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.