The therapist stood at the head end of the couch with one of her hands supporting the patient’s affected shoulder over the acromial region and the other hand holding and supporting the head and neck. The patients were positioned in supine with neutral cervical spine, shoulder abducted to 30°, and hand resting on the stomach. Patients with red flags for pathologic spinal condition (e.g., infection, tumors, osteoporosis, and spinal fracture) history of spinal surgery prolapsed intervertebral disc vertebrobasilar artery insufficiency or hyperexcitability, such as reflex sympathetic dystrophy any deformity or soft tissue inflammatory condition were excluded. The inclusion criteria were age 18–45 years, pain of 5–74 mm on the Visual Analog Scale (VAS) in the upper quarter that radiated to the upper limbs and was persistent for 2–12 weeks, satisfying Elvey’s criteria with positive Upper Limb Tension Test-1. Study subjects were screened from the physiotherapy departments of various hospitals located in Delhi (India) who complained of unilateral pain in the upper quarter that radiated to the upper limb. Ethical clearance for the study was obtained from the Institutional Review Board of Jamia Hamdard University (approval no., 019).
Nerve flossing neck diagrams trial#
The study was designed as a randomized single-blinded controlled trial and was conducted as per the principles of the Declaration of Helsinki. Therefore, the centralization of symptoms along the median nerve may play a pivotal role in determining the improvement in the condition of patients with CBPS after treatment. The C5–C6 nerve roots provide major autonomic supply to the median nerve thus, patients with CBPS often present with symptoms of median nerve distribution. It is observed that C5–C6 is the most affected segment in the cervical spine.
![nerve flossing neck diagrams nerve flossing neck diagrams](https://chiro-trust.org/wp-content/uploads/2019/10/female-bones-and-nerves-lumbar-spine-picture-id470864503-v2-790x413.jpg)
Although centralization is considered a predictor of the treatment outcomes in low back pain, limited studies have been conducted on patients with CBPS. , the centralization of symptoms supports favorable outcomes in patients. Centralization is also described as a diagnostic and treatment tool owing to its association with a lower pain level and superior functionality. It is characterized by progressive abolishing of the symptoms in the distal to the proximal direction in response to movement. This movement of the pain from the arm to the spine is called centralization. Owing to these negative effects of CBPS, it is important to reduce not only the intensity of the pain but also the radiation of symptoms. This results in a substantial burden in terms of lower productivity that increases the cost of health care. Over a period of time, this exerts serious effects on physical and mental functioning, leading to disability.
![nerve flossing neck diagrams nerve flossing neck diagrams](https://deskjockeyphysio.com/wp-content/uploads/2017/11/radial-nerve-flossing.jpg)
Pain and peripheralization of the symptoms in CBPS lead to active limitation of movements during activities of daily living.