Effects of Neural Mobilization on Pain Intensity, Disability, and Mechanosensitivity: An Umbrella Review With Meta-Meta-Analysis

Proprioceptive Neuromuscular Facilitation and/or Electrical Stimulation in Patients with Peripheral Facial Paralysis: A Systematic Review

BACKGROUND

Peripheral facial paralysis (PFP) affects the facial nerve, the seventh cranial nerve. It has an incidence rate of 20-30 cases per 100,000 habitants. The diagnosis is clinical, though imaging tests may be required in some cases. The treatment protocol includes medication, physiotherapy, and, in certain cases, surgery. Proprioceptive neuromuscular facilitation (PNF) techniques and electrical stimulation have been shown to be significant for recovery. Although PFP has a high recovery rate, up to 40% of patients may experience permanent sequelae.

OBJECTIVE

to assess the efficacy of treatment based on electrical stimulation and/or PNF in patients affected by PFP.

METHODS

A systematic search was conducted across six databases (PubMed, Medline, SportDiscus, CINAHL, Scopus, and Web of Science) in November 2024. Randomized controlled trials were included.

RESULTS

Fourteen articles were analyzed, applying PNF and/or electrical stimulation methods, pharmacological treatment, low-level laser treatment, subcutaneous collagen injections, and physiotherapy protocols involving facial expression exercises, yielding evidence for the variables assessed.

CONCLUSIONS

PNF and/or electrical stimulation treatment in patients with PFP can be effective when employed early with appropriate parameters, showing promising results in improving quality of life, facial movement quality, and CMAP and reducing both the incidence and degree of synkinesis.

Neural mobilisation effects in nerve function and nerve structure of patients with peripheral neuropathic pain: A systematic review with meta-analysis

OBJECTIVE

To assess the effects of neural mobilisation on nerve function and nerve structure of patients with peripheral neuropathic pain.

METHODS

A systematic review with meta-analysis was conducted. Medline, Embase, CINAHL, Cochrane Library, and World Health Organization International Clinical Trials Registry Platform were searched without restrictions. Eligibility criteria included controlled trials or quasi-experimental studies comparing neural mobilisation versus sham, active or inactive control in adults with peripheral neuropathic pain. Primary outcomes were the change in peripheral nerve cross-sectional area. Secondary outcomes included nerve echogenicity, nerve excursion and nerve conduction. Random effects meta-analysis was conducted. Risk of bias was assessed with the Cochrane Collaboration tool, and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework.

RESULTS

Eleven randomised controlled trials and four quasi-experimental studies (total sample = 722 participants) were included. Thirteen studies included participants with carpal tunnel syndrome. Two studies examined the cross-sectional area, revealing improvements (i.e., a reduction) in the cross-sectional area after the neural mobilisation. Neural mobilisation improved motor [mean difference = 2.95 (95%CI 1.67 to 4.22)] and sensory conduction velocity in short-term [mean difference = 11.74 (95%CI 7.06 to 16.43)], compared to control. Neural mobilisation did not alter distal motor or sensory latency.

CONCLUSION

Neural mobilisation seems to improve (i.e., a reduced) the cross-sectional area (very low-quality evidence) and sensory conduction velocity (very low-quality evidence). Neural mobilisation was superior to control in improving motor conduction velocity in patients with peripheral neuropathic pain with moderate quality evidence. Distal motor or sensory latency presented similar results compared to other interventions. Our findings should be interpreted cautiously since most studies included patients with carpal tunnel syndrome.

Effectiveness of Neural Mobilisation on Pain Intensity, Functional Status, and Physical Performance in Adults with Musculoskeletal Pain - A Systematic Review with Meta-Analysis

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.

Therapeutic management of the painful nerve: a narrative review of common rehabilitation interventions

There are many ways that rehabilitation therapists, including occupational and physical therapists, treat nerve-related pain. Commonly used interventions include neurodynamic treatment, pain neuroscience education, desensitization, exercise, physical agent modalities, mirror box therapy, and Kinesio taping. Despite common practice and anecdotal support, it can be challenging to determine the appropriate intervention for each patient. In this article, each of these treatment approaches is discussed, including indicated pain phenotypes and diagnoses, timing, efficacy, mechanism, contraindications, and limitations.

Pain and the Non-Pharmacological Management of Pain in People with Parkinson's Disease

Pain is a distressing and universal experience, yet everyone's pain experience is influenced by a complex array of biological, psychological, and social factors. For people with Parkinson's disease (PwP), these biopsychosocial factors include neurodegeneration and the psychological and social factors that accompany living with a chronic, neurodegenerative condition in addition to the factors experienced by those in the general population (e.g., living with co-morbidities such as osteoarthritis). The way these factors influence each individual is likely to determine which pain management strategies are optimal for them. This review first describes pain and the biopsychosocial model of pain. It explores how pain is classified in Parkinson's disease (PD) and describes the three main types of pain: nociceptive, neuropathic, and nociplastic pain. This background provides context for a discussion of non-pharmacological pain management strategies that may aid in the management of pain in PwP; exercise, psychological strategies, acupuncture and massage. While there is little PD-specific research to inform the non-pharmacological management of pain, findings from current PD research are combined with that from chronic pain research to present recommendations for clinical practice. Recommendations include assessment that incorporates potential biopsychosocial contributors to pain that will then guide a holistic, multi-modal approach to management. As exercise provides overall benefits for PwP, those with chronic pain should be carefully monitored with exercise prescribed and adjusted accordingly. Research is needed to develop and evaluate multi-modal approaches to pain management that are delivered in a biopsychosocial framework.

Specific Neurodynamic Exercises on Pain and Disability in Old Women with Chronic Mechanical Neck Pain: A Randomized Controlled Trial

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.

Effect of tibial nerve mobilization on balance & gait functions in subjects with subclinical diabetic neuropathy: A randomized clinical trial

Introduction

With advancing age, balance control diminishes as a result of cognitive impairment, decreased muscle strength, and impairment in visual, vestibular, and somatosensory systems. Besides aforesaid factors, the addition of diabetes to all these leads to balance and gait-related issues such as falls and fall-related injuries. Impaired balance and gait performance in diabetics are primarily attributed to the diminished sensory function of the foot and ankle region owing to diabetic neuropathy. The purpose of this study was to explicitly examine the impact of neural mobilization on the balance & gait functions of subjects having subclinical diabetic neuropathy.

Methods

40 individuals with subclinical diabetic neuropathy, ranging in age from 50 to 75 years, were assigned to two groups at random: Group 1 received the concurrent application of Tibial nerve mobilization and Balance-Gait training whereas Group 2 received only Balance-Gait training. The therapy was administered five times each week, for four weeks. On the first and last day of treatment, measurements of VPT, BBS, TUG, and DGI were taken from each subject.

Results

The results of the study found that post neural mobilization and Balance-Gait training, scores of VPT, BBS, DGI, and TUG showed improvement but it was not significant. As it is evident that diabetic neuropathy is progressive in nature, even small changes can be helpful.

Conclusion

Neural mobilization integrated with balance-gait training of subclinical diabetic neuropathic individuals resulted in improved sensory functions along with enhanced balance-gait functions.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01246-w.

Upper limb neurodynamic mobilization disperses intraneural fluid in cervical nerve roots: A human cadaveric investigation

BACKGROUND

Cervical radiculopathy is a common cause of neck pain with resultant intraneural edema and impaired nerve function. One strategy to treat radiculopathy is neurodynamic mobilization (NDM); however, little is known about the effect of this treatment on nerve tissue fluid dynamics.

OBJECTIVE

Investigate the impact of upper limb, median nerve-biased NDM on longitudinal intraneural fluid dispersion in the C5,C6,C7 nerve roots in un-embalmed cadavers.

DESIGN

In situ repeated measures.

METHODS

Human cadavers (n = 8) were dissected to expose and inject C5,C6,C7 cervical nerve roots with a dying agent. Initial longitudinal dye spread was recorded after dye spread stabilization. Cadavers were taken through 150 repetitions of upper limb, median nerve-biased NDM followed by dye spread re-measurement. Paired-samples t-tests with Bonferroni correction (α = 0.017) were used to compare pre-vs post-NDM dye spread measurements at C5,C6,C7 nerve roots; a one-way repeated measures ANOVA (α = 0.05) was used to examine differences between change scores for C5,C6,C7 nerve roots.

RESULTS

Median nerve-biased NDM resulted in significant intraneural longitudinal dye spread at C5 and C6 nerve roots of 0.6 ± 0.6 mm and 3.4 ± 3.9 mm, respectively (p < 0.014). Dye spread was not significant at C7 nerve root (0.4 ± 0.7 mm). There was no between root difference in change of longitudinal dye spread between C5, C6, and C7 nerve roots.

CONCLUSIONS

The results of this study show median nerve-biased NDM produced internal fluid movement within C5 and C6 cervical nerve roots. Results provide insight regarding possible mechanism of action and feasibility of NDM in treatment of patients with cervical radiculopathy.

The Effectiveness of Neuromobilization in Patients With Cervical Radiculopathy: A Systematic Review With Meta-Analysis

CONTEXT

Neuromobilization exercises (NE) could be a useful therapeutic tool to induce analgesia and increase function and range of motion (ROM) in patients with musculoskeletal pathologies with neuropathic components; however, the effectiveness of this intervention in patients with cervical radiculopathy (CR) is unknown.

OBJECTIVE

To determine the effectiveness of NE in CR on pain, function, and ROM.

DESIGN

Systematic review and meta-analysis.

EVIDENCE ACQUISITION

An electronic search was performed in the MEDLINE, Scopus, PEDro, and EBSCO databases from inception until June 2022. The authors included randomized clinical trials that evaluated the effectiveness of NE against control groups or other interventions that aimed to treat patients with CR.

EVIDENCE SYNTHESIS

Seven clinical trials met the eligibility criteria, and for the quantitative synthesis, 5 studies were included. For the studies that compared NE with a control group, the standardized mean difference for pain was -1.33/10 (95% confidence interval [CI], -1.80 to -0.86; P < .01; I2 = 0%), for function with the Neck Disability Index was -1.21/50 (95% CI, -1.67 to -0.75; P < .01; I2 = 0%), and for neck flexion and extensions was 0.66 (95% CI, 0.23 to 1.10; P < .01; I2 = 0%) and 0.47 (95% CI, 0.04 to 0.90; P < .01; I2 = 0%), respectively, with evidence of clinical effectiveness. These findings were based on moderate-quality evidence according to the Grading of Recommendation, Assessment, Development, and Evaluation rating. In studies that compared NE with other interventions, the meta-analysis failed to demonstrate the statistical or clinical superiority of NE.

CONCLUSIONS

Moderate quality of evidence suggests that NE may be superior to no treatment for pain, function, and ROM in patients with CR. In contrast, NE are not superior to other interventions in the same outcomes, based on low- to very low-quality evidence. More high-quality research is needed to assess the consistency of these results.

The Effects of Mind-Body Exercises on Chronic Spinal Pain Outcomes: A Synthesis Based on 72 Meta-Analyses

An umbrella review of systematic reviews with a meta-analysis was developed to summarize the evidence on the effectiveness of qigong, tai chi, and yoga in chronic spinal pain outcomes. The CINAHL, Cochrane Library, Embase, PsycINFO, PubMed and SPORTDiscus databases were searched. Pain, psychological factors, and quality of life (QOL) were the outcomes of interest. The methodological quality of the reviews was evaluated using the AMSTAR-2 tool. The overlap was calculated using the corrected covered area. A total of 72 meta-analyses drawn from 20 systematic reviews were included and often were rated at a critically low quality. The effects of qigong on chronic low back and neck pain (CLBP and CNP, respectively) were inconsistent, although it improved the physical component of QOL after 12 weeks for CNP. Tai chi was superior to the controls in reducing CLBP; no reviews of interest were found on CNP. Yoga was superior to multiple controls in reducing CLBP, but no relevant effects on depression or QOL were found. QOL, anxiety, depression, and general mood improved with yoga for CNP. Inconsistencies arose related to yoga and CNP. Our findings mainly supported the potential effects of yoga and tai chi on pain-related outcomes, psychological factors, and QOL in populations with CLBP and NP. Clinical and methodological considerations were discussed.