Nerve Gliding Exercises in Cervical Radiculopathy

The cervical spine is not only the most mobile region of the spine, but also acts as a functional bridge between the head and the torso, consisting of a total of seven vertebrae. The vertebrae in this region are relatively small in size and have a high capacity for movement due to the need for a wide range of joint motion; these characteristics allow for free movement of the head and enable optimal head-neck positioning in response to environmental stimuli.

Mechanical compression, irritation or inflammation of the cervical nerve roots results in a clinical picture of cervical radiculopathy (broadly defined as cervical neuropathy). This condition presents with symptoms such as pain radiating from the neck to the upper extremities, paraesthesia, muscle weakness and sensory loss. Spondylotic changes in the mobile cervical segments can lead to a decrease in intervertebral disc height, disc protrusion, and degenerative changes in the facet joint capsule.

In cervical radiculopathy, patients may only complain of upper extremity pain; however, they report significant difficulties in functions such as hand-eye coordination, gross and fine grip strength, dressing, and heavy lifting. Indeed, in radiculopathy, in addition to pain and sensory changes, decreased grip strength and reduced upper extremity function are frequently observed findings.

The specific clinical presentations at the root level vary. In C5 root involvement, pain radiates from the end of the cervical level over the shoulder to the upper lateral aspect of the arm; involvement of the deltoid and biceps muscles may cause painful limitation in shoulder abduction and elbow flexion. Degenerative disc disease most commonly affects the C5-6 and C6-7 levels. In C6 root compression, pain starts in the lower part of the neck and extends to the biceps, lateral forearm, and dorsal hand/fingers; it is often accompanied by pain in the proximal arm and sensory deficit in the hand. The most common cause of C7 root radiculopathy is disc herniation; pain in the back of the shoulder and dorsolateral arm with decreased triceps reflex is typical; triceps weakness during overhead activities may be a prominent complaint. The flexor carpi radialis, pronator teres, extensor digitorum communis, and latissimus dorsi may also be affected. The C8 root innervates sensation in the ulnar side of the forearm and hand; compression may cause pain and numbness similar to ulnar nerve lesions. With involvement of the flexor digitorum profundus/superficialis and intrinsic hand muscles, finger flexion and abduction become difficult; weakness of the first dorsal interosseous muscle impairs fine hand skills (e.g., turning a key, holding small objects) and reduces grip strength.

The primary goals of rehabilitation are to reduce pain, preserve nerve function, increase range of motion, and improve quality of life. Among conservative approaches, neural gliding/sliding exercises have gained increasing prominence in recent years. These exercises are targeted manual/exercise-based applications that aim to increase the relative movement of compressed nerve tissue in relation to surrounding tissues; they are reported to improve transmission by reducing intraneural pressure, increase intraneural circulation, and improve the mobility of the connective tissue surrounding the nerve. These mechanisms target pain reduction, increased functional capacity, and improved nerve mobility.

The current literature reports positive effects of nerve gliding exercises on pain, function, and cervical range of motion in cervical radiculopathy. However, most studies have focused on a single peripheral nerve (mostly the median nerve) and applied nerve mobilisation using "one-size-fits-all" protocols independent of the affected root level. This approach carries the risk of overlooking the clinically distinct patterns of radiculopathy that vary according to the root level.

Therefore, our planned study aims to compare the effectiveness of targeted nerve gliding exercises specific to the peripheral nerves (median, ulnar, radial) in cases affected at the C5-C6, C6-C7, and C7-T1 levels. Thus, the effect of nerve mobilisation will be evaluated based on specific nerve-root relationships; determining which nerve mobilisation is more effective at which root level will provide a unique contribution to individualised clinical decision-making processes in the treatment of cervical radiculopathy.