Neurodynamic treatment did not improve pain and disability at two weeks in patients with chronic nerve-related leg pain: a randomised trial

Ferreira, Giovanni E; Stieven, Fábio Franciscatto; Araújo, F. X. de; Wiebusch, Matheus; Rosa, Carolina Gomes; Plentz, Rodrigo Della Méa; Silva, Marcelo

doi:10.1016/j.jphys.2016.08.007

Cited by 25 publications

(34 citation statements)

References 30 publications

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“…In larger human clinical trials, neural mobilization is typically part of a multimodal intervention [52][53][54][55]. If neural mobilization is evaluated as a unimodal intervention, different neurodynamic techniques are often combined [52,53], making it impossible to isolate the effects of tensioning techniques. A few smaller studies that evaluate the immediate effects of tensioning techniques are, however, available.…”

Section: Evidence From Human Trialsmentioning

confidence: 99%

Neurodynamics: is tension contentious?

Ellis

Carta

Andrade

et al. 2021

Journal of Manual & Manipulative Therapy

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Tensioning techniqueswere the first neurodynamic techniques used therapeutically in the management of people with neuropathies. This article aims to provide a balanced evidenceinformed 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.

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Section: Evidence From Human Trialsmentioning

confidence: 99%

Neurodynamics: is tension contentious?

Ellis

Carta

Andrade

et al. 2021

Journal of Manual & Manipulative Therapy

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“…The development over time of the correlations between PSFS and CSOMs has led us to conclude that the underlying constructs are different and, therefore, should not be used for the same purpose. Although the PSFS has been used in several studies as a secondary outcome measure to analyze longitudinal development of activity restrictions on a group level [8,11,[21][22][23] and seemed to perform well for this purpose, our data suggest that the underlying construct remains unclear. Therefore, we cannot recommend the use of the PSFS without taking into account that the underlying construct is besides different from CSOM also unclear to interpret on a group level, at the moment [24].…”

Section: Discussionmentioning

confidence: 70%

Construct Validity and Validity to Change of the Patient-Specific Functional Scale in Patients with Shoulder and Low Back Pain: A Clinimetric Study

TO¹,

Saner²,

Sieben³

et al. 2021

physmedrehabilint

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Background: Patient-specific and condition-specific measures are widely used in clinical practice and research to measure disability or change over time. While condition-specific outcome measures comprise a range of restrictions generally relevant for all patients, the Patient-Specific Functional Scale measures restrictions chosen by the individual patient. Objectives: Based on the hypothesis that patient-specific and conditionspecific scales deliver comparable results when used on group level. The aim of this study was to test for floor and ceiling effects, to evaluate construct validity and validity to change of the Patient-Specific Functional Scale when compared to condition-specific outcome measures. For this purpose, two datasets from patients with shoulder pain and low back pain were analyzed. Methods: Patient-Specific Functional Scale scores were compared to the Shoulder Pain and Disability Index and the Roland Morris Disability Questionnaire at 4 time-points using stem-and-leaf-plots and correlations using Pearson’s r. Hypothesis-driven correlation levels for data interpretation were predefined, with r ≥0.75=high, r ≥0.5=moderate, r ≥0.25=low. Results: Patient-Specific Functional Scale floor effects were comparable to condition-specific outcome measures in both samples. At none of the timepoints did the Patient-Specific Functional Scale correlate with the conditionspecific outcome measures in the expected manner. Conclusion: Hypotheses regarding expected ranges of correlation between the Patient-Specific Functional Scale and the condition-specific outcome measures for construct validity and validity to change were not met. While the use of the Patient-Specific Functional Scale in a clinical context has its advantages, the measure is not recommended for group-level evaluations.

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“…Pain relief was previously described in case studies using neural mobilization for sciatica patients [26,27]. A recent high-quality randomized controlled trial showed that adding four sessions of sciatic neural mobilization achieved a greater reduction in leg pain, lumbar pain, and function at four weeks follow-up compared to advice to stay active alone [28].…”

Section: Discussionmentioning

confidence: 90%

Pragmatic neural tissue management improves short-term pain and disability in patients with sciatica: a single-arm clinical trial

Almeida

Machado

Yamato

et al. 2019

Journal of Manual & Manipulative Therapy

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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, R 2 = 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.

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Neurodynamic treatment did not improve pain and disability at two weeks in patients with chronic nerve-related leg pain: a randomised trial

Abstract: NCT01954199. [Ferreira G, Stieven F, Araujo F, Wiebusch M, Rosa C, Plentz R, et al. (2016) Neurodynamic treatment did not improve pain and disability at two weeks in patients with chronic nerve-related leg pain: a randomised trial.Journal of Physiotherapy62: 197-202].

Cited by 25 publications

References 30 publications

Neurodynamics: is tension contentious?

Neurodynamics: is tension contentious?

Construct Validity and Validity to Change of the Patient-Specific Functional Scale in Patients with Shoulder and Low Back Pain: A Clinimetric Study

Pragmatic neural tissue management improves short-term pain and disability in patients with sciatica: a single-arm clinical trial

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