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 exercises in carpal tunnel syndrome: Systematic review and meta-analysis.

PURPOSE: To examine the effectiveness of Neuromobilization Exercises (NE) on pain, grip and pinch strength, two-point discrimination, motor and sensory distal latency, symptom severity, and functional status using the Boston Carpal Tunnel Questionnaire (BCTQ) in Carpal Tunnel Syndrome (CTS). METHODS: Major electronic databases were searched from inception up to September 2021 for randomized trials comparing the effects of NE with or without other interventions against no treatment, surgery, or other interventions in patients with CTS. Standardized Mean Differences (SMD) and 95% confidence interval (CI) were calculated using a random-effects inverse variance model according to the outcome of interest and comparison group. Methodological quality was assessed with PEDro and quality of evidence with the GRADE approach. RESULTS: Twenty-five articles were included and sixteen of them demonstrated high methodological quality. NE was superior to no treatment on pain (very low-quality evidence; SMD = -2.36, 95% CI -4.31 to -0.41). NE was superior to no treatment on the functional scale of the BCTQ (low-quality evidence; SMD = -1.27 95% CI -1.60 to -0.94). Most importantly, NE did not demonstrate evidence of clinical effectiveness. CONCLUSION: Low to very low-quality evidence suggests that there are no clinical benefits of NE in patients with mild to moderate CTS.

Neural mobilization in low back and radicular pain: a systematic review.

BACKGROUND: Low back pain can present with radicular pain caused by lumbosacral nerve root pathology. Neural mobilization (NM) is a treatment technique used to treat low back and radicular pain (LBRP). PURPOSE: To evaluate the effectiveness of NM interventions in improving pain, disability, and function in adults with LBRP. DATA SOURCES: CINAHL Plus, MEDLINE (Ovid), Physiotherapy Evidence Database, and Cochrane databases were searched. STUDY SELECTION: Randomized controlled trials assessing the effect of NM on pain, disability, and/or function in adults with LBRP. DATA EXTRACTION: Authors reviewed studies and used the PEDro scale and the revised Cochrane risk-of-bias tool to assess methodological quality and risk of bias. DATA SYNTHESIS: Eight studies were included. Six of the eight studies found the addition of NM to conservative treatment improved all measured outcomes. One study found improvements in some but not all functional measures, and delayed improvements in pain. One study found improvements in measures of neural sensitivity, but not overall pain and disability. CONCLUSIONS: NM may be an effective tool for short-term improvements in pain, function, and disability associated with LBRP. Additional high quality research is needed. STUDY REGISTRATION: : This systematic review protocol was registered with PROSPERO (registration number: CRD42020192338).

Peripheral and central changes induced by neural mobilization in animal models of neuropathic pain: a systematic review.

Introduction: Neural mobilization (NM) is a physiotherapy technique involving the passive mobilization of limb nerve structures with the aim to attempt to restore normal movement and structural properties. In recent years, human studies have shown pain relief in various neuropathic diseases and other pathologies as a result of this technique. Improvement in the range of motion (ROM), muscle strength and endurance, limb function, and postural control were considered beneficial effects of NM. To determine which systems generate these effects, it is necessary to conduct studies using animal models. The objective of this study was to gather information on the physiological effects of NM on the peripheral and central nervous systems (PNS and CNS) in animal models. Methods: The search was performed in Medline, Pubmed and Web of Science and included 8 studies according to the inclusion criteria. Results: The physiological effects found in the nervous system included the analgesic, particularly the endogenous opioid pathway, the inflammatory, by modulation of cytokines, and the immune system. Conclusion: On the basis of these results, we can conclude that NM physiologically modifies the peripheral and central nervous systems in animal models.

The Effect of Neurodynamic Techniques on the Dispersion of Intraneural Edema: A Systematic Review with Meta-Analysis.

BACKGROUND: There is evidence for the positive effects of neurodynamic techniques in some peripheral entrapment neuropathies, but the rationale for these effects has not been validated. We aimed to estimate the direct effect of neurodynamic techniques on the dispersion of artificially induced intraneural edema measured by dye spread in cadavers. METHODS: We systematically searched the MEDLINE, WOS, Scopus, and the Cochrane databases from inception to February 2020 for experimental studies addressing the efficacy of neurodynamic techniques on the dispersion of artificially induced intraneural edema. The DerSimonian and Laird method was used to compute pooled estimates of the mean differences (MDs) and its respective 95% confidence intervals (CIs). Subgroup analyses were conducted according to the type of neurodynamic technique. In addition, a 95% prediction interval was calculated to reflect the variation in true treatment effects in different settings, including the effect to be expected in future patients. RESULTS: Pooled results showed a significant increase in fluid dispersion (MD = 2.57 mm; 95%CI: 1.13 to 4.01). Subgroup analysis showed increased dye spread in the tensioning techniques group (MD = 2.22 mm; 95%CI: 0.86 to 3.57). CONCLUSION: Neurodynamic techniques improved the intraneural edema dispersion and should be considered for the management of peripheral compression neuropathies. Furthermore, tensioning techniques appear to be effective in helping to disperse intraneural edema.

