Contralateral Neural Tissue Mobilization for Cervical Radiculopathy

NCT07248943 | Not Yet Recruiting

• 1 other identifier: ContralateralNTM2025
• Study Type: interventional
• Target: 40
• Locations: 0 countries
• Sites: N/A

Brief Summary

Cervical radiculopathy (CR) is a common form of peripheral neuropathic pain characterized by neck and upper extremity symptoms in a dermatomal distribution. Neural tissue mobilization (NTM) is an intervention shown to provide benefit for neuropathic pain presentations; however, some patients are unable to tolerate direct treatment of the symptomatic limb due to allodynia, hyperalgesia, or fear of movement. Early evidence from lower-extremity research suggests that contralateral NTM may produce therapeutic effects similar to ipsilateral treatment, but this approach has not been investigated in individuals with upper-extremity symptoms. This exploratory case series aims to examine the immediate effects of contralateral NTM in adults presenting to outpatient physical therapy with CR. Participants will undergo pre- and post-treatment assessments of pain intensity, disability, fear-avoidance beliefs, pain distribution, and neurodynamic mechanosensitivity. Findings will provide preliminary evidence regarding whether contralateral NTM may serve as a viable treatment option when direct symptomatic limb treatment is not tolerated.

Conditions

Cervical Radiculopathy; Pain; Neuropathic Pain; Radicular Pain

Keywords

Cervical Radiculopathy; Neuropathic Pain; Peripheral Neuropathic Pain; Upper Extremity Pain; Radicular Pain; Cervical Spine Disorders; Nerve Root Compression; Neural Tissue Mobilization; Neurodynamic Mobilization; Neurodynamics; Contralateral Treatment; Median Nerve Mobilization; Upper Limb Neurodynamic Test (ULNT1a); Physical Therapy; Musculoskeletal Pain; Pain Phenotyping; Manual Therapy; Rehabilitation; Mechanosensitivity

Outcome Measures

Primary Outcomes (2)

• Numeric Pain Rating Scale (NPRS)

  Change in patient-reported upper-extremity pain intensity measured using the 0-10 Numeric Pain Rating Scale, where 0 = no pain and 10 = worst imaginable pain. The NPRS is commonly used in musculoskeletal research to quantify pain severity.

  Pre-intervention to immediately post-intervention (same session).

• Upper Limb Neurodynamic Test 1a (ULNT1a) - Elbow Extension Range

  Change in degrees of elbow extension measured with a goniometer at the onset of symptoms during ULNT1a testing of the affected limb. The test assesses neurodynamic mechanosensitivity related to the median nerve.

  Pre-intervention to immediately post-intervention (same session).

Secondary Outcomes (3)

• Neck Disability Index (NDI)

  Pre-intervention to immediately post-intervention (same session).

• Fear-Avoidance Beliefs Questionnaire - Physical Activity Subscale (FABQ-PA)

  Pre-intervention to immediately post-intervention (same session).

• Pain Drawing Area (Body Chart Grid Count)

  Pre-intervention to immediately post-intervention (same session).

Study Arms (1)

Contralateral Neural Tissue Mobilization

EXPERIMENTAL

Participants with unilateral cervical radiculopathy will receive a single treatment session of neural tissue mobilization applied to the contralateral (uninvolved) upper extremity. The intervention is delivered by licensed physical therapists with post-professional training in pain science and neurodynamic techniques.

