1
|
Baptista FM, Nery E, Cruz EB, Afreixo V, Silva AG. Effectiveness of Neural Mobilisation on Pain Intensity, Functional Status, and Physical Performance in Adults with Musculoskeletal Pain - A Systematic Review with Meta-Analysis. Clin Rehabil 2024; 38:145-183. [PMID: 37990512 PMCID: PMC10725147 DOI: 10.1177/02692155231215216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 11/02/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE To investigate up-to-date evidence of the effectiveness of neural mobilisation techniques compared with any type of comparator in improving pain, function, and physical performance in people with musculoskeletal pain. DATA SOURCES The following sources were consulted: PubMed, Web of Science, CENTRAL, CINAHL, Scopus, and PEDro databases; scientific repositories; and clinical trial registers. The last search was performed on 01/06/2023. METHODS Two reviewers independently assessed the studies for inclusion. We included randomised, quasi-randomised, and crossover trials on musculoskeletal pain in which at least one group received neural mobilisation (alone or as part of multimodal interventions). Meta-analyses were performed where possible. The RoB 2 and the Grading of Recommendations Assessment, Development and Evaluation tools were used to assess risk of bias and to rate the certainty of evidence, respectively. RESULTS Thirty-nine trials were identified. There was a significant effect favouring neural mobilisation for pain and function in people with low back pain, but not for flexibility. For neck pain, there was a significant effect favouring neural mobilisation as part of multimodal interventions for pain, but not for function and range of motion. Regarding other musculoskeletal conditions, it was not possible to conclude whether neural mobilisation is effective in improving pain and function. There was very low confidence for all effect estimates. CONCLUSIONS Neural mobilisation as part of multimodal interventions appears to have a positive effect on pain for patients with low back pain and neck pain and on function in people with low back pain. For the other musculoskeletal conditions, results are inconclusive.
Collapse
Affiliation(s)
| | - Ellen Nery
- CINTESIS.UA@RISE, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Eduardo Brazete Cruz
- Departamento Fisioterapia, Instituto Politécnico de Setúbal, Escola Superior de Saúde, Setúbal, Portugal / CHRC – Comprehensive Health Research Center, Setubal, Portugal
| | - Vera Afreixo
- Department of Mathematics, CIDMA – Center for Research and Development in Mathematics and Applications, University of Aveiro, Aveiro, Portugal
| | - Anabela G Silva
- CINTESIS.UA@RISE, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| |
Collapse
|
2
|
de Brito VM, Neto HP, Gama ACC. Manual Therapy with Neural Mobilization: Immediate Effect on the Vocal Quality of Women with Dysphonia. J Voice 2024; 38:120-128. [PMID: 34312025 DOI: 10.1016/j.jvoice.2021.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the immediate effect of neural mobilization on the voice quality, self-perceived phonatory effort, and laryngeal muscles of women with behavioral dysphonia. METHOD This is an intrasubject comparative study. The research included 21 women aged 18 to 59 years with vocal complaints. Therefore, the selection of this sample excluded the lower limit of the voice change period and the upper limit of presbyphonia. The participants were assessed by voice acoustic and auditory-perceptual analysis, self-reported vocal effort, and laryngeal palpation performed at three moments: at baseline, after 10 minutes of vocal resting, and after manual therapy. The participants were divided into two groups: the group with 10 minutes of vocal resting (G1) and the group with intervention (G2). The patients in the intervention group underwent manual therapy using neural mobilization in the laryngeal region. For the statistical analysis, a descriptive analysis of the data was performed first with measures of central tendency and dispersion. Subsequently, the Anderson-Darling test was used to verify sample normality. To analyze the difference between three groups were used the parametric One-Way ANOVA or the non-parametric Friedman's test. The McNemar's or chi-squared tests were used to compare categorical variables and to compare an ordinal variable a non-parametric Wilcoxon test was used. The Gwet's AC1 test was used to assess intra-rater agreement in the auditory-perceptual analysis response. RESULTS Neural mobilization in the laryngeal region showed no positive effects on the acoustic voice parameters and voice quality of women with dysphonia. Phonatory effort improved after neural mobilization in the laryngeal region (p = 0.004). There was no significant change in supralaryngeal resistance, lateral laryngeal resistance, and laryngeal position after neural mobilization in the laryngeal region. CONCLUSION Neural mobilization improved phonatory comfort but did have any effect on the voice quality and laryngeal musculature of women with dysphonia.
Collapse
Affiliation(s)
| | - Hugo Pasin Neto
- Department of Physiotherapy, University of Sorocaba - UNISO; Director of the Brazilian College of Osteopathy - CBO, São Paulo, Brazil
| | | |
Collapse
|
3
|
Polo-Ferrero L, Canchal-Crespo D, Sáez-Gutiérrez S, Dávila-Marcos A, Puente-González AS, Méndez-Sánchez R. Specific Neurodynamic Exercises on Pain and Disability in Old Women with Chronic Mechanical Neck Pain: A Randomized Controlled Trial. Healthcare (Basel) 2023; 12:20. [PMID: 38200926 PMCID: PMC10779372 DOI: 10.3390/healthcare12010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Neurodynamic exercise is a specific type of exercise used as a neural treatment that focuses on restoring altered homeostasis in the neuroimmune system by mobilising the nervous system and other structures. A prospective, randomized clinical trial was performed to evaluate the effect of neurodynamic exercises on disability and neck pain in elderly women over four weeks. Participants were randomized into two groups: a neurodynamic (NM) group (n = 28) and a non-specific exercise (NSE) group (n = 28). Inclusion criteria were women over 65 years of age who subjectively admitted to having mechanical neck pain for more than six months. Results showed that specific neurodynamic exercises can improve pain and disability in older women with chronic mechanical neck pain. Improvements were observed in all variables (p < 0.05). Significant between-group differences in favour of the NM group were only found for neck pressure pain thresholds and both tibialis anterior muscles. Larger effect sizes were obtained in favour of the NM group, especially for pain, disability, neck extension and inclination and pressure pain thresholds. Neurodynamic exercises have been shown to be more clinically relevant in disability and neck pain in older women.
Collapse
Affiliation(s)
- Luis Polo-Ferrero
- Department of Nursing and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain; (L.P.-F.); (S.S.-G.); (A.D.-M.); (R.M.-S.)
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
| | | | - Susana Sáez-Gutiérrez
- Department of Nursing and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain; (L.P.-F.); (S.S.-G.); (A.D.-M.); (R.M.-S.)
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
| | - Arturo Dávila-Marcos
- Department of Nursing and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain; (L.P.-F.); (S.S.-G.); (A.D.-M.); (R.M.-S.)
| | - Ana Silvia Puente-González
- Department of Nursing and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain; (L.P.-F.); (S.S.-G.); (A.D.-M.); (R.M.-S.)
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
| | - Roberto Méndez-Sánchez
- Department of Nursing and Physiotherapy, University of Salamanca, 37007 Salamanca, Spain; (L.P.-F.); (S.S.-G.); (A.D.-M.); (R.M.-S.)
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
| |
Collapse
|
4
|
Lin LH, Lin TY, Chang KV, Wu WT, Özçakar L. Neural Mobilization for Reducing Pain and Disability in Patients with Lumbar Radiculopathy: A Systematic Review and Meta-Analysis. Life (Basel) 2023; 13:2255. [PMID: 38137856 PMCID: PMC10744707 DOI: 10.3390/life13122255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Lumbar radiculopathy causes lower back and lower extremity pain that may be managed with neural mobilization (NM) techniques. This meta-analysis aims to evaluate the effectiveness of NM in alleviating pain and reducing disability in patients with lumbar radiculopathy. We hypothesized that NM would reduce pain and improve disability in the lumbar radiculopathy population, leveraging the statistical power of multiple studies. Electronic databases from their inception up to October 2023 were searched for randomized controlled trials (RCTs) that explored the impact of NM on lumbar radiculopathy. Our primary outcome measure was the alteration in pain intensity, while the secondary one was the improvement of disability, standardized using Hedges' g. To combine the data, we employed a random-effects model. A total of 20 RCTs comprising 877 participants were included. NM yielded a significant reduction in pain intensity (Hedges' g = -1.097, 95% CI = -1.482 to -0.712, p < 0.001, I2 = 85.338%). Subgroup analyses indicated that NM effectively reduced pain, whether employed alone or in conjunction with other treatments. Furthermore, NM significantly alleviated disability, with a notable effect size (Hedges' g = -0.964, 95% CI = -1.475 to -0.453, p < 0.001, I2 = 88.550%), particularly in chronic cases. The findings provide valuable insights for clinicians seeking evidence-based interventions for this patient population. This study has limitations, including heterogeneity, potential publication bias, varied causal factors in lumbar radiculopathy, overall study quality, and the inability to explore the impact of neural pathology on NM treatment effectiveness, suggesting opportunities for future research improvements.
