Se ha denunciado esta presentación.
Utilizamos tu perfil de LinkedIn y tus datos de actividad para personalizar los anuncios y mostrarte publicidad más relevante. Puedes cambiar tus preferencias de publicidad en cualquier momento.
Title
Name
Neurodynamics as a therapeutic
intervention; effectiveness and
scientific evidence
Dr Toby Hall
Specialist	Musc...
What	about	drugs?
Drugs
• Morphine	for	5	days	
commencing	10	days	aher	CCI	
in	rat	model	
– Doubles	the	duracon	of	
neurop...
Exercise	reduces	features	of	acute	neuropathic	pain
• Rat	sciacc	nerve	CCI	
– Daily	progressive	exercise	on	
treadmill	(60...
Summary	
Basic	science
• Movement		
– Exercise	prevents	development	of	NP	
– Exercise	aids	nerve	recovery	aher	injury	&	re...
Why?	Do	other	factors	predict	pain	
in	CTS?
• n=54	CTS	confirmed	by	nerve	conduccon	tests	
– Not	electrophysiological	tescn...
Neck/arm	pain
• RCT	60	Pacents	with	neck/arm	pain	
– Randomized	to	neural	mobs	+	neural	ex	+	
advise		(n=40)	or	control	(n...
Sub-groups	of	neural	disorders
• Some	pacents	respond	well	others	not	-	Why	?	
– Sub-groups?	
• Schafer,	2008
Compressive	...
NP	compressive	
neuropathy
Nerve	trunk	
mechanosensicvity	?
NP	sensory	
hypersensicvity
Peripheral	nerve	
sensiczacon
Musc...
Treatment	-	PNS
• Responders	to	neural	mobilization	
– Positive	LANSS,		age,	large	ROM	deficits	on	median	
nerve	neurodyna...
Relevance	to	intervencon?
• How	to	resolve	axonal	mechanical	sensitivity?	
– “Tensioners”	
• Raise	intraneural	pressure		r...
Are	“opening”	
techniques	beaer	for	
CN?
Thank	you!
Ha terminado este documento.
Descárguela y léala sin conexión.
Próximo SlideShare
What to Upload to SlideShare
Siguiente
Próximo SlideShare
What to Upload to SlideShare
Siguiente
Descargar para leer sin conexión y ver en pantalla completa.

Compartir

‘Neurodynamics as a therapeutic intervention; the effectiveness and scientific evidence?’

Descargar para leer sin conexión

Toby hall

Libros relacionados

Gratis con una prueba de 30 días de Scribd

Ver todo

Audiolibros relacionados

Gratis con una prueba de 30 días de Scribd

Ver todo

‘Neurodynamics as a therapeutic intervention; the effectiveness and scientific evidence?’

  1. 1. Title Name Neurodynamics as a therapeutic intervention; effectiveness and scientific evidence Dr Toby Hall Specialist Musculoskeletal Physiotherapist Adjunct Associate Professor (Curtin University) Snr Teaching Fellow (The University of Western Australia) Accredited Mulligan Concept Teacher toby@manualconcepts.com ‘I cringe every time I hear a physical therapist claim that they use neural mobilization’ ‘We have assumed too much when it comes to neural tension tests and the treatments associated with these assessments’ ‘There is no plausible evidence that we can mobilize neural tissue ….. or that "neural mobilization" is effective in the treatment of musculoskeletal dysfunction’ Neural Mobilization: The impossible? Di Fabio Editorial JOSPT 2001 Presentation Outline • Is neural mobilisation the best way to manage neural tissue pain disorders: have we assumed too much? – Drugs; Exercise; Neural mobilisation; Do nothing: advice? Severe Mod Nerve damage does not always cause pain Ishimoto, 2013 n=938 • Most common painful neuropathies, pain present <20% – Zusman, 2010; Bennea, 2006 • Traumacc nerve injury causes pain <10% – Zusman, 2010; Marchedni, 2006 • Severe stenosis in 30% >40 years – Ishimoto, 2013 • Neural mobilisacon not necessary in all cases for nerve recovery – Scrimshaw, 2001; Svernlov, 2009
  2. 2. What about drugs? Drugs • Morphine for 5 days commencing 10 days aher CCI in rat model – Doubles the duracon of neuropathic pain from spinal microglia accvacon • Ancconvulsant Pregabalin (Lyrica) not effeccve for sciacca 6 Grace PNAS 2016 Mathieson 2017 Movement is the best therapy Passive movement promotes nerve recovery post trauma • Rat sciacc nerve crush injury (axonotmesis) – 15 sessions of 3x3min passive ankle dorsiflexion 1-day post injury – Improved mechanical hyperalgesia, motor funccon, histology, morphology, & immunohistochemical funccon – Inhibicon of glial cell accvacon 8Martins, Pain 2011 Mechanical hyperalgesia
  3. 3. Exercise reduces features of acute neuropathic pain • Rat sciacc nerve CCI – Daily progressive exercise on treadmill (60 minutes) or swimming (90 minutes with rests) – Mechanical & thermal hyperalgesia improved – Aaenuated cytokine produccon (TNF-α & IL-1β) 9 Chen, 2012 Thermal hyperalgesia Mechanical hyperalgesia Exercise reduces neuropathic pain • Rat sciacc nerve chronic constriccon or inflammatory model – Treadmill daily progressive exercise 30 minutes 7 days post surgery for 14 days – Mechanical & thermal hyperalgesia improved – Aaenuated pain within 3 weeks, sensory hypersensicvity returned 5 days aher stopping exercise. Effect of exercise reversed with opioid receptor antagonist. Same effect if exercise delayed by 4 weeks. • Exercise upregulates endogenous opioids 10 Stagg, 2011 CC CCI NMI Sham NM Naive Movement promotes nerve recovery: reduces NP • Rat sciacc nerve CCI model – 10 sessions NM under light anaestheczacon 14 days post injury – Allodynia & hyperalgesia improved – Significant change in glial cell density & nerve growth factor expression in the DRG & spinal cord 11 Santos, Molecular Pain 2011 Mechanical hyperalgesia Exercise reduces NP post CCI • Rat sciacc CCI – Wheel running 6/52 prior to CCI & aher CCI – Allodynia improved aher injury – Prior exercise decreased neuroimmune signalling in DH & neuron injury. Suppressed pro-inflammatory and increased anc-inflammatory mediators – Significant changes in glial cell density & NGF expression in the DRG & spinal cord • Exercise prevents pain, promotes recovery & relieves pain 12 Grace, Pain 2016 Allodynia