Behavioral: Contralateral Neural Tissue Mobilization (NTM)

Interventions

Contralateral Neural Tissue Mobilization (NTM) BEHAVIORAL

A standardized 8-10 minute contralateral NTM protocol will be performed and includes: 1. Supine passive neurodynamic mobilization (ULNT1a pattern) with: * Cervical side flexion toward the non-symptomatic side * Movement to the point of resistance * 1-2 seconds of gentle engagement followed by release * Repeated 15 times 2. Supine passive neurodynamic mobilization with: * Neutral cervical position * Repeated 15 times 3. Supine passive neurodynamic mobilization with: * Cervical side flexion away from the non-symptomatic side * Repeated 15 times 4. Sitting active neurodynamic exercises (contralateral UE) * 10 active "sliders" * 10 active "tensioners" * 10 additional active "sliders" The neurodynamic pattern follows the ULNT1a sequence: shoulder abduction to 90°, external rotation, forearm supination, wrist/finger extension with ulnar deviation, and progressive elbow extension. Single treatment session delivered in-person by a trained physical therapist.

Contralateral Neural Tissue Mobilization

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age 18 years or older Presence of unilateral upper-extremity pain in a dermatomal distribution consistent with cervical radiculopathy (with or without neck pain)
• Able to read and understand English
• Willing and able to provide written informed consent

You may not qualify if:

• Bilateral upper-extremity pain
• Upper-extremity pain that is non-dermatomal in distribution
• Presence of contraindications or precautions preventing use of the contralateral limb for neural tissue mobilization (e.g., injury, allodynia, recent surgery, postsurgical complications)
• Not willing to participate in the study

Sponsors & Collaborators

• Evidence In Motion: lead
• Rockhurst University: collaborator

Related Publications (18)

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  BACKGROUND

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• Schmid AB, Nee RJ, Coppieters MW. Reappraising entrapment neuropathies--mechanisms, diagnosis and management. Man Ther. 2013 Dec;18(6):449-57. doi: 10.1016/j.math.2013.07.006. Epub 2013 Sep 2.

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  PMID: 32766466 BACKGROUND

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• Cook, CE, DI Rhon, J Bialosky, M Donaldson, SZ George, T Hall, G Kawchuk, et al. 2023. "Developing Manual Therapy Frameworks for Dedicated Pain Mechanisms." Journal of Orthopaedic & Sports Physical Therapy (JOSPT) 1 (1): 48-62.

  BACKGROUND

• Nijs J, Kosek E, Chiarotto A, Cook C, Danneels LA, Fernandez-de-Las-Penas C, Hodges PW, Koes B, Louw A, Ostelo R, Scholten-Peeters GGM, Sterling M, Alkassabi O, Alsobayel H, Beales D, Bilika P, Clark JR, De Baets L, Demoulin C, de Zoete RMJ, Elma O, Gutke A, Hanafi R, Hotz Boendermaker S, Huysmans E, Kapreli E, Lundberg M, Malfliet A, Meziat Filho N, Reis FJJ, Voogt L, Zimney K, Smeets R, Morlion B, de Vlam K, George SZ. Nociceptive, neuropathic, or nociplastic low back pain? The low back pain phenotyping (BACPAP) consortium's international and multidisciplinary consensus recommendations. Lancet Rheumatol. 2024 Mar;6(3):e178-e188. doi: 10.1016/S2665-9913(23)00324-7. Epub 2024 Feb 1.

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  PMID: 39964488 BACKGROUND

MeSH Terms

Conditions

Radiculopathy; Pain; Neuralgia; Musculoskeletal Pain

Condition Hierarchy (Ancestors)

Peripheral Nervous System Diseases; Neuromuscular Diseases; Nervous System Diseases; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Muscular Diseases; Musculoskeletal Diseases

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Participants with unilateral cervical radiculopathy will receive a single treatment session of neural tissue mobilization applied to the contralateral (uninvolved) upper extremity. The intervention is delivered by licensed physical therapists with post-professional training in pain science and neurodynamic techniques.

Study Record Dates

• First Submitted: November 18, 2025
• First Posted: November 25, 2025
• Study Start: December 1, 2025
• Primary Completion (Estimated): August 1, 2026
• Study Completion (Estimated): September 1, 2026
• Last Updated: November 25, 2025

Record last verified: 2025-11

Data Sharing

• IPD Sharing: Will not share