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Cervical RadiculopathyNTMNCT07248943

Contralateral Neural Tissue Mobilization for Cervical Radiculopathy

A study testing Contralateral Neural Tissue Mobilization (NTM) in people with Cervical Radiculopathy and Pain, run by Evidence In Motion.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Official record
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Trial summary

Cervical radiculopathy (CR) is a common form of peripheral neuropathic pain characterized by neck and upper extremity symptoms in a dermatomal distribution. Neural tissue mobilization (NTM) is an intervention shown to provide benefit for neuropathic pain presentations; however, some patients are unable to tolerate… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Cervical Radiculopathy, Pain, Neuropathic Pain
What is being tested?
Contralateral Neural Tissue Mobilization (NTM)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
40 participants
Where
No sites listed yet
Study dates
Dec 2025to Sep 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age 18 years or older Presence of unilateral upper-extremity pain in a dermatomal distribution consistent with cervical radiculopathy (with or without neck pain)
  • Able to read and understand English
  • Willing and able to provide written informed consent
  • New patient to the clinic or established patient who meets inclusion criteria and has not previously received neural tissue mobilization as part of treatment

Who cannot join

  • Bilateral upper-extremity pain
  • Upper-extremity pain that is non-dermatomal in distribution
  • Presence of contraindications or precautions preventing use of the contralateral limb for neural tissue mobilization (e.g., injury, allodynia, recent surgery, postsurgical complications)
  • Not willing to participate in the study

About this study

Official title: Contralateral Neural Tissue Mobilization for Cervical Radiculopathy: An Exploratory Study

Cervical radiculopathy (CR) is a common form of peripheral neuropathic pain characterized by neck and upper extremity symptoms in a dermatomal distribution. Neural tissue mobilization (NTM) is an intervention shown to provide benefit for neuropathic pain presentations; however, some patients are unable to tolerate direct treatment of the symptomatic limb due to allodynia, hyperalgesia, or fear of movement. Early evidence from lower-extremity research suggests that contralateral NTM may produce therapeutic effects similar to ipsilateral treatment, but this approach has not been investigated in individuals with upper-extremity symptoms.

This exploratory case series aims to examine the immediate effects of contralateral NTM in adults presenting to outpatient physical therapy with CR. Participants will undergo pre- and post-treatment assessments of pain intensity, disability, fear-avoidance beliefs, pain distribution, and neurodynamic mechanosensitivity. Findings will provide preliminary evidence regarding whether contralateral NTM may serve as a viable treatment option when direct symptomatic limb treatment is not tolerated.

Read the detailed description

Background and Rationale:

Pain phenotyping has emerged as an important clinical framework within physical therapy, enabling classification of pain presentations on the basis of pain mechanisms, clinical features, and patient-reported symptoms. Current pain phenotyping models identify three primary mechanisms: nociceptive, peripheral neuropathic, and nociplastic pain. Peripheral neuropathic pain is estimated to account for approximately one-quarter of patients presenting to outpatient physical therapy. It is characterized by pain arising from a lesion or disease of the somatosensory nervous system, with complex underlying biological mechanisms including neurogenic inflammation, immune dysregulation, demyelination, axonal loss, ion channel changes, and vascular alterations. Clinically, peripheral neuropathic pain commonly presents with pain in dermatomal or cutaneous nerve distributions, a history of nerve injury or mechanical compromise, and symptom provocation during neurodynamic or palpatory testing.

Cervical radiculopathy (CR) is a frequent and well-recognized form of peripheral neuropathic pain. CR most often results from intervertebral disc herniation or spondylosis, typically affecting the C7, C6, and C8 nerve roots. Patients commonly present with neck pain, upper extremity pain, and/or sensory, motor, or reflex deficits. Current evidence suggests that when patient presentation aligns with a peripheral neuropathic phenotype, interventions should be matched accordingly. Neural tissue mobilization (NTM) has demonstrated effectiveness in individuals with chronic neck and arm pain and is believed to exert beneficial effects through improvements in neuromeningeal mobility, blood flow, intraneural and extraneural fluid dynamics, inflammatory modulation, and graded exposure to movement.