  4. 4. Summary Basic science • Movement – Exercise prevents development of NP – Exercise aids nerve recovery aher injury & reduces NP in animal models • Passive limb movement • Aerobic non-specific exercise: walking, running and swimming • Neural mobilisacon 13 But….. 14 – Is movement effective in humans? – Is movement effective for all nerve disorders? – Is movement effective for chronic & acute nerve disorders? – Is specific nerve movement (NM) more effective than other forms of movement/exercise? What is the evidence in humans? • Limited evidence – SR of RCT’s for neural mobilization – 20 trials identified; generally small scale – Evidence NM more effective minimal treatment (pain & disability), but no better than other treatments. • Su, 2016 • SR identified 6 studies of NM for CTS – NM better than no treatment: weak effect size • McKeon, 2008 • Cochrane review found no benefit for NM • Page, 2012 • European guidelines for management of CTS do not include physiotherapy! • Huisstede, 2014 15 Neural gliding exercise • Limited & poor quality evidence for the effeccveness of neural gliding exercises in CTS 16 Effectiveness of Nerve Gliding Exercises on Carpal Tunnel Syndrome: A Systematic Review Ruth Ballestero-Pérez, PhD,a Gustavo Plaza-Manzano, PhD,b Alicia Urraca-Gesto, PT,c Flor Romo-Romo, PT,c María de los Ángeles Atín-Arratibel, MD,a Daniel Pecos-Martín, PhD,d Tomás Gallego-Izquierdo, PhD,d and Natalia Romero-Franco, PhDe ABSTRACT Objective: The objective of this study was to review the literature regarding the effectiveness of neural gliding exercises for the management of carpal tunnel syndrome (CTS). Methods: A computer-based search was completed through May 2014 in PubMed, Physiotherapy Evidence Database (PEDro), Web of Knowledge, Cochrane Plus, and CINAHL. The following key words were included: nerve tissue, gliding, exercises, carpal tunnel syndrome, neural mobilization, and neurodynamic mobilization. Thirteen clinical trials met the inclusion/exclusion criteria, which were: nerve gliding exercise management of participants aged 18 years or older; clinical or electrophysiological diagnostics of CTS; no prior surgical treatment; and absence of systemic diseases, degenerative joint diseases, musculoskeletal affectations in upper limbs or spine, or pregnancy. All studies were independently appraised using the PEDro scale. Results: The majority of studies reported improvements in pain, pressure pain threshold, and function of CTS patients after nerve gliding, combined or not with additional therapies. When comparing nerve gliding with other therapies, 2 studies reported better results from standard care and 1 from use of a wrist splint, whereas 3 studies reported greater and earlier pain relief and function after nerve gliding in comparison with conservative techniques, such as ultrasound and wrist splint. However, 6 of the 13 studies had a quality of 5 of 11 or less according to the PEDro scale. Conclusion: Limited evidence is available on the effectiveness of neural gliding. Standard conservative care seems to be the most appropriate option for pain relief, although neural gliding might be a complementary option to accelerate recovery of function. More high-quality research is still necessary to determine its effectiveness and the subgroups of patients who may respond better to this treatment. (J Manipulative Physiol Ther 2017;40:50-59) Key Indexing Terms: Carpal Tunnel Syndrome; Nerve Tissue; Stress, Mechanical; Exercise Therapy; Movement Effectiveness of Nerve Gliding Exercises on Carpal Tunnel Syndrome: A Systematic Review Ruth Ballestero-Pérez, PhD,a Gustavo Plaza-Manzano, PhD,b Alicia Urraca-Gesto, PT,c Flor Romo-Romo, PT,c María de los Ángeles Atín-Arratibel, MD,a Daniel Pecos-Martín, PhD,d Tomás Gallego-Izquierdo, PhD,d and Natalia Romero-Franco, PhDe ABSTRACT Objective: The objective of this study was to review the literature regarding the effectiveness of neural gliding exercises for the management of carpal tunnel syndrome (CTS). Methods: A computer-based search was completed through May 2014 in PubMed, Physiotherapy Evidence Database (PEDro), Web of Knowledge, Cochrane Plus, and CINAHL. The following key words were included: nerve tissue, gliding, exercises, carpal tunnel syndrome, neural mobilization, and neurodynamic mobilization. Thirteen clinical trials met the inclusion/exclusion criteria, which were: nerve gliding exercise management of participants aged 18 years or older; clinical or electrophysiological diagnostics of CTS; no prior surgical treatment; and absence of systemic diseases, degenerative joint diseases, musculoskeletal affectations in upper limbs or spine, or pregnancy. All studies were independently appraised using the PEDro scale. Results: The majority of studies reported improvements in pain, pressure pain threshold, and function of CTS patients after nerve gliding, combined or not with additional therapies. When comparing nerve gliding with other therapies, 2 studies reported better results from standard care and 1 from use of a wrist splint, whereas 3 studies reported greater and earlier pain relief and function after nerve gliding in comparison with conservative techniques, such as ultrasound and wrist splint. However, 6 of the 13 studies had a quality of 5 of 11 or less according to the PEDro scale. Conclusion: Limited evidence is available on the effectiveness of neural gliding. Standard conservative care seems to be the most appropriate option for pain