Effectiveness of neural mobilisation for the treatment of nerve-related cervicobrachial pain: a systematic review with subgroup meta-analysis.

Nerve-related pain spreading from the neck into the arm, sometimes called cervicobrachial pain, is often treated with neural mobilisation, a hands-on technique meant to improve how nerves move and tolerate stretch. But it has been unclear which patients, if any, actually benefit. This systematic review pooled data from 27 randomised trials comparing neural mobilisation against no treatment, standard physiotherapy, cervical traction, or exercise, measuring pain and disability. Overall, neural mobilisation outperformed no treatment and improved outcomes when added to standard physiotherapy, and outperformed exercise for disability, but did not show a statistically significant advantage over cervical traction.

A notable pattern was that results differed depending on how studies defined the condition, with the strongest and most consistent effects found in trials that used a specific diagnostic approach known as the Wainner cluster. This diagnostic variability, along with differences between studies, is the main limitation, meaning findings cannot be applied uniformly to everyone with arm and neck nerve pain.

If you have neck and arm pain linked to nerve irritation, you may have heard of neural mobilisation, a type of physical therapy technique that involves specific movements aimed at easing nerve-related symptoms. This review pulled together findings from 27 clinical trials to see whether it actually helps. The pooled results suggest that neural mobilisation reduced pain and disability more than doing nothing, and that adding it to usual physiotherapy care gave extra improvement beyond physiotherapy alone.

It also did better than exercise for reducing disability. However, when compared against cervical traction, a treatment that gently stretches the neck, there was no clear difference detected in pain, and the disability result was uncertain too. Interestingly, how much people benefited seemed to depend on how their condition was diagnosed in each study, with the clearest benefits seen in trials using one particular set of diagnostic criteria.

Because diagnostic methods varied so much across studies, it is hard to know exactly which patients are most likely to respond.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This review addresses a recurring clinical question: whether neural mobilisation offers measurable benefit for nerve-related cervicobrachial pain, and crucially, whether that benefit depends on how patients are identified as appropriate candidates. Across 27 randomised controlled trials, pooled analyses showed neural mobilisation outperformed no treatment on pain (mean difference -2.81) and disability, improved outcomes when added to standard physiotherapy compared with physiotherapy alone, and outperformed exercise for disability (mean difference -18.27), though these subgroup estimates carry varying numbers of underlying studies and should be read with corresponding caution.

Against cervical traction, no statistically significant difference was detected for either pain or disability, meaning the abstract does not establish superiority there. The most clinically relevant signal is the subgroup finding: among the 13 studies classifying patients using the Wainner cluster criteria, neural mobilisation consistently outperformed every comparator tested. This raises the possibility that diagnostic classification matters for predicting response, but as a subgroup finding nested within a heterogeneous evidence base, it should be treated as hypothesis-generating rather than confirmed practice guidance. The review does not establish which specific patients outside this classification system might respond, nor does it report adverse events, so safety conclusions cannot be drawn.

The study was prospectively registered on PROSPERO, and risk of bias was assessed using Cochrane RoB2, though the abstract does not detail overall risk-of-bias ratings across included trials.