However, some patients with CR present with significant allodynia, hyperalgesia, or fear of movement, making direct treatment of the symptomatic extremity challenging. Basic neuroanatomy and preliminary research suggest that contralateral NTM may produce therapeutic effects similar to ipsilateral NTM. Although early work in the lower extremity-including one clinical trial and one case study-has shown that contralateral NTM can reduce pain related to lumbar radiculopathy, this concept has not yet been explored in the upper extremity. Therefore, this exploratory study seeks to examine whether contralateral NTM produces immediate positive effects in patients presenting to physical therapy with CR.

Study Design:

This investigation uses a case-series design with pre- and post-intervention measures. A convenience sample will be recruited from four outpatient physical therapy clinics specializing in musculoskeletal pain. Clinicians participating in the study must have completed at least a 2-day (15-hour) post-professional training course in pain science and assessment of peripheral neuropathic pain, including instruction in NTM.

A total of approximately 40 patients aged 18 years or older will be recruited over a 3-month period. Eligible individuals must demonstrate unilateral arm pain in a dermatomal distribution consistent with CR, with or without neck pain. Exclusion criteria include bilateral upper-extremity pain, non-dermatomal pain, contraindications to NTM on the contralateral limb (e.g., recent surgery, significant tissue injury, allodynia), inability to read English, or unwillingness to consent.

Procedures and Outcome Measures:

After obtaining written informed consent, participants will complete baseline (pre-intervention) measures including:

Demographic questionnaire (non-identifiable data only)

Numeric Pain Rating Scale (NPRS) for upper-extremity pain

Neck Disability Index (NDI)

Fear-Avoidance Beliefs Questionnaire - Physical Activity subscale (FABQ-PA)

Pain drawing, quantified using a standardized grid overlay

Upper Limb Neurodynamic Test 1a (ULNT1a) of the affected limb, including goniometric measurement of elbow extension at symptom onset

Following baseline measures, each participant will receive a single treatment session of contralateral NTM, performed on the limb opposite the symptomatic side. The intervention consists of 8-10 minutes of standardized passive neurodynamic mobilizations in supine with specific variations in cervical positioning, followed by active "slider" and "tensioner" exercises in sitting.

Immediately after the intervention, participants will repeat all outcome measures (NPRS, FABQ-PA, pain drawing, and ULNT1a). After data collection is complete, clinical care will proceed according to the treating clinician's usual practice and will not be influenced by study procedures.

Data Handling and Analysis:

All data packets will be de-identified and coded by clinic and clinician. Data will be transferred to a secure electronic spreadsheet for analysis. Descriptive statistics (means, standard deviations, frequencies, and percentages) will summarize demographic variables and baseline characteristics. Pre- to post-intervention changes will be evaluated using paired t-tests with statistical significance set at p < 0.05.

Purpose of the Study:

The purpose of this exploratory case series is to determine whether contralateral neural tissue mobilization produces immediate changes in pain intensity, disability, fear-avoidance beliefs, pain distribution, and neurodynamic mechanosensitivity among individuals presenting with clinical features of cervical radiculopathy. Findings may inform future research and contribute to clinical understanding of whether contralateral NTM is a viable treatment option in patients unable to tolerate direct treatment of the symptomatic extremity

Being tested
Contralateral Neural Tissue Mobilization (NTM)
Keywords
Cervical Radiculopathy, Neuropathic Pain, Peripheral Neuropathic Pain, Upper Extremity Pain, Radicular Pain, Cervical Spine Disorders, Nerve Root Compression, Neural Tissue Mobilization, Neurodynamic Mobilization, Neurodynamics, Contralateral Treatment, Median Nerve Mobilization, Upper Limb Neurodynamic Test (ULNT1a), Physical Therapy, Musculoskeletal Pain, Pain Phenotyping, Manual Therapy, Rehabilitation, Mechanosensitivity
Medical subject headings
Radiculopathy, Pain, Neuralgia, Musculoskeletal Pain

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Contralateral Neural Tissue Mobilization (NTM)Behavioural

    A standardized 8-10 minute contralateral NTM protocol will be performed and includes:

    1. Supine passive neurodynamic mobilization (ULNT1a pattern) with:
    • Cervical side flexion toward the non-symptomatic side
    • Movement to the point of resistance
    • 1-2 seconds of gentle engagement followed by release
    • Repeated 15 times
    1. Supine passive neurodynamic mobilization with:
    • Neutral cervical position
    • Repeated 15 times
    1. Supine passive neurodynamic mobilization with:
    • Cervical side flexion away from the non-symptomatic side
    • Repeated 15 times
    1. Sitting active neurodynamic exercises (contralateral UE)
    • 10 active "sliders"
    • 10 active "tensioners"
    • 10 additional active "sliders" The neurodynamic pattern follows the ULNT1a sequence: shoulder abduction to 90°, external rotation, forearm supination, wrist/finger extension with ulnar deviation, and progressive elbow extension.

