upper extremities, stiffness and/or tenderness and/or hyperalgesia in the cervical and/or upper thoracic area;
- Obtained "Cervical Radiculopathy" diagnosis from a physician, according to neurological examination findings: Positive cervical radiculopathy specific provocative tests (Spurling's Maneuver, Upper Limb Tension Test; Reduced Deep Tendon Reflexes of brachioradialis, biceps and triceps.
Who cannot join
- Any recent head/neck or shoulder trauma in the last 3 months;
- Received physiotherapy for neck - related complaints in the last 3 months;
- Received or currently receiving any kind of pharmacological intervention (muscle relaxants, NSAIDs, corticosteroids injections) in the last 3 months;
- Presents with symptoms favoring shoulder pathology: pain localized at the shoulder that worsens at night, positive Drop Arm Test, pain referral patterns are localized in the upper arm above elbow;
- Any recent surgeries to the neck, upper extremities within the last 6 months;
- Any diagnosed neurologic or musculoskeletal conditions that could mimic cervical radiculopathy, i.e. peripheral neuropathies of different origin, thoracic outlet syndrome medial/lateral epicondylitis, myofascial pain syndrome, etc.;
Show all 11Show fewer
- Any cardiovascular (recent DVT, congestive heart failure), metabolic (diabetic polyneuropathy), neurologic (impaired consciousness, epilepsy), malignant conditions in which application of electrotherapy or exercises imposes risk on the patient;
- Presence of pregnancy;
- Active implants, e.g. cardiac pacemaker;
- Any skin lesions in the cervical and/or scapular region, i.e. infections, open - wounds;
- Refuses to participate in the study.
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Effects of Electrical Muscle Stimulation Applied Concurrently With Active Movement and Exercise Therapy in Cervical Radiculopathy: A Randomized Trial
Cervical Radiculopathy (CR) is an objective loss of sensory and/or motor function as a result of compression or irritation of the cervical spinal nerve root.
The individuals with CR present with findings indicating an altered neural control of the neck musculature, leaving the cervical spine vulnerable to reactive forces.
Read more
Thus, physical therapy options should mainly focus on improving muscle function of the neck.
Given the promising results of electrical muscle stimulation and exercise therapy in recent literature the proposed study is aimed to investigate the effects of exercise therapy with electrical muscle on cervical muscle function and see, if muscle control has any impact on CR findings.
A superiority, randomized trial, with 2 intervention groups and allocation ratio of 1:1. 50 students, at the age from 18 to 29, from healthcare - related departments of European University of Lefke, who are diagnosed with CR will be recruited in the study.
To assess neck muscle function - Deep Neck Flexors Endurance time (s) and Cervical Progressive Iso - inertial Lifting scores (kg) will be used. Pain (Numeric Rating Scale 0 -10) and Muscle strength (grades 0 -5) will be used to measure the impact on CR findings.
All of the therapeutic exercises prescription parameters for warm-up (deep cervical flexors training), strengthening (cervical and scapulo-thoracic resistance training) and cool - down (flexibility training), will be the same for both groups: 60 minutes per session, 2 days in a week, for 6 weeks. In total each participant will recieve 12 sessions.
For the intervention details, while 'Intervention Group 1' will recieve only active exercises under supervision of the physiotherapist, in 'Intervention Group 2' as a part of the strengthening protocol, EMS will be applied over scapular region, bilaterally.
Read the detailed description
Cervical Radiculopathy (CR) is an objective loss of sensory and/or motor function as a result of conduction block in axons of a spinal nerve or its roots due to compression or irritation of the cervical spinal nerve root . Etiology is attributed to cervical foraminal compression in 70-75 % of cases due to anterior and posterior degenerative changes of the zygapophyseal joints, cervical spondylosis and reduction in disc height. The most common clinical manifestations of CR include sensory impairments (e.g. paresthesia), motor abnormalities (e.g. muscle weakness) and neck pain radiating to the arm.
It is a common diagnosis, incidence of which ranged between 0.832 - 1.79 per 1,000 person, and prevalence values ranged from 1.21 - 5.8 per 1,000 according to the latest epidemiological studies.
The incidence of neck pain was found to be high in college students: 48%-78%. What is more, the annual growth rate of cervical spondylosis in college students was twice that of the 50-year-old participants. A high incidence of neck pain among college students was associated with a heavy academic workload and the pressure of examinations, which may lead to the deformation of the neck and shoulders, as well as soft tissue damage.
