Efficacy Of Gross Myofascial Release With Neural Mobilization Versus Neural Mobilization Alone On Pain, Functional Limitations, And Cervical Range Of Motion In Cervical Radiculopathy

This is a randomized control trial aims to evaluate the efficacy of gross myofascial release with neural mobilization versus neural mobilization alone on pain, functional limitations, and cervical range of motion in cervical radiculopathy. Cervical radiculopathy, is characterized by neck pain, pain radiating down the arm, numbness, tingling, weakness of muscles and functionality limitations with compression or irritation of the cervical nerve root due to cervical spondylosis, cervical disc herniations or degeneration of the cervical spine leading to cervical radiculopathy and the diminished quality of life from decreased day-to-day functional capacity and productivity at work. The study will evaluate pain, functional limitations, and cervical range of motion.

Study Overview

• Status: Recruiting
• Conditions: Cervical Radiculopathy
• Intervention / Treatment: Other: Gross Myofascial Release + Neural Mobilization; Other: Neural Mobilization

• Study Type: Interventional
• Enrollment (Estimated): 44
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: komal hameed, MSPT; Phone Number: +923315798880; Email: komal.hamees4455@gmail.com
• Study Contact Backup: Name: Salma Bibi, DPT, MS OMPT; Phone Number: +923417312210; Email: salma.bibi@uipt.iiui.edu.pk

Study Locations

• Pakistan
  • KPK
    • Peshawar, KPK, Pakistan
      • Recruiting
      • My Health Wellness center, Peshawar
      • Contact: Dr. Naeem ullah (PT), DPT, MS PT MSK; Phone Number: +923308088558; Email: naeemphysio58@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Male and female patients aged between 25-55 years
• Presence of chronic neck pain radiating to one upper limb
• Positive Upper Limb Tension Test-I (Median nerve)
• Patients having pain, numbness, tingling, or paresthesia in the cervical nerve root distribution.
• Symptom's duration of at least 4 weeks

Exclusion Criteria:

• Patients with cervical myelopathy
• History of cervical spine fracture, tumor, infection, or malignancy
• Previous cervical spine surgery
• Severe osteoporosis or inflammatory joint disease
• Presence of systemic neurological disorders such as multiple sclerosis or stroke
• Patients with severe cervical instability or vertebral artery insufficiency
• Recent physiotherapy treatment for cervical radiculopathy within the last 3 months

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Gross Myofascial Release + Neural Mobilization; Participants in this group will receive Gross Myofascial Release followed by median nerve neural mobilization. The GMFR intervention will include a gross stretch of the posterior cervical musculature and an upper-quarter (arm pull) fascial stretch. The stretch will be maintained for 90 seconds or until a palpable release of fascial tension is appreciated. Neural mobilization will be performed using the median nerve slider technique. Neural mobilization will be performed by simultaneously moving the shoulder into greater abduction while the cervical spine is moved into contralateral side flexion to facilitate median nerve sliding(1 set of 10 repetitions with a 3-second hold per repetition). Each treatment session will also include a 10-minute hot pack before treatment and 10 minutes of TENS after treatment. The total session duration will be approximately 40 minutes, administered 3 sessions per week on alternate days for 4 weeks (12 sessions).	Other: Gross Myofascial Release + Neural Mobilization; Participants allocated to the experimental group will receive Gross Myofascial Release (GMFR) followed by median nerve neural mobilization. The GMFR intervention will include a gross stretch of the posterior cervical musculature and an upper-quarter (arm pull) fascial stretch. The stretch will be maintained for 90 seconds or until a palpable release of fascial tension is appreciated. Neural mobilization will be performed using the median nerve slider technique.. Neural mobilization will be performed by simultaneously moving the shoulder into greater abduction while the cervical spine is moved into contralateral side flexion to facilitate median nerve sliding(1 set of 10 repetitions with a 3-second hold per repetition). Each treatment session will also include a 10-minute hot pack before treatment and 10 minutes of TENS after treatment. The total session duration will be approximately 40 minutes, administered 3 sessions per week on alternate days for 4 weeks (12 sessions).
Active Comparator: Neural Mobilization with conventional therapy; Participants allocated to the control group will receive neural mobilization technique. The intervention will be performed with the participant in the supine position, with the shoulder abducted and externally rotated, elbow extended, forearm supinated, and wrist, fingers, and thumb maintained in extension. Neural mobilization will be applied by simultaneously increasing shoulder abduction while moving the cervical spine into contralateral side flexion to facilitate median nerve sliding. Each treatment session will also include a 10-minute hot pack before treatment and 10 minutes of TENS after treatment. The treatment will be administered in 3 sets of 10 repetitions, with each repetition held for 3 seconds and a 60-second rest interval between sets, The total session duration will be approximately 40 minutes, administered 3 sessions per week on alternate days for 4 weeks (12 sessions).	Other: Neural Mobilization; Participants allocated to the control group will receive neural mobilization technique. The intervention will be performed with the participant in the supine position, with the shoulder abducted and externally rotated, elbow extended, forearm supinated, and wrist, fingers, and thumb maintained in extension. Neural mobilization will be applied by simultaneously increasing shoulder abduction while moving the cervical spine into contralateral side flexion to facilitate median nerve sliding. Each treatment session will also include a 10-minute hot pack before treatment and 10 minutes of TENS after treatment. The treatment will be administered in 3 sets of 10 repetitions, with each repetition held for 3 seconds and a 60-second rest interval between sets, The total session duration will be approximately 40 minutes, administered 3 sessions per week on alternate days for 4 weeks (12 sessions).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Universal Goniometer	The Universal Goniometer (UG) will used in this study to measure active cervical range of motion (ROM), is a simple, inexpensive, and portable clinical instrument that provides objective measurements of joint movement in degrees. Cervical range of motion is recorded in degrees (°) for each movement direction. Lower ROM values indicate greater movement restriction and functional impairment, whereas higher values reflect improved cervical mobility.	Baseline to 4th week
Neck Disability Index (NDI)	The Neck Disability Index (NDI) will used in this study to evaluate the level of functional disability associated with cervical radiculopathy. The NDI is one of the most widely accepted patient-reported outcome measures for assessing the impact of neck pain on daily functioning. The questionnaire consists of 10 items, including pain intensity, personal care, lifting, reading, headaches, concentration, work, driving, sleeping, and recreational activities. Each item is scored from 0 to 5, The total NDI score ranges from 0 to 50, with higher scores representing greater functional disability. For clinical interpretation, scores are commonly classified as follows: 0-4 (no disability), 5-14 (mild disability), 15-24 (moderate disability), 25-34 (severe disability), and 35-50 (complete disability). A reduction in the total score following treatment indicates an improvement in functional status and a decreased impact of neck pain on daily activities.	Baseline to 4th week
Visual Analogue Scale	The intensity of the pain will be measured with the help of the Visual Analogue Scale (VAS). The VAS is a 10-cm horizontal line with two opposite endpoints marked with the following words: "no pain" at one end and "worst imaginable pain" at the other. The patient will then mark a point on the line that they feel most accurately reflects their current pain. The distance in centimeters or millimeters between the "no pain" point and the patient's mark will be taken as the measure of the patient's pain.	Baseline to 4th week
Magnetic Resonance Imaging (MRI)	Magnetic Resonance Imaging (MRI) of the cervical spine was used in this study to confirm the diagnosis cervical radiculopathy before participant enrollment. It enables accurate identification of disc herniation, foraminal stenosis, nerve root compression, and other degenerative changes associated with cervical radiculopathy.	Baseline to 4th week