    Single treatment session delivered in-person by a trained physical therapist.

Study groups in NCT07248943
Study groupRoleWhat they receive
Contralateral Neural Tissue MobilizationExperimentalParticipants with unilateral cervical radiculopathy will receive a single treatment session of neural tissue mobilization applied to the contralateral (uninvolved) upper extremity. The intervention is delivered by licensed physical therapists with post-professional training in pain science and neurodynamic techniques.
Receives: Behavioral: Contralateral Neural Tissue Mobilization (NTM)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Numeric Pain Rating Scale (NPRS)

    Change in patient-reported upper-extremity pain intensity measured using the 0-10 Numeric Pain Rating Scale, where 0 = no pain and 10 = worst imaginable pain. The NPRS is commonly used in musculoskeletal research to quantify pain severity.

    Measured: Pre-intervention to immediately post-intervention (same session).

  2. Upper Limb Neurodynamic Test 1a (ULNT1a) - Elbow Extension Range

    Change in degrees of elbow extension measured with a goniometer at the onset of symptoms during ULNT1a testing of the affected limb. The test assesses neurodynamic mechanosensitivity related to the median nerve.

    Measured: Pre-intervention to immediately post-intervention (same session).

Secondary outcomes (3)

  1. Neck Disability Index (NDI)

    Change in self-reported neck-related disability using the 10-item Neck Disability Index, scored from 0 to 50 and converted to a percentage (0-100%), with higher scores indicating greater disability.

    Measured: Pre-intervention to immediately post-intervention (same session).

  2. Fear-Avoidance Beliefs Questionnaire - Physical Activity Subscale (FABQ-PA)

    Change in fear-avoidance beliefs related to physical activity, assessed using the 4-item FABQ-PA (scores range from 0 to 24; higher scores indicate greater fear of physical activity).

    Measured: Pre-intervention to immediately post-intervention (same session).

  3. Pain Drawing Area (Body Chart Grid Count)

    Change in pain distribution quantified using a standardized body chart with an overlay grid. The number of grid blocks marked by the participant represents pain extent.

    Measured: Pre-intervention to immediately post-intervention (same session).

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted25 Nov 2025
  2. Study startDec 2025 (estimated)
  3. Primary completionAug 2026 (estimated)
  4. Study completionSep 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Model description
Participants with unilateral cervical radiculopathy will receive a single treatment session of neural tissue mobilization applied to the contralateral (uninvolved) upper extremity. The intervention is delivered by licensed physical therapists with post-professional training in pain science and neurodynamic techniques.
Masking
None (open label)
Enrolment
40 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07248943
Sponsor's protocol ID
ContralateralNTM2025
Acronym
NTM
Status last verified
Nov 2025
First submitted
18 Nov 2025
Last updated
25 Nov 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Latimer J, Maher C, Refshauge K. The attitudes and beliefs of physiotherapy students to chronic back pain. Clin J Pain. 2004 Jan-Feb;20(1):45-50. doi: 10.1097/00002508-200401000-00009.

    PubMed 14668656

  • Gurudut P, Sherpa LB. Comparison of Ipsilateral Versus Contralateral LOwer Limb Neural Mobilization in Unilateral Lumbar Radiculopathy - A Randomized Clinical Trial. Int J Physiother. 2021;8(1):26-30.

  • Louw A, Schmidt SG, Louw C, Puentedura EJ. Moving without moving: immediate management following lumbar spine surgery using a graded motor imagery approach: a case report. Physiother Theory Pract. 2015;31(7):509-17. doi: 10.3109/09593985.2015.1060656.

    PubMed 26395828

  • Gilbert KK, Smith MP, Sobczak S, James CR, Sizer PS, Brismee JM. Effects of lower limb neurodynamic mobilization on intraneural fluid dispersion of the fourth lumbar nerve root: an unembalmed cadaveric investigation. J Man Manip Ther. 2015 Dec;23(5):239-45. doi: 10.1179/2042618615Y.0000000009.

