PAIN+ CPN

OBJECTIVE: To evaluate the impact of articular and neural mobilization on pain intensity and disability in patients with cervical radicular pain. DESIGN: Intervention systematic review with network meta-analysis. LITERATURE RESEARCH: The MEDLINE, SciELO, PubMed, PEDro, Scopus, Web of Science, and Cochrane databases were searched up to February 2024. STUDY SELECTION CRITERIA: Randomized controlled trials studying the effects of articular or neural mobilization in adults with cervical radicular pain were included. DATA SYNTHESIS: A frequentist network meta-analysis was used to assess pain intensity and disability. The risk of bias and the certainty of the evidence were evaluated using Version 2 of the Cochrane Risk of Bias (RoB 2) tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, respectively. RESULTS: Out of 777 reports, 50 were analyzed quantitatively. The combination of articular and neural mobilization with usual care was most effective in reducing short-term pain intensity compared to wait and see, sham, or placebo interventions (mean difference [MD], -3.23; 95% confidence interval [CI]: -4.33, -2.12) and to standard care alone (MD, -1.52; 95% CI: -2.31, -0.73). There were significant improvements in pain-related disability with neural mobilization plus usual care, surpassing wait and see, sham, placebo interventions (standardized mean difference [SMD], -1.57; 95% CI: -2.53, -0.61), and usual care alone (SMD, -1.31; 95% CI: -1.88, -0.73). Risk of bias and heterogeneity of included trials downgraded the certainty of evidence. CONCLUSION: Combining mobilization techniques with standard care may be considered in clinical practice, although with care due to the moderate to very low certainty of the evidence. J Orthop Sports Phys Ther 2025;55(7):1-14. Epub 16 May 2025. doi:10.2519/jospt.2025.12757.

Rehab Clinician (OT/PT) rater

This analysis appears to side-step causality when addressing the study population, namely adults with cervical radiculopathy or cervical radicular pain. The study suggested that a combination of articular and neural mobilization with usual care was considered most effective in reducing short-term pain intensity; however, it acknowledges that the evidence is very low certainty. Thus, treating such findings with caution as generalisability of outcome cannot logically be assumed for an individual on the basis of generalised symptoms observed in a group.

Rehab Clinician (OT/PT) rater

I think this is wonderful information to inform clinical decisions on treating cervical radiculopathy. Although manual therapy has been widely accepted as treatment, this article gives specifics as far as which treatment interventions are most effective and helpful.

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