relief, although neural gliding might be a complementary option to accelerate recovery of function. More high-quality research is still necessary to determine its effectiveness and the subgroups of patients who may respond better to this treatment. (J Manipulative Physiol Ther 2017;40:50-59) Key Indexing Terms: Carpal Tunnel Syndrome; Nerve Tissue; Stress, Mechanical; Exercise Therapy; Movement Effectiveness of Nerve Gliding Exercises on Carpal Tunnel Syndrome: A Systematic Review Ruth Ballestero-Pérez, PhD,a Gustavo Plaza-Manzano, PhD,b Alicia Urraca-Gesto, PT,c Flor Romo-Romo, PT,c María de los Ángeles Atín-Arratibel, MD,a Daniel Pecos-Martín, PhD,d Tomás Gallego-Izquierdo, PhD,d and Natalia Romero-Franco, PhDe ABSTRACT Objective: The objective of this study was to review the literature regarding the effectiveness of neural gliding exercises for the management of carpal tunnel syndrome (CTS). Methods: A computer-based search was completed through May 2014 in PubMed, Physiotherapy Evidence Database (PEDro), Web of Knowledge, Cochrane Plus, and CINAHL. The following key words were included: nerve tissue, gliding, exercises, carpal tunnel syndrome, neural mobilization, and neurodynamic mobilization. Thirteen clinical trials met the inclusion/exclusion criteria, which were: nerve gliding exercise management of participants aged 18 years or older; clinical or electrophysiological diagnostics of CTS; no prior surgical treatment; and absence of systemic diseases, degenerative joint diseases, musculoskeletal affectations in upper limbs or spine, or pregnancy. All studies were independently appraised using the PEDro scale. Results: The majority of studies reported improvements in pain, pressure pain threshold, and function of CTS patients after nerve gliding, combined or not with additional therapies. When comparing nerve gliding with other therapies, 2 studies reported better results from standard care and 1 from use of a wrist splint, whereas 3 studies reported greater and earlier pain relief and function after nerve gliding in comparison with conservative techniques, such as ultrasound and wrist splint. However, 6 of the 13 studies had a quality of 5 of 11 or less according to the PEDro scale. Conclusion: Limited evidence is available on the effectiveness of neural gliding. Standard conservative care seems to be the most appropriate option for pain relief, although neural gliding might be a complementary option to accelerate recovery of function. More high-quality research is still necessary to determine its effectiveness and the subgroups of patients who may respond better to this treatment. (J Manipulative Physiol Ther 2017;40:50-59) Key Indexing Terms: Carpal Tunnel Syndrome; Nerve Tissue; Stress, Mechanical; Exercise Therapy; Movement INTRODUCTION Carpal tunnel syndrome (CTS) is the result of an irritation, compression, or stretching of the median nerve as it passes through the carpal tunnel in the wrist. Symptoms range from pain (mainly nightly)1 and paresthesia to thenar eminence muscle atrophy2-6 This syndrome represents the most prevalent neural injury in the general population (1-4%)7-9 and workers at risk (15-20%)10-12 (those requiring a Departamento de Medicina Física y Rehabilitación, Universidad Complutense de Madrid, Madrid, Spain. b Departamento de Medicina Física y Rehabilitación, Facultad de Medicina, Universidad Complutense de Madrid; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain. c Departamento de Rehabilitación y Fisioterapia, Hospital Universitario Fundación Alcorcón, Madrid, Spain. d Departamento de Enfermería y Fisioterapia, Universidad de Alcalá, Madrid, Spain. e Department of Nursing and Physiotherapy, University of the
  5. 5. Why? Do other factors predict pain in CTS? • n=54 CTS confirmed by nerve conduccon tests – Not electrophysiological tescng • Not extent of nerve compression – Not age, sex or other demographic variables – Illness behaviour predict pain • Depression & catastrophizacon account for 39% of variance in pain • Nunez, 2010 • n= 82 post surgical recovery from CTS – Dissacsfaccon and perceived disability predicted by depression and poor coping skills & less degree by nerve damage • Lozano Calderon, 2008 Screen for psychosocial issues Why? Do other factors predict pain in CTS? • Case control series of 68 patients with CTS & 138 healthy controls – Matched for age & gender & stratified for BMI – Side laying sleeping position strongly associated with presence of CTS • McCabe, 2011 • Sleep quality most important predictor of recovery neck disorders • Kovacs, 2016 Screen for sleep position & quality Compressive neuropathy < sliding Central sensiczacon Sleep issues Axonal mechanosensicvity Musculoskeletal pain > transverse sliding Nerve swelling Not all with CTS are suited to neural mobilisacon: wash-out effect 2017 [ RESEARCH REPORT ] Cnearly injuries in the ge ported to Individua been ide likely to asymptom in a mass dividual a STUDY DESIGN: Randomized parallel-group trial. BACKGROUND: Carpal tunnel syndrome (CTS) is a common pain condition that can be managed surgically or conservatively. OBJECTIVE: To compare the effectiveness of manual therapy versus surgery for improving self- reported function, cervical range of motion, and pinch-tip grip force in women with CTS. METHODS: In this randomized clinical trial, 100 women with CTS were randomly allocated to either a manual therapy (n = 50) or a surgery (n = 50) group. The primary outcome was self-rated hand function, assessed with the Boston Carpal Tunnel Questionnaire. Secondary outcomes included active cervical range of