Collapse
Affiliation(s)
- Long-Huei Lin
- Kaohsiung Rukang Physiotherapy Clinic, Kaohsiung 83050, Taiwan;
| | - Ting-Yu Lin
- Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Yilan 26546, Taiwan;
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10048, Taiwan;
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10048, Taiwan;
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara 06100, Turkey;
| |
Collapse
|
5
|
Myofascial force transmission between the calf and the dorsal thigh is dependent on knee angle: an ultrasound study. Sci Rep 2023; 13:3738. [PMID: 36878944 PMCID: PMC9988973 DOI: 10.1038/s41598-023-30407-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/22/2023] [Indexed: 03/08/2023] Open
Abstract
A recent in-vivo experiment has shown that force can be transmitted between the gastrocnemius and the hamstring muscles due to a direct tissue continuity. However, it remains unclear if this mechanical interaction is affected by the stiffness of the structural connection. This study therefore aimed to investigate the impact of the knee angle on myofascial force transmission across the dorsal knee. A randomized, cross-over study was performed, including n = 56 healthy participants (25.36 ± 3.9 years, 25 females). On two separate days, they adopted a prone position on an isokinetic dynamometer (knee extended or 60° flexed). In each condition, the device moved the ankle three times from maximal plantarflexion to maximal dorsal extension. Muscle inactivity was ensured using EMG. High-resolution ultrasound videos of the semimembranosus (SM) and the gastrocnemius medialis (GM) soft tissue were recorded. Maximal horizontal tissue displacement, obtained using cross-correlation, was examined as a surrogate of force transmission. SM tissue displacement was higher at extended (4.83 ± 2.04 mm) than at flexed knees (3.81 ± 2.36 mm). Linear regression demonstrated significant associations between (1) SM and GM soft tissue displacement (extended: R2 = 0.18, p = 0.001; flexed: R2 = 0.17, p = 0.002) as well as (2) SM soft tissue displacement and ankle range of motion (extended: R2 = 0.103, p = 0.017; flexed: R2 = 0.095, p = 0.022). Our results further strengthen the evidence that local stretching induces a force transmission to neighboring muscles. Resulting remote exercise effects such as increased range of motion, seem to depend on the stiffness of the continuity.Trial registration: DRKS (Deutsches Register Klinischer Studien), registration number DRKS00024420, first registered 08/02/2021, https://drks.de/search/de/trial/DRKS00024420 .
Collapse
|
6
|
Molina-Álvarez M, Arribas-Romano A, Rodríguez-Rivera C, García MM, Fernández-Carnero J, Armijo-Olivo S, Goicoechea Garcia C. Manual Therapy Effect in Placebo-Controlled Trials: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14021. [PMID: 36360901 PMCID: PMC9654326 DOI: 10.3390/ijerph192114021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 06/01/2023]
Abstract
PURPOSE Background: Evaluate whether the design of placebo control groups could produce different interpretations of the efficacy of manual therapy techniques. METHODS Nine databases were searched (EMBASE, CINAHL, PsycINFO, MEDLINE, PubMed, SCOPUS, WEB of SCIENCE, COCHRANE, and PEDro). Randomized placebo-controlled clinical trials that used manual therapy as a sham treatment on subjects suffering from pain were included. Data were summarized qualitatively, and meta-analyses were conducted with R. RESULTS 53 articles were included in the qualitative analysis and 48 were included in the quantitative analyses. Manipulation techniques did not show higher effectiveness when compared with all types of sham groups that were analyzed (SMD 0.28; 95%CI [-0.24; 0.80]) (SMD 0.28; 95%CI [-0.08; 0.64]) (SMD 0.42; 95%CI [0.16; 0.67]) (SMD 0.82; 95%CI [-0.57; 2.21]), raising doubts on their therapeutic effect. Factors such as expectations of treatment were not consistently evaluated, and analysis could help clarify the effect of different sham groups. As for soft tissue techniques, the results are stronger in favor of these techniques when compared to sham control groups (SMD 0.40; 95%CI [0.19, 0.61]). Regarding mobilization techniques and neural gliding techniques, not enough studies were found for conclusions to be made. CONCLUSIONS The literature presents a lack of a unified placebo control group design for each technique and an absence of assessment of expectations. These two issues might account for the unclear results obtained in the analysis.
Collapse
Affiliation(s)
- Miguel Molina-Álvarez
- Escuela Internacional de Doctorado, Faculty of Health Sciences, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Area of Pharmacology, Nutrition and Bromatology, Department of Basic Health Sciences, Rey Juan Carlos University, Unidad Asociada I+D+i Instituto de Química Médica (IQM) CSIC-URJC, 28922 Alcorcón, Spain
| | - Alberto Arribas-Romano
- Escuela Internacional de Doctorado, Faculty of Health Sciences, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, 28922 Alcorcón, Spain
| | - Carmen Rodríguez-Rivera
- Area of Pharmacology, Nutrition and Bromatology, Department of Basic Health Sciences, Rey Juan Carlos University, Unidad Asociada I+D+i Instituto de Química Médica (IQM) CSIC-URJC, 28922 Alcorcón, Spain
- High Performance Experimental Pharmacology Research Group, Rey Juan Carlos University (PHARMAKOM), 28922 Alcorcón, Spain
| | - Miguel M. García
- Area of Pharmacology, Nutrition and Bromatology, Department of Basic Health Sciences, Rey Juan Carlos University, Unidad Asociada I+D+i Instituto de Química Médica (IQM) CSIC-URJC, 28922 Alcorcón, Spain
- High Performance Experimental Pharmacology Research Group, Rey Juan Carlos University (PHARMAKOM), 28922 Alcorcón, Spain
- Grupo Multidisciplinar de Investigación y Tratamiento del Dolor, Grupo de Excelencia Investigadora URJC-Banco de Santander, 28922 Alcorcón, Spain
| | - Josué Fernández-Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, 28922 Alcorcón, Spain
- Grupo Multidisciplinar de Investigación y Tratamiento del Dolor, Grupo de Excelencia Investigadora URJC-Banco de Santander, 28922 Alcorcón, Spain
- La Paz Hospital Institute for Health Research, IdiPAZ, 28029 Madrid, Spain
| | - Susan Armijo-Olivo
- Faculty of Business and Social Sciences, University of Applied Sciences, 30A, 49076 Osnabruck, Germany
- Faculties of Rehabilitation Medicine and Medicine and Dentistry, 3-48 Corbett Hall, Edmonton, AB T6G 2G4, Canada
| | - Carlos Goicoechea Garcia
- Area of Pharmacology, Nutrition and Bromatology, Department of Basic Health Sciences, Rey Juan Carlos University, Unidad Asociada I+D+i Instituto de Química Médica (IQM) CSIC-URJC, 28922 Alcorcón, Spain
- High Performance Experimental Pharmacology Research Group, Rey Juan Carlos University (PHARMAKOM), 28922 Alcorcón, Spain
- Grupo Multidisciplinar de Investigación y Tratamiento del Dolor, Grupo de Excelencia Investigadora URJC-Banco de Santander, 28922 Alcorcón, Spain
| |
Collapse
|
7
|
Cuenca-Martínez F, La Touche R, Varangot-Reille C, Sardinoux M, Bahier J, Suso-Martí L, Fernández-Carnero J. Effects of Neural Mobilization on Pain Intensity, Disability, and Mechanosensitivity: An Umbrella Review With Meta-Meta-Analysis. Phys Ther 2022; 102:6566427. [PMID: 35421227 DOI: 10.1093/ptj/pzac040] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 11/09/2021] [Accepted: 02/03/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the current evidence for the effects of neural mobilization (NM) treatments. METHODS Three umbrella reviews with meta-meta-analyses were conducted to determine the effects of NM on pain intensity and disability in people with musculoskeletal disorders and on mechanosensitivity in participants who were asymptomatic. The study used the grading criteria proposed by the Physical Activity Guidelines Advisory Committee to assess the quality of evidence. RESULTS One meta-meta-analysis revealed a statistically significant moderate effect on pain intensity (standardized mean difference [SMD] = -0.75, 95% CI = -1.12 to -0.38) but with evidence of heterogeneity (Q = 14.13; I2 = 65%). The study found a significantly large effect of NM on disability (SMD = -1.22, 95% CI = -2.19 to -0.26), again with evidence of heterogeneity (Q = 31.57; I2 = 87%). The third meta-meta-analysis showed a statistically significant moderate effect of NM on mechanosensitivity (SMD = 0.96, 95% CI = 0.35 to 1.57), with no evidence of heterogeneity (Q = 2.73; I2 = 63%). For all examined outcomes, the quality of evidence was limited. CONCLUSION Overall, the results indicated that although NM treatment had a moderate to large beneficial clinical effect on pain intensity and disability in people with musculoskeletal disorders and on mechanosensitivity in individuals who were asymptomatic, the quality of evidence was limited. IMPACT Neural mobilization treatments showed positive results on the pain intensity and disability in individuals with musculoskeletal conditions. Neural mobilization could be integrated into the physical therapy management, although more research is needed.