Study Protocol titled as "Effectiveness of neural mobilization in improving the ankle ROM and plantar pressure distribution in patients with diabetic peripheral neuropathy: A single group, pre post, quasi experimental study protocol".

Objectives: Diabetic Peripheral Neuropathy (DPN) is the commonest complication in individuals with type 2 diabetes mellitus affecting 50% of total diabetic population. The ankle mobility is seen to be significantly reduced along with alteration in plantar pressure distribution. Neural mobilization is a neoteric technique that is being used to treat various conditions of neural involvement. It is hypothesized that the application of neural mobilization will improve ankle mobility and plantar pressure distribution in individuals with DPN by restoring the mechanical and neurophysiological functions of the tibial and common peroneal nerves. Methods: A single group pre-post, quasi experimental, same subject design will be used. Participants with prior diagnosis of DPN will be selected according to eligibility criteria. The ankle ranges of motion (Both Active & Passive) and plantar pressure distribution at six foot regions will be taken as the outcome measures. All the participants will receive neural mobilization of tibial & common peroneal nerves (3 sets of 30 repetitions in 2 min with 1 min break in between) for 3 times/ week for 4 weeks. Outcome measurements will be taken at the baseline and after completion of the intervention. Conclusion: This study will be investigating the possible advantageous effects of neural mobilization in improving ankle joint ranges of motion and plantar pressure distribution in patients with DPN and will help the clinicians and researchers develop preventive measures to reduce the burden of diabetic ulcers.CTRI/2022/04/042187 [Registered on: 27/04/2022].

A retrospective comparative cohort study of the effects of neural mobilization (NM) alone and NM combined with transcranial direct current stimulation in patients with cervical radiculopathy.

BACKGROUND: Transcranial direct current stimulation (tDCS) and neural mobilization (NM) are widely used in clinical practice as two effective treatment. However, there have existed few studies of the combination of these two treatments, particularly in cervical radiculopathy (CR). To explore the value of combined tDCS and NM for the management of pain, disability, and quality of life (QoL) in patients with CR, authors designed this study. METHODS: According to certain inclusion criteria, 36 subjects were selected from 224 patients with CR enrolled in Zhejiang Provincial People's Hospital between June 2021 and December 2021. Subjects were divided into two groups based on the treatment they had already received at the hospital. Patients in the combined tDCS group received tDCS and NM therapy, while patients in the NM group received NM therapy alone. Visual analog scale (VAS), Neck Disability Index (NDI), and EuroQuol-5 dimensions (EQ-5D) scores were assessed at baseline, immediately after treatment, and at the 4-week follow-up to evaluate pain, neck disability, and the QoL of patients. SPSS 22.0 software (IBM Corp., Armonk, NY, USA) is used as main tool for data analysis. RESULTS: A total of 36 patients were enrolled (19 in the combined tDCS group and 17 in the NM group). The baseline VAS, NDI, and EQ-5D scores in the combined tDCS group were 54.3±16.4 mm, 35.1±14.7, and 0.62±0.15, respectively, while the baseline VAS, NDI, and EQ-5D scores in the NM group were 54.0±16.5 mm, 31.8±12.8, and 0.64±0.15, respectively. There was no significant difference in baseline data between the two groups. At the 4-week post-treatment follow-up, the VAS score was significantly lower in the combined tDCS group than in the NM group (24.5±16.1 and 40.7±17.3 mm, respectively, P=0.008), and the NDI was also significantly lower in the combined tDCS group than in the NM group (16.1±11.5 vs. 26.6±17.7, P=0.045). There was no significant difference between the combined tDCS and NM groups in EQ-5D (0.75±0.15 vs. 0.69±0.09, P=0.192). CONCLUSIONS: Compared with NM therapy alone, combined tDCS and NM therapy may play a role in pain relief and neck disability improvement in CR patients.

Effectiveness of Neurodynamic Interventions in Patients With Stroke: Protocol for a Systematic Review and Meta-analysis.

BACKGROUND: Stroke is the most common and serious neurological condition, which can lead to death, limited functionality, and reduced quality of life. Studies with conflicting results and various methodological limitations have been conducted to assess the effectiveness of neurodynamic interventions for patients with stroke. OBJECTIVE: This systematic review and meta-analysis aimed to investigate the pooled effectiveness of different neurodynamic interventions on patients with stroke. METHODS: The PubMed, PEDro, and Google Scholar databases will be searched for studies published with full text in the English language from inception to date. Randomized controlled trials evaluating the effect of different neurodynamic techniques on patients with stroke will be included. The primary outcome measures will include pain, disability/function, and quality of life. Secondary outcome measures will include physical performance measures such as balance, range of motion, muscle strength, and specific diagnostic and neurodynamic test outcomes. The screening, data extraction, and methodological quality assessment will be performed by two independent reviewers. The PEDro scale will be used to systematically appraise the methodological quality. Review Manager V.5.4 software will be used for statistical analysis. Weighted mean difference or standardized mean difference with 95% CIs and P values will be used to calculate the treatment effect for each outcome variable. RESULTS: Search terms and search databases have been identified. The data extraction sheet has also been developed. This study is expected to be completed by the end of 2022. CONCLUSIONS: This study will provide up-to-date evidence on the effectiveness and use of neurodynamic interventions for patients with stroke in clinical practice. TRIAL REGISTRATION: PROSPERO CRD42022319972; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=319972. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/38956.

Neurodynamic Exercises in College Athletes With Musculoskeletal Pain: A Critically Appraised Topic.

CLINICAL SCENARIO: Pain is a common complaint following an orthopedic injury; however, the exact cause of nociception can be complex. Multiple tissues can generate a patient's complaint of pain, such as the skin, muscle, ligaments, tendon, nerves, and bones. Regarding the somatosensory system, inflammation around the nerve can create pain and alter movement coordination; this information has resulted in increased awareness of neurodynamic assessments and exercises. Neurodynamic assessments and exercises provide a unique paradigm to effectively assess and treat neural tissue, which may not commonly be considered within the traditional orthopedic examination. CLINICAL QUESTION: In college athletes with musculoskeletal pain and activity impairments, does the use of neurodynamic exercises improve pain or function? SUMMARY OF KEY FINDINGS: Of the 5 studies, all consisted of chronic injuries with 3 involving upper-extremity pathologies and 2 focusing on lower-extremity pathologies. All 5 studies noted short- and long-term improvement following the incorporation of neurodynamic sliders or tensioners into the treatment plan. Four of the studies had follow-up periods greater than 30 days with sustained improvement on patient outcomes. Only 2 studies described a progression of neurodynamic exercises through sliders and tensioners. Three studies utilized a set/repetition format for exercise prescription, whereas a fourth used a time-based format, and a fifth article utilized both. Finally, 4 studies utilized neurodynamic assessments to identify whether there was a neural component to the patient's presentation (eg, peripheral nerve mechanosensitivity). CLINICAL BOTTOM LINE: In individuals with musculoskeletal impairments, evidence exists to support the use of neurodynamic exercises, such as sliders and tensioners, to improve pain and pain-related disability when neural sensitivity exists. STRENGTH OF RECOMMENDATION: Grade C evidence exists to support the use of neurodynamic exercises in college athletes with a musculoskeletal impairment.

Effects of neural mobilization in disorders associated with chronic secondary musculoskeletal pain: A systematic review and meta-analysis.

PURPOSE: To evaluate the effect of neural mobilization (NM) in people with disorders associated with chronic secondary musculoskeletal pain due to persistent inflammation or diseases of the nervous system. METHODS: A database search was conducted to select randomized controlled trials where NM, alone or within a multimodal protocol, was the main intervention for patients with neurological, autoimmune, or autoinflammatory disorders. The risk of bias and the certainty of evidence were assessed using the Cochrane Risk of Bias Tool for Randomized Trials and the GRADE approach. The primary outcome was pain intensity. Secondary measures were inflammatory biomarkers, range of motion and the level of spasticity. RESULTS: Eleven studies were included (360 participants; 57% females). The most reported condition was arthritis, and the overall risk of bias was high in more than half of the studies. Pooled data showed a significant effect of NM, based on very low quality of evidence, on reducing pain intensity in people with systemic disorders (three studies: SMD = -0.58; 95% CI = -0.98, -0.18; p = 0.005), and the level of spasticity in individuals with brain or spinal cord injury (two studies: SMD = -0.85; 95% CI = -1.70, 0.00; p = 0.05). CONCLUSIONS: There is scant and very low certainty of evidence to support that NM, compared to control interventions, may improve pain intensity and spasticity in patients with disorders associated with chronic secondary musculoskeletal pain. Further research with high methodological quality is needed to recommend for or against the use of NM in this population.

The effect of median nerve mobilization on two point discrimination.

[Purpose] Two-point discrimination (TPD) is expressed as the minimum distance at which two mechanical stimuli applied simultaneously to the skin can be perceived as two separate points. The aim of this study was to investigate the effect of median nerve mobilization on TPD in healthy adults. [Participants and Methods] This study included 120 healthy adults. Participants were randomized according to their gender into the Neural Mobilization Group (NMG) and Control Group (CG). Demographic data of the participants (gender, age, height, weight, BMI, smoking) were recorded and TPD measurement was performed with baseline aesthesiometer on the palm with distal phalanges of the thumb, index and middle finger on the right-left hand. After the baseline TPD test, participants in the NMG performed Median Nerve Mobilization for 14 days. Measurements were taken before and after training. [Results] A statistically significant difference was found in all other measurements in both groups, except for the right and left palm TPD measurements in the control group. [Conclusion] It is thought that it would be beneficial to investigate the healing effects of the neural mobilization applications, which include all parts of the nerve line in disease conditions.

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

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.

Effects of neurodynamic interventions on pain sensitivity and function in patients with multiple sclerosis: a randomized clinical trial.

OBJECTIVE: To assess the effects of adding a neurodynamic intervention into a multimodal management approach in individuals with multiple sclerosis (MS) with upper extremity pain symptoms. DESIGN: Randomized clinical trial. SETTING: Tertiary hospital center. PARTICIPANTS: Thirty-two individuals with MS were randomly assigned to multimodal usual care alone (n=16) or multimodal usual care plus neurodynamic intervention (n=16). INTERVENTIONS: Both groups received 5 sessions of multimodal usual care of 30minutes duration, twice per week. Subjects allocated to the neurodynamic group also received bilateral neurodynamic slider interventions targeting the upper extremity nerve trunks. OUTCOME MEASURES: Pressure pain thresholds (PPTs) at the radial, median and ulnar nerve trunks, second metacarpal and tibialis anterior, pain intensity in the upper extremity (NPRS, 0-10), light touch detection threshold (von Frey hairs) and manual dexterity (nine-hole peg test) were assessed before and after the intervention. RESULTS: Subjects receiving the neurodynamic interventions experienced larger improvements in PPTs at all locations (moderate effect size, between-groups differences from 89.5 to 186.5kPa), a higher decrease in pain intensity at rest (large effect, difference 1.7, 95%CI 0.4 to 3.0) and improvements in sensitivity to light touch (moderate effect, difference -0.7, 95%CI -1.3 to -0.1) and in manual dexterity (large effect, difference 7.7, 95%CI 4.0 to 11.4seconds) than those that did not receive the neurodynamic intervention. CONCLUSIONS: The inclusion of neural mobilization into a multimodal management approach resulted in reduction of pressure sensitivity, greater reduction in pain and improvement in sensitivity to light touch and manual dexterity in MS. Further studies are necessary to confirm these findings at longer term follow-ups. (ClinicalTrials.gov: NCT03595631).

Effectiveness of bent leg raise technique and neurodynamics in patients with radiating low back pain.

OBJECTIVE: To compare the effectiveness of bent leg raise technique and neurodynamics in patients with low back pain that radiates up to the knee. METHODS: The pre-test post-test control group study was conducted at Department of Physical therapy, Maqsood Medical Complex and General Hospital Peshawar from February to July 2019. Patients with radiating low back pain of both genders aged 18-60 years were included in the study. Patients were divided into Group-A and Group-B. Group-A patients received Mulligan bent leg raise technique while Group-B patients received neurodynamics. Both groups received five sessions per week, for four weeks. Numeric pain rating scale, Oswestry disability index and goniometer was used to assess pain, functional disability and straight leg raise range before and after the interventions. Data was analyzed using SPSS version 20. RESULTS: Thirty-two participants with mean age of 38.81±9.94 years, participated in the study. There were no significant differences (P-value>0.05) between the two groups at baseline. Post-treatment, within Group-Analysis showed that all three variables (pain, functional disability and straight leg raise range) significantly (P<0.05) improved in both groups. However, post treatment between Group-Analysis showed that there were no significant differences (P>0.05) between the two groups. CONCLUSION: Both neurodynamics and bent leg raise technique significantly improved pain, functional disability and straight leg raise range in patients with low back pain that radiates up to the knee. However, there were no significant differences between the groups who received either neurodynamics or bent leg raise technique.

Influence of Tensioner's Mobilization on the Centralization of Symptoms in Cervicobrachial Pain Syndrome: A Randomized Controlled Trial.

STUDY DESIGN: This study was designed as a randomized controlled trial. PURPOSE: The present study aimed to determine the impact of neural mobilization by tensioner's technique (NMTT) on the centralization of symptoms and pain in patients with cervicobrachial pain syndrome (CBPS). OVERVIEW OF LITERATURE: CBPS is a disabling condition of the neck that is characterized by pain and paresthesia in the upper quarter. Several techniques have successfully provided immediate and long-term relief in CBPS; however, few studies have evaluated the effect of these techniques on the centralization of symptoms. METHODS: Thirty patients aged 18-45 years with a complaint of pain in the neck that had persisted for 2-12 weeks radiating to the arm and fulfilling Elvey's criteria were randomly selected and divided into two groups. Group A received NMTT plus conventional treatment (hot pack and postural advice with cervical lateral glide), and group B received only conventional treatment 3 times a week for 2 weeks. The outcome measures were Wernicke's scale score for the centralization of symptoms and Visual Analog Scale score for pain intensity. Within- and between-group comparisons were made before initiating treatment and at the end of the 3rd and 6th sessions. Within group analyses for the centralization values were performed using Friedmann test, and between-group analyses were performed using Mann-Whitney test. A 2×3 mixed model of the analysis of variance was used for analyzing the pain levels. RESULTS: There was a significant difference (p<0.05) within and between the groups for both the measures at the end of the 3rd and 6th sessions. Thus, NMTT may be beneficial in decreasing the peripheralization of symptoms and pain intensity in patients with CBPS. CONCLUSIONS: NMTT can be used as an alternative and effective treatment option for patients with CBPS.

Effects of adding neural mobilization to traditional physical therapy on pain, functional disability, and H-reflex in patients after lumbar laminectomy: A randomized controlled trial.

OBJECTIVE: To investigate whether adding neural mobilization to a standard postoperative physical therapy program could improve the outcomes of patients after lumbar laminectomy. DESIGN: A single blinded randomized controlled trial. SETTING: Outpatient setting. PARTICIPANTS: Sixty participants of both sexes who had undergone lumbar laminectomy. INTERVENTIONS: Participants were allocated randomly to two groups; study and control groups. All patients received a standard postoperative physical therapy program. Those in the study group received additional neural mobilization in the form of straight leg raising and dorsiflexion with two-ended slider. Treatment was administered three times/week for six successive weeks. OUTCOME MEASURES: Visual analog scale (VAS), Oswestry disability index (ODI), and H-reflex latency were measured pre and post-treatment. RESULTS: The mean age of participants was 44.23 ± 4.64 and 45.3 ± 5.3 in study and control groups respectively (P > 0.05). There were statistically significant differences in VAS, ODI, and H-reflex latency in favor of the study group (P < 0.05). The mean ± SD for VAS, ODI, and H-reflex latency pre vs post treatment was 6.13 ± 1.22 vs 1.40 ± 0.77, 64.46 ± 4.05 vs 16.86 ± 2.55, and 32.07 ± 2.76 vs 27.46 ±1.79 in study group and 5.86 ± 1.07 vs 2.46 ± 0.73, 63.93 ± 3.91 vs 23.40 ± 2.93, and 31.76 ± 2.69 vs 29.4 ± 1.94 in control group, respectively. CONCLUSIONS: Neural mobilization combined with traditional physical therapy program achieved better improvement in pain, functional disability and H-reflex in patients who underwent decompressive laminectomy than traditional physical therapy program only.

Effectiveness of Neural Mobilization Techniques in the Management of Musculoskeletal Neck Disorders with Nerve-Related Symptoms: A Systematic Review and Meta-Analysis with a Mapping Report.

OBJECTIVE: The objective was to assess the effectiveness of neural mobilization (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 favorable outcomes were observed for NM on pain intensity compared with control interventions (standardized 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 to 2.15). Regarding neck pain intensity, no significant differences were found in favor of NM compared with OTs (SMD 0.37; 95% CI -0.35 to 1.1). However, between-treatment differences were found in favor 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 to 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 favorable 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.

Short-term Effects of Neurodynamic Techniques for Treating Carpal Tunnel Syndrome: A Systematic Review With Meta-analysis.

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.

Manual Therapy with Neural Mobilization: Immediate Effect on the Vocal Quality of Women with Dysphonia.

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.

Cervical traction combined with neural mobilization for patients with cervical radiculopathy: A randomized controlled trial.

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.