Neural tissue management provides immediate clinically relevant benefits without harmful effects for patients with nerve-related neck and arm pain: a randomised trial

Om hvordan manipulering av vevet rundt nerver gir en umiddelbar bedring av nakkesmerter med utstårling ut armen.

These results enable physiotherapists to inform patients that neural tissue management provides immediate clinically relevant benefits beyond advice to remain active with no evidence of harmful effects.

One month prevalence rates for activity-limiting neck pain range from 7.5% to 14.5% in the general population (Hogg-Johnson et al 2008, Webb et al 2003). Neck pain spreading down the arm is more common than neck pain alone and is associated with higher levels of self-reported disability (Daffner et al 2003). One mechanism for neck pain spreading down the arm is the sensitisation of neural tissues (Bogduk 2009).

Neural tissue management was based on principles proposed by Elvey (1986) and Butler (2000). Along with advice to continue their usual activities, participants assigned to the experimental group received an educational component, manual therapy techniques, and a home program of nerve gliding exercises. The educational component attempted to reduce unnecessary apprehension participants may have had about neural tissue management (Butler 2000). The manual therapy techniques and nerve gliding exercises have been advocated for reducing nerve mechanosensitivity (Butler 2000, Coppieters and Butler 2008, Elvey 1986).

The educational component emphasised two points. First, examination findings suggested that participants’ symptoms were at least partly related to nerves in the neck and arm that had become overly sensitive to movement. Second, neural tissue management techniques would move the nerves in a gentle and pain-free manner, aiming to reduce this sensitivity. The manual therapy techniques included a contralateral cervical lateral glide and a shoulder girdle oscillation combined with active craniocervical flexion to elongate the posterior cervical spine (Elvey 1986). The home program of nerve gliding exercises involved a ‘sliding’ and a ‘tensioning’ technique for the median nerve and cervical nerve roots (Coppieters and Butler 2008).

There was no evidence to suggest that neural tissue management was harmful. ‘Worst case’ intention-to- treat and ‘complete case’ analyses showed no difference in the prevalence of worsening between groups (Table 2).

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