Efficacy of Adding Neural Mobilization Techniques in Patients With Cervical Radiculopathy

Effectiveness of Slider and Tensioner Neurodynamic Mobilization Techniques in Patients With Cervical Radiculopathy: A Randomized Controlled Trial

The goal of this randomized controlled trial is to investigate the effects of adding slider neural mobilization technique compared to tensioner neural mobilization technique to conventional physical therapy treatment on pain, function, cervical range of motion, hand grip strength, and electrophysiological parameters of the median nerve in patients with cervical radiculopathy.

Cervical radiculopathy (CR) is a condition where the nerve root of a spinal nerve is compressed or impaired, causing the pain and symptoms to spread beyond the neck, radiating to the shoulder, and upper limb. Cervical radiculopathy primarily results from an impingement and inflammation of a nerve root induced by a space-occupying lesion that reduces the size of the intervertebral foramen, as a degenerative lesion of the zygapophyseal joint, or it is associated with a cervical disc derangement.

Patients presenting with CR complain of neck, periscapular, and radicular pain into the hand and arm. As well as neurologic symptoms such as sensory disturbances (paresthesia or numbness), muscle weakness with reduced tendon reflexes in the affected nerve root, or a combination of these signs and symptoms.

The reported annual incidence of CR is 85 cases per 100,000 people in the population, while the prevalence is 3.5/1000 persons. The C7 nerve root is most frequently impacted, with more than half of all cases affecting this level.

Several studies utilized therapeutic exercises, manual therapy, other modalities, cervical collars, cervical traction, postural education, and different medications such as drugs and steroid injections in the conservative management for cervical radiculopathy in its different stages.

The neural mobilization (NM) is a manual therapy method that improves neural flexibility, lowers dynamic sensitivity of the nervous system, increases blood flow, and relieves pain; for that, improved neural mobility and alleviated pain increase joint range of motion (ROM).

The NM techniques are delivered by two techniques, "sliding/gliding" and "tensioning." Tensioner technique generate tension from both ends of the nerve, while sliders involve gliding of the nerve relative to its surrounding structures by performing joint movements that elongate the nerve bed with minimal strain. In addition, sliders are usually less aggressive than tensioners, and their use might be indicated at early disease stages.

Both techniques aid in preventing the formation of adhesions, reducing endoneurial pressure, reducing intraneural edema, increasing nerve oxygenation, and decreasing ischemic pain.

Studies that used sliders and tensioners techniques in their clinical studies showed significant changes in biomechanical factors such as patients' self-reports of pain, disability, ROM, endurance, and muscle strength in the management of musculoskeletal neck disorders with nerve-related symptoms.

Therefore, what are the possible effects of adding the tensioner neural mobilization technique versus the slider neural mobilization technique to conventional physical treatment in treating patients with cervical radiculopathy?

Inclusion Criteria:

1. Current continuous or intermittent pain that has persisted for more than 3 months.
2. Motor, reflex, and/or sensory changes in the upper limb.
3. Both genders aged 30-50 years.
4. Three positive special tests out of five as a predefined diagnostic criterion from the following tests: Upper Limb Neural Tension A (ULNT) test for the median nerve, Spurling's test, compression test, cervical distraction test, less than 60° cervical rotation towards the symptomatic side, and Valsalva maneuver.
5. A motor nerve conduction study, F wave, and H reflex were performed in the involved limb to confirm CR.

Exclusion Criteria:

1. History of surgical procedures for cervical or upper extremity.
2. Clinical signs or symptoms of medical red flags (infection, cancer, and cardiac involvement).
3. Patients with neck pain for signs and symptoms of serious pathology, upper cervical ligamentous insufficiency, unexplained cranial nerve dysfunction, and spinal fractures.
4. Any systematic disease such as rheumatism and tuberculosis, cervical myelopathy, or multiple sclerosis.
5. Systemic disease is known to cause generalized peripheral neuropathy, such as diabetes mellitus.
6. Complete loss of sensation along the involved nerve root.
7. Upper limb compression syndrome, such as thoracic outlet syndrome, carpal tunnel syndrome, and pronator syndrome.
8. Pregnant woman.
9. Patients who have received any physical therapy of the cervical region in the past 3 months.