The Immediate Effects of a Cervical Lateral Glide Treatment Technique in Patients With Neurogenic Cervicobrachial Pain

Abstract

Study Design: Randomized clinical trial.Objectives: To analyze the immediate treatment effects of cervical mobilization and therapeutic ultrasound in patients with neurogenic cervicobrachial pain. Background: Different treatment modalities have been described for patients with neurogenic cervicobrachial pain. Although it has been suggested that a more specific approach, like cervical mobilization, would be more effective, effect studies are scarce. Methods and Measures: Twenty patients with subacute peripheral neurogenic cervicobrachial pain were assessed. Besides other criteria, patients were included if a cervical segmental motion restriction was present which could be regarded as a possible cause of the neurogenic disorder. Patients were randomly assigned to a mobilization or ultrasound group. Mobilization consisted of a contralateral lateral glide technique. The range of elbow extension, symptom distribution, and pain intensity during the neural tissue provocation test for the median nerve were used as outcome measures. Results were analyzed using a 2-way mixed-design ANOVA. Results: Significant differences in treatment effects between the 2 groups could be observed for all outcome measures (PՅ.0306). For the mobilization group, the increase in elbow extension from 137.3°to 156.7°, the 43.4% decrease in area of symptom distribution, and the decreased pain intensity from 7.3 to 5.8 were significant (PՅ.0003). For the ultrasound group, there were no significant improvements (PՆ.0521). Conclusions: When a cervical dysfunction can be regarded as a cause of the neurogenic disorder or as a contributing factor that impedes natural recovery, a cervical lateral glide mobilization has positive immediate effects in patients with subacute peripheral neurogenic cervicobrachial pain. This movement-based approach seems preferable to ultrasound. J Orthop Sports Phys Ther 2003;33:369-378.

Outcomes differ between subgroups of patients with low back and leg pain following neural manual therapy: a prospective cohort study

“…Moderate to low level evidence from clinical trials and case studies indicates that neural mobilisation has beneficial effects in patients with evidence of PNS in the lumbar spine [27][28][29] and in the cervical spine [30][31][32][33]. Patients included in these studies were comparable to the subjects in the present study: all had radiating pain in the extremities and positive nerve provocation tests in the absence of neurological deficits.…”

The immediate effects of soft tissue mobilization versus therapeutic ultrasound for patients with neck and arm pain with evidence of neural mechanosensitivity: a randomized clinical trial

“…To determine sample size, an estimate of effect size was calculated from the data provided by Coppieters et al 21 This study examined the effects of a neuromobilization technique in a patient population similar to the current study. Using the values for each group provided by Coppieters et al, Cohen's d was estimated as d52.02 for improvement in elbow ROM during the ULNT, and d51.1 for the NPRS, both large effects.…”

“…9,11,15,[19][20][21][22][23] An example of such an intervention includes the cervical lateral glide mobilization with the involved upper extremity placed in a position designed to take up the slack in the brachial plexus. 16,21,24,25 However, several authors have advised against applying cervical spine mobilization techniques to patients who demonstrate either normal or excessive mobility of the cervical spine, 26,27 which may include some patients with cervicobrachial syndrome. 17 Hypermobility is a frequent finding in patients with whiplash-associated disorder, 28 a group who commonly reports neck and arm pain.…”

“…17 It has been suggested that neural mobilization, a treatment approach focusing on facilitating movement of the nerve and surrounding structures, may be beneficial for those who present with cervicobrachial syndrome. 9,10,15,[19][20][21] The goal of interventions is either to encourage gliding of the nerve by controlled angular movements or to allow more space for the nerve to move by improving mobility of the structures that surround the nerve (the neural container). 9,11,15,[19][20][21][22][23] An example of such an intervention includes the cervical lateral glide mobilization with the involved upper extremity placed in a position designed to take up the slack in the brachial plexus.…”

“…9,10,15,[19][20][21] The goal of interventions is either to encourage gliding of the nerve by controlled angular movements or to allow more space for the nerve to move by improving mobility of the structures that surround the nerve (the neural container). 9,11,15,[19][20][21][22][23] An example of such an intervention includes the cervical lateral glide mobilization with the involved upper extremity placed in a position designed to take up the slack in the brachial plexus. 16,21,24,25 However, several authors have advised against applying cervical spine mobilization techniques to patients who demonstrate either normal or excessive mobility of the cervical spine, 26,27 which may include some patients with cervicobrachial syndrome.…”