In the meta-analysis of the college grade differences on neck pain in 2287 college students, it was shown that a higher probability and frequency of neck pain occurred at senior grade level. As can be seen from the review of existing literature, based on the incidence of neck pain, the potential of developing cervical radiculopathy is increasing at a younger age than was previously believed, with the peak age being 50 to 54 years. If left untreated, CR could lead to future disability and persistent functional impairments due to neural inflammation and edema, hypoxia and ischemia of structures.
However, despite the severity of the condition and the rapid incidence growth rate, there is still a lack of evidence in the area of conservative treatment, i.e. physiotherapy options. In previous studies, Electrical Muscle Stimulation (EMS) had no significant impact on pain relief, disability and patient satisfaction when used as an adjunct to cervical mobilization and manipulation, at post treatment, short-term and intermediate-term follow-up. Moreover, exercise treatment (ET) also consists of various interventions and is typically combined with drugs and other treatments, which make it difficult to determine the effects of a single intervention.
Nevertheless, results of more recent studies, are favoring application of EMS on various muscle groups, for example it was stated that EMS has significant effect on muscle strength of quadriceps and trunk extensors, similar results were also observed in the study assessing effects of EMS on upper extremity strength. Moreover, it was shown that neuromuscular electrical stimulation (NMES) induced a decrease of cortical activation during execution of hand movements, which indicates that application of NMES can increase the efficiency of the cerebral cortex during execution of motor tasks.
One should also consider that in the recent systematic review solitary ET directed on strengthening deep cervical flexors, scapulo - thoracic and upper extremity muscles had beneficial effect on pain and function at immediate post treatment and up to long-term follow-up. Moreover, strong evidence was found for effectiveness of deep cervical flexors (DCF) training on neuromuscular coordination of the neck, because it reduces the overactivation of the superficial muscles and improves the activation pattern of the cervical muscles.
It is also worth mentioning that, compared with the healthy adults, the individuals with CR have significantly smaller anterior displacements of the centers of mass and pressure, reduced muscle activity of the upper trapezius, sternocleidomastoid and splenius capitis muscles in response to all postural perturbations. Those findings are indicative of altered neural control of the neck musculature, leaving the cervical spine vulnerable to reactive forces.
Thus, physical therapy options for conservative management of CR should mainly focus on improving muscle function and neuromuscular control of the neck.
Given the promising results of EMS and ET, it is worth to investigate both in terms of neck muscle function. Thus, this research will try to do that.
Looking at the existing literature, training based on electrical muscle stimulation and voluntary muscle contraction has positive effects on muscle strength of various muscle groups, when applied in superimposition due to facilitation of additional muscle fibers recruitment.
However, superimposition of electrical stimulation on exercise was not assessed in the context of CR patients, who present with incomplete central activation levels and could favor from this kind of treatment, in terms of improving motor control. Additionally, restoring muscle balance in cervico - scapular region, adds to the proper neutral alignment of the cervical vertebrae, leading to increased intervertebral foraminal area, decreased nerve root compression and relieve of cervical radiculopathy symptoms.
Thus, the proposed study is aimed to investigate the effects of exercise therapy with electrical muscle stimulation and just exercise on cervical muscle function. Secondly, compare the effects of both therapy options. Lastly, see if improvement of neck muscle function would have and impact on cervical radiculopathy symptoms, in terms of pain and motor deficits.
- Conditions
- Cervical Radiculopathy, Cervical Radicular Pain, Neck Pain, Numbness, Paresthesia, Weakness, Muscle
- Being tested
- Exercise Therapy, Superimposition of electrical muscle stimulation on active movement
- Keywords
- cervical radiculopathy (CR), radicular pain, radicular symptoms, scapular dyskinesia, cervical deep flexors endurance (CDFE), cervical spine functional performance, electrical muscle stimulation, resistance training, superimposition
- Medical subject headings
- Radiculopathy, Neck Pain, Hypesthesia, Paresthesia, Muscle Weakness
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Exercise TherapyProcedure or surgery
Active therapeutic exercises prescription in face - to - face therapy sessions under supervision, for the duration of approximately 60 minutes per session.
Therapy session will start with a warm - up including segmental stability exercise , i.e. deep cervical flexors training to improve neuromuscular coordination of the neck: Participant will do chin - tucks (cervical retraction and axial extension) for 2 sets of 5 seconds hold for 12 repetions, with between set rest interval of 2 minutes, in sitting.
