None listed
Conditions
Brief summary
Subacute or chronic neck pain aetiology is not yet defined, but could be related to a sensitization process of nerve roots from the neck region. - The objective is to compare short-term effectiveness of cervical lateral glides in isolation or as a component of the median nerve mobilization in patients with non-acute neck pain. In addition, to evaluate each technique separately. - The main hypothesis is that cervical lateral glides as a component of the median nerve mobilization are more efficient in reducing pain (main outcome variable) compared to cervical lateral glides in isolation in both types of patients, neuropathic pain (patients with a DN4 evaluation equal or higher than 4) and nociceptive pain (DN4 less than 4) - Single-blinded randomized clinical trial. Study takes part at University of Alcalá. 72 patients will be recruited, allocated randomly in 2 groups, will be likewise classified by the Neuropathic Pain Scale (DN4). A result equals to 4 or superior determines the neuropathic, or neurogenic if result is below 4 out of 10. Both types of patients will be submitted to both mobilization groups. Excluded patients with diabetes, previous spine surgeries,soft tissue neck surgery, previous neck trauma (car accidents,...), previous or current tumors, to have received treatment with chemo/radiotherapy, to have received physiotherapy in the past 6 weeks, severe infections, cervical radiculopathy with strength deficits, cervical mielopathy and spinal stenosis only if provokes spasticity, gait disorders, sphyncter dysfunction, clonus and other severe neurologic deficits. - Group 1: cervical lateral glides associated to median nerve glide and home neurodynamic exercises. Group 2: cervical lateral glides in isolation and general neck mobility exercises. - Outcomes will be gathered baseline, post-intervention, at 2 and 4 weeks. These measurements will be: spontaneous neck pain by using Visual Analogue Scale; pressure pain threshold in C6, median nerve at the elbow flexion fold and tibialis anterior muscle, measured with an algometry device; elbow extension range of motion during Upper Limb Neurodynamic Test 1 (median nerve); neck mobility, measured by cervical goniometer. Besides, information about neck function and fear of motion is taken at baseline, 2 weeks and at the end of the study using the Neck Disability Index and 11-item Tampa Scale of Kinesiophobia, respectively.
Interventions
- Cervical lateral glides as part of the median nerve mobilization. Individual face-to-face intervention. A splint to fix wrist and finger motion of the intervention upper limb will be used, along with a fixation at the shoulder to not let the humeral head to ascend. This will let the patient move the elbow as intended. The intervention is described as follows: 4 sets of mobilizations of 60 seconds each in first session. After that, patient will be instructed orally and subtitled youtube video d
- Cervical lateral glides as part of the median nerve mobilization. Individual face-to-face intervention. A splint to fix wrist and finger motion of the intervention upper limb will be used, along with a fixation at the shoulder to not let the humeral head to ascend. This will let the patient move the elbow as intended. The intervention is described as follows: 4 sets of mobilizations of 60 seconds each in first session. After that, patient will be instructed orally and subtitled youtube video documented (https://www.youtube.com/watch?v=1q4VWi9tWvg ) to perform median nerve mobilization exercises at home (1 minute per set, 3 times a day, consecutive days) every day until next visit. Next visit: in 2 weeks, same protocol of mobilizations and home-exercises. Final evaluation (no intervention) at 4 weeks. Patients are phone-called once two days after they have started with exercises at home to clarify doubts and another time in the mid-term between sessions to assure their compliance. - The interventions will be conducted at University of Alcala and Principe de Asturias Hospital (Spain) and will be delivered by an expert clinician with more than 8 years of expertise.
Sponsors
Principe De Asturias University Hospital
Study design
Allocation
Randomised controlled trial
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
- 18 y 65 years of range of age. - Non-traumatic origin neck pain (checked and diagnosed by a specialist) with or without complaints to the head or upper limbs, following the Neck Pain Task Force definition about neck pain, of at least 4 weeks of duration. Then, neck pain patients will be categorized on the basis of the marks obtained in Douleur Neuropatique 4 questionnaire (DN4 spanish version). - ULNT1 test (Neurodynamic Test for the median nerve) must be at least partially positive matching the affected side for subjects that have also DN4 positiv neuropathic pain. Reflexes abolition or slight diminution of sensitivity are not exclusion criteria, as well as herniated discs that do not produce strength decrease of the affected segment.
Exclusion criteria
-Previous spine surgeries -Soft tissue neck surgery. -Previous trauma over the neck (car accidents) -Previous or current tumors -To have received treatment with chemo/radiotherapy -To have received physiotherapy in the past 6 weeks. -Previous severe infections -Diabetes. -Cervical radiculopathy with strength deficits -Cervical Mielopathy -Spinal Stenosis if only provoke spasticity, gait disorders, sphyncter dysfunction, clonus and other severe neurologic deficits.
Outcome results
None listed