Collapse
Affiliation(s)
- Ferran Cuenca-Martínez
- Department of Physiotherapy, Exercise Intervention for Health Research Group (EXINH-RG), University of Valencia, Valencia, Spain
| | - Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Neurociencia y Dolor Craneofacial (INDCRAN), Madrid, Spain
| | - Clovis Varangot-Reille
- Department of Physiotherapy, Exercise Intervention for Health Research Group (EXINH-RG), University of Valencia, Valencia, Spain
| | - Maëva Sardinoux
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Jade Bahier
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Luis Suso-Martí
- Department of Physiotherapy, Exercise Intervention for Health Research Group (EXINH-RG), University of Valencia, Valencia, Spain
| | - Josué Fernández-Carnero
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain
- Grupo Multidisciplinar de Investigación y Tratamiento del Dolor Grupo de Excelencia Investigadora URJC-Banco de Santander, Rey Juan Carlos University, Madrid, Spain
| |
Collapse
|
8
|
González-Matilla R, Abuín-Porras V, Casuso-Holgado MJ, Riquelme I, Heredia-Rizo AM. Effects of neural mobilization in disorders associated with chronic secondary musculoskeletal pain: A systematic review and meta-analysis. Complement Ther Clin Pract 2022; 49:101618. [DOI: 10.1016/j.ctcp.2022.101618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/09/2022] [Accepted: 06/09/2022] [Indexed: 11/15/2022]
|
9
|
Baptista FM, Cruz EB, Afreixo V, Silva AG. Effectiveness of neural mobilization on pain intensity, disability, and physical performance in adults with musculoskeletal pain-A protocol for a systematic review of randomized and quasi-randomized controlled trials and planned meta-analysis. PLoS One 2022; 17:e0264230. [PMID: 35271600 PMCID: PMC8912212 DOI: 10.1371/journal.pone.0264230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 02/05/2022] [Indexed: 11/18/2022] Open
Abstract
Recent studies show that musculoskeletal conditions contribute significantly to years lived with disability considering the entire global population. Pain and functional disability are the main problems that people with these conditions suffer. Neural mobilization has been shown to be an effective intervention in the treatment of musculoskeletal pain within individual trials, also contributing to improved functionality. Some systematic reviews have been carried out during the last years with the aim of synthesizing the scientific evidence on the use of neural mobilization techniques in the treatment of musculoskeletal disorders. However, they varied a lot in the methodological approaches and, consequently, in the findings and conclusions. Thus, this document is a planned protocol of a comprehensive systematic review with meta-analysis that we intend to carry out to review the scientific literature regarding up-to-date evidence on the use of neural mobilization in the management of people suffering from musculoskeletal pain disorders. The study designs that we will consider as inclusion criteria will be randomized and quasi-randomized clinical trials. The target population will be adults and older adults with musculoskeletal pain. Any controlled trial using any neural mobilization technique as an intervention in one of the trial groups will be included. The main outcomes of interest will be pain, functional status, and physical performance tests (muscle strength, flexibility, and balance). There will be no restrictions on follow-up time or type of setting. The risk of bias of the included studies will be assessed by the RoB 2 tool and the certainty of the evidence will be evaluated using the comprehensive Assessment, Development and Assessment of Assessment Recommendation (GRADE) approach. We intend to present the findings through narrative descriptions and, if possible, through meta-analytic statistics. Trial registration: PROSPERO registration number. CRD42021288387.
Collapse
Affiliation(s)
| | - Eduardo Brazete Cruz
- Department of Physiotherapy, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
| | - Vera Afreixo
- CIDMA–Center for Research and Development in Mathematics and Applications, Department of Mathematics, University of Aveiro (UA), Aveiro, Portugal
| | - Anabela G. Silva
- Center for Health Technology and Services Research (CINTESIS.UA), School of Health Sciences, University of Aveiro, Aveiro, Portugal
| |
Collapse
|
10
|
Corrêa LA, Bittencourt JV, Mainenti Pagnez MA, Mathieson S, Saragiotto BT, Telles GF, Meziat-Filho N, Calazans Nogueira LA. Neural management plus advice to stay active on clinical measures and sciatic neurodynamic for patients with chronic sciatica: Study protocol for a controlled randomised clinical trial. PLoS One 2022; 17:e0263152. [PMID: 35120149 PMCID: PMC8815873 DOI: 10.1371/journal.pone.0263152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/28/2021] [Indexed: 12/04/2022] Open
Abstract
Advice to stay active is the primary management strategy for sciatica. Other conservative treatments such as neural management techniques may also contribute to sciatica recovery, but currently, the effects have not been robustly assessed. Thus, the aim of this study is to compare the effects of adding neural management to advice to stay active versus advice to stay active alone in improving pain intensity and functional limitation. Secondarily, to compare the effects of the experimental intervention in the sciatic neurodynamic, pain modulation, and psychosocial factors. A parallel-group, controlled, examiner-blinded superiority clinical trial randomised at a 1:1 allocation will be conducted in 210 participants with chronic sciatica. Patients will be recruited from outpatient physiotherapy clinics and community advertisements. The experimental group will receive neural mobilisation techniques and soft tissue mobilisation techniques for 30 minutes per session, 10 weekly sessions, plus advice to stay active on their activities of daily living, information on physical activity, imaging tests, and sciatica for 5 biweekly sessions lasting 25-30 minutes. The control group will receive advice to stay active only. The re-evaluation will be performed out after 5 weeks, 10 weeks, and 26 weeks after randomisation and primary endpoints will be pain intensity and functional limitation at 10 weeks. Secondary outcomes will include neuropathic symptoms, sciatic neurodynamic, pain modulation, and psychosocial factors. Adverse events and patient satisfaction will be assessed. Ethical approval has been granted from an Institutional Human Research Ethics Committee. Trial registration: Trial was prospectively registered in the Brazilian Registry of Clinical Trials (number: RBR-3db643c).
Collapse
Affiliation(s)
- Leticia Amaral Corrêa
- Rehabilitation Science Postgraduation Program, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
| | - Juliana Valentim Bittencourt
- Rehabilitation Science Postgraduation Program, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
| | - Maria Alice Mainenti Pagnez
- Rehabilitation Science Postgraduation Program, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
| | - Stephanie Mathieson
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Gustavo Felicio Telles
- Rehabilitation Science Postgraduation Program, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
| | - Ney Meziat-Filho
- Rehabilitation Science Postgraduation Program, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
| | - Leandro Alberto Calazans Nogueira
- Rehabilitation Science Postgraduation Program, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
- Physiotherapy Department, Federal Institute of Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
| |
Collapse
|
11
|
Sousa Filho LF, Barbosa Santos MM, Matos Vasconcelos DB, Soares EA, dos Santos GHF, da Silva Júnior WM. Neurodynamic exercises provide no additional benefit to extension-oriented exercises in people with chronic low back-related leg pain and a directional preference: A randomized clinical trial. J Bodyw Mov Ther 2022; 30:140-147. [DOI: 10.1016/j.jbmt.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 01/30/2022] [Indexed: 11/28/2022]
|
12
|
|
13
|
Short-term Effects of Neurodynamic Techniques for Treating Carpal Tunnel Syndrome: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2021; 51:566-580. [PMID: 34784245 DOI: 10.2519/jospt.2021.10533] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES We aimed (1) to estimate the short-term effect (postintervention period) of neurodynamic techniques on pain, symptom severity, functional status, electrophysiological status, grip strength, and pinch strength in people with carpal tunnel syndrome (CTS); and (2) to estimate the effect of neurodynamic techniques compared to other physical therapy modalities and surgical interventions. DESIGN Intervention systematic review with meta-analysis. LITERATURE SEARCH We searched the MEDLINE, Cochrane Database of Systematic Reviews, Web of Science, Physiotherapy Evidence Database, and Scopus databases from their inception to September 2020. STUDY SELECTION CRITERIA We included randomized controlled trials reporting the effect of neurodynamic techniques on pain, symptom severity, function, distal motor latency, grip strength, and pinch strength in people with CTS. DATA SYNTHESIS Using the DerSimonian-Laird method, we estimated pooled standardized mean differences (SMDs) and 95% confidence intervals (CIs). We used the Grading of Recommendations Assessment, Development and Evaluation approach to judge the certainty of the evidence of each pairwise comparison. RESULTS There were 22 trials included (n = 1203 people with CTS; mean age, 26.0 to 57.9 years; mean symptom duration, 4.1 to 62.8 months). There was very low-certainty evidence of neurodynamic techniques improving pain (SMD, -0.54; 95% CI: -0.95, -0.13) and function (SMD, -0.35; 95% CI: -0.61, -0.09). There was no significant effect on symptom severity (very low certainty), distal motor latency (very low certainty), and grip and pinch strength (low certainty). CONCLUSION Neurodynamic techniques were effective for improving pain and function in people with CTS, albeit with very low-certainty evidence. J Orthop Sports Phys Ther 2021;51(12):566-580. Epub 16 Nov 2021.doi:10.2519/jospt.2021.10533.