Next, participant will perform global stability exercises emphasizing flexor and extensor group musculature, with a gym ball, as a part of strengthening protocol.
Lastly, as a cool -down, participant performs: pectoralis stretch, scalene stretch, suboccipitals stretch. Each position is held for 15 seconds and repeated 4 times for each muscle group bilaterally.
Superimposition of electrical muscle stimulation on active movementProcedure or surgery
EMS will be applied over scapular region, bilaterally. Electophysiological motor points of upper trapezius will be identified through surface mapping with a pen electrode to minimize limited spatial recruitment of motor units, that occurs due to poor electrodes placement.
Reference electrode is placed at the antagonist muscle, i.e. insertion of lower trapezius over the medial end of spine of scapula. Self - adhesive, disposable electrodes (4pcs) will be allocated for each participant at the first session.
Movements of the participants will be synchronized with the EMS impulses, i.e. motion intiation - ramp up, hold - on time, rest - off time. Since present systematic reviews contain low quality evidence and EMS parameters are highly heteregenous, choice of the parameters will be done activating slow - twitch endurance muscle fibers.
| Study group | Role | What they receive |
|---|---|---|
| Voluntary Exercise | Active comparator | Active therapeutic exercises prescription for neck and scapular region, including warm-up, strengthening and cool - down under supervision of a physiotherapist. Receives: Procedure: Exercise Therapy |
| Electrically Stimulated Exercise | Experimental | All of the therapeutic exercises prescription parameters for warm-up, strengthening and cool - down, including patient positioning, type of exercise, duration, frequency and intensity will be the same as in 'Voluntary Exercise'.
For the intervention details, while 'Voluntary Exercise' will recieve only active exercises under supervision of the physiotherapist, in 'Electrically Stimulated Exercise' as a part of the strengthening protocol, electrical muscle stimulation unit will be applied over scapular region, bilaterally. Receives: Procedure: Superimposition of electrical muscle stimulation on active movement |
What is being measured
The primary outcome is the main question the study is designed to answer.
Deep Neck Flexors Endurance Test
To assess motor control of the neck, deep neck flexors endurance test will be used as a measure of neck muscle function. The reliability indexes suggest that the Deep Neck Flexors Endurance Test (DNFET )is an appropriate measure for group comparisons.
Measured: From pre - treatment (at the enrollment stage) to post - treatment assessment after 6 weeks (12th session).
Cervical Progressive Iso - Inertial Lifting Evaluation
Cervical Progressive Iso - Inertial Lifting Evaluation is functional restoration measure in spinal disorders. The endurance test of the short neck flexors and the cervical PILE test can be regarded as appropriate instruments for measuring different aspects of neck muscle function in patients with non-specific neck pain. Moreover, the cervical PILE test - showed high inter-rater reliability and between-days repeatability out of 8 physical performance tests.
Measured: From pre - treatment (at the enrollment) to post - treatment assessment after 6 weeks (12th session).
Secondary outcomes (2)
Muscle Strength Assessment
Muscle strength testing of the Biceps Brachii and Deltoid had highest sensitivity, while Biceps Brachii and Triceps Brachii had highest specificity, with overall sensitivity being 61% compared to imaging and electromyographic studies in the diagnosis of Cervical Radiculopathy.
Thus, muscle strength of biceps brachii, triceps brachii and deltoids will be used as an outcome measure in this study and assessed according to Manual Muscle Test grades 0 to 5.
Muscle strength has been classified into 6 grades, from 0 being no evidence of muscle contraction, 1- palpatable muscle contraction and no range of motion, 2 - active movement throughout range of motion without gravity, 3 - active movement throughout range of motion against gravity and no other resistance, 4 - active range of motion against gravity and slight resistance, 5 - ability to maintain test position against gravity and maximal resistance.
Measured: From pre - treatment (at the enrollment) to post - treatment assessment at 6 weeks (after 12th session).
Pain (Numeric Pain Rating Scale)
The intensity of pain can be assessed by Numeric Rating Scale (NRS) in cases of Cervical Radiculopathy. The Numerical Rating Scale uses whole numbers from 0 to 10 along a line or a bar, with 0 indicating no pain and 10 being the most excruciating pain one has ever felt. 4 or 5 points (average pain intensity) on the 10 point scale are usually considered as an indication for physical therapy.
Measured: From pre - treatment (at enrollment stage) to post - treatment assessment at 6 weeks (after 12th session).
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted29 Jan 2026
- Study start1 Dec 2025
- Primary completion23 Mar 2026
- Study completion23 Mar 2026
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (82)Papers the sponsor has linked to this study.
