The Effectiveness of Neural Mobilization for Neuromusculoskeletal Conditions: A Systematic Review and Meta-analysis

Abstract

Study Design Systematic review with meta-analysis. Objectives To determine the efficacy of neural mobilization (NM) for musculoskeletal conditions with a neuropathic component. Background Neural mobilization, or neurodynamics, is a movement-based intervention aimed at restoring the homeostasis in and around the nervous system. The current level of evidence for NM is largely unknown. Methods A database search for randomized trials investigating the effect of NM on neuromusculoskeletal conditions was conducted, using standard methods for article identification, selection, and quality appraisal. Where possible, studies were pooled for meta-analysis, with pain, disability, and function as the primary outcomes. Results Forty studies were included in this review, of which 17 had a low risk of bias. Meta-analyses could only be performed on self-reported outcomes. For chronic low back pain, disability (Oswestry Disability Questionnaire [0-50]: mean difference, -9.26; 95% confidence interval [CI]: -14.50, -4.01; P<.001) and pain (intensity [0-10]: mean difference, -1.78; 95% CI: -2.55, -1.01; P<.001) improved following NM. For chronic neck-arm pain, pain improved (intensity: mean difference, -1.89; 95% CI: -3.14, -0.64; P<.001) following NM. For most of the clinical outcomes in individuals with carpal tunnel syndrome, NM was not effective (P>.11) but showed some positive neurophysiological effects (eg, reduced intraneural edema). Due to a scarcity of studies or conflicting results, the effect of NM remains uncertain for various conditions, such as postoperative low back pain, cubital tunnel syndrome, and lateral epicondylalgia. Conclusion This review reveals benefits of NM for back and neck pain, but the effect of NM on other conditions remains unclear. Due to the limited evidence and varying methodological quality, conclusions may change over time. Level of Evidence Therapy, level 1a. J Orthop Sports Phys Ther 2017;47(9):593-615. Epub 13 Jul 2017. doi:10.2519/jospt.2017.7117.

Manual Therapy: Art or Science?

“…Similarly, we know that clinical pictures of symptomatic disc hernias have in most cases a positive prognosis within 3-6 months [118]. However, this data does not take into account the impact that a disorder of this type can have in the daily life of the patient in that period of time and the potential benefits of therapeutic techniques that have been shown to be able to significantly modify pain symptoms already in the first month [101]. Finally, symptom modification can play a very important educational role by enabling patients to realize that they are not the bearers of an incurable and unchangeable disorder, thereby acting on psychosocial factors that play an important prognostic role in the chronicity of the symptom [116].…”

“…It may therefore be very useful to use painless techniques, far from the tissue barrier and symptom elicitation, which have been shown to alleviate pain, but not to improve the patient's ROM [99]. Witness patients suffering from phase II frozen shoulder or symptomatic disc herniation [100,101]. On the contrary, or progressively upon decrease in pain, patients with joint limitations and mild/moderate pain elicitable at the end of the joint range (whom Maitland defines as "stiffness dominant") will benefit from more intense, longer-lasting techniques carried out at the end of the joint range, possibly with the reproduction of a symptomatology during application, which have proven capable of improving both pain and ROM in these patients [102,103]: phase III frozen shoulder or osteoarthritis clinical pictures can be considered as emblematic examples [100,104].…”

Neural and visceral manipulation in infants with congenital muscular torticollis: a feasibility study

“…Neural mobilization research has mainly focused on the effectiveness of neural sliding and gliding exercises to decrease pain and improve range of motion in adults. Basson et al undertook a meta-analysis of 40 studies (1,759 participants) which showed that neural mobilization positively affected cervical pain, back pain, plantar heel pain, and tarsal tunnel syndrome 34) . Neto et al analyzed 45 studies looking at the effects on neural mobilization on the lower body 35) .…”

The effect of neurodynamic technique of tibial nerve on range of motion, pain, and mechanosensitivity of the lower extremity in healthy individuals: A preliminary study

“…Various attempts have been made to reduce neural mechanosensitivity (Ellis & Hing, 2008;Santana et al, 2015). Recent studies suggest the neurodynamic technique as an efficient way to decrease neural mechanosensitivity (Basson et al, 2017).…”