Collapse
|
14
|
Abstract
Tensioning techniqueswere the first neurodynamic techniques used therapeutically in the management of people with neuropathies. This article aims to provide a balanced evidence-informed view on the effects of optimal tensile loading on peripheral nerves and the use of tensioning techniques. Whilst the early use of neurodynamics was centered within a mechanical paradigm, research into the working mechanisms of tensioning techniques revealed neuroimmune, neurophysiological, and neurochemical effects. In-vitro and ex-vivo research confirms that tensile loading is required for mechanical adaptation of healthy and healing neurons and nerves. Moreover, elimination of tensile load can have detrimental effects on the nervous system. Beneficial effects of tensile loading and tensioning techniques, contributing to restored homeostasis at the entrapment site, dorsal root ganglia and spinal cord, include neuronal cell differentiation, neurite outgrowth and orientation, increased endogenous opioid receptors, reduced fibrosis and intraneural scar formation, improved nerve regeneration and remyelination, increased muscle power and locomotion, less mechanical and thermal hyperalgesia and allodynia, and improved conditioned pain modulation. However, animal and cellular models also show that ‘excessive’ tensile forces have negative effects on the nervous system. Although robust and designed to withstand mechanical load, the nervous system is equally a delicate system. Mechanical loads that can be easily handled by a healthy nervous system, may be sufficient to aggravate clinical symptoms in patients. This paper aims to contribute to a more balanced view regarding the use of neurodynamics and more specifically tensioning techniques.
Collapse
Affiliation(s)
- Richard Ellis
- School of Clinical Sciences, Active Living and Rehabilitation: Aotearoa, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.,Department of Physiotherapy, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Giacomo Carta
- Department of Clinical and Biological Sciences, University of Torino, Orbassano, Italy.,Neuroscience Institute Cavalieri Ottolenghi (Nico), University of Torino, Orbassano, Italy.,ASST Nord Milano, Sesto San Giovanni Hospital, Milan, Italy
| | - Ricardo J Andrade
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia.,School of Health Sciences and Social Work, Griffith University, Queensland, USA
| | - Michel W Coppieters
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia.,Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
15
|
Varangot-Reille C, Cuenca-Martínez F, Arribas-Romano A, Bertoletti-Rodríguez R, Gutiérrez-Martín Á, Mateo-Perrino F, Suso-Martí L, Blanco-Díaz M, Calatayud J, Casaña J. Effectiveness of Neural Mobilisation Techniques in the Management of Musculoskeletal Neck Disorders with Nerve-Related Symptoms: A Systematic Review and Meta-Analysis with a Mapping Report. PAIN MEDICINE 2021; 23:707-732. [PMID: 34633462 DOI: 10.1093/pm/pnab300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/17/2021] [Accepted: 10/08/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The objective was to assess the effectiveness of neural mobilisation (NM) techniques in the management of musculoskeletal neck disorders with nerve-related symptoms (MND-NRS). METHODS We conducted a systematic review with meta-analysis, using pain intensity, disability, perceived function, cervical range of motion and mechanosensitivity as the main outcome measures. RESULTS The systematic review included 22 studies (n = 978). More favourable outcomes were observed for NM on pain intensity compared with control interventions (standardised mean differences (SMDs) -0.92; 95% CI - 1.66--0.18), but not compared with other treatments (OTs) (SMD 1.06; 95% CI - 0.02-2.15). Regarding neck pain intensity, no significant differences were found in favour of NM compared with OTs (SMD 0.37; 95% CI - 0.35-1.1). However, between-treatment differences were found in favour of OT on arm-pain intensity (SMD 0.57; 95% CI 0.08-1.05). In addition, the grouped MA did not show statistically significant differences between NM and OT outcomes on the cervical range of motion (SMD 0.16; 95% CI - 0.06-0.38). However, compared with no intervention, NM was associated with significantly improved outcomes in cervical rotation (SMD 0.91; 95% CI 0.61-1.22). Similar results were found regarding disability (SMD -0.08; 95% CI - 0.36--0.20, and SMD -1.44; 95% CI - 2.28--0.6, respectively). Finally, NM was associated with more favourable outcomes on mechanosensitivity compared with OT (SMD 0.79; 95% CI 0.15-1.42) and greater improvements in function compared with no intervention (SMD 0.89; 95% CI 0.16-1.62). CONCLUSIONS NM appeared to be effective to improve overall pain intensity when embedded in a physiotherapy treatment in the management of MND-NRS. When compared with no intervention, it was effective to improve neck rotation, disability, and function. However, it was not superior to other types of treatments in improving overall pain intensity, neck pain intensity, arm pain intensity, cervical range of motion and disability, except for mechanosensitivity.
Collapse
Affiliation(s)
- Clovis Varangot-Reille
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain
| | - Ferran Cuenca-Martínez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alberto Arribas-Romano
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Rodrigo Bertoletti-Rodríguez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain
| | - Álvaro Gutiérrez-Martín
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain
| | - Fernando Mateo-Perrino
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain
| | - Luis Suso-Martí
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Department of Physiotherapy, Universidad CEU Cardenal Herrera, CEU Universities, Valencia, Spain
| | - María Blanco-Díaz
- Surgery and Medical Surgical Specialities Department, Faculty of Medicine and Health Sciences, University of Oviedo, Oviedo, Asturias, Spain
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - José Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| |
Collapse
|
16
|
González ÁC, Berenguer SB, Luque Mañas JM, Martin-Pintado-Zugasti A. Validation of a sham novel neural mobilization technique in patients with non-specific low back pain: A randomized, placebo-controlled trial. Musculoskelet Sci Pract 2021; 53:102378. [PMID: 33930856 DOI: 10.1016/j.msksp.2021.102378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is no validated sham neural mobilization (NM) intervention for lower quadrant conditions. A suitable sham NM comparator will allow to blind patients with low back pain (LBP) and reduce bias by limiting the confounding effects of expectations. OBJECTIVE The primary aim was to develop a sham NM technique in patients with non-specific LBP and assess its validity in supplying a suitable blinding. Secondly, we compared the short-term effects of NM and the sham comparator on pain and the straight leg raise. DESIGN A randomized placebo-controlled trial in which participants and assessors were blinded. METHOD Fifty one patients (20 men,31 women), aged 22-65 years (43 ± 12y) were allocated randomly to a NM group (n = 26) or a sham NM group (n = 25). The primary outcome of believability of the sham technique was measured one week after the intervention. Secondary outcomes of pain intensity and the straight leg raise range-of-motion were assessed at baseline, immediately after the intervention and one week after. RESULTS The believability of the sham technique in terms of the frequencies of perceived group assignment showed no differences between groups. Eighteen participants believed they had received the experimental NM technique in the experimental group (69.2%) and 14 in the placebo NM group (56%). Pain and the straight leg raise changes did not show differences between groups. CONCLUSIONS The novel sham NM demonstrated to be a believable intervention, capable of supplying a suitable blinding. Both groups showed similar short term perceived effects on pain and the straight leg raise.