    PubMed 26955255

  • Song XJ, Gan Q, Cao JL, Wang ZB, Rupert RL. Spinal manipulation reduces pain and hyperalgesia after lumbar intervertebral foramen inflammation in the rat. J Manipulative Physiol Ther. 2006 Jan;29(1):5-13. doi: 10.1016/j.jmpt.2005.10.001.

    PubMed 16396724

  • Varangot-Reille C, Cuenca-Martinez F, Arribas-Romano A, Bertoletti-Rodriguez R, Gutierrez-Martin A, Mateo-Perrino F, Suso-Marti L, Blanco-Diaz M, Calatayud J, Casana J. Effectiveness of Neural Mobilization Techniques in the Management of Musculoskeletal Neck Disorders with Nerve-Related Symptoms: A Systematic Review and Meta-Analysis with a Mapping Report. Pain Med. 2022 Apr 8;23(4):707-732. doi: 10.1093/pm/pnab300.

    PubMed 34633462

  • Basson A, Olivier B, Ellis R, Coppieters M, Stewart A, Mudzi W. The Effectiveness of Neural Mobilization for Neuromusculoskeletal Conditions: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. 2017 Sep;47(9):593-615. doi: 10.2519/jospt.2017.7117. Epub 2017 Jul 13.

    PubMed 28704626

  • Tanaka N, Fujimoto Y, An HS, Ikuta Y, Yasuda M. The anatomic relation among the nerve roots, intervertebral foramina, and intervertebral discs of the cervical spine. Spine (Phila Pa 1976). 2000 Feb 1;25(3):286-91. doi: 10.1097/00007632-200002010-00005.

    PubMed 10703098

  • Murphy DR, Hurwitz EL, Gerrard JK, Clary R. Pain patterns and descriptions in patients with radicular pain: does the pain necessarily follow a specific dermatome? Chiropr Osteopat. 2009 Sep 21;17:9. doi: 10.1186/1746-1340-17-9.

    PubMed 19772560

  • Iyer S, Kim HJ. Cervical radiculopathy. Curr Rev Musculoskelet Med. 2016 Sep;9(3):272-80. doi: 10.1007/s12178-016-9349-4.

    PubMed 27250042

  • Smart KM, Blake C, Staines A, Thacker M, Doody C. Mechanisms-based classifications of musculoskeletal pain: part 2 of 3: symptoms and signs of peripheral neuropathic pain in patients with low back (+/- leg) pain. Man Ther. 2012 Aug;17(4):345-51. doi: 10.1016/j.math.2012.03.003. Epub 2012 Mar 31.

    PubMed 22465002

  • Schmid AB, Nee RJ, Coppieters MW. Reappraising entrapment neuropathies--mechanisms, diagnosis and management. Man Ther. 2013 Dec;18(6):449-57. doi: 10.1016/j.math.2013.07.006. Epub 2013 Sep 2.

    PubMed 24008054

  • Schmid AB, Fundaun J, Tampin B. Entrapment neuropathies: a contemporary approach to pathophysiology, clinical assessment, and management. Pain Rep. 2020 Jul 22;5(4):e829. doi: 10.1097/PR9.0000000000000829. eCollection 2020 Jul-Aug.

    PubMed 32766466

  • Kim KH, Moon SH, Hwang CJ, Cho YE. Prevalence of Neuropathic Pain in Patients Scheduled for Lumbar Spine Surgery: Nationwide, Multicenter, Prospective Study. Pain Physician. 2015 Sep-Oct;18(5):E889-97.

    PubMed 26431142

  • Orita S, Yamashita T, Ohtori S, Yonenobu K, Kawakami M, Taguchi T, Kikuchi SI, Ushida T, Konno SI, Nakamura M, Fujino K, Matsuda S, Yone K, Takahashi K. Prevalence and Location of Neuropathic Pain in Lumbar Spinal Disorders: Analysis of 1804 Consecutive Patients With Primary Lower Back Pain. Spine (Phila Pa 1976). 2016 Aug 1;41(15):1224-1231. doi: 10.1097/BRS.0000000000001553.

    PubMed 26967122

Questions about this trial

What is this clinical trial studying?

A study testing Contralateral Neural Tissue Mobilization (NTM) in people with Cervical Radiculopathy and Pain, run by Evidence In Motion.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 25 Nov 2025. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Numeric Pain Rating Scale (NPRS) (time frame: Pre-intervention to immediately post-intervention (same session).). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07248943, which also lists 18 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 Nov 2025.

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