- Other trials for Cervical RadiculopathyStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 50 participants (actual)
Sponsor and investigators
- Lead sponsor
- European University of Lefke
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Zhanna Abdrakhmanova, European University of Lefke
- Investigators
- Zhanna Abdrakhmanova, BSc in Physical Therapy, Principal investigator, European University of LefkeNazemin Gilanlıoğulları, Asst. Prof. Dr., PhD in Rehabilitation, Study chair, Faculty of Health Sciences, Vice Dean, European University of LefkeBeraat Alptuğ, Asst. Prof. Dr., PhD in Physical Therapy, Study chair, Head of the Department of Physiotherapy and Rehabilitation Faculty of Health Sciences European University of Lefke
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07375823
- Sponsor's protocol ID
- BAYEK057.12
- Status last verified
- Feb 2026
- First submitted
- 22 Jan 2026
- Last updated
- 24 Mar 2026
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Publications
Akesson I, Lundborg G, Horstmann V, Skerfving S. Neuropathy in female dental personnel exposed to high frequency vibrations. Occup Environ Med. 1995 Feb;52(2):116-23. doi: 10.1136/oem.52.2.116.
PubMed 7757164Algarni AD, Al-Saran Y, Al-Moawi A, Bin Dous A, Al-Ahaideb A, Kachanathu SJ. The Prevalence of and Factors Associated with Neck, Shoulder, and Low-Back Pains among Medical Students at University Hospitals in Central Saudi Arabia. Pain Res Treat. 2017;2017:1235706. doi: 10.1155/2017/1235706. Epub 2017 Nov 7.
PubMed 29238618Alshami AM, Bamhair DA. Effect of manual therapy with exercise in patients with chronic cervical radiculopathy: a randomized clinical trial. Trials. 2021 Oct 18;22(1):716. doi: 10.1186/s13063-021-05690-y.
PubMed 34663421American College of Sports Medicine ACSM's for exercise testing and prescription, 10th edition, 2018
Anekstein Y, Blecher R, Smorgick Y, Mirovsky Y. What is the best way to apply the Spurling test for cervical radiculopathy? Clin Orthop Relat Res. 2012 Sep;470(9):2566-72. doi: 10.1007/s11999-012-2492-3. Epub 2012 Jul 18.
PubMed 22806265Barsi GI, Popovic DB, Tarkka IM, Sinkjaer T, Grey MJ. Cortical excitability changes following grasping exercise augmented with electrical stimulation. Exp Brain Res. 2008 Oct;191(1):57-66. doi: 10.1007/s00221-008-1495-5. Epub 2008 Jul 29.
PubMed 18663439Boudreau SA, Falla D. Chronic neck pain alters muscle activation patterns to sudden movements. Exp Brain Res. 2014 Jun;232(6):2011-20. doi: 10.1007/s00221-014-3891-3. Epub 2014 Mar 15.
PubMed 24632836Brage K, Ris I, Falla D, Sogaard K, Juul-Kristensen B. Pain education combined with neck- and aerobic training is more effective at relieving chronic neck pain than pain education alone--A preliminary randomized controlled trial. Man Ther. 2015 Oct;20(5):686-93. doi: 10.1016/j.math.2015.06.003. Epub 2015 Jun 25.
PubMed 26169796Carette S, Fehlings MG. Clinical practice. Cervical radiculopathy. N Engl J Med. 2005 Jul 28;353(4):392-9. doi: 10.1056/NEJMcp043887. No abstract available.
PubMed 16049211Chan CWY. Neurophysiological basis underlying the use of resistance to facilitate movement. Physiother Can. 1984;36(6):335-341.
Childress MA, Becker BA. Nonoperative Management of Cervical Radiculopathy. Am Fam Physician. 2016 May 1;93(9):746-54.
PubMed 27175952Coenen P, Kingma I, Boot CR, Twisk JW, Bongers PM, van Dieen JH. Cumulative low back load at work as a risk factor of low back pain: a prospective cohort study. J Occup Rehabil. 2013 Mar;23(1):11-8. doi: 10.1007/s10926-012-9375-z.
PubMed 22718286Cools AM, Declercq GA, Cambier DC, Mahieu NN, Witvrouw EE. Trapezius activity and intramuscular balance during isokinetic exercise in overhead athletes with impingement symptoms. Scand J Med Sci Sports. 2007 Feb;17(1):25-33. doi: 10.1111/j.1600-0838.2006.00570.x. Epub 2006 Jun 15.