motion, pinch-tip grip force, and the symptom severity subscale of the Boston Carpal Tunnel Questionnaire. Patients were assessed at baseline and 1, 3, 6, and 12 months after the last treatment by an assessor unaware of group assignment. Analysis was by intention to treat, with mixed analyses of covariance adjusted 1 month for self-reported function (mean change, –0.8; 95% confidence interval [CI]: –1.1, –0.5) and pinch-tip grip force on the symptomatic side (thumb-index finger: mean change, 2.0; 95% CI: 1.1, 2.9 and thumb-little finger: mean change, 1.0; 95% CI: 0.5, 1.5). Improvements in self-reported function and pinch grip force were similar between the groups at 3, 6, and 12 months. Both groups reported improvements in symptom severity that were not significantly different at all follow-up periods. No significant changes were observed in pinch-tip grip force on the less symptomatic side and in cervical range of motion in either group. CONCLUSION: Manual therapy and surgery had similar effectiveness for improving self-reported function, symptom severity, and pinch-tip grip force on the symptomatic hand in women with CTS. Neither manual therapy nor surgery resulted in changes in cervical range of motion. LEVEL OF EVIDENCE: Therapy, level 1b. Pro- spectively registered September 3, 2014 at www. clinicaltrials.gov (NCT02233660). J Orthop Sports CÉSAR FERNÁNDEZ-DE-LAS-PEÑAS, PT, PhD, DMSc1 • JOSHUA CLELAND, PT, PhD, OCS, FAAOMPT2-4 • STELLA FUENSALIDA-NOVO, PT1 • JUAN A. PAREJA, MD, PhD5 • CRISTINA ALONSO-BL The Effectiveness of Manual T Versus Surgery on Self-reported Cervical Range of Motion, and P Force in Carpal Tunnel Synd A Randomized Clinical Tr ournalofOrthopaedic&SportsPhysicalTherapy® ownloadedfromwww.jospt.orgatCurtinUniofTechnologyonMarch7,2017.Forpersonaluseonly.Nootheruseswithoutpermission. opyright©2017JournalofOrthopaedic&SportsPhysicalTherapy®.Allrightsreserved. [ RESEARCH REPORT ] C arpal tunnel synd (CTS), a pain con associated with rep movements, accoun nearly 50% of all work-r injuries.31 The prevalence o in the general population has b ported to range between 6% and Individuals diagnosed with CT been identified as significantly likely to miss more work day asymptomatic individuals, which in a massive economic burden to dividual and society.2 The management of CTS can b conservative or surgical. Conse management is often chosen as t approach when symptoms are m STUDY DESIGN: Randomized parallel-group trial. BACKGROUND: Carpal tunnel syndrome (CTS) is a common pain condition that can be managed surgically or conservatively. OBJECTIVE: To compare the effectiveness of manual therapy versus surgery for improving self- reported function, cervical range of motion, and pinch-tip grip force in women with CTS. METHODS: In this randomized clinical trial, 100 women with CTS were randomly allocated to either a manual therapy (n = 50) or a surgery (n = 50) group. The primary outcome was self-rated hand function, assessed with the Boston Carpal Tunnel Questionnaire. Secondary outcomes included active cervical range of motion, pinch-tip grip force, and the symptom severity subscale of the Boston Carpal Tunnel Questionnaire. Patients were assessed at baseline and 1, 3, 6, and 12 months after the last treatment by an assessor unaware of group assignment. Analysis was by intention to treat, with mixed analyses of covariance adjusted for baseline scores. RESULTS: At 12 months, 94 women completed the follow-up. Analyses showed statistically sig- nificant differences in favor of manual therapy at 1 month for self-reported function (mean change, –0.8; 95% confidence interval [CI]: –1.1, –0.5) and pinch-tip grip force on the symptomatic side (thumb-index finger: mean change, 2.0; 95% CI: 1.1, 2.9 and thumb-little finger: mean change, 1.0; 95% CI: 0.5, 1.5). Improvements in self-reported function and pinch grip force were similar between the groups at 3, 6, and 12 months. Both groups reported improvements in symptom severity that were not significantly different at all follow-up periods. No significant changes were observed in pinch-tip grip force on the less symptomatic side and in cervical range of motion in either group. CONCLUSION: Manual therapy and surgery had similar effectiveness for improving self-reported function, symptom severity, and pinch-tip grip force on the symptomatic hand in women with CTS. Neither manual therapy nor surgery resulted in changes in cervical range of motion. LEVEL OF EVIDENCE: Therapy, level 1b. Pro- spectively registered September 3, 2014 at www. clinicaltrials.gov (NCT02233660). J Orthop Sports Phys Ther 2017;47(3):151-161. Epub 3 Feb 2017. doi:10.2519/jospt.2017.7090 KEY WORDS: carpal tunnel syndrome, cervical spine, force, manual therapy, neck, surgery CÉSAR FERNÁNDEZ-DE-LAS-PEÑAS, PT, PhD, DMSc1 • JOSHUA CLELAND, PT, PhD, OCS, FAAOMPT2-4 • MARÍA PALACIOS-CEÑA, STELLA FUENSALIDA-NOVO, PT1 • JUAN A. PAREJA, MD, PhD5 • CRISTINA ALONSO-BLANCO, PT, PhD1 The Effectiveness of Manual Therapy Versus Surgery on Self-reported Function Cervical Range of Motion, and Pinch Gri Force in Carpal Tunnel Syndrome: A Randomized Clinical Trial JournalofOrthopaedic&SportsPhysicalTherapy® Downloadedfromwww.jospt.orgatCurtinUniofTechnologyonMarch7,2017.Forpersonaluseonly.Nootheruseswithoutpermission. Copyright©2017JournalofOrthopaedic&SportsPhysicalTherapy®.Allrightsreserved. Mulcmodal manual therapy effeccve in CTS