Collapse
Affiliation(s)
| | | | | | - Aitor Martin-Pintado-Zugasti
- Department of Physiotherapy, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660, Boadilla Del Monte, Madrid, Spain.
| |
Collapse
|
17
|
Neural Mobilization Short-Term Dose Effect on the Lower-Limb Flexibility and Performance in Basketball Athletes: A Randomized, Parallel, and Single-Blinded Study. J Sport Rehabil 2021; 30:1060-1066. [PMID: 34034229 DOI: 10.1123/jsr.2020-0389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 03/07/2021] [Accepted: 03/24/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT Neural mobilization is commonly used in sports, and previous studies have suggested that it has a positive impact on lower-limb flexibility and performance. However, studies exploring the effect of neural mobilization dosage are almost nonexistent. OBJECTIVES This study aimed to assess whether 2 distinct dosages of neural gliding mobilization (4 and 8 sets of 10 repetitions) impact the flexibility and performance of both the mobilized and nonmobilized lower limb in basketball athletes differently. DESIGN Randomized, parallel, and single-blinded study. SETTING Amateur and professional basketball clubs. PARTICIPANTS Fifty-two basketball athletes (40 men and 12 women), who were distributed into 2 groups; one received 40 (n = 28) and the other 80 repetitions (n = 24) of neural gliding mobilization. INTERVENTION Neural gliding mobilization applied to a single limb (the dominant limb). MAIN OUTCOME MEASURES Knee extension angle for hamstring flexibility; hop tests and single-leg vertical jump for performance. RESULTS There was a significant main effect of time (P < .001), a significant interaction between time and limb for flexibility (P = .003), and a significant interaction between time and limb for the single-leg hop test (P = .032). No other significant main effect for any of the remaining variables was found (P > .05). CONCLUSIONS The application of both 40 repetitions and 80 of neural gliding significantly improved lower-limb flexibility, and one was not superior to the other. Neither one dosage nor the other positively or negatively impacted the lower-limb performance of basketball athletes.
Collapse
|
18
|
Kurt V, Aras O, Buker N. Comparison of conservative treatment with and without neural mobilization for patients with low back pain: A prospective, randomized clinical trial. J Back Musculoskelet Rehabil 2021; 33:969-975. [PMID: 32144973 DOI: 10.3233/bmr-181241] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Low back pain (LBP) is a common problem that causes pain, disability, and gait and balance problems. Neurodynamic techniques are used in the treatment of LBP. OBJECTIVE The aim of this study was to compare the effects of electrotherapy and neural mobilization on pain, functionality, gait, and balance in patients with LBP. MATERIALS AND METHODS A total of 41 patients were randomly assigned to either the neural mobilization group (NMG, n= 20) or electrotherapy group (ETG, n= 21). Assessment tools used were Visual Analogue Scale (VAS) for pain, Oswestry Disability Index (ODI) for functionality, straight leg raise test (SLRT) for neural involvement, and baropedographic platform (Zebris FDM-2TM) for gait and static balance measurements. RESULTS Both groups showed a significant decrease in pain and functional disability, while only the NMG group showed a significant increase in SLRT scores (p< 0.05). However, there were no statistically significant pre- to post-treatment changes in gait or static balance parameters in either group (p< 0.05). CONCLUSION Neural mobilization was effective in reducing pain and improving functionality and SLRT performance in patients with LBP, but induced no change in gait and static balance parameters. Neural mobilization may be used as self-practice to supplement standard treatment programs.
Collapse
Affiliation(s)
- Vedat Kurt
- Deparment of Physiotherapy and Rehabilitation, Faculty of Health Science, Kutahya Health Science University, Kutahya, Turkey
| | - Ozgen Aras
- Deparment of Physiotherapy and Rehabilitation, Faculty of Health Science, Kutahya Health Science University, Kutahya, Turkey
| | - Nihal Buker
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| |
Collapse
|
19
|
Michaeli A. Treating low back pain - Bridging the gap between manual therapy and exercise. J Bodyw Mov Ther 2020; 24:452-461. [PMID: 33218547 DOI: 10.1016/j.jbmt.2020.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 05/22/2020] [Accepted: 06/13/2020] [Indexed: 12/16/2022]
Abstract
As therapists, we often recommend exercise to reduce patients' low-back pain, as well as increase their active range of motion and muscle strength. However, physical therapists face a challenge when recommending exercise to reduce low-back pain because the pain itself often inhibits the patient's ability to exercise or perform activities of daily living. This situation becomes even more challenging if the prescribed exercise program aggravates the individual's low-back pain. This article discusses a method which provides for the effective treatment of low back pain by allowing patients to exercise pain free earlier in the rehabilitation process. The method comprises a unique approach utilizing the following four components simultaneously from the onset of treatment: isometric muscle contraction (IMC); assisted active oscillatory mobilization; end-of-range passive stretch; and mindfulness.
Collapse
Affiliation(s)
- Arie Michaeli
- Clinical Solutions, Johannesburg, Gauteng, South Africa.
| |
Collapse
|
20
|
Savva C, Korakakis V, Efstathiou M, Karagiannis C. Cervical traction combined with neural mobilization for patients with cervical radiculopathy: A randomized controlled trial. J Bodyw Mov Ther 2020; 26:279-289. [PMID: 33992259 DOI: 10.1016/j.jbmt.2020.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 07/24/2020] [Accepted: 08/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although both neural mobilization (NM) and cervical traction (CT) are widely used interventions in cervical radiculopathy (CR), there is limited clinical data to support their use. OBJECTIVE To evaluate the effects of CT, with or without the addition of NM, on pain, function, and disability in patients with CR. DESIGN A randomized, double-blinded, placebo-controlled clinical trial. METHODS 66 patients with CR were randomly allocated to: a group (n = 22) received CT combined with NM (CT + NM), a group (n = 22) received CT combined with sham NM (CT + shamNM) and a wait-list control (WLC) group (n = 22). The Neck Disability Index (NDI), the Patient-Specific Functional Scale, the Numeric Pain Rating Scale (NPRS), grip strength and cervical spine mobility were used as outcome measures. A two-way analysis of variance was used to evaluate differences between the three groups at baseline and at 4-week follow-up. RESULTS Statistically and clinically significant between-group differences at 4-week follow-up were found between CT + NM and WLC groups in favor of CT + NM group in NDI scores (d = 1.30), NRPS (d = 1.94), and active cervical rotation towards the opposite arm (d = 1.18) and between CT + NM and CT + shamNM groups in favor of CT + NM group in NRPS (d = 1.21). No significant differences were observed between CT + shamNM and WLC groups in all outcome measures. Clinically significant within-group improvements were found only for the CT + NM group. CONCLUSION At 4-week follow-up, CT in combination with NM resulted in improved outcomes in pain, function and disability in patients with CR.
Collapse
Affiliation(s)
- Christos Savva
- Department of Health Science, European University, Diogenous 6, Engomi, Nicosia, Cyprus.
| | | | - Michalis Efstathiou
- Department of Life and Health Sciences, University of Nicosia, 46 Makedonitissas Avenue, Nicosia, Cyprus
| | - Christos Karagiannis
- Department of Health Science, European University, Diogenous 6, Engomi, Nicosia, Cyprus
| |
Collapse
|
21
|
Effect of Adding Neural Mobilization Versus Myofascial Release to Stabilization Exercises after Lumbar Spine Fusion: A Randomized Controlled Trial. Arch Phys Med Rehabil 2020; 102:251-260. [PMID: 32827553 DOI: 10.1016/j.apmr.2020.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 07/16/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To test the effect of adding neural mobilization (NM) versus myofascial release (MFR) to stabilization exercises (SE) on disability, pain, and lumbar range of motion (ROM) in patients with lumbar spine fusion (LSF). DESIGN A single blinded, parallel groups, randomized controlled trial. SETTING Outpatient public and governmental hospital clinics. PARTICIPANTS Patients (N=60) who had undergone LSF were randomly assigned into 3 equal groups. INTERVENTION Group I received NM plus SE, group II received MFR and SE, and group III received SE only. Each group visited the hospital 3 times a week for 4 weeks. MAIN OUTCOME MEASURES Oswestry disability index (ODI), visual analog scale, and back range of motion (BROM) were assessed before starting treatment, immediately after finishing treatment, and 1 month later. RESULTS There were statistically significant differences among the groups regarding the ODI and pain (P<.05) in favor of the study groups, but no statistically significant differences were found among groups regarding the BROM outcome (P>.05). Regarding the within-group effect, statistically significant differences were found in all outcomes after 1 month of treatment, as well as after 1 month of follow-up in each group (P<.05). CONCLUSIONS Patients who received NM or MFR combined with SE demonstrated better improvement, in favor of the NM group, regarding disability and pain than patients who received SE alone after LSF. No differences were found among the groups regarding lumbar ROM.
