The effect of neural mobilisation on cervico-brachial pain: design of a randomised controlled trial

Abstract

BackgroundNeck pain is a common musculoskeletal complaint and is often associated with shoulder or arm pain. There is a paucity of information on effective treatment for neck and arm pain, such as radiculopathy or cervico-brachial pain. Guidelines recommend neck mobilisation/ manipulation, exercises and advice as the treatment for neck pain, and neck and arm pain. There are a few studies that have used neural mobilisation as the treatment for cervico-brachial pain. Although results seem promising the studies have small sample sizes that make it difficult to draw definite conclusions.MethodsA randomised controlled trial will be used to establish the effect of neural mobilisation on the pain, function and quality of life of patients with cervico-brachial pain. Patients will be recruited in four physiotherapy private practices and randomly assigned to usual care or usual care plus neural mobilisation.DiscussionIn clinical practice neural mobilisations is commonly used for cervico-brachial pain. Although study outcomes seem promising, most studies have small participant numbers. Targeting the neural structures as part of the management plan for a subgroup of patients with nerve mechano-sensitivity seems feasible. Patients with neuropathic pain and psychosocial risk factors such as catastrophising, respond poorly to treatment. Although a recent study found these patients less likely to respond to neural mobilisation, the current study will be able to assess whether neural mobilisation has any added benefit compared to usual care. The study will contribute to the knowledge base of treatment of patients with cervico-brachial pain. The findings of the study will be published in an appropriate journal.Trial registrationTrial registration Number: PACTR201303000500157.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-419) contains supplementary material, which is available to authorized users.

Is pharmacologic treatment better than neural mobilization for cervicobrachial pain? A randomized clinical trial

“…A change of 1.39 points may be considered as a clinical significance 40 . A high intraclass correlation coefficient (ICC) between the NRSP and visual analog scale (ICC = 0.88) and a good inter-rater reliability (kappa coefficient = 0.84) were shown 41 , 42 .…”

Effects of Median Nerve Neural Mobilization in Treating Cervicobrachial Pain: A Randomized Waiting List–Controlled Clinical Trial

“…A high intraclass correlation coefficient (ICC) between the NRSP and visual analog scale (ICC = 0.88) and good inter‐rater reliability (kappa coefficient = 0.84) have been shown for patients. A 2‐point reduction is considered a clinically relevant finding …”

<b>Different frequencies of transcutaneous electrical nerve stimulation on sympatho-vagal balance

“…They might be fixed on the injury, on dermatomes and near the site of injury (Sluka & Walsh, 2003). In this study, electrodes were placed along the brachial nerve plexus, which is normally used in cervicobrachial pain (Basson et al, 2014;MorenoMartín & Santana-Pineda, 2014). This was described in a recent study (Franco et al, 2014) that used the same parameters of TENS as the present study.…”

“…These contradictory results stimulated us to investigate the effects of different frequencies of TENS applied in the trajectory of the brachial nerve plexus on ANS, since this form of application is usually used in the nonpharmacological management of cervicobrachial pain (Basson, Stewart, & Mudzi, 2014;MorenoMartín & Santana-Pineda, 2014). The hypothesis is that this therapeutic applied in the trajectory of the brachial nerve plexus (Franco et al, 2014) resource modifies the autonomic balance, with the high frequency being responsible for the decrease of the sympathetic activity, demonstrating that this application site presents opposite results to previous studies (Stein et al, 2011;Vieira et al, 2012;Ngai & Jones, 2013).…”