PubMed 16774650Crawford RJ, Volken T, Schaffert R, Bucher T. Higher low back and neck pain in final year Swiss health professions' students: worrying susceptibilities identified in a multi-centre comparison to the national population. BMC Public Health. 2018 Oct 19;18(1):1188. doi: 10.1186/s12889-018-6105-2.
PubMed 30340573Crochetiere WJ, Vodovnik L, Reswick JB. Electrical stimulation of skeletal muscle--a study of muscle as an actuator. Med Biol Eng. 1967 Mar;5(2):111-25. doi: 10.1007/BF02474499. No abstract available.
PubMed 6039455
Study at a glance
From the registry record, last updated by the sponsor on 24 Mar 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effects of Electrical Muscle Stimulation Applied Concurrently With Active Movement and Exercise Therapy in Cervical Radiculopathy: A Randomized Trial
- ClinicalTrials.gov ID
- NCT07375823
- Acronym / sponsor ID
- BAYEK057.12
- Conditions
- Cervical Radiculopathy, Cervical Radicular Pain, Neck Pain, Numbness, Paresthesia, Weakness, Muscle
- Keywords
- cervical radiculopathy (CR), radicular pain, radicular symptoms, scapular dyskinesia, cervical deep flexors endurance (CDFE), cervical spine functional performance, electrical muscle stimulation, resistance training
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 50 participants (actual)
- Lead sponsor
- European University of LefkeUniversity, hospital or other
- Study start
- 1 Dec 2025 (actual)
- Primary completion
- 23 Mar 2026 (actual)
- Study completion
- 23 Mar 2026 (actual)
- First posted
- 29 Jan 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Cervical Radiculopathy (CR) is an objective loss of sensory and/or motor function as a result of compression or irritation of the cervical spinal nerve root.
The individuals with CR present with findings indicating an altered neural control of the neck musculature, leaving the cervical spine vulnerable to reactive forces.
Thus, physical therapy options should mainly focus on improving muscle function of the neck.
Given the promising results of electrical muscle stimulation and exercise therapy in recent literature the proposed study is aimed to investigate the effects of exercise therapy with electrical muscle on cervical muscle function and see, if muscle control has any impact on CR findings.
A superiority, randomized trial, with 2 intervention groups and allocation ratio of 1:1. 50 students, at the age from 18 to 29, from healthcare - related departments of European University of Lefke, who are diagnosed with CR will be recruited in the study.
To assess neck muscle function - Deep Neck Flexors Endurance time (s) and Cervical Progressive Iso - inertial Lifting scores (kg) will be used. Pain (Numeric Rating Scale 0 -10) and Muscle strength (grades 0 -5) will be used to measure the impact on CR findings.
All of the therapeutic exercises prescription parameters for warm-up (deep cervical flexors training), strengthening (cervical and scapulo-thoracic resistance training) and cool - down (flexibility training), will be the same for both groups: 60 minutes per session, 2 days in a week, for 6 weeks. In total each participant will recieve 12 sessions.
For the intervention details, while 'Intervention Group 1' will recieve only active exercises under supervision of the physiotherapist, in 'Intervention Group 2' as a part of the strengthening protocol, EMS will be applied over scapular region, bilaterally.
Detailed description
Cervical Radiculopathy (CR) is an objective loss of sensory and/or motor function as a result of conduction block in axons of a spinal nerve or its roots due to compression or irritation of the cervical spinal nerve root . Etiology is attributed to cervical foraminal compression in 70-75 % of cases due to anterior and posterior degenerative changes of the zygapophyseal joints, cervical spondylosis and reduction in disc height. The most common clinical manifestations of CR include sensory impairments (e.g. paresthesia), motor abnormalities (e.g. muscle weakness) and neck pain radiating to the arm.
It is a common diagnosis, incidence of which ranged between 0.832 - 1.79 per 1,000 person, and prevalence values ranged from 1.21 - 5.8 per 1,000 according to the latest epidemiological studies.
The incidence of neck pain was found to be high in college students: 48%-78%. What is more, the annual growth rate of cervical spondylosis in college students was twice that of the 50-year-old participants. A high incidence of neck pain among college students was associated with a heavy academic workload and the pressure of examinations, which may lead to the deformation of the neck and shoulders, as well as soft tissue damage.
