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

Abstract

The objective is to determine if pain and disability outcomes of patients treated with neural mobilisation differ for sub-classifications of low back and leg pain (LB&LP). Radiating leg pain is a poor prognostic factor for recovery in patients with LBP. To improve outcome, a new pathomechanism-based classification system was proposed: neuropathic sensitization (NS), denervation (D), peripheral nerve sensitization (PNS) and musculoskeletal (M). Seventy-seven patients with unilateral LB&LP were recruited. Following classification, all subjects were treated seven times with neural mobilisation techniques. A successful outcome was defined as achieving a minimal clinically important change in pain intensity (11-point numerical rating scale), physical function (Roland Morris disability questionnaire) and global perceived change (7-point Likert scale: from 1 = ''completely recovered'' to 7 = ''worse than ever''). The proportion of responders was significantly greater in PNS (55.6%) than the other three groups (NS 10%; D 14.3% and M10%). After adjusting for baseline differences, mean magnitude of improvement of the outcome measures were significantly greater in PNS compared to the other groups. Patients classified as PNS have a more favourable prognosis following neural mobilisation compared to the other groups.

The effects of neurodynamic straight leg raise treatment duration on range of hip flexion and protective muscle activity at P1

“…Although no previous study has investigated the increase in ROM HF that is required to be meaningful, the large increases found in the current study (361-minute group improving by a mean of 6.7u and the 362-minute group improving by a mean of 5.1u) might be suggested to be clinically significant. Current research demonstrates that neurodynamic mobilization can have a significant hypoalgesic effect 9,13,15,[19][20][21][22][23] that might explain the increases in ROM HF found in the present study; however, it might also be the product of elastic deformation, in the form of creep and hysteresis. The current study's results are in agreement with Tal-Akabi and Rushton 13 who investigated the effects of neurodynamic treatment (ULTT2a) on active range of wrist flexion and extension in patients with carpal tunnel syndrome (CTS).…”

“…13,15,[19][20][21][22]24 Some investigations have used up to seven different neurodynamic techniques consisting of one to seven sets lasting 5-60 seconds, 9,15,[19][20][21][22][23][24] with one study adapting treatment dose based on patients' responses. 13 To the authors' knowledge, there have been no published studies that have compared different treatment durations; therefore, all treatment doses selected in clinical practice are based on anecdotal evidence and empirical evidence is needed to validate their efficacy.…”

“…10,16,18 Only a limited number of studies were found investigating the efficacy of lower limb neurodynamic treatment. 15,[19][20][21] provide insight into our understanding of who will likely respond to neurodynamic treatment and suggest that if patients are sub-grouped prior to treatment, the efficacy is greatly enhanced. Published research about neurodynamic treatment appears to support its use in the treatment of altered nerve mechanosensitivity; however, an optimum treatment dose has not yet been established.…”

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

“…22 Neural mobilization exercises, derived from neurodynamic tests, such as the slump test or straight leg raise test, have been advocated in clinical texts 14,15,37,44 and as a result of published clinical trials. 7,17,34,36,42,48 However, to the authors' knowledge, no previous research has been published that has examined in vivo measurement of sciatic nerve excursion in normal, healthy participants during different types of neural mobilization exercises. Such work would complement previous work performed on the upper limbs.…”

Low back related leg pain: An investigation of construct validity of a new classification system

“…The classification system as a whole has demonstrated good inter-rater reliability [14] 1 as well as predictive ability [15]. The LANSS has demonstrated good discriminate 2 validity [27].…”