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The Effectiveness of Neural Mobilization for Neuro-Musculoskeletal Conditions: A Systematic Review and Meta-Analysis

updated

Tags: treatment, neurology

PainSci summary of Basson 2017: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible.

Neural mobilization or neurodynamics is a treatment for neuropathic pain based on the idea that physical stimulation through movement is good for unhappy nerve tissues, but not just any movement: only quite specific movements need apply. There are several conceptual pitfalls here, and it’s a tough thing to test (technical, messy, hard to standardize).

Currently the level of evidence for NM is “largely unknown” according to this review of forty studies (only seventeen with a low risk of bias, and with lots of variety in methods throughout). The results were mixed, and NM notably failed for relatively straightforward peripheral neuropathies like carpal tunnel syndrome — if NM is good for anything, it should be good for that, at least.

On the bright side, according to the paper, the data “reveals benefits of NM for back and neck pain,” but these are complex conditions and notoriously multifactorial, so I remain pessimistic in the absence of more and better data. As the authors understate: “Due to the limited evidence and varying methodological quality, conclusions may change over time.” I’d say it’s so likely that “conclusions may change” that the word “conclusion” isn’t really useful here.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

STUDY DESIGN: Systematic review with meta-analysis.

BACKGROUND: Neural mobilization (NM) 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.

OBJECTIVES: To determine the efficacy of NM for musculoskeletal conditions with a neuropathic component.

METHODS: Databases were searched for randomised trials investigating the effect of NM for neuro-musculoskeletal conditions. Standard methods for article identification, selection and quality appraisal were used. Where possible, studies were pooled for meta-analysis. Primary outcomes were pain, disability and function.

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 (0-50): mean difference -9.26; 95%CI: -14.50 - -4.01; p=0.0001) and pain (Intensity (0-10): mean difference -1.78; 95%CI: -2.55 - -1.01; p=0.0001) improved following NM. For chronic neck-arm pain, pain improved (Intensity (0-10): mean difference -1.89; 95%CI: -3.14 - -0.64; p=0.0003) following NM. For carpal tunnel syndrome, NM was not effective for most clinical outcomes (p>0.11), but showed positive neurophysiological effects (e.g., reduced intraneural oedema). Due to a scarcity of studies or conflicting results, the effect of NM remains uncertain for various conditions, such as post-operative 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 for other conditions remains unclear. Due to the limited evidence and varying methodological quality, conclusions may change over time. Level of Evidence Level 1.

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