Collapse
|
22
|
Neto T, Freitas SR, Andrade RJ, Vaz JR, Mendes B, Firmino T, Bruno PM, Nordez A, Oliveira R. Shear Wave Elastographic Investigation of the Immediate Effects of Slump Neurodynamics in People With Sciatica. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:675-681. [PMID: 31633231 DOI: 10.1002/jum.15144] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/28/2019] [Accepted: 09/15/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Neurodynamic techniques are often used to treat people with sciatica pain, but their mechanical effects on the sciatic nerve are unknown. Shear wave elastography (SWE) has been shown to effectively estimate the stiffness of peripheral nerves in real time. The aim of this study was to use SWE to assess the effects of slump neurodynamics in the sciatic stiffness of people with sciatica. METHODS Sixteen participants volunteered for this study. The sciatic stiffness of 8 patients with unilateral chronic sciatica and 8 healthy control participants was measured by SWE, with the participants in a prone position and during a dynamic condition (ie, ankle dorsiflexion). These measurements were performed before and immediately after the neurodynamic intervention, which consisted of a static slump position applied to the symptomatic limb of the patients with sciatica and in a randomly chosen limb of the healthy participants. RESULTS The 8 patients with sciatica included 6 male and 2 female patients, and the 8 healthy control participants included 5 male and 3 female volunteers. Slump neurodynamics resulted in an immediate decrease in the sciatic nerve stiffness of the symptomatic limb in people with sciatica by 16.1% (effect size = 0.65; P = .019). The intervention showed no significant changes in the sciatic nerve stiffness of the healthy participants (effect size = 0.05; P = .754). CONCLUSIONS Slump neurodynamics have the potential of decreasing the sciatic nerve stiffness in people with sciatica, and this effect can be quantified by SWE, which may provide valuable information for health professionals.
Collapse
Affiliation(s)
- Tiago Neto
- Department of Physiotherapy, LUNEX International University of Health, Exercise, and Sports, Differdange, Luxembourg
| | - Sandro R Freitas
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Ricardo J Andrade
- Movement, Interactions, and Performance Laboratory, Faculty of Sport Sciences, University of Nantes, Nantes, France
- Menzies Health Institute Queensland and School of Allied Health Sciences, Griffith University, Brisbane and Gold Coast, Queensland, Australia
| | - João R Vaz
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Bruno Mendes
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Telmo Firmino
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Human Performance Department, Sport Lisboa e Benfica, Lisbon, Portugal
| | - Paula M Bruno
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Antoine Nordez
- Movement, Interactions, and Performance Laboratory, Faculty of Sport Sciences, University of Nantes, Nantes, France
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Raúl Oliveira
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| |
Collapse
|
23
|
Zollars JA, Burtner PA, Stockman G, Werbelow P, Swartzentruber J, Lowe JR. Neural and visceral manipulation in infants with congenital muscular torticollis: a feasibility study. J Phys Ther Sci 2020; 32:7-15. [PMID: 32082020 PMCID: PMC7008025 DOI: 10.1589/jpts.32.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 10/17/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] As an alternative to manual stretching, the aim of this study was to
investigate the feasibility of using neural/visceral manipulation as a safe and effective
intervention to increase neck range of motion of infants with congenital muscular
torticollis. [Participants and Methods] Ten 4-month old infants with congenital muscular
torticollis received eight sessions of neural/visceral manipulation administered for 30–50
minutes without observed pain. Specific palpation techniques addressed restricted tissue
areas of neck, head, trunk and extremities. Neck rotation and lateral flexion were
assessed by still photography and a computer program calculating ROM angles before,
immediately following, and 4 months post intervention. Motor development and social
competence were monitored over time using the Alberta Infant Motor Scale and Bayley-III
Social Emotional Scale. [Results] Results of analysis of variances revealed significant
improvements in passive and active neck rotation and lateral flexion. Significant
increases were also found on the Alberta Infant Motor Scale and Bayley-III
Social-Emotional scale. [Conclusion] Neural/visceral manipulation can be used safely in
infants with congenital muscular torticollis to improve neck range of motion.
Collapse
Affiliation(s)
- Jean Anne Zollars
- Physical Therapy, Inc.: 1100 Alvarado Dr. NE, Suite C, Albuquerque, NM 87110, USA
| | - Patricia A Burtner
- Occupational Therapy Graduate Program, Department of Pediatrics, University of New Mexico, USA
| | - Gail Stockman
- Occupational Therapy Graduate Program, Department of Pediatrics, University of New Mexico, USA
| | - Prisca Werbelow
- Occupational Therapy Graduate Program, Department of Pediatrics, University of New Mexico, USA
| | - Jessie Swartzentruber
- Occupational Therapy Graduate Program, Department of Pediatrics, University of New Mexico, USA
| | - Jean R Lowe
- Division of Pediatrics/Neonatology, University of New Mexico, USA
| |
Collapse
|
24
|
Development of a Clinical Decision Aid for Chiropractic Management of Common Conditions Causing Low Back Pain in Veterans: Results of a Consensus Process. J Manipulative Physiol Ther 2019; 42:677-693. [PMID: 31864769 DOI: 10.1016/j.jmpt.2019.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this study was to develop a clinical decision aid for chiropractic management of common conditions causing low back pain (LBP) in veterans receiving treatment in US Veterans Affairs (VA) health care facilities. METHODS A consensus study using an online, modified Delphi technique and Research Electronic Data Capture web application was conducted among VA doctors of chiropractic. Investigators reviewed the scientific literature pertaining to diagnosis and treatment of nonsurgical, neuromusculoskeletal LBP. Thirty seed statements summarizing evidence for chiropractic management, a graphical stepped management tool outlining diagnosis-informed treatment approaches, and support materials were then reviewed by an expert advisory committee. Email notifications invited 113 VA chiropractic clinicians to participate as Delphi panelists. Panelists rated the appropriateness of the seed statements and the stepped process on a 1-to-9 scale using the RAND/University of California, Los Angeles methodology. Statements were accepted when both the median rating and 80% of all ratings occurred within the highly appropriate range. RESULTS Thirty-nine panelists (74% male) with a mean (standard deviation) age of 46 (11) years and clinical experience of 17 (11) years participated in the study. Accepted statements addressed included (1) essential components of chiropractic care, (2) treatments for conditions causing or contributing to LBP, (3) spinal manipulation mechanisms, (4) descriptions and mechanisms of commonly used chiropractic interventions, and (5) a graphical stepped clinical management tool. CONCLUSION This study group produced a chiropractic clinical decision aid for LBP management, which can be used to support evidence-based care decisions for veterans with LBP.
Collapse
|
25
|
Comparative Effects of Tensioning and Sliding Neural Mobilization on Static Postural Control and Lower Limb Hop Testing in Football Players. J Sport Rehabil 2019; 28:840-846. [PMID: 30222495 DOI: 10.1123/jsr.2017-0374] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 07/31/2018] [Accepted: 08/06/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT Sliding and tensioning neural mobilization are used to restore normal function of the nervous system, but they impose different stresses on it. Particularly, sliding induces greater nerve excursion than tensioning. Conceivably, they might impact nervous system function differently. OBJECTIVE To compare the effects of tensioning neural mobilization versus sliding neural mobilization of the dominant lower limb on static postural control and hop testing. DESIGN Randomized, parallel and double blinded trial. SETTING/PARTICIPANTS Thirty-seven football players. INTERVENTION(S) Participants were randomized into 2 groups: sliding neural mobilization (n = 18) or tensioning neural mobilization (n = 19) targeting the tibial nerve. MAIN OUTCOME MEASURES Static postural sway was assessed with a force plate and functional performance with hop tests. Measurements were taken at baseline, after the intervention, and at 30-minute follow-up. RESULTS There was a significant effect of time for the center of pressure total displacement and velocity (P < .05), for the single-leg hop test (P < .05), the 6-m timed hop test (P < .05), and the cross-over hop test (P < .05), but no significant effect of the intervention. CONCLUSIONS Sliding and tensioning neural mobilization improved postural control and hop testing in football players, and improvements remained 30 minutes after the intervention. Additional research examining the influence of neural mobilization on sensory motor impairments, postural control, and functional performance is needed.