Collaborators and Investigators

• Sponsor: Ibadat International University, Islamabad
• Investigators: Study Chair: salma bibi, Ibadat International University, Islamabad

Publications and helpful links

General Publications

• Agarwal, V., Goel, A., Srivastava, A., Rawat, P., & Singh, R. (2024). Optimizing Pain Relief and Range of Motion in Unilateral Cervical Radiculopathy: A Study on Neural Tissue Mobilization and Cervical Stabilization Exercises. Cureus, 16(7), e65646. doi:10.7759/cureus.65646 Borrella-Andrés, S., Marqués-García, I., Lucha-López, M. O., Fanlo-Mazas, P., Hernández-Secorún, M., Pérez-Bellmunt, A., . . . Hidalgo-García, C. (2021). Manual Therapy as a Management of Cervical Radiculopathy: A Systematic Review. Biomed Res Int, 2021, 9936981. doi:10.1155/2021/9936981 Butler, D. S. (2005). The neurodynamic techniques: a definitive guide from the Noigroup team: Noigroup publications. Gauns, S. V., & Gurudut, P. V. (2018). A randomized controlled trial to study the effect of gross myofascial release on mechanical neck pain referred to upper limb. International journal of health sciences, 12(5), 51. Kuligowski, T., Skrzek, A., & Cieślik, B. (2021). Manual Therapy in Cervical and Lumbar Radiculopathy: A Systematic Review of the Literature. Int J Environ Res Public Health, 18(11). doi:10.3390/ijerph18116176 Lopez-Pardo, M. J., Calvache-Mateo, A., Martin-Nunez, J., Heredia-Ciuro, A., Lopez-Lopez, L., Valenza, M. C., & Cabrera-Martos, I. (2024). Routine physical therapy with and without neural mobilization in chronic musculoskeletal neck disorders with nerve-related symptoms: Systematic review and meta-analysis. Paper presented at the Healthcare. Lutke Schipholt, I. J., Scholten-Peeters, G. G. M., Logghe, S., Koop, M., Donders, S., Stenneberg, M. S., & Coppieters, M. W. (2024). The CROM-VAS Test: A novel and reliable clinical test to assess immediate pain relief following treatment for movement-evoked neck pain. Musculoskeletal Science and Practice, 74, 103191. doi:https://doi.org/10.1016/j.msksp.2024.103191 Mahmoud, L., Aly, S., & Abd Alhamid, H. M. M. (2025). Gross myofascial release on pain and function in cervical radiculopathy: a randomised controlled study. Human Movement, 26,

Study record dates

Study Major Dates

• Study Start (Actual): July 10, 2026
• Primary Completion (Estimated): November 15, 2026
• Study Completion (Estimated): November 30, 2026

Study Registration Dates

• First Submitted: August 28, 2026
• First Submitted That Met QC Criteria: September 7, 2026
• First Posted (Actual): September 8, 2026

Study Record Updates

• Last Update Posted (Actual): September 8, 2026
• Last Update Submitted That Met QC Criteria: September 7, 2026
• Last Verified: September 1, 2026

More Information

Terms related to this study

• Keywords: gross myofascial release, neural mobilization,
• Additional Relevant MeSH Terms: Nervous System Diseases; Neuromuscular Diseases; Peripheral Nervous System Diseases; Radiculopathy
• Other Study ID Numbers: IIUI/RERC/ADT/2026/07/371

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