Abstract
BackgroundNeck pain is a common musculoskeletal complaint and is often associated with shoulder or arm pain. There is a paucity of information on effective treatment for neck and arm pain, such as radiculopathy or cervico-brachial pain. Guidelines recommend neck mobilisation/ manipulation, exercises and advice as the treatment for neck pain, and neck and arm pain. There are a few studies that have used neural mobilisation as the treatment for cervico-brachial pain. Although results seem promising the studies have small sample sizes that make it difficult to draw definite conclusions.MethodsA randomised controlled trial will be used to establish the effect of neural mobilisation on the pain, function and quality of life of patients with cervico-brachial pain. Patients will be recruited in four physiotherapy private practices and randomly assigned to usual care or usual care plus neural mobilisation.DiscussionIn clinical practice neural mobilisations is commonly used for cervico-brachial pain. Although study outcomes seem promising, most studies have small participant numbers. Targeting the neural structures as part of the management plan for a subgroup of patients with nerve mechano-sensitivity seems feasible. Patients with neuropathic pain and psychosocial risk factors such as catastrophising, respond poorly to treatment. Although a recent study found these patients less likely to respond to neural mobilisation, the current study will be able to assess whether neural mobilisation has any added benefit compared to usual care. The study will contribute to the knowledge base of treatment of patients with cervico-brachial pain. The findings of the study will be published in an appropriate journal.Trial registrationTrial registration Number: PACTR201303000500157.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-419) contains supplementary material, which is available to authorized users.
Highlights
Neck pain is a common musculoskeletal complaint and is often associated with shoulder or arm pain
Neck pain is one of the most common debilitating musculoskeletal complaints seen in physiotherapy practice [1,2,3]
The questionnaire is recommended for use in the South African Guidelines for management of neuropathic pain [53]
Summary
Pilot study Four physiotherapists in private practice (including the researcher) will be the treating physiotherapists. The training workshop will consist of: training of the application of neural mobilisation along the course of the nerve, protocol for treatment groups, outcomes measures, baseline measures as well as patient screening. Neural conduction tests of sensation, muscle power and reflexes will be done according to Petty & Moore [58] at six and 12 months They will be asked to complete a demographic questionnaire on age, gender, duration of symptoms, previous neck pain, injury or insidious onset, education, occupation, sport, presence of headache or dizziness and indicate the area of pain on a body chart. This research assistant will give a patient number sequentially and treatment (group) allocation to participating physiotherapists after all baseline measurements has been done. Two treatment groups will be compared with respect to the change from baseline at six weeks in the NPRS, PSFS and EQ-5D scores using an analysis of covariance (ANCOVA) with baseline scores, catastrophising (yes & no) and neuropathic pain (yes & no) as covariates. For all data description and analyses an intention-to-treat analysis will be performed
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