Collapse
|
26
|
Gamelas T, Fernandes A, Magalhães I, Ferreira M, Machado S, Silva AG. Neural gliding versus neural tensioning: Effects on heat and cold thresholds, pain thresholds and hand grip strength in asymptomatic individuals. J Bodyw Mov Ther 2019; 23:799-804. [DOI: 10.1016/j.jbmt.2019.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 04/22/2019] [Indexed: 12/20/2022]
|
27
|
Mateus A, Rebelo J, Silva AG. Effects of a Multimodal Exercise Program Plus Neural Gliding on Postural Control, Pain, and Flexibility of Institutionalized Older Adults: A Randomized, Parallel, and Double-Blind Study. J Geriatr Phys Ther 2019; 43:3-11. [PMID: 31569173 DOI: 10.1519/jpt.0000000000000249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE The effect of adding neural mobilization to a multimodal program of exercises has not been investigated, despite its potential positive effects. The aim of this study was to compare the acute effects of a multimodal exercise program and neural gliding against a multimodal exercise program only, on pain intensity, gait speed, Timed Up and Go (TUG) test, lower limb flexibility, and static balance of institutionalized older adults. METHODS Older adults who were institutionalized (n = 26) were randomized to receive a multimodal exercise program plus neural gliding or a multimodal exercise program only. Both interventions were delivered twice a week for 8 weeks. Participants were assessed for pain, gait velocity, balance, flexibility, and TUG at baseline and postintervention. RESULTS A significant main effect of time for pain intensity (F1,24 = 8.95, P = .006), balance (F1,24 = 10.29, P = .004), and gait velocity (F1,24 = 5.51, P = .028) was observed, indicating a positive impact of both interventions. No other significant effects were found (TUG and flexibility; P > .05). DISCUSSION A 45-minute multimodal exercise program, twice a week for 8 weeks, has a positive impact on pain intensity, balance, and gait velocity, but neural gliding has no additional benefit. It is unclear whether dose and type of neural mobilization may have had an impact on results. Considering the structural and physiological changes that tend to occur with age, future studies could explore the effects of neural tensioning or of higher doses of neural mobilization. CONCLUSIONS This study suggests that adding neural gliding to a multimodal exercise program has no additional benefit.
Collapse
Affiliation(s)
- Ana Mateus
- School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, Portugal
| | - Jessica Rebelo
- Lar Santa Catarina do Reboleiro, Avenida da Ribeirinha, Trancoso, Portugal
| | - Anabela G Silva
- School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, Portugal.,CINTESIS.UA, University of Aveiro, Campus Universitário de Santiago, Portugal
| |
Collapse
|
28
|
Strunce J, Spoonemore S, Golding J, Randall T, Krok M, Lee S, Bordt D, Walker-Ferrell W, Cordel D. Physical rehabilitation therapists' perspective of the opioid crisis with evidence-based recommendations. Pain Manag 2019; 9:483-495. [PMID: 31452447 DOI: 10.2217/pmt-2019-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In 2017, the Secretary of Health and Human Services and Office of the Surgeon General declared the opioid crisis of our nation to be a public health emergency. In response to the Office of the Assistant Secretary of Health and Office of the Surgeon General's 'Call to Action', the Therapist category of the US Public Health Service commissioned a nine-member task force consisting of pain science subject matter experts to study the Therapists' role in effectively reducing chronic pain and opioid abuse. This article addresses the opioid epidemic, how patients with chronic pain have been managed inappropriately, and five key, evidence-based recommendations from this task force.
Collapse
Affiliation(s)
- Joseph Strunce
- Rehabilitation Department, Four Corners Regional Health Center, Red Mesa, AZ 86514, USA
| | - Stephen Spoonemore
- Rehabilitation Department, Physical Therapy & Exercise Southcentral Foundation, Anchorage, AK 99508, USA
| | - Joseph Golding
- Rehabilitation Department, Parker Indian Health Center, Parker, AZ 85344, USA
| | - Tarri Randall
- Rehabilitation Department, Whiteriver Indian Hospital, Whiteriver, AZ 85941, USA
| | - Michael Krok
- Rehabilitation Department, Womack Army Medical Center, Fort Bragg, NC 28310, USA
| | - Steven Lee
- Rehabilitation Department, Valley Native Primary Care Center, Wasilla, AK 99654, USA
| | - Daniel Bordt
- Rehabilitation Department, Federal Medical Center Rochester, Rochester, MN 55904, USA
| | - Wendy Walker-Ferrell
- Rehabilitation Department, Chinle Comprehensive Health Care Facility, Chinle, AZ 86503, USA
| | - Douglas Cordel
- Rehabilitation Department, Four Corners Regional Health Center, Red Mesa, AZ 86514, USA
| |
Collapse
|
29
|
Sousa Filho LF, Barbosa Santos MM, de Farias Neto JP, da Silva Junior WM. The addition of neurodynamic exercises to extension-oriented exercises among patients with chronic back-related leg pain: A study protocol. J Bodyw Mov Ther 2019; 23:473-478. [PMID: 31563358 DOI: 10.1016/j.jbmt.2018.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 06/25/2018] [Accepted: 08/25/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with back-related leg pain exhibit nociceptive and neuropathic characteristics. Few studies have investigated the combination of interventions considering these characteristics. OBJECTIVES To investigate if the addition of neurodynamic exercises (EEN) to extension-oriented exercises (EE) promotes additional benefits in individuals with back-related leg pain and a directional preference. METHODS Patients will be randomized to either EE or EEN. Patients from both groups will receive 7 sessions over 3 weeks. Low back and leg pain, function, quality of life, disability, and global perceived effect will be evaluated at baseline, 3 weeks after randomization and 1-month follow-up. A linear mixed model will be used for outcomes analysis.
Collapse
Affiliation(s)
- Luis F Sousa Filho
- Master's Program in Physical Education, Universidade Federal de Sergipe, São Cristovão, Sergipe, Brazil.
| | - Marta M Barbosa Santos
- Department of Physiotherapy, Universidade Federal de Sergipe, São Cristovão, Sergipe, Brazil.
| | - Jader P de Farias Neto
- Department of Physiotherapy, Universidade Federal de Sergipe, São Cristovão, Sergipe, Brazil.
| | - Walderi M da Silva Junior
- Master's Program in Physical Education, Universidade Federal de Sergipe, São Cristovão, Sergipe, Brazil.
| |
Collapse
|
30
|
Pagnez MAM, Corrêa LA, Almeida RS, Meziat-Filho NA, Mathieson S, Ricard F, Nogueira LAC. The Variation of Cross-Sectional Area of the Sciatic Nerve in Flexion-Distraction Technique: A Cross-Sectional Study. J Manipulative Physiol Ther 2019; 42:108-116. [PMID: 31029470 DOI: 10.1016/j.jmpt.2019.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 05/23/2018] [Accepted: 03/05/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the cross-sectional area of the sciatic nerve in different positions of spinal manipulation using flexion-distraction technique. METHODS Thirty healthy participants were assessed in 6 different flexion-distraction technique positions of varying lumbar, knee, and ankle positions. Participants stood in the following 3 positions with the lumbar in the neutral position: (A) with knee extended, (B) with knee flexed, and (C) with the knee extended and ankle dorsiflexion. Participants then stood in the following 3 positions with the lumbar flexed: (D) with the knee extended, (E) with the knee flexed, and (F) with knee extended and ankle dorsiflexion. The cross-sectional area (CSA) of the sciatic nerve was measured with ultrasound imaging in transverse sections in the posterior medial region of the left thigh. The CSA values measured at each position were compared. RESULTS We analyzed 180 ultrasound images. The cross-sectional area of the sciatic nerve (in mm2) in position B (mean; standard deviation) (59.71-17.41) presented a higher mean cross-sectional area value compared with position D (51.18-13.81; P =.005), position F (48.71-15.16; P = .004), and position C (48.37-16.35; P = .009). CONCLUSION The combination of knee extension and ankle dorsiflexion reduced the CSA of the sciatic nerve, and flexing the knee and keeping the ankle in the neutral position increased it.
