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

Question: What are the benefits and harms of neural tissue management in the short term for treating nerve-related neck and arm pain? Design: Randomised controlled trial. Participants: Sixty participants with non-traumatic nerve-related neck and unilateral arm pain were randomised to experimental (n = 40) or control (n = 20) groups. Intervention: Both groups were advised to continue usual activities. The experimental group also received education, manual therapy, and nerve gliding exercises in 4 treatments over 2 weeks. Outcome measures: Primary outcomes were participant-reported improvement and worsening on a Global Rating of Change scale. Secondary outcomes were neck pain, arm pain, the Neck Disability Index, the Patient-Specific Functional Scale, and adverse events related to treatment. Follow-up occurred 3-4 weeks after baseline. Results: Numbers needed to treat favoured the experimental intervention for participant-reported improvement (2.7, 95% CI 1.7 to 6.5), neck pain (3.6, 95% CI 2.1 to 10), arm pain (3.6, 95% CI 2.1 to 10), Neck Disability Index (4.3, 95% CI 2.4 to 18.2), and Patient-Specific Functional Scale (3.0, 95% CI 1.9 to 6.7). The prevalence of worsening in the experimental (13%) and control (20%) groups were not different (RD -7%, 95% CI -28 to 13). Adverse events had minimal impact on daily activities and did not reduce the chance of improving with the experimental intervention (RR = 1.03, 95% CI 0.58 to 1.84). Conclusion: 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. Trial registration: ACTRN 12610000446066. © 2012 Australian Physiotherapy Association.