Contralateral Neural Tissue Mobilization for Cervical Radiculopathy (NTM)

November 18, 2025 updated by: Evidence In Motion

Contralateral Neural Tissue Mobilization for Cervical Radiculopathy: An Exploratory Study

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.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

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:

This investigation uses a case-series design with pre- and post-intervention measures. A convenience sample will be recruited from four outpatient physical therapy clinics specializing in musculoskeletal pain. Clinicians participating in the study must have completed at least a 2-day (15-hour) post-professional training course in pain science and assessment of peripheral neuropathic pain, including instruction in NTM.

A total of approximately 40 patients aged 18 years or older will be recruited over a 3-month period. Eligible individuals must demonstrate unilateral arm pain in a dermatomal distribution consistent with CR, with or without neck pain. Exclusion criteria include bilateral upper-extremity pain, non-dermatomal pain, contraindications to NTM on the contralateral limb (e.g., recent surgery, significant tissue injury, allodynia), inability to read English, or unwillingness to consent.

Procedures and Outcome Measures:

After obtaining written informed consent, participants will complete baseline (pre-intervention) measures including:

Demographic questionnaire (non-identifiable data only)

Numeric Pain Rating Scale (NPRS) for upper-extremity pain

Neck Disability Index (NDI)

Fear-Avoidance Beliefs Questionnaire - Physical Activity subscale (FABQ-PA)

Pain drawing, quantified using a standardized grid overlay

Upper Limb Neurodynamic Test 1a (ULNT1a) of the affected limb, including goniometric measurement of elbow extension at symptom onset

Following baseline measures, each participant will receive a single treatment session of contralateral NTM, performed on the limb opposite the symptomatic side. The intervention consists of 8-10 minutes of standardized passive neurodynamic mobilizations in supine with specific variations in cervical positioning, followed by active "slider" and "tensioner" exercises in sitting.

Immediately after the intervention, participants will repeat all outcome measures (NPRS, FABQ-PA, pain drawing, and ULNT1a). After data collection is complete, clinical care will proceed according to the treating clinician's usual practice and will not be influenced by study procedures.

Data Handling and Analysis:

All data packets will be de-identified and coded by clinic and clinician. Data will be transferred to a secure electronic spreadsheet for analysis. Descriptive statistics (means, standard deviations, frequencies, and percentages) will summarize demographic variables and baseline characteristics. Pre- to post-intervention changes will be evaluated using paired t-tests with statistical significance set at p < 0.05.

Purpose of the Study:

The purpose of this exploratory case series is to determine whether contralateral neural tissue mobilization produces immediate changes in pain intensity, disability, fear-avoidance beliefs, pain distribution, and neurodynamic mechanosensitivity among individuals presenting with clinical features of cervical radiculopathy. Findings may inform future research and contribute to clinical understanding of whether contralateral NTM is a viable treatment option in patients unable to tolerate direct treatment of the symptomatic extremity

Study Type

Interventional

Enrollment (Estimated)

40

Phase

  • Not Applicable

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • 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
  • New patient to the clinic or established patient who meets inclusion criteria and has not previously received neural tissue mobilization as part of treatment

Exclusion Criteria:

  • 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

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Contralateral Neural Tissue Mobilization
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)

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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Numeric Pain Rating Scale (NPRS)
Time Frame: Pre-intervention to immediately post-intervention (same session).
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
Time Frame: Pre-intervention to immediately post-intervention (same session).
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 Outcome Measures

Outcome Measure
Measure Description
Time Frame
Neck Disability Index (NDI)
Time Frame: Pre-intervention to immediately post-intervention (same session).
Change in self-reported neck-related disability using the 10-item Neck Disability Index, scored from 0 to 50 and converted to a percentage (0-100%), with higher scores indicating greater disability.
Pre-intervention to immediately post-intervention (same session).
Fear-Avoidance Beliefs Questionnaire - Physical Activity Subscale (FABQ-PA)
Time Frame: Pre-intervention to immediately post-intervention (same session).
Change in fear-avoidance beliefs related to physical activity, assessed using the 4-item FABQ-PA (scores range from 0 to 24; higher scores indicate greater fear of physical activity).
Pre-intervention to immediately post-intervention (same session).
Pain Drawing Area (Body Chart Grid Count)
Time Frame: Pre-intervention to immediately post-intervention (same session).
Change in pain distribution quantified using a standardized body chart with an overlay grid. The number of grid blocks marked by the participant represents pain extent.
Pre-intervention to immediately post-intervention (same session).

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Evidence In Motion

Collaborators

Rockhurst University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

December 1, 2025

Primary Completion (Estimated)

August 1, 2026

Study Completion (Estimated)

September 1, 2026

Study Registration Dates

First Submitted

November 18, 2025

First Submitted That Met QC Criteria

November 18, 2025

First Posted (Actual)

November 25, 2025

Study Record Updates

Last Update Posted (Actual)

November 25, 2025

Last Update Submitted That Met QC Criteria

November 18, 2025

Last Verified

November 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • ContralateralNTM2025

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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