The effectiveness of neural mobilization for neuromusculoskeletal conditions: A systematic review and meta-Analysis

Annalie Basson*, Benita Olivier, Richard Ellis, Michel Coppieters, Aimee Stewart, Witness Mudzi

*Corresponding author for this work

Research output: Contribution to JournalReview articleAcademicpeer-review

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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.

Original languageEnglish
Pages (from-to)593-615
Number of pages23
JournalJournal of Orthopaedic and Sports Physical Therapy
Volume47
Issue number9
Early online date31 Aug 2017
DOIs
Publication statusPublished - Sept 2017

Funding

1Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 2Department of Physiotherapy, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand. 3Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands. 4School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia. 5School of Allied Health Sciences, Faculty of Health, Griffith University, Gold Coast, Australia. The protocol for this systematic review was published in the journal Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports (registration number 1401). Dr Basson receives funding for her PhD from the Orthopaedic Research Investment Fund of the South African Society of Physiotherapy and from the Faculty Research Committee Individual Grants of the University of the Witwatersrand. The authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article. Address correspondence to Dr Annalie Basson, 407 Stonewall Avenue, Faerie Glen 0043 South Africa. E-mail: bassonannalie@gmail.com U Copyright ©2017 Journal of Orthopaedic & Sports Physical Therapy®

FundersFunder number
South African Society of Physiotherapy
University of the Witwatersrand, Johannesburg

    Keywords

    • Back pain
    • Exercise
    • Manual therapy
    • Musculoskeletal conditions
    • Neck pain
    • Nerve mobilization
    • Neurodynamics
    • Physical therapy

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