The effectiveness of neural mobilizations in the treatment of musculoskeletal conditions: a systematic review protocol

Abstract

Musculoskeletal disorders were ranked as the second largest contributor to disability worldwide in a study on the global burden of disease. Low back pain and neck pain contributed to 70% of disability in this comprehensive population-based study. Low back pain and neck pain are multifactorial, with heterogeneous populations. It has been proposed that targeting subgroups of patients may result in better treatment outcomes. Neck pain associated with upper limb pain is prevalent. These patients are more disabled than patients with neck pain alone. Similarly, low back pain with leg pain is a common phenomenon and is acknowledged as a predictor for chronicity.Neuropathic pain is often associated with musculoskeletal complaints including low back pain, whiplash associated disorders (WAD) and acute or chronic radiculopathy, and can be a feature of syndromes such as cervico-brachial pain syndrome. According to the International Association for the Study of Pain, neuropathic pain can be described as "pain caused by a lesion or disease of the somatosensory nervous system." Leg pain associated with back pain can be caused by central sensitization, denervation, nerve sensitization or somatically referred pain. In patients with WAD, neck pain is the most common symptom, but upper limb pain, weakness, paraesthesia and anesthesia are often present. Other conditions in which neural tissue is thought to contribute to the clinical picture are, for instance, lateral epicondalalgia and carpal tunnel syndrome.Management strategies for back pain and neck pain are often multimodal. However, the evidence for effective treatment of nerve related pain is lacking. Neural mobilizations are often used to affect the neural structures in conditions with signs of neural involvement or neural mechano-sensitivity. Neural mobilizations are defined as interventions aimed at affecting the neural structures or surrounding tissue (interface) directly or indirectly through manual techniques or exercise. Neural mobilizations have been studied in various populations such as low back pain, carpal tunnel syndrome, lateral epicondalalgia and cervico-brachial pain. Neural mobilization techniques studied include cervical lateral glides for cervico-brachial pain, nerve gliding exercises for the treatment of carpal tunnel syndrome, cervical lateral glides for lateral epicondalalgia and the slump as a neural mobilization technique in the treatment of low back pain. No specialized equipment is needed in the performance of neural mobilization techniques, which contributes to its popularity.Neural mobilization is said to affect the axoplasmic flow, movement of the nerve and its connective tissue and the circulation of the nerve by alteration of the pressure in the nervous system and dispersion of intraneural oedema. Neural mobilization decreases the excitability of dorsal horn cells. Neural mobilizations can be performed in various ways using passive movement, manual mobilization of the nerve or interface, and exercise. The aim of neural mobilization is to restore ...

Rehabilitative Principles in the Management of Thoracolumbar Syndrome: A Case Report

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Studi Kasus: Program Fisioterapi Pada Carpal Tunnel Syndrome Case Study: Physiotherapy Programs in Carpal Tunnel Syndrome

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