  6. 6. Neck/arm pain • RCT 60 Pacents with neck/arm pain – Randomized to neural mobs + neural ex + advise (n=40) or control (n=20, stay accve) – 4 treatment session over 2 weeks – 4 week follow-up – GRC, NDI, pain, PSFS – NNT 2.7 to 4 – Neural mobilizacon provides immediate, clinically relevant benefits beyond advice to stay accve • Nee, Coppieters 2012 • Healthy people – Increases flexibility • LBP – Improves pain & disability c CIPER - Universidade de Lisboa, Faculdade de Motricidade Humana, Lisbon, Portugal d Escola Superior de Saúde, Instituto Politecnico de Setúbal, Portugal e Laboratory “Movement, Interactions, Performance” (EA 4334), University of Nantes, UFR STAPS, Nantes, France a r t i c l e i n f o Article history: Received 18 March 2016 Received in revised form 10 November 2016 Accepted 19 November 2016 Keywords: Neurodynamics Peripheral nerves Slump Flexibility Pain Disability a b s t r a c t Background: Neural mobilization (NM) is widely used to assess and treat several neuromuscular disor- ders. However, information regarding the NM effects targeting the lower body quadrant is scarce. Objectives: To determine the effects of NM techniques targeting the lower body quadrant in healthy and low back pain (LBP) populations. Design: Systematic review with meta-analysis. Method: Randomized controlled trials were included if any form of NM was applied to the lower body quadrant. Pain, disability, and lower limb flexibility were the main outcomes. PEDro scale was used to assess methodological quality. Results: Forty-five studies were selected for full-text analysis, and ten were included in the meta- analysis, involving 502 participants. Overall, studies presented fair to good quality, with a mean PEDro score of 6.3 (from 4 to 8). Five studies used healthy participants, and five targeted people with LBP. A moderate effect size (g ¼ 0.73, 95% CI: 0.48e0.98) was determined, favoring the use of NM to increase flexibility in healthy adults. Larger effect sizes were found for the effect of NM in pain reduction (g ¼ 0.82, 95% CI 0.56e1.08) and disability improvement (g ¼ 1.59, 95% CI: 1.14e2.03), in people with LBP. Conclusion: Evidence suggests that there are positive effects from the application of NM to the lower body quadrant. Specifically, NM shows moderate effects on flexibility in healthy participants, and large effects on pain and disability in people with LBP. Nevertheless, more studies with high methodological quality are necessary to support these conclusions. © 2016 Elsevier Ltd. All rights reserved. 1. Introduction Neural mobilization (NM) techniques are widely used to eval- uate, and improve, the mechanical and neurophysiological integrity of the peripheral nerves (Shacklock, 1995) in clinical populations (Butler, 2000). These techniques include combinations of joint movements that promote either neural tensioning (i.e. through displacement of the nerve endings in opposite directions) or sliding (i.e. through displacement of nerve endings in the same direction (Coppieters et al., 2009). Several studies have successfully used NM to improve flexibility, in both healthy (Herrington and Lee, 2006) and clinical populations (Coppieters et al., 2003), and also to induce different amounts of neural excursion (Coppieters et al., 2015). This is particularly relevant because it has been reported that nerve properties (e.g. cross-sectional area) are altered in certain periph- eral neuropathies (Lee and Dauphinee, 2005), and in upper limb nerve entrapment syndromes (Hough et al., 2007; Kantarci et al., 2013). These changes in the nerve properties may be associated with a compromised nerve function (Li and Shi, 2007; Rickett et al., 2010). In addition, it has also been shown that people with pe- ripheral neuropathy have a higher lower body quadrant mecha- nosensitivity (Boyd et al., 2010). Consequently, the NM techniques are used as treatment for different neuromuscular disorders. * Corresponding author. Faculdade de Motricidade Humana, Estrada da Costa, 1499-002, Cruz Quebrada - Dafundo, Universidade de Lisboa, Portugal. E-mail addresses: netogtiago@gmail.com (T. Neto), sfreitas@fmh.ulisboa.pt (S.R. Freitas). http://dx.doi.org/10.1016/j.msksp.2016.11.014 2468-7812/© 2016 Elsevier Ltd. All rights reserved. 12 Research 3 Neurodynamic treatment did not improve pain and disability at two weeks in 4 patients with chronic nerve-related leg pain: a randomised trial 5 Giovanni E Ferreira a , Fa´bio F Stieven b , Francisco X Araujo c , Matheus Wiebusch c , 6 Carolina G Rosa c , Rodrigo Della Me´a Plentz d , Marcelo F Silva d 7 a Master’s Program in Rehabilitation Sciences, Universidade Federal de Cieˆncias da Sau´de de Porto Alegre; b Doctoral Program in Health Sciences, Universidade Federal de Cieˆncias da 8 Sau´de de Porto Alegre; c Universidade Federal de Cieˆncias da Sau´de de Porto Alegre; d Graduate Program in Rehabilitation Sciences, Universidade Federal de Cieˆncias da Sau´de de Porto 9 Alegre, Porto Alegre, Brazil Journal of Physiotherapy xxx (2016) xxx–xxx K E Y W O R D S Low back pain Sciatica Manual therapy Neurodynamic treatment Slump test A B S T R A C T Question: In people with nerve-related leg pain, does adding neurodynamic treatment to advice to remain active improve leg pain, disability, low back pain, function, global perceived effect and location of symptoms?. Design: Randomised trial with concealed allocation and intention-to-treat analysis. Participants: Sixty participants with nerve-related leg pain recruited from the community. Interventions: The experimental group received four sessions of neurodynamic treatment. Both groups received advice to remain active. Outcome measures: Leg pain and low back pain (0 none to 10 worst), Oswestry Disability Index (0 none to 100 worst), Patient-Specific Functional