Contralateral Neural Tissue Mobilization for Cervical Radiculopathy: An Exploratory Study

Background and Rationale:

Pain phenotyping has emerged as an important clinical framework within physical therapy, enabling classification of pain presentations on the basis of pain mechanisms, clinical features, and patient-reported symptoms. Current pain phenotyping models identify three primary mechanisms: nociceptive, peripheral neuropathic, and nociplastic pain. Peripheral neuropathic pain is estimated to account for approximately one-quarter of patients presenting to outpatient physical therapy. It is characterized by pain arising from a lesion or disease of the somatosensory nervous system, with complex underlying biological mechanisms including neurogenic inflammation, immune dysregulation, demyelination, axonal loss, ion channel changes, and vascular alterations. Clinically, peripheral neuropathic pain commonly presents with pain in dermatomal or cutaneous nerve distributions, a history of nerve injury or mechanical compromise, and symptom provocation during neurodynamic or palpatory testing.

Cervical radiculopathy (CR) is a frequent and well-recognized form of peripheral neuropathic pain. CR most often results from intervertebral disc herniation or spondylosis, typically affecting the C7, C6, and C8 nerve roots. Patients commonly present with neck pain, upper extremity pain, and/or sensory, motor, or reflex deficits. Current evidence suggests that when patient presentation aligns with a peripheral neuropathic phenotype, interventions should be matched accordingly. Neural tissue mobilization (NTM) has demonstrated effectiveness in individuals with chronic neck and arm pain and is believed to exert beneficial effects through improvements in neuromeningeal mobility, blood flow, intraneural and extraneural fluid dynamics, inflammatory modulation, and graded exposure to movement.

However, some patients with CR present with significant allodynia, hyperalgesia, or fear of movement, making direct treatment of the symptomatic extremity challenging. Basic neuroanatomy and preliminary research suggest that contralateral NTM may produce therapeutic effects similar to ipsilateral NTM. Although early work in the lower extremity-including one clinical trial and one case study-has shown that contralateral NTM can reduce pain related to lumbar radiculopathy, this concept has not yet been explored in the upper extremity. Therefore, this exploratory study seeks to examine whether contralateral NTM produces immediate positive effects in patients presenting to physical therapy with CR.

Study Design: