Effects of Neural Tension Versus Neural Sliding Technique on Cervical Radiculopathy.
Condition: Cervical Radiculopathy
MeSH terms: Radiculopathy
Study type: Interventional

Summary: 
      The aim of this research is to find the effects of neural tension versus neural sliding
      technique on pain, cervical muscle endurance and hand grip strength in unilateral cervical
      radiculopathy. It will be a randomized controlled trial in which participants selected
      through non probability convenience sampling with age from 18 to 65 years having unilateral
      cervical radicular pain in upper limb since 3 months and any two of the following positive
      test Spurling's test, Distraction test and Upper Limb Tension Test. Participants will be
      randomly allocated, into three groups (A, B, and C). On the contrary, patients with any
      orthopedic or neurological conditions of cervical spine and shoulder joint, malignancy,
      cervical surgeries and bilateral cervical radiculopathies will be excluded from the study.
      Baseline measurement of all groups will be taken by using Numerical Pain Rating Scale (NPRS)
      for pain, Cranio-cervical Flexion Test for endurance and Hand-Held Dynamometer for hand grip
      strength. Group A will receive 7 neural tension technique, Group B will receive neural
      sliding technique, while Group C will receive both neural tension technique and neural
      sliding technique for 4 weeks (6 successive sessions). Both techniques (slider and tensioner)
      will be provided three sets in every session; Each set will be performed in a slow,
      oscillatory manner with 10 seconds rest between the sets. Posttest measurement will be taken
      after 4 weeks of treatment. SPSS 21 software will be used for data entry and analysis.
    

Detailed description: 
      Cervical radiculopathy also known as "pinched nerve", is a neurological condition caused by
      compression of the cervical spine nerve and roots. It is basically a lower motor neuron and
      sensory demonstration of neurological dysfunction of the involved cervical nerve root.
      Cervical radiculopathy is most commonly caused by the herniation of the cervical spine
      intervertebral disc or any space-occupying lesion that may lead to nerve root inflammation or
      impingement. Other common causes of cervical radiculopathy are spondylosis, trauma,
      osteoporosis, cervical instability, and sometimes oncological issues. Such problems either
      directly compress the cervical nerve roots or narrow the space of the vertebral foramen from
      where the cervical nerve root emerges which leads to neuritis, hypoxia, ischemia, fibrosis,
      edema, or decreased nerve mobility. Cervical radiculopathy has an average annual incident
      rate of 83 per 100,000 of the population with an increased prevalence in the fourth and fifth
      decade of life.

      According to studies, the most commonly affected cervical nerve root is C7 followed by the C6
      and C8. The clinical manifestation of cervical radiculopathy is quite broad involving motor
      and sensory changes in the upper extremity. Patients with cervical radiculopathy usually
      experience loss of sensation, tingling, numbness, motor defects in the neck and sometimes in
      the scapula, and pain in the arm and hand along the pathway of the nerve depending upon the
      location of the affected nerve root. The pain can be radiated both bilaterally and
      unilaterally into the arms, however, the prevalence of bilateral cervical radiculopathy is
      only 5 - 36%.

      The symptoms of muscle weakness in the upper limb are often seen in patients with cervical
      radiculopathy. According to the principles of the kinetic chain, the upper limb is an
      integrated system consisting of different segments working together to accomplish the
      activities of daily living. In simpler words, the muscle weakness produced in any segment of
      the upper limb would result in generalized muscle weakness and ultimately decreased hand grip
      strength. To perform functional activities of daily living it is very important to maintain
      the grip strength of the upper extremity. But, to achieve the maximum grip strength the
      physical and physiological properties of nerve tissues need to be intact. Since reduced grip
      strength is often seen in patients with cervical radiculopathy, it becomes essential to
      administer an appropriate technique to rehabilitate its strength

