Hypoalgesic Effect of Neural Mobilization

Study Overview
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Brief Summary
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The purpose of these study is to compare the effectivity of the Cervical Lateral Glide physical therapy neural mobilization technique to the complete absence of treatment in a group of patients who suffer cervicobrachial pain.

Detailed Description
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The Cervical Lateral Glide (CLG) is a neural tissue mobilization technique capable of achieving a hypoalgesic effect during the onset of cervicobrachial pain symptoms. This happens through a series of complex physiologic interactions which are not fully understood. The CLG Physical therapy technique consists of controlled movements of the cervical and brachial plexus neural tissue. Hypoalgesic effect produced by CLG is associated to an increase in neural tissue mobility, edema, inflammation and intraneural pressure reduction, without any known side effects when applied properly, except for a momentary worsening of symptoms (the only known side effect of CLG), which is an important contrast to the wide and sometimes severe spectrum of side effects derived from drug therapy used to treat cervicobrachial pain. It is believed that the hypoalgesic effect offered by neural tissue mobilization is a consequence of descending nervous system pain modulation activity and an improvement in the distinct biomechanical properties of the involved neural tissue.Despite the increase in scientific interest in evidence based options to treat pain and neural tissue mobilization techniques there is a current lack of enough controlled double blind clinical trials that measure the effectiveness of neural tissue mobilization techniques such as the CLG and its specific effect over cervicobrachial pain. For this reason the present investigation consisted in the application of a treatment protocol based on CLG neural tissue mobilization in a controlled double blind clinical trial with the aim to assess its clinical effectiveness in treating pain symptoms

Official Title
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Hypoalgesic Effect of Neural Mobilization in Cervicobrachial Pain Compared to a Controlled Group

Conditions
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Cervicobrachial Neuralgia

Intervention / Treatment
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* Procedure: Cervical Lateral Glide neural mobilization


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Clinical diagnosis of cervicobrachial pain confirmed by magnetic resonance imaging Presence of unilateral symptoms of arm pain, paresthesia or numbness in the upper extremity during at least 3 continuous months previous to the application of treatment. Positive results in all of the following tests: Spurling, Distraction, and Upper Limb Exclusion Criteria: Contraindication in the use of nonsteroidal anti inflammatory drugs (NSAIDs) The use of any type of treatment, therapy, procedure or drug to relieve pain Patients who are under anticonvulsant, antidepressant or psychotropic medication Vertebral instability Vertebral osteoporosis Vertebral or spine infection. Neurologic diseases of genetic, infectious or neoplastic origin Cervical stenosis myelopathy Pregnancy Kinesiophobia Endocrine disorders and menopause History of spine surgery Intellectual disability, severe mental illness, intoxication, severe sleep deprivation, Alzheimer's disease.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cervical Lateral Glide<br>15 minutes Cervical Lateral Glide neural mobilization 5 times a week During 6 weeks Patient's adequate cervical spine linear alignment was determined through the baseline use of a Universal Goniometer Device in each application of Cervical Lateral Glide neural mobilization. | Procedure: Cervical Lateral Glide neural mobilization<br>* Non-surgical non-invasive Cervical Lateral Glide neural mobilization procedure was applied by a physical therapist continuously during 2 minutes in 5 different occasions with 1 minute of rest between each 2 minute application of the Neural Mobilization technique. The intervention was applied during a period of 6 weeks. The correct linear alignment of patient's cervical spine was determined through the baseline use of a Universal Goniometer Device in each application of Cervical Lateral Glide neural mobilization.<br>* Other names: Cervical Lateral Glide Neurodynamics;|
| No Intervention: Waiting list control group<br>- Patients assigned to a 6 week waiting list to receive treatment | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline using the Numeric Rating Scale for Pain at 1 hour | the Numeric Rating scale for Pain (NRS) is an 11 point scale for patient self reporting of pain in which 0 points represents the total absence of pain and 10 points the worst state of pain, it was employed to evaluate the presence and relieve of cervicobrachial pain symptoms. | at baseline for both arms and 1 hour after the application of treatment only in the experimental arm, corresponding to intervention days 1, 15 and 30 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline of the Physical function involving the affected upper limb using the Quik DASH Scale | The disabilities of the arm quick test (Quick DASH) is a self report short questionnaire designed to measure physical function and symptoms in people with any or several musculoskeletal disorders of the upper limb. | at baseline, corresponding to intervention days 1 and 30 of treatment | 
| Cervical Rotation Range of Motion (CROM) | Cervical rotation was assessed in units of rotation degrees, using the cervical range-of-motion device (CROM). | at baseline for both arms and 1 hour after the application of treatment only in the experimental arm, corresponding to intervention days 1 and 30 |