In the meta-analysis of the college grade differences on neck pain in 2287 college students, it was shown that a higher probability and frequency of neck pain occurred at senior grade level. As can be seen from the review of existing literature, based on the incidence of neck pain, the potential of developing cervical radiculopathy is increasing at a younger age than was previously believed, with the peak age being 50 to 54 years. If left untreated, CR could lead to future disability and persistent functional impairments due to neural inflammation and edema, hypoxia and ischemia of structures.
However, despite the severity of the condition and the rapid incidence growth rate, there is still a lack of evidence in the area of conservative treatment, i.e. physiotherapy options. In previous studies, Electrical Muscle Stimulation (EMS) had no significant impact on pain relief, disability and patient satisfaction when used as an adjunct to cervical mobilization and manipulation, at post treatment, short-term and intermediate-term follow-up. Moreover, exercise treatment (ET) also consists of various interventions and is typically combined with drugs and other treatments, which make it difficult to determine the effects of a single intervention.
Nevertheless, results of more recent studies, are favoring application of EMS on various muscle groups, for example it was stated that EMS has significant effect on muscle strength of quadriceps and trunk extensors, similar results were also observed in the study assessing effects of EMS on upper extremity strength. Moreover, it was shown that neuromuscular electrical stimulation (NMES) induced a decrease of cortical activation during execution of hand movements, which indicates that application of NMES can increase the efficiency of the cerebral cortex during execution of motor tasks.
One should also consider that in the recent systematic review solitary ET directed on strengthening deep cervical flexors, scapulo - thoracic and upper extremity muscles had beneficial effect on pain and function at immediate post treatment and up to long-term follow-up. Moreover, strong evidence was found for effectiveness of deep cervical flexors (DCF) training on neuromuscular coordination of the neck, because it reduces the overactivation of the superficial muscles and improves the activation pattern of the cervical muscles.
It is also worth mentioning that, compared with the healthy adults, the individuals with CR have significantly smaller anterior displacements of the centers of mass and pressure, reduced muscle activity of the upper trapezius, sternocleidomastoid and splenius capitis muscles in response to all postural perturbations. Those findings are indicative of altered neural control of the neck musculature, leaving the cervical spine vulnerable to reactive forces.
Thus, physical therapy options for conservative management of CR should mainly focus on improving muscle function and neuromuscular control of the neck.
Given the promising results of EMS and ET, it is worth to investigate both in terms of neck muscle function. Thus, this research will try to do that.
Looking at the existing literature, training based on electrical muscle stimulation and voluntary muscle contraction has positive effects on muscle strength of various muscle groups, when applied in superimposition due to facilitation of additional muscle fibers recruitment.
However, superimposition of electrical stimulation on exercise was not assessed in the context of CR patients, who present with incomplete central activation levels and could favor from this kind of treatment, in terms of improving motor control. Additionally, restoring muscle balance in cervico - scapular region, adds to the proper neutral alignment of the cervical vertebrae, leading to increased intervertebral foraminal area, decreased nerve root compression and relieve of cervical radiculopathy symptoms.
Thus, the proposed study is aimed to investigate the effects of exercise therapy with electrical muscle stimulation and just exercise on cervical muscle function. Secondly, compare the effects of both therapy options. Lastly, see if improvement of neck muscle function would have and impact on cervical radiculopathy symptoms, in terms of pain and motor deficits.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Voluntary Exercise | Active comparator | Procedure: Exercise TherapyActive therapeutic exercises prescription for neck and scapular region, including warm-up, strengthening and cool - down under supervision of a physiotherapist. |
| Electrically Stimulated Exercise | Experimental | Procedure: Superimposition of electrical muscle stimulation on active movementAll of the therapeutic exercises prescription parameters for warm-up, strengthening and cool - down, including patient positioning, type of exercise, duration, frequency and intensity will be the same as in 'Voluntary Exercise'. For the intervention details, while 'Voluntary Exercise' will recieve only active exercises under supervision of the physiotherapist, in 'Electrically Stimulated Exercise' as a part of the strengthening protocol, electrical muscle stimulation unit will be applied over scapular region, bilaterally. |
Who may qualify
- Ages
