Cervical Osteopathic Manipulation Shown to Affect Median Nerve Function

Whelan G, Johnston R, Millward C, Edwards DJ. The immediate effect of osteopathic cervical mobilization on median nerve mechanosensitivity: a triple-blind, randomized placebo-controlled trial [published online May 18, 2017]. J Bodyw Mov Ther. doi:10.1016/j.jmbt.2017.05.009

Osteopathic researchers in the United Kingdom performed cervical mobilization from C2 to T1 and then assessed range of motion (ROM) at the elbow joint bilaterally using median nerve upper limb neurodynamic test (ULNT) positioning of the upper limb. The triple-blind design called for separate individuals to perform the 3 phases of the experiment: 1 to perform cervical mobilization, 1 to perform the ULNT positioning, and 1 to measure ROM at the elbow joint.

Inclusion criteria were first- and second-year osteopathy students aged 18 to 45 years. Exclusion criteria included symptoms of paresthesia, dysesthesia, radiculopathy, previous diagnosis of nerve entrapment (such as carpal tunnel syndrome), or a positive Spurlings test. Thirty individuals (11 men, 19 women) were randomly assigned to an osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths), sham therapy, or control group. The OMTh group received C2 to T1 mobilization that in the United States would be considered soft tissue and myofascial release procedures. The sham therapy group was told they would receive a gentle cranial OMTh technique, and their head simply rested on the hands of the experimenter. Participants in the control group lay supine on the table with their head on a single pillow. Each condition was conducted for 3 minutes, and then ROM was measured using a goniometer while the ULNT position was applied.

The results were significant (P<.05) in both upper extremities for the mobilization group compared with both the sham therapy and control groups, which showed no increase in elbow ROM and no statistical differences between the 2 groups.

The authors’ explanation of the mechanism of action for the increased elbow ROM was reduced mechanosensitivity of the median nerve in the ULNT position brought about by the cervical mobilization. This study is the first of its kind to measure the effects of osteopathic techniques in this way. The cervical mobilization is presumed to have affected the median nerve in such a way as to allow for greater flexibility of the upper extremity muscles and reduce any nociception as the muscles were extended to their normal limits.

This study illustrates a novel approach to studying the effects of osteopathic manipulative treatment that may have significant utility in future osteopathic research.