Evaluating the effectiveness of McKenzie vs. Myofascial release techniques for cervical radiculopathy: A Brief Review Amandeep Bhana1, Ajanti Indora2, Paras Jaiya3, Ishani Sinha4 1Assistant Professor, Department of Physiotherapy, Guru Kashi University, Talwandi Sabo, Bathinda, Punjab 2Student M.P.Th Neurology, College of Physiotherapy, Pt. B.D. Sharma University of Health Sciences, Rohtak , India 3Student M.P.Th Sports, College of Physiotherapy,

INTRODUCTION

Neck pain can be considered as one of the most vulnerable musculoskeletal conditions since it is not only prone to degenerative changes, mechanical stress and postural imbalances but also has a large burden on the healthcare systems and the economic system of the society both in terms of causing pain and dysfunction.

Neck pain is a commonly reported complaint amongst working professionals, especially within those professions that involve sitting in one position, repetitive actions, or spending a lot of time at the computer or other screens. Spinal manipulative therapy that comprises of mobilization and spinal adjustments is one of the widely used treatment procedures in the management of neck pain. Studies have indicated that spinal manipulation is a safe and effective treatment of short-term management of neck pain, but not all patients are appropriate candidates of spinal manipulative therapy and some of them may reject or have contraindications against this therapy. In this scenario, alternative therapeutic modalities need to be considered in order to offer therapeutic benefits in terms of symptom relief and functional recovery.²⁰

Cervical radiculopathy (CR) is a neurological condition caused by the compression or irritation of the cervical nerve roots of neural foramen. CR is clinically characterized by acute neck pain, which radiates along the involved dermatome in the upper limb, which is usually accompanied by sensory impairments, including tingling, burning pains and numbness.^1,3 In more severe situations, it may cause motor deficit such as muscle weakness and loss of reflex responses. The symptoms are usually worsened by some neck movements that may also limit mobility and functional capacity.

McKenzie protocol has become widely known as an alternative treatment method in management of spinal disorders, including cervical pain syndromes, as the McKenzie approach is founded on the centralization phenomenon where symptoms are moved to a more central and proximal locality (McKenzie protocol).¹¹ Initially designed to manage low back pain, the McKenzie protocol is based on the concept of mechanical diagnosis and therapy (MDT), which involves The McKenzie Method seeks to regain the alignment of the spine, improve the mobility, and decrease the pain by applying certain exercise programs depending on how the patient reacts to the pain.¹³

Conversely, Myofascial Release (MFR) treatment has been reported to have a beneficial effect as a pain reliever and restorative intervention especially when it comes to myofascial trigger points (MTrPs).¹² Research has shown that trigger points are also more common on the side of the radiculopathy, which is a source of local and referred pain. Active trigger points are common in patients with cervical radiculopathy and they result in elevated muscle tension and limited movement.¹³ MFR therapy is based on sustained pressure and manual stretching to loosen fascial adhesions, enhance blood flow and decrease muscular tone. The studies indicate that gross MFR applied to the upper limb and neck can be helpful in the reduction of mechanical neck pain and the improvement of the functional abilities.¹⁴

Although it has been established that both McKenzie Method and Myofascial Release Therapy are effective, comparative research has not been done to determine their comparative effectiveness in managing cervical radiculopathy. As the two techniques differ in terms of biomechanical principles and treatment mechanisms, it is important to know their relative effects on reduction of pain, range of motion and functional outcomes in general to optimize clinical decisions in relation to the two techniques. Hence, the proposed study will examine and compare the effects of McKenzie-based exercise therapy and Myofascial Release techniques on patients with cervical radiculopathy. The research results of this study can be utilized in evidence-based practice because they could determine the most effective rehabilitation method to be used to treat patients with cervical radiculopathy.

Method

A comprehensive literature search was conducted using databases such as PubMed, Scopus, and Google Scholar. Keywords used in the search included Cervical Radiculopathy, Neck Pain, McKenzie Method, Myofascial Release, Spinal Disorders, Trigger Points, Pain Management, Rehabilitation, Physiotherapy, Manual Therapy, Functional Improvement, Mechanical Diagnosis, Centralization, Neuromuscular Therapy, Musculoskeletal Disorders. Articles published from [insert year range, e.g., 2000 to 2024] were included to ensure that recent and relevant studies were captured.