Collapse
Affiliation(s)
- Maria Alice Mainenti Pagnez
- Physiotherapy Department, Rehabilitation Science Postgraduate Program, Augusto Motta University Centre, Rio de Janeiro, Brazil; Academic Department, Madrid School of Osteopathy, Rio de Janeiro, Brazil.
| | - Leticia Amaral Corrêa
- Physiotherapy Department, Rehabilitation Science Postgraduate Program, Augusto Motta University Centre, Rio de Janeiro, Brazil
| | - Renato Santos Almeida
- Physiotherapy Department, Rehabilitation Science Postgraduate Program, Augusto Motta University Centre, Rio de Janeiro, Brazil; Physiotherapy Department, Serra dos Órgãos University Centre, Teresópolis, Brazil
| | - Ney Armando Meziat-Filho
- Physiotherapy Department, Rehabilitation Science Postgraduate Program, Augusto Motta University Centre, Rio de Janeiro, Brazil
| | - Stephanie Mathieson
- Musculoskeletal Health Sydney, School of Public Health, The University of Sydney New South Wales, Australia
| | - François Ricard
- Academic Department, Madrid School of Osteopathy, Rio de Janeiro, Brazil
| | - Leandro Alberto Calazans Nogueira
- Physiotherapy Department, Rehabilitation Science Postgraduate Program, Augusto Motta University Centre, Rio de Janeiro, Brazil; Physiotherapy Department, Federal Institute of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
31
|
Almeida RSD, Machado E, Yamato TP, Santos De Melo L, Nogueira LAC. Pragmatic neural tissue management improves short-term pain and disability in patients with sciatica: a single-arm clinical trial. J Man Manip Ther 2019; 27:208-214. [PMID: 30935325 DOI: 10.1080/10669817.2019.1580420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objectives: To evaluate the clinical effect of sciatic neural mobilization in combination with the treatment of surrounding structures for sciatica patients. Secondly, we were also interested in identifying possible baseline characteristics that may be associated with improvements in pain and disability for sciatica patients. Methods: Twenty-eight patients with a clinical diagnosis of sciatica were treated with neural mobilization, joint mobilization and soft tissue techniques. Pain intensity and lumbar disability were assessed at baseline and after treatment using a Numerical Rating Scale (0-10) and the Oswestry Disability Index (0-100), respectively. The pre- and post-intervention data were compared. The research protocol was registered under the number NCT03663842. Results: Participants attended an average of 16 (SD±5.6) treatment
sessions over an average of 12 weeks. Decrease in pain scores (before median = 8, after median = 2; p < 0.001) and improvement in lumbar disability scores (before median = 33.3%, after median = 15.6%; p < 0.001) were observed. A multiple linear regression analysis showed that duration of pain and age of the patient predicted the disability improvement: F (2, 24) = 4.084, p < 0.030, R2 = 0.254. Discussion: Patients with sciatica may benefit from neural mobilization in combination with manual therapy for pain and lumbar disability. Longer pain duration and younger age had a negative influence on lumbar disability improvement.
Collapse
Affiliation(s)
- Renato Santos de Almeida
- a Physiotherapy Department, Serra dos Órgãos University Centre (UNIFESO) , Teresópolis , Brazil.,b Rehabilitation Science Postgraduation Progam, Augusto Motta University Centre (UNISUAM) , Rio de Janeiro , Brazil
| | - Eduardo Machado
- c Physiotherapy Department, Gaffrée and Guinle University Hospital , Rio de Janeiro , Brazil
| | - Tiê Parma Yamato
- d Musculoskeletal Health Sydney, School of Public Health, Sydney Medical School, The University of Sydney , Sydney , Australia
| | - Luciano Santos De Melo
- e Rheumatology Department, Royal North Shore Hospital, School of Medicine, University of Sydney , Australia.,f Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney , Australia
| | - Leandro Alberto Calazans Nogueira
- b Rehabilitation Science Postgraduation Progam, Augusto Motta University Centre (UNISUAM) , Rio de Janeiro , Brazil.,g Physiotherapy Department, Federal Institute of Rio de Janeiro (IFRJ) , Rio de Janeiro , Brazil
| |
Collapse
|
32
|
Neural gliding and neural tensioning differently impact flexibility, heat and pressure pain thresholds in asymptomatic subjects: A randomized, parallel and double-blind study. Phys Ther Sport 2019; 36:101-109. [PMID: 30710858 DOI: 10.1016/j.ptsp.2019.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/18/2019] [Accepted: 01/18/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To compare the effect of neural gliding and tensioning on hamstring flexibility, nerve function (heat and cold thresholds) and pain sensitivity (pain intensity and pressure pain threshold) of the mobilized and non-mobilized lower limbs at post-intervention and 24 h follow up. DESIGN Randomized, parallel and double blinded trial. SETTING/PARTICIPANTS Forty-eight asymptomatic participants. INTERVENTION(S) Participants received neural gliding (n = 23) or tensioning (n = 25). Main Outcome Measures - Straight leg raising (SLR; in degrees), heat and cold threshold (ºC), pressure pain threshold (PPT; in Kgf) and pain intensity (visual analogue scale), taken at baseline, post-intervention and at 24 h follow up. RESULTS There was a significant interaction between time, intervention and limb for SLR (F2,45 = 3.83; p = 0.029). A significant interaction between time and intervention for PPT (F2,45 = 3.59; p = 0.036) and heat threshold (F2,45 = 5.10; p = 0.01). A significant effect of time (F2,45 = 9.42; p < 0.001) and of limb (F1,46 = 4.78; p = 0.035) for pain intensity during SLR, and a significant effect of time (F2,45 = 3.65; p = 0.034) for pain intensity during PPT. CONCLUSION Gliding and tensioning had similar and positive effects for flexibility in the mobilized limb, but tensioning was superior for the non-mobilized limb. Gliding was superior to tensioning for pressure pain and heat thresholds.
Collapse
|
33
|
Pourahmadi M, Hesarikia H, Keshtkar A, Zamani H, Bagheri R, Ghanjal A, Shamsoddini A. Effectiveness of Slump Stretching on Low Back Pain: A Systematic Review and Meta-analysis. PAIN MEDICINE 2018; 20:378-396. [DOI: 10.1093/pm/pny208] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mohammadreza Pourahmadi
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Hesarikia
- Department of Orthopedic Surgery, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abbasali Keshtkar
- Department of Health Sciences Education Development, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Zamani
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Rasool Bagheri
- Neuromuscular Rehabilitation Research Center, Department of Physiotherapy, Semnan University of Medical Sciences, Semnan, Iran
| | - Ali Ghanjal
- Health Management Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Alireza Shamsoddini
- Exercise Physiology Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| |
Collapse
|
34
|
The Effectiveness of Neural Mobilization for Neuromusculoskeletal Conditions: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther 2017; 47:593-615. [PMID: 28704626 DOI: 10.2519/jospt.2017.7117] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Systematic review with meta-analysis. Objectives To determine the efficacy of neural mobilization (NM) for musculoskeletal conditions with a neuropathic component. Background Neural mobilization, or neurodynamics, is a movement-based intervention aimed at restoring the homeostasis in and around the nervous system. The current level of evidence for NM is largely unknown. Methods A database search for randomized trials investigating the effect of NM on neuromusculoskeletal conditions was conducted, using standard methods for article identification, selection, and quality appraisal. Where possible, studies were pooled for meta-analysis, with pain, disability, and function as the primary outcomes. Results Forty studies were included in this review, of which 17 had a low risk of bias. Meta-analyses could only be performed on self-reported outcomes. For chronic low back pain, disability (Oswestry Disability Questionnaire [0-50]: mean difference, -9.26; 95% confidence interval [CI]: -14.50, -4.01; P<.001) and pain (intensity [0-10]: mean difference, -1.78; 95% CI: -2.55, -1.01; P<.001) improved following NM. For chronic neck-arm pain, pain improved (intensity: mean difference, -1.89; 95% CI: -3.14, -0.64; P<.001) following NM. For most of the clinical outcomes in individuals with carpal tunnel syndrome, NM was not effective (P>.11) but showed some positive neurophysiological effects (eg, reduced intraneural edema). Due to a scarcity of studies or conflicting results, the effect of NM remains uncertain for various conditions, such as postoperative low back pain, cubital tunnel syndrome, and lateral epicondylalgia. Conclusion This review reveals benefits of NM for back and neck pain, but the effect of NM on other conditions remains unclear. Due to the limited evidence and varying methodological quality, conclusions may change over time. Level of Evidence Therapy, level 1a. J Orthop Sports Phys Ther 2017;47(9):593-615. Epub 13 Jul 2017. doi:10.2519/jospt.2017.7117.
Collapse
|