Scale (0 unable to perform to 30 able to perform), global perceived effect (–5 to 5) and location of symptoms were measured at 2 and 4 weeks after randomisation. Continuous outcomes were analysed by linear mixed models. Location of symptoms was assessed by relative risk (95% CI). Results: At 2 weeks, the experimental group did not have significantly greater improvement that the control group in leg pain (MD –1.1, 95% CI –2.3 to 0.1) or disability (MD –3.3, 95% CI –9.6 to 2.9). At 4 weeks, the experimental group experienced a significantly greater reduction in leg pain (MD –2.4, 95% CI –3.6 to –1.2) and low back pain (MD –1.5, 95% CI –2.8 to –0.2). The experimental group also improved significantly more in function at 2 weeks (MD 5.2, 95% CI 2.2 to 8.2) and 4 weeks (MD 4.7, 95% CI 1.7 to 7.8), as well as global perceived effect at 2 weeks (MD 2.5, 95% CI 1.6 to 3.5) and 4 weeks (MD 2.9, 95% CI 1.9 to 3.9). No significant between-group differences occurred in disability at 4 weeks and location of symptoms. Conclusion: Adding neurodynamic treatment to advice to remain active did not improve leg pain and disability at 2 weeks. Trial registration: NCT01954199. [Ferreira GE, Stieven FF, Araujo FX, Wiebusch M, Rosa CG, Della Me´a Plentz R, et al. (2016) Neurodynamic treatment did not improve pain and disability at two weeks in patients with chronic nerve-related leg pain: a randomised trial. Journal of Physiotherapy XX: XX-XX] ß 2016 Australian Physiotherapy Association. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). G Model JPHYS 275 1–6 Journal of PHYSIOTHERAPY journal homepage: www.elsevier.com/locate/jphys 2016 Research urodynamic treatment did not improve pain and disability at two weeks in patients with chronic nerve-related leg pain: a randomised trial Giovanni E Ferreira a , Fa´bio F Stieven b , Francisco X Araujo c , Matheus Wiebusch c , Carolina G Rosa c , Rodrigo Della Me´a Plentz d , Marcelo F Silva d Program in Rehabilitation Sciences, Universidade Federal de Cieˆncias da Sau´de de Porto Alegre; b Doctoral Program in Health Sciences, Universidade Federal de Cieˆncias da Porto Alegre; c Universidade Federal de Cieˆncias da Sau´de de Porto Alegre; d Graduate Program in Rehabilitation Sciences, Universidade Federal de Cieˆncias da Sau´de de Porto Alegre, Porto Alegre, Brazil uction back pain is a highly prevalent and disabling condition that nts the major cause of years lived with disability in both ped and developing countries.1 Among the wide array of presentations, the prevalence of radiating leg pain can be 27treatment.4 Despite the high risk of bias of several included studies, 28as well as moderate-to-high levels of between-study heterogene- 29ity, this network meta-analysis provided evidence that commonly 30used conservative interventions were not capable of altering the 31natural history of leg pain. Therefore, other conservative treatment 32strategies should be investigated in this population as a research Journal of Physiotherapy xxx (2016) xxx–xxx W O R D S k pain herapy namic treatment st A B S T R A C T Question: In people with nerve-related leg pain, does adding neurodynamic treatment to advice to remain active improve leg pain, disability, low back pain, function, global perceived effect and location of symptoms?. Design: Randomised trial with concealed allocation and intention-to-treat analysis. Participants: Sixty participants with nerve-related leg pain recruited from the community. Interventions: The experimental group received four sessions of neurodynamic treatment. Both groups received advice to remain active. Outcome measures: Leg pain and low back pain (0 none to 10 worst), Oswestry Disability Index (0 none to 100 worst), Patient-Specific Functional Scale (0 unable to perform to 30 able to perform), global perceived effect (–5 to 5) and location of symptoms were measured at 2 and 4 weeks after randomisation. Continuous outcomes were analysed by linear mixed models. Location of symptoms was assessed by relative risk (95% CI). Results: At 2 weeks, the experimental group did not have significantly greater improvement that the control group in leg pain (MD –1.1, 95% CI –2.3 to 0.1) or disability (MD –3.3, 95% CI –9.6 to 2.9). At 4 weeks, the experimental group experienced a significantly greater reduction in leg pain (MD –2.4, 95% CI –3.6 to –1.2) and low back pain (MD –1.5, 95% CI –2.8 to –0.2). The experimental group also improved significantly more in function at 2 weeks (MD 5.2, 95% CI 2.2 to 8.2) and 4 weeks (MD 4.7, 95% CI 1.7 to 7.8), as well as global perceived effect at 2 weeks (MD 2.5, 95% CI 1.6 to 3.5) and 4 weeks (MD 2.9, 95% CI 1.9 to 3.9). No significant between-group differences occurred in disability at 4 weeks and location of symptoms. Conclusion: Adding neurodynamic treatment to advice to remain active did not improve leg pain and disability at 2 weeks. Trial registration: NCT01954199. [Ferreira GE, Stieven FF, Araujo FX, Wiebusch M, Rosa CG, Della Me´a Plentz R, et al. (2016) Neurodynamic treatment did not improve pain and disability at two weeks in patients with chronic nerve-related leg pain: a randomised trial. Journal of Physiotherapy XX: XX-XX] ß 2016 Australian Physiotherapy Association. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). 275 1–6 Journal of PHYSIOTHERAPY journal homepage: www.elsevier.com/locate/jphys Conclusion: NM not recommended for the treatment of chronic nerve- related leg pain!!!!!!! sample size = 60 4 sessions NM Summary Evidence of effect in humans with and without pain. Pacent seleccon may be a factor, not all neural disorders suitable?
