Effectiveness of Neurodynamic Mobilization in the Treatment of Patients Presenting with Lower Extremity Pathologies: A Systematic Review Tyler Bischof SPT, Daniel Cassmeyer SPT, Kody Lueders SPT, Melissa Pickett SPT Terry Cox PT, DPT, OCS, CSMT, FAAOMPT Southwest Baptist University, Bolivar, MO

BACKGROUND AND RESULTS REFERENCES OBJECTIVES The studies reviewed dealt with different populations of patients with neuropathic with diagnoses including diabetes, 1. Kavlak Y, Uygur F. Effects of nerve mobilization exercise stroke, syndrome and low back pain. Outcomes assessed were also different based upon the population as an adjunct to the conservative treatment for patients Approximately 9.8% of the population with . Journal Of Manipulative And may have neuropathic pain in the and included pain, function, short-term disability, strength, range-of-motion, sensation, straight leg raise, functional reach Physiological Therapeutics. 2011;34(7):441-8. and pain questionnaires. Neural mobilization was shown to improve pain in those with and diabetic neuropathy 2. Kumar P, Adhikari P, Prabhu M. Efficacy of lower extremity (LE). This pain may neurodynamic mobilization for neuropathic pain in type II be caused by , nerve and flexibility, range-of-motion and function in those with sciatica and stroke. Sensation was improved in patients with a diabetes mellitus- a randomized controlled trial. Indian diagnosis of tarsal tunnel syndrome. Journal of Physiotherapy & Occupational Therapy. compression, or entrapment 2011;5(4):189-92. compromising the proper functioning 3. Ahmed N, Tufel S, Khan M, Khan P. Effectiveness of DISCUSSION AND CONCLUSION neural mobilization in the management of sciatica. Journal of the nerve. In theory, neurodynamic of Musculoskeletal Research. 2013;16(3):1350012-1- mobilization techniques may help to 1350012-9. Overall there were positive affects to adding neural mobilization to other interventions for the patient populations that 4. Hyun-Kyu C, Hyuk-Shin C, Jong-Duk C. Effects of the mobilize these nerves to provide them were included in the studies reviewed. It is not known if the affects were diagnosis-specific based upon this review. Nerve Mobilization Technique on Lower Limb Function in with the space, movement, and blood There were no adverse events reported in any of the studies, making neural mobilization a low risk intervention. Patients with Poststroke Hemiparesis. Journal of Physical that they need. The purpose of this Therapy Science. 2014;26(7):981-3. Clinically, the addition of neural mobilization to standard care should be added to patients with the * Additional references are available upon request. systematic review was to assess the diagnoses present in the studies reviewed. Various outcomes were affected based upon the diagnosis of the population efficacy of adding neurodynamic studied. The exact mechanism for the improvements seen from neural mobilization is still unclear. Patients with lower mobilization to the treatment plan for extremity diagnoses are commonly treated in the physical therapy clinic. Interventions, such as neural mobilization, that ACKNOWLEDGEMENTS patients with LE symptoms. are shown to benefit this condition are a welcomed addition to the physical therapy toolbox. We would like to give thanks to God Our METHODS SUMMARY OF STUDIES Father for giving us this opportunity and all of the professors in the Doctorate of Physical The databases CINAHL complete, Study PEDro Subjects Control Group Experimental group Outcome Measures Results Therapy Program at Southwest Baptist MEDLINE, Cochran Database of Score Treatment Intervention Intervention Treatment University. 2011 8/10 Physician 16 subjects. 16 subjects. Vibration Thresholds Improvements by both groups in all Controlled Reviews, SPORTDiscus, Kumar diagnosed type-II Treatment: 45 min.: standard care of Treatment: 45 min.: standard care Straight-leg neurodynamic 4 variables studied SocINDEX, Gale Virtual Reference diabetes for ≥ 2 glycemic control, diet advice and palliative plus neurodynamic mob. of the test Experimental group plus standard years, neuropathic knee, , and ; passive NPQ care was better than standard care Library, and Google Scholar were care for neuropathic pain, gentle active pain in the legs movements, 25 min walking to be done 5 stretches; tibial nerve massage, tibial NeuroQoL alone in type II diabetes subjects CONTACT INFORMATION systematically searched using and feet, times a week nerve slider and tensioner mob. with peripheral neuropathic pain keywords related to neurodynamic 2014 7/10 Patients 10 subjects. 10 subjects. Foot pressure test mob. had a positive Hyun- diagnosed with a Treatment : Conservative physical Treatment : Three stages effect on functional improvement of mobilization and lower extremity pain. Kyu stroke at least 6 therapy of the LEs for two daily 30 min. (combination of about 10 min.) of Two- dimensional imaging the LE’s for the stroke patients. Terry Cox PT, DPT, OCS, CSMT, FAAOMPT The search was limited to randomized months prior to the sessions five times per week for four sciatic nerve mob. techniques after analyzer system Improvements in neurodynamics in Professor of Physical Therapy study. weeks. conservative physical therapy the intervention group. controlled trials. The initial search Functional reach test Improvement of knee joint angles Southwest Baptist University provided 32 publications that were and flexibility. Department of Physical Therapy 2013 8/10 Subjects with or 15 subjects. 15 subjects. Body diagram for location of Nerve mob.in combination with then screened by title and abstract, Ahmed without low back Physiotherapy only: TENS, advice about Sciatic nerve mob. to the lower limb symptoms standard physiotherapy improved 1600 University Avenue Bolivar, MO 65613 followed by an in-depth full text pain, for 2 weeks sciatica, and either flexion or extension in addition to physiotherapy short-term disability, function, pain. [email protected] to 3 months with exercise as advised Numerical pain rating scale analysis, after which five articles still radicular leg pain met the study criteria. Furthermore, > back pain Short form-12 questionnaire 2011 8/10 Patients 14 subjects. 14 subjects. VAS, ROM of the ankle and Improvements in ROM, strength, the remaining articles were evaluated Kavlak diagnosed as Treatment : Muscles strengthening with Treatment: Included the same subtalar joint, strength of and pain. The addition of nerve for quality using the PEDro scale, and having tarsal thera-band, Home exercise program for 6 procedure as with the control group the foot muscles innervated mob. did not enhance these tunnel syndrome weeks consisting of gastrocnemius plus tibial nerve mob. by the tibial nerve, 2-point outcomes. A decrease in Tinel’s test one article was excluded. The by an orthopedic stretching, strengthening, ice application, discrimination, light touch, and 2-point discrimination in the resulting four articles were included in surgeon bandaging, medial arch supports, and Tinel sign, tibial nerve study group implies that sensory wedges as necessary. stretch test, paresthesia parameters may benefit from nerve this review. mob. Abbreviations: Min.= minutes; NPQ=Neuropathic Pain Quationnaire; NeuroQoL=Neuropathy-specific Quality of Life; LE’s= Lower extremities; TENS=transcutaneous electrical nerve stimulation; Mob.= mobilization; VAS= visual analogue scale; ROM= range of motion;