- 18 to 29 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (6 listed)
- Student must be enrolled in the last 2 years of Bachelor degree or in Master's degree in one of the healthcare - related programs at the European University of Lefke;
- Age 18 - 29 years old;
- Neck pain of minimum 4 or more on numerical rating scale (0 - 10);
- Duration of symptoms 3 < months < 6, i.e. subacute symptoms with chronic/stable presentation;
- Has 1 or more of the following symptoms: paresthesia of 1 or both upper extremities at the level below elbow; pain radiating from neck to shoulder/arm/below elbow; feeling of weakness in 1 or both of the upper extremities, stiffness and/or tenderness and/or hyperalgesia in the cervical and/or upper thoracic area;
Key exclusion criteria (11 listed)
- Any recent head/neck or shoulder trauma in the last 3 months;
- Received physiotherapy for neck - related complaints in the last 3 months;
- Received or currently receiving any kind of pharmacological intervention (muscle relaxants, NSAIDs, corticosteroids injections) in the last 3 months;
- Presents with symptoms favoring shoulder pathology: pain localized at the shoulder that worsens at night, positive Drop Arm Test, pain referral patterns are localized in the upper arm above elbow;
- Any recent surgeries to the neck, upper extremities within the last 6 months;
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Exercise TherapyActive therapeutic exercises prescription in face - to - face therapy sessions under supervision, for the duration of approximately 60 minutes per session. Therapy session will start with a warm - up including segmental stability exercise , i.e. deep cervical flexors training to improve neuromuscular coordination of the neck: Participant will do chin - tucks (cervical retraction and axial extension) for 2 sets of 5 seconds hold for 12 repetions, with between set rest interval of 2 minutes, in sitting. Next, participant will perform global stability exercises emphasizing flexor and extensor group musculature, with a gym ball, as a part of strengthening protocol. Lastly, as a cool -down, participant performs: pectoralis stretch, scalene stretch, suboccipitals stretch. Each position is held for 15 seconds and repeated 4 times for each muscle group bilaterally. | Procedure or surgery | Voluntary Exercise |
| Superimposition of electrical muscle stimulation on active movementEMS will be applied over scapular region, bilaterally. Electophysiological motor points of upper trapezius will be identified through surface mapping with a pen electrode to minimize limited spatial recruitment of motor units, that occurs due to poor electrodes placement. Reference electrode is placed at the antagonist muscle, i.e. insertion of lower trapezius over the medial end of spine of scapula. Self - adhesive, disposable electrodes (4pcs) will be allocated for each participant at the first session. Movements of the participants will be synchronized with the EMS impulses, i.e. motion intiation - ramp up, hold - on time, rest - off time. Since present systematic reviews contain low quality evidence and EMS parameters are highly heteregenous, choice of the parameters will be done activating slow - twitch endurance muscle fibers. | Procedure or surgery | Electrically Stimulated Exercise |
Primary outcome
Deep Neck Flexors Endurance Test
Time frame: From pre - treatment (at the enrollment stage) to post - treatment assessment after 6 weeks (12th session).
To assess motor control of the neck, deep neck flexors endurance test will be used as a measure of neck muscle function. The reliability indexes suggest that the Deep Neck Flexors Endurance Test (DNFET )is an appropriate measure for group comparisons.
Cervical Progressive Iso - Inertial Lifting Evaluation
Time frame: From pre - treatment (at the enrollment) to post - treatment assessment after 6 weeks (12th session).
Cervical Progressive Iso - Inertial Lifting Evaluation is functional restoration measure in spinal disorders. The endurance test of the short neck flexors and the cervical PILE test can be regarded as appropriate instruments for measuring different aspects of neck muscle function in patients with non-specific neck pain. Moreover, the cervical PILE test - showed high inter-rater reliability and between-days repeatability out of 8 physical performance tests.
2 secondary outcomes
Muscle Strength Assessment
Time frame: From pre - treatment (at the enrollment) to post - treatment assessment at 6 weeks (after 12th session).
Pain (Numeric Pain Rating Scale)
Time frame: From pre - treatment (at enrollment stage) to post - treatment assessment at 6 weeks (after 12th session).
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 24 Mar 2026.
- Background: PubMed 7757164Akesson I, Lundborg G, Horstmann V, Skerfving S. Neuropathy in female dental personnel exposed to high frequency vibrations. Occup Environ Med. 1995 Feb;52(2):116-23. doi: 10.1136/oem.52.2.116.
- Background: PubMed 29238618Algarni AD, Al-Saran Y, Al-Moawi A, Bin Dous A, Al-Ahaideb A, Kachanathu SJ. The Prevalence of and Factors Associated with Neck, Shoulder, and Low-Back Pains among Medical Students at University Hospitals in Central Saudi Arabia. Pain Res Treat. 2017;2017:1235706. doi: 10.1155/2017/1235706. Epub 2017 Nov 7.