  7. 7. Sub-groups of neural disorders • Some pacents respond well others not - Why ? – Sub-groups? • Schafer, 2008 Compressive neuropathy sliding Central sensiczacon Other Axonal mechanosensicvity Musculoskeletal transverse sliding Nerve swelling Neural sub-group classificaEon based on mechanisms Trauma, compression, or chemical irritaEon of nerve/nerve roots Neuropathic pain sensory hypersensiEvity InflammaEon Peripheral nerve sensiEsaEon NegaEve featuresPosiEve features “Neuropathic” Compressive neuropathy Musculoskeletal pain DeafferentaEon, loss of inhibiEon, facilitaEon etc AMS or nervi nervorum sensiEzaEon If none Convergence Axonal damage Neuropathic Mixed Inflammatory Mechanism? Hall, 2011 Classification of Neural Pain • Syndrome based classification Peripheral neural pain DN, PHN, MS, radiculopathy, CTS, CUTS • Mechanism based classification Aß C Dorsal root ganglion Dorsal horn midline Woolf, 1999 Central mechanism Peripheral mechanism Classification by syndrome • Does not explain pain • Does not help treatment – Patients with similar diagnoses have diverse symptoms – Resolution of the pathology does not always improve the disorder
  8. 8. NP compressive neuropathy Nerve trunk mechanosensicvity ? NP sensory hypersensicvity Peripheral nerve sensiczacon Musculoskeletal yes noNegacve features Conduccon loss Posicve features Sensory gain conduccon loss no yes yes no yes Musculoskeletal Peripheral nerve sensiEzaEon NP compression neuropathy NP sensory hypersensiEvity Hierarchical order to classificacon 1 2 3 4 Order of classificaEon Respond to physical treatment Non-respond to physical intervenEons Compression neuropathy Nerve trunk sensicvity ? Neuropathic pain - Sensory hypersensicvity Peripheral nerve sensiczacon Musculoskeletal yes no Neurological deficit ? LANSS SCALE 12 ? Hierarchical classificacon of neural pain disorders no yes yes no • Reliable valid classificacon system in chronic lumbar radicular pain, cervical radiculopathy, NSAP Schäfer, 2008; 2009; 2010; 2014 Moloney, 2013; 2014; 2015 Tampin, 2014 Treatment • Treatment: NM, educacon, home ex – Significantly more responders greater improvement in PNS compared to other groups • Group PNS showed greater improvement in C fibre funccon following intervencon – Decreased sensicvity to cold pain – Decreased wind up raco. • Group sensory hypersensicvity exhibited loss of C fibre funccon increased pressure pain sensicvity • Schäfer, 2009; 2011
  9. 9. Treatment - PNS • Responders to neural mobilization – Positive LANSS, age, large ROM deficits on median nerve neurodynamic tests predict 10% chance of recovery – Negative LANSS, age, small ROM deficits predicts 90% chance of recovery • Nee, Coppieters et al 2013 Original Research Article Cervical Lateral Glide Neural Mobilization Is Effective in Treating Cervicobrachial Pain: A Randomized Waiting List Controlled Clinical Trial David Rodrıguez-Sanz, PhD, PT, DP,* Ce´sar Calvo-Lobo, PhD, PT,† Francisco Unda-Solano, MSc, PT,* Irene Sanz-Corbalan, PhD, DP,‡ Carlos Romero-Morales, PhD, PT,* and Daniel Lopez-Lopez, PhD, DP§ *Faculty of Health, Exercise and Sport, Department of Physical Therapy and Podiatry, Physical Therapy Health Sciences Research group, Universidad Europea de Madrid, Villaviciosa de Odon, Madrid, Spain; † Department of Physical Therapy, School of Health Sciences, University of Leon, Ponferrada, Leon, Spain; ‡ Podiatry, Nursing and Physical Therapy Department, Universidad Complutense de Madrid, Madrid, Spain; § Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coru~na, Coru~na, Spain Correspondence to: Ce´sar Calvo Lobo, PhD, MSc, PT Nursing and Physical Therapy Department, Faculty of Health Sciences, University of Leon, Av. Astorga, s/n, 24401 Ponferrada, Leon, Spain (e-mail: cecalvo19@ hotmail.com). Tel: 912-115-268, ext. 5268. Funding sources: None. Conflicts of interest: All authors have no conflicts of interest to report. None of the authors of the manu- script received any remuneration. Further, the authors have not received any reimbursement or honorarium in any other manner. The authors are not affiliated in any manner. Ethics committee board approval review of study protocol: The “Centro Policlinico Valencia” Research Ethics Committe approved the study (CE0072015). Public trial registry: Registered at Clinical Trials NCT02595294. Trial registration: NCT02595294. Abstract Background. Cervicobrachial pain (CP) is a high- incidence and prevalent condition. Cervical lateral glide (CLG) is a firstline treatment of CP. There is a cur- rent lack of enough high-quality randomized controlled double-blind clinical trials that measure the effective- ness of neural tissue mobilization techniques such as the CLG and its specific effect over CP. Objectives. The aim of the present study was to as- sess the effect of CLG neural mobilization in treat- ing subjects who suffer from CP, compared with the complete absence of treatment. Study Design. This investigation was a single- center, blinded, parallel randomized controlled clin- ical trial (RCT). Setting. One hundred forty-seven individuals