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I went on a mission to look for an article to assist me with patients that have neck pain, radicular symptoms into the arms, and hypersensitivity to touch.  The greatest obstacle to overcome would be the nerve pain and hypersensitivity.  Patients can get flared up with certain movements of the neck or pressure at the wrong areas.  Sometimes it is tough to manage symptoms if you cannot get your hands on the affected side when the symptoms are at their most extreme.  So then what can you do to calm down the nerves while still working on the origin of the problem?

The article I came across assessed effects of using a contralateral lateral glide to the unaffected side of the problem cervical vertebrae.  This allows you to improve the mobility of the affected joint/s by working on the unaffected side while avoiding a flare up.  The researchers used Grade 2 and 3 mobilizations to the unaffected side of the problem vertebrae for an average total time of 4.5 minutes.  They also placed the arm in a progressively abducted position to tension the nerve if the subject could tolerate the position.  I would combine this treatment technique with soft tissue massage to the affected upper extremity and light compression of the radiocarpal, humeroulnar, and glenohumeral joints to implement aspects of the gate theory. (Joint compression has been shown to create a calming effect on the body.)

(Click the link below for access to the article)

The Immediate Effects of a Cervical Lateral Glide Treament Technique in Patients with Neurogenic Cervicobrachial Pain

Purpose: To analyze the immediate treatment effects of cervical mobilization and therapeutic ultrasound in patients with neurogenic cervicobrachial pain.

Methods: This was a randomized controlled trial.  Inclusion criteria consisted of individuals that had an active movement dysfunction related to noncompliance of the median nerve (active neurotensioning causing pain), a passive movement dysfunction correlating with the active dysfunction (passive neurotensioning causing pain), an adverse response to median nerve palpation, a positive Upper Limb Tension Test A, and a sign of a local musculoskeletal dysfunction that would indicate a possible cause of the neurogenic disorder.  The researchers compared subjects treated with cervical mobilizations to subjects treated with ultrasound to affected upper extremity.  The subjects received cervical segmental contralateral lateral glide at one or more cervical spine segments (C5-T1) in supine for an average of 4.5 minutes at Grade 2 initially and eventually Grade 3.  The tester placed pressure for 2-3 seconds/repetition during the mobilization.  They made sure to avoid cervical side flexion or rotation during the mobilization.  The subject was placed in a nerve tensioning position (shoulder abduction) during the mobilizations if they can tolerate it and if not the upper extremity was placed on the abdomen.

Results: They found significant improvements with elbow range of motion (average increase of ~19.4 degrees), area of symptom provocation (average reduction of ~43.3%), and pain intensity (average reduction of ~1.5 points).  Pain intensity was measured using the Visual Analog Scale 0-10 point scale.

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