Inclusion and Exclusion Criteria

Inclusion Criteria

Studies were included based on the following criteria:

• Published between 2000 and 2025

• Study population: patients diagnosed with cervical radiculopathy or mechanical neck pain with radicular symptoms

• Study designs: Randomized Controlled Trials (RCTs)

• Comparative studies

• Systematic reviews

• Case studies (with clinical relevance)

• Interventions involving: McKenzie Method

• Myofascial Release (MFR)

• Related physiotherapy interventions (e.g., neural mobilization, traction, MET)

• Outcomes measured: Pain (VAS/NPRS)

• Functional disability (NDI)

• Range of motion (ROM)

• Muscle endurance or quality of life

• Articles published in English

Exclusion Criteria

Studies were excluded based on:

• Non-clinical studies (e.g., animal studies, cadaveric studies)

• Studies not related to cervical spine or radiculopathy

• Articles lacking clear outcome measures

• Studies focusing solely on surgical interventions

• Duplicate publications

• Conference abstracts without full text

• Studies with poor methodological quality or insufficient data

Study Selection Process (PRISMA Flow Summary)

Identification

• Total studies identified through databases (PubMed, Google Scholar, etc.): n = 25

Screening

• Duplicates removed: n = 3

• Studies screened by title/abstract: n = 22

Eligibility

• Full-text articles assessed: n = 20

• Excluded after full-text review: n = 3

Included

• Studies included in final review: n = 17

Reasons for Exclusion

Reason for Exclusion	Number of Studies (n)
Not specific to cervical radiculopathy	1
Lack of outcome measures	1
Methodological limitations / insufficient data	1

Summary Chart

Stage	Number of Studies (n)
Identified	25
After duplicates removed	22
Screened	22
Full-text assessed	20
Excluded	3
Included in review	17

Table 1: - Summary of studies conducted on evaluating the effectiveness of McKenzie vs. Myofascial release techniques for cervical radiculopathy.
Author(s) & Year	Study Title / Focus	Key Findings
Priyanshu Joshi et al. (2018)	Incidence and influencing factors of cervical radiculopathy	The incidence rate is 3.3 per 1000 people, with higher prevalence among individuals aged 30-40. More common in females (66.66%) than males (33.33%). Right-hand involvement (75%) was more frequent than left-hand involvement (16.66%).
Tarek Ammar (2018)	Stabilization vs. McKenzie Exercises in Mechanical Neck Dysfunction (MND)	Both stabilization and McKenzie exercises were effective in improving pain perception, disability, pain threshold, and range of motion.
Sweta V. Ganus & Peeyoosha V. Gurudut (2018)	Effects of Gross Myofascial Release (MFR) on mechanical neck pain radiating to the upper extremity	MFR showed significant improvement in pain intensity, cervical flexor endurance, range of motion, and functional outcomes. Recovery was quicker (5-6 sessions).
Sanjiv Kumar (2010)	Systematic review of Neural Mobilization and McKenzie Intervention in Cervical Radiculopathy	McKenzie method provided peak pain relief within the first five days, whereas traditional approaches provided more relief between days 5-10. Range of motion improvement was consistent across techniques.
Ritika Sambyal, Monika Moitra et al. (2015)	Effectiveness of Myofascial Release vs. Conventional Physiotherapy in Myofascial Trigger Points (MTrPs)	MFR was effective in managing MTrPs in cervical radiculopathy when combined with conventional therapy.
Sundeep Rathore (2003)	McKenzie cervical technique for radicular neck pain in a machinist	McKenzie therapy improved pain and function in radicular neck pain patients.
Ritika Sambyal, Monika Moitra et al. (2016)	Role of Myofascial Release in Cervical Radiculopathy	MFR reduced neck impairment and improved functional recovery.
Dr. Reham Hussein Diab et al. (2016)	Effectiveness of McKenzie Method in Non-Specific Neck Pain	McKenzie therapy improved cervical range of motion (CROM), reduced pain, and increased therapeutic efficacy.
Rodriguez-Fuentes et al. (2016)	Myofascial Release Therapy in Occupational Neck Pain	MFR was more effective than manual therapy in correcting forward head posture, restoring ROM, and enhancing quality of life.
Kumar Neeraj & Shiv Verma (2016)	Strengthening Exercises vs. McKenzie Neck Exercises in Neck Pain	McKenzie therapy was more effective than isometric strengthening exercises and hot pack therapy.
Ibrahim M. Moustafa & Aliaa A. Diab (2014)	Multimodal Therapy for Discogenic Cervical Radiculopathy	A multimodal approach with unique cervical traction significantly reduced pain, disability, and frequency of neurological symptoms.
Apoorva Phadke et al. (2016)	Muscle Energy Technique (MET) vs. Static Stretching for Chronic Neck Pain	MET was more effective than stretching in reducing pain and improving functional ability.
Jeong-II Kang et al. (2019)	McKenzie Training on Neck Muscle Fatigue and Disability Index in Chronic Neck Pain	McKenzie therapy reduced muscle fatigue and improved endurance in the upper trapezius and splenius capitis muscles.
Aida A. Nassif et al. (2016-2020)	Spinal Mobilization with Arm Movement (SMWAM) in Chronic Cervical Radiculopathy	SMWAM improved proprioception and functional capacity in chronic cervical radiculopathy patients.
Mark A. Waldrop (2006)	Evaluation & Management of Cervical Radiculopathy using Diagnostic Rule & Multimodal Therapy	Intermittent cervical traction (ICR) and thoracic thrust joint manipulation (TJM) helped reduce radicular pain and improve functional outcomes.
Dr. Trupti Siddapur et al. (2019)	Comparison of Neck Isometrics vs. McKenzie Method in Cervical Radiculopathy	Both approaches were effective, but neck isometric therapy showed slightly better clinical improvement.
Sanduja A. (2010)	Mechanical Traction for Cervical Radiculopathy	Mechanical cervical traction effectively reduced neck pain and impairment.

Discussion

Cervical radiculopathy (CR) is a serious clinical disease that afflicts a significant portion of the population resulting in functional disabilities and poor quality of life. According to the results of the literature reviewed, the McKenzie Method as well as the Myofascial Release (MFR) techniques are both beneficial therapeutic techniques that can be used in people with CR. Nevertheless, the mechanism of action and their overall effectiveness vary, and this has the need to examine more closely their comparative role in relieving the symptoms, functional recovery, and patient satisfaction.

The experiments in the studies reviewed in this paper give a thorough interpretation of the effectiveness of the two methods. Directional preference exercises and the centralization phenomenon have been demonstrated to increase the cervical range of motion, decrease the sensation of pain, and increase the control of the neuromuscular system (McKenzie therapy). A number of diverse studies, including those by Sanjiv Kumar (2010), Dr. Reham Hussein Diab et al. (2016), and Jeong-II Kang et al. (2019) showed a substantial decrease in pain and disability after McKenzie-based approaches. Also, McKenzie exercises were also revealed to be especially effective in the treatment of mechanical neck dysfunction, as pointed out in the paper by Tarek Ammar (2018). The fact that the symptoms diminish rapidly during the first five days as reported by Kumar (2010) is an indication that McKenzie therapy can be used as an effective early intervention in acute cervical radiculopathy.

Conversely, Myofascial Release therapy has been proved to offer significant benefits especially in the situations that require myofascial trigger points (MTrPs) and chronic neck pain. Sweta V. Ganus and Peeyoosha V. Gurudut (2018), Ritika Sambyal and Monika Moitra et al. (2015, 2016), and Rodriguez-Fuentes et al. (2016) reported that MFR can be successfully used to decrease the level of pain, improve cervical flexibility, and functional outcomes. The fact that MFR can treat muscle tightness and fascial restrictions, which are typical causes of radicular pains, supports the fact that it is significant in the conservative treatment of CR. Moreover, the use of multimodal interventions, such as MFR, in the attainment of the best treatment outcomes was noted by Kumar Neeraj & Shiv Verma (2016) and Ibrahim M. Moustafa and Aliaa A. Diab (2014).

Although both the interventions have proven to be effective, comparative effectiveness of McKenzie therapy and MFR is one of the areas that still need to be studied. Although McKenzie therapy seems to be faster in terms of eliminating the symptoms with the help of the postural corrections and the alignment of the spine, MFR is effective in terms of addressing the issues of soft tissue dysfunction and muscular imbalance. Dr. Trupti Siddapur et al. (2019) study indicated that the two interventions were both effective with a slightly better clinical outcome of isometric neck exercises with McKenzie therapy. In the same manner, the systematic review conducted by Sanjiv Kumar (2010) highlighted the significance of personal response of a patient to various modalities of treatment.

The most important weakness of the current research is the absence of long-term follow-up information in order to identify the long-term effectiveness of such interventions. Although McKenzie therapy can be very effective in the short run with regard to relieving the symptoms, MFR can have long term benefits due to its ability to treat underlying myofascial dysfunction. Moreover, the compliance of the patient, proficiency of therapists and personal anatomical differences may affect the treatment outcomes. Randomized controlled trials using bigger sample sizes in future studies should be applied comparing the long-term effectiveness of McKenzie therapy and MFR in CR patients.

Conclusion

To recap it all, McKenzie therapy and Myofascial Release therapy show a great potential in the treatment of cervical radiculopathy. The intervention must depend on the clinical presentation of the patient, the severity of the symptoms, and musculoskeletal dysfunction. Although McKenzie therapy would be appropriate to treat patients with mechanical neck pain and postural abnormalities, MFR would be useful especially when the patient has myofascial trigger points and experiences chronic muscle tightness. The combination of these two techniques in a multimodal approach might have the most desirable results, as it would guarantee the full recovery of symptoms and functional recovery among patients with cervical radiculopathy.

Declaration by Authors

Ethical Approval: Not Applicable

Acknowledgement: None

Source of Funding: None

Conflict of Interest: The authors declare no conflict of interest.

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