Cervical radiculopathy (CR) is a common clinical condition, resulting from the compression of cervical nerve roots, and is responsible for neck and unilateral upper limb symptoms and disability 1. Patients diagnosed with CR commonly complain of pain in their neck and one arm, with a combination of sensory loss, motor function loss, or reflex changes in the affected nerve-root distribution 2. A recent systematic review suggests that the prevalence of cervical radiculopathy ranges from 1.21 to 5.8 per 1,000 3. The economic burden of cervicobrachial pain was estimated at approximately 868 million US dollars per year, gradually increasing with each passing day 4.

In patients diagnosed with cervical radiculopathy, the weakening of one myotomal set of muscles results in other muscles being recruited to perform the missing function. These compensatory muscles can then be overused, leading to injury, pain, and musculoskeletal problems. Thus, cervical radiculopathy can then lead to musculoskeletal conditions. Conversely, musculoskeletal conditions arising from poor posture and muscle contracture can lead to forces pulling on the cervical spine, narrowing facets, worsened arthritis with cervical spondylosis, dehydration or height reductions in discs, and the formation of bone spurs that contribute to the cervical spine degenerative cascade which causes foraminal stenosis. Thus, musculoskeletal conditions can lead to cervical radiculopathy 5. Additionally, a systematic review of the upper limbs conducted in 2019 suggests the existence of fascial continuity between the cervical and shoulder region with the forearm 6.

Fascia is a type of connective tissue that is divided into 3 layers: the superficial layer, a layer of potential space, and a deep layer. As the fibers of the fascia run in many directions, it is capable of moving and changing with the surrounding tissues 7. Fascia is a unit connective tissue structure surrounding the whole body and is a continuous piece of connected tissue-like chains8. Therefore, when fascia in cervical area is stretched, it can cause tightness, restriction, and pain in upper extremities 7. It has recently been purported that the innervation of the fascia with its potential nociceptive function may be considered a possible mechanism in musculoskeletal pain 9.

To the best of our knowledge, there are no studies that have applied the myofascial release technique while simultaneously evaluating the pain pressure threshold of the upper extremities of cervical radiculopathy patients. Moreover, no studies regarding the effects of cervical exercises or the myofascial release technique on the strength of the arm muscles in patients diagnosed with cervical radiculopathy could be found. In the present study, primary outcome measures were chosen to be the pain pressure threshold, the cervical range of motion, and muscle strength measures, while the secondary outcome measures were perceived pain, function and disability. The purpose of the present randomized clinical trial was to assess the effectiveness of the myofascial release technique and to compare it with a cervical exercise program in patients diagnosed with unilateral cervical radiculopathy. This goal can be assessed through the main hypothesis:

H0: Muscle strength, cervical range of motion, and pain pressure threshold scores of the MRT protocol group are similar to muscle strength, cervical range of motion, and pain pressure threshold scores of the exercise group.

H1: Muscle strength, cervical range of motion, and pain pressure threshold scores of the MRT protocol group are greater than muscle strength, cervical range of motion, and pain pressure threshold scores of the exercise group.