- Background: PubMed 34663421Alshami AM, Bamhair DA. Effect of manual therapy with exercise in patients with chronic cervical radiculopathy: a randomized clinical trial. Trials. 2021 Oct 18;22(1):716. doi: 10.1186/s13063-021-05690-y.
- BackgroundAmerican College of Sports Medicine ACSM's for exercise testing and prescription, 10th edition, 2018
- Background: PubMed 22806265Anekstein Y, Blecher R, Smorgick Y, Mirovsky Y. What is the best way to apply the Spurling test for cervical radiculopathy? Clin Orthop Relat Res. 2012 Sep;470(9):2566-72. doi: 10.1007/s11999-012-2492-3. Epub 2012 Jul 18.
- Background: PubMed 18663439Barsi GI, Popovic DB, Tarkka IM, Sinkjaer T, Grey MJ. Cortical excitability changes following grasping exercise augmented with electrical stimulation. Exp Brain Res. 2008 Oct;191(1):57-66. doi: 10.1007/s00221-008-1495-5. Epub 2008 Jul 29.
- Background: PubMed 24632836Boudreau SA, Falla D. Chronic neck pain alters muscle activation patterns to sudden movements. Exp Brain Res. 2014 Jun;232(6):2011-20. doi: 10.1007/s00221-014-3891-3. Epub 2014 Mar 15.
- Background: PubMed 26169796Brage K, Ris I, Falla D, Sogaard K, Juul-Kristensen B. Pain education combined with neck- and aerobic training is more effective at relieving chronic neck pain than pain education alone--A preliminary randomized controlled trial. Man Ther. 2015 Oct;20(5):686-93. doi: 10.1016/j.math.2015.06.003. Epub 2015 Jun 25.
- Background: PubMed 16049211Carette S, Fehlings MG. Clinical practice. Cervical radiculopathy. N Engl J Med. 2005 Jul 28;353(4):392-9. doi: 10.1056/NEJMcp043887. No abstract available.
- BackgroundChan CWY. Neurophysiological basis underlying the use of resistance to facilitate movement. Physiother Can. 1984;36(6):335-341.
- Background: PubMed 27175952Childress MA, Becker BA. Nonoperative Management of Cervical Radiculopathy. Am Fam Physician. 2016 May 1;93(9):746-54.
- Background: PubMed 22718286Coenen P, Kingma I, Boot CR, Twisk JW, Bongers PM, van Dieen JH. Cumulative low back load at work as a risk factor of low back pain: a prospective cohort study. J Occup Rehabil. 2013 Mar;23(1):11-8. doi: 10.1007/s10926-012-9375-z.
Related trials for Cervical Radiculopathy
Recruiting
Ultrasound-Guided Electrical Dry Needling for Chronic Cervical Radiculopathy
Cervical Radiculopathy
Not yet recruitingObservational study
Correlation Between Forward Head Posture and Executive Functions in Cervical Radiculopathy
Cervical Radiculopathy, Forward Head Posture
Recruiting
Myo-Electrical and Nerve Root Function Response to Focused Extracorpeal Shock Wave in Cervical Radiculopathy
Cervical Radiculopathy
Not yet recruiting
Endoscopic Posterior Cervical Foraminotomy Versus Anterior Cervical Discectomy and Fusion for Cervical Radiculopathy
Cervical Disc Herniation, Cervical Foraminal Stenosis
RecruitingObservational study
Cervical Spinal Cord Signal Abnormalities in Patients With Cervical Radicular Pain
Cervical Radiculopathy, Cervical Myelomalacia
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Zhanna Abdrakhmanova, BSc in Physical Therapy principal investigator
European University of Lefke
Nazemin Gilanlıoğulları, Asst. Prof. Dr., PhD in Rehabilitation study chair
Faculty of Health Sciences, Vice Dean, European University of Lefke
Beraat Alptuğ, Asst. Prof. Dr., PhD in Physical Therapy study chair
Head of the Department of Physiotherapy and Rehabilitation Faculty of Health Sciences European University of Lefke
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Exercise Therapy and Superimposition of electrical muscle stimulation on active movement in people with Cervical Radiculopathy and Cervical Radicular Pain, run by European University of Lefke at 1 site in Cyprus.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 6 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 24 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Cyprus. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Deep Neck Flexors Endurance Test (time frame: From pre - treatment (at the enrollment stage) to post - treatment assessment after 6 weeks (12th session).). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07375823, which also lists 82 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 24 Mar 2026.