Neural Mobilization: A Systematic Review of Randomized Controlled Trials with an Analysis of Therapeutic Efficacy

Abstract

Neural mobilization is a treatment modality used in relation to pathologies of the nervous system. It has been suggested that neural mobilization is an effective treatment modality, although support of this suggestion is primarily anecdotal. The purpose of this paper was to provide a systematic review of the literature pertaining to the therapeutic effi cacy of neural mobilization. A search to identify randomized controlled trials investigating neural mobilization was conducted using the key words neural mobilisation/mobilization, nerve mobilisation/mobilization, neural manipulative physical therapy, physical therapy, neural/nerve glide, nerve glide exercises, nerve/neural treatment, nerve/neural stretching, neurodynamics, and nerve/neural physiotherapy. The titles and abstracts of the papers identifi ed were reviewed to select papers specifi cally detailing neural mobilization as a treatment modality. The PEDro scale, a systematic tool used to critique RCTs and grade methodological quality, was used to assess these trials. Methodological assessment allowed an analysis of research investigating therapeutic effi cacy of neural mobilization. Ten randomized clinical trials (discussed in 11 retrieved articles) were identifi ed that discussed the therapeutic effect of neural mobilization. This review highlights the lack in quantity and quality of the available research. Qualitative analysis of these studies revealed that there is only limited evidence to support the use of neural mobilization. Future research needs to re-examine the application of neural mobilization with use of more homogeneous study designs and pathologies; in addition, it should standardize the neural mobilization interventions used in the study.

Outcomes differ between subgroups of patients with low back and leg pain following neural manual therapy: a prospective cohort study

“…However, treatment effects found in two controlled trials were low [27,30]. Also, a recent systematic review [34] of the therapeutic efficacy of neural mobilisation for a variety of conditions concludes that there is limited evidence to support its use. One reason for low treatment effects and inconsistent results could be heterogeneity in patient samples.…”

Comparison of Longitudinal Sciatic Nerve Movement With Different Mobilization Exercises: An In Vivo Study Utilizing Ultrasound Imaging

“…However, the underlying mechanisms associated with clinical improvements following neural mobilization remain unclear. 11 There are many theories that have been postulated, including physiological effects (removal of intraneural edema 11,15,20,28,44 ), central effects (reduction of dorsal horn and supraspinal sensitization 13,15,21 ), and mechanical effects (enhanced nerve excursion 15,18,21,22,28,38,44 ). Future research needs to focus on uncovering the underlying mechanisms of neural mobilization.…”

“…28 Until recently, the proposed effects of neural mobilization were based on theory rather than research evidence. Accordingly, it is possible that many authors of randomized controlled trials 28 chose neural mobilization exercises on a theoretical and ad hoc basis, rather than specifically designing exercises to match clinical conditions. In fact, several authors have stated that the exercises utilized were chosen solely on those used in previous studies.…”

The immediate effects of soft tissue mobilization versus therapeutic ultrasound for patients with neck and arm pain with evidence of neural mechanosensitivity: a randomized clinical trial

“…9,10,15,[19][20][21] The goal of interventions is either to encourage gliding of the nerve by controlled angular movements or to allow more space for the nerve to move by improving mobility of the structures that surround the nerve (the neural container). 9,11,15,[19][20][21][22][23] An example of such an intervention includes the cervical lateral glide mobilization with the involved upper extremity placed in a position designed to take up the slack in the brachial plexus. 16,21,24,25 However, several authors have advised against applying cervical spine mobilization techniques to patients who demonstrate either normal or excessive mobility of the cervical spine, 26,27 which may include some patients with cervicobrachial syndrome.…”