      Manual therapy techniques are considered effective in the treatment of cervical
      radiculopathy. Neurodynamic mobilization has been considered effective as a conservative
      management approach for the treatment of upper quadrant pain. It restores homeostasis in and
      around the neural tissues by improving the mechanical and neurophysiological integrity of the
      peripheral nerves, thus reducing pain and disability. Slider and tensioner are the two most
      commonly used neural mobilization techniques and a biomechanical distinction can be made
      between these two techniques. Neural mobilization plays an important role in returning to
      normal functional activities by restoring the range of motion and extensibility of the
      nervous system

      Neurodynamic mobilization restores the neural tissues' ability to resist tension and stress
      by promoting the restoration of normal physiological function, decreasing pain, and improving
      function. The slider neurodynamic mobilization causes sliding movement in the neural tissue
      in correspondence to the nearby structures; distributing the compression and tension along
      the entire nervous instead of one particular region. On the other hand, tensioner
      neurodynamic mobilization causes tension in the neural tissue without surpassing the tissue
      elastic capacity that enhances nerve's viscoelastic properties. This procedure is done by
      taking the nerve, in the end, range of movement (elongated position), maintaining the
      position for a short duration, and then fully releasing the tension.

      A systematic review of a randomized control trial was done by Papacharalambous C et al. in
      2022 to evaluate the effectiveness of slider and tensioner neural mobilization techniques in
      the management of upper quadrant pain. The results of the study concluded that slider and
      tensioner neural mobilization techniques are quite effective in reducing pain in certain
      musculoskeletal conditions. Moreover, the results revealed that slider neural mobilization
      technique is more effective in the treatment of acute conditions than tensioner neural
      mobilization.

      A randomized clinical trial was conducted by Shou MK et al. in 2022, to determine the effects
      of neural slider and contralateral cervical lateral glide in athletes with cervicobrachial
      pain syndrome. Thirty patients were recruited in the study that were divided into groups. One
      group received neural slider technique whereas the other received contralateral cervical
      lateral glide. The results revealed that both techniques are effective in improving pain and
      functional disability. However, the contralateral cervical lateral glide is more effective
      than the neural mobilization technique for patients with cervicobrachial pain syndrome.

      Raval MM et al. conducted a comparative study in 2022 to determine the effect of neural
      sliding technique versus neural sliding technique on functional disability and pain in
      patients with cervical radiculopathy. A total of thirty patients were recruited for the study
      and later divided into two equal groups. Group A received neural tension mobilization while
      Group B received neural sliding mobilization. Outcome measure tools Numeric Pain Rating
      Scale, Neck Disability Index, and Patient Specific Functional Scale were used to access the
      patient before and after the treatment. The results of the study concluded that tensioner
      neurodynamic mobilization is more effective in reducing functional disability and pain than
      slider neurodynamic mobilization.
    

Intervention name(s): Neural Tension Technique(ulnar, median, radial); Neural Slider Technique (ulnar, median, radial); Neural Tension Technique and Neural Sliding Technique(ulnar, median, radial)
Intervention type(s): Other; Other; Other
Intervention description(s): Neural Tension Technique for 4 weeks (6 successive sessions). Three sets will be provided in every session; Each set will be performed in a slow, oscillatory manner with 10 seconds rest between the sets. Posttest measurement will be taken after 4 weeks of treatment; Neural Slider Technique for 4 weeks (6 successive sessions). Three sets will be provided in every session; Each set will be performed in a slow, oscillatory manner with 10 seconds rest between the sets. Posttest measurement will be taken after 4 weeks of treatment; Neural Tension and Sliding Technique for 4 weeks (6 successive sessions). Three sets will be provided in every session; Each set will be performed in a slow, oscillatory manner with 10 seconds rest between the sets. Posttest measurement will be taken after 4 weeks of treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Other
Keywords: Slider; Tensioner Neurodynamic Mobilization; Cervical Radiculopathy; Hand Grip Strength; Numeric Pain Rating Scale