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 (P < or = .0306). For the mobilization group, the increase in elbow extension from 137.3 degrees to 156.7 degrees, the 43.4% decrease in area of symptom distribution, and the decreased pain intensity from 7.3 to 5.8 were significant (P < or = .0003). For the ultrasound group, there were no significant improvements (P > or = .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.
RCT Entities:
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 (P < or = .0306). For the mobilization group, the increase in elbow extension from 137.3 degrees to 156.7 degrees, the 43.4% decrease in area of symptom distribution, and the decreased pain intensity from 7.3 to 5.8 were significant (P < or = .0003). For the ultrasound group, there were no significant improvements (P > or = .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.
Authors: Mark D Bishop; Rafael Torres-Cueco; Charles W Gay; Enrique Lluch-Girbés; Jason M Beneciuk; Joel E Bialosky Journal: Pain Manag Date: 2015-09-24
Authors: Kerry K Gilbert; Michael P Smith; Stéphane Sobczak; C Roger James; Phillip S Sizer; Jean-Michel Brismée Journal: J Man Manip Ther Date: 2015-12