were screened in a medical center from July to November 2015. Fifty-eight participants were diagnosed with CP. Methods. Participants were recruited and randomly assigned into two groups of 29 subjects. The inter- vention group received CLG treatment, and the control group (CG) was assigned to a six-week waiting list to receive treatment. Randomization was carried out by concealed computer software randomized printed cards. The primary outcome was pain intensity, reported through the Numeric Rating Scale for Pain (NRSP). Secondary outcomes were physical function involving the affected upper limb using the Quick DASH scale and ipsilateral cervical rotation (ICR) using a CROM device. Assessments were made at baseline and one hour after treatment. Results. The CLG group NRSP mean value was sig- nificantly (P 0.0001) superior to those obtained by the CG. Subjects treated with CLG reported an VC 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 1 Pain Medicine 2017; 00: 1–12 doi: 10.1093/pm/pnx011 Original Research Article Cervical Lateral Glide Neural Mobilization Is Effective in Treating Cervicobrachial Pain: A Randomized Waiting List Controlled Clinical Trial David Rodrıguez-Sanz, PhD, PT, DP,* Ce´sar Calvo-Lobo, PhD, PT,† Francisco Unda-Solano, MSc, PT,* Irene Sanz-Corbalan, PhD, DP,‡ Carlos Romero-Morales, PhD, PT,* and Daniel Lopez-Lopez, PhD, DP§ *Faculty of Health, Exercise and Sport, Department of Physical Therapy and Podiatry, Physical Therapy Health Sciences Research group, Universidad Europea de Madrid, Villaviciosa de Odon, Madrid, Spain; † Department of Physical Therapy, School of Health Sciences, University of Leon, Ponferrada, Leon, Spain; ‡ Podiatry, Nursing and Physical Therapy Department, Universidad Complutense de Madrid, Madrid, Spain; § Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coru~na, Coru~na, Spain Correspondence to: Ce´sar Calvo Lobo, PhD, MSc, PT Nursing and Physical Therapy Department, Faculty of Health Sciences, University of Leon, Av. Astorga, s/n, 24401 Ponferrada, Leon, Spain (e-mail: cecalvo19@ hotmail.com). Tel: 912-115-268, ext. 5268. Funding sources: None. Conflicts of interest: All authors have no conflicts of interest to report. None of the authors of the manu- script received any remuneration. Further, the authors have not received any reimbursement or honorarium in any other manner. The authors are not affiliated in any manner. Ethics committee board approval review of study protocol: The “Centro Policlinico Valencia” Research Ethics Committe approved the study (CE0072015). Public trial registry: Registered at Clinical Trials NCT02595294. Trial registration: NCT02595294. Abstract Background. Cervicobrachial pain (CP) is a high- incidence and prevalent condition. Cervical lateral glide (CLG) is a firstline treatment of CP. There is a cur- rent lack of enough high-quality randomized controlled double-blind clinical trials that measure the effective- ness of neural tissue mobilization techniques such as the CLG and its specific effect over CP. Objectives. The aim of the present study was to as- sess the effect of CLG neural mobilization in treat- ing subjects who suffer from CP, compared with the complete absence of treatment. Study Design. This investigation was a single- center, blinded, parallel randomized controlled clin- ical trial (RCT). Setting. One hundred forty-seven individuals were screened in a medical center from July to November 2015. Fifty-eight participants were diagnosed with CP. Methods. Participants were recruited and randomly assigned into two groups of 29 subjects. The inter- vention group received CLG treatment, and the control group (CG) was assigned to a six-week waiting list to receive treatment. Randomization was carried out by concealed computer software randomized printed cards. The primary outcome was pain intensity, reported through the Numeric Rating Scale for Pain (NRSP). Secondary outcomes were physical function involving the affected upper limb using the Quick DASH scale and ipsilateral cervical rotation (ICR) using a CROM device. Assessments were made at baseline and one hour after treatment. Results. The CLG group NRSP mean value was sig- nificantly (P 0.0001) superior to those obtained by the CG. Subjects treated with CLG reported an VC 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 1 Pain Medicine 2017; 00: 1–12 doi: 10.1093/pm/pnx011 Original Research Article Cervical Lateral Glide Neural Mobilization Is Effective in Treating Cervicobrachial Pain: A Randomized Waiting List Controlled Clinical Trial David Rodrıguez-Sanz, PhD, PT, DP,* Ce´sar Calvo-Lobo, PhD, PT,† Francisco Unda-Solano, MSc, PT,* Irene Sanz-Corbalan, PhD, DP,‡ Carlos Romero-Morales, PhD, PT,* and Daniel Lopez-Lopez, PhD, DP§ *Faculty of Health, Exercise and Sport, Department of Physical Therapy and Podiatry, Physical Therapy Health Sciences Research group, Universidad Europea de Madrid, Villaviciosa de Odon, Madrid, Spain; † Department of Physical Therapy, School of Health Sciences, University of Leon, Ponferrada, Leon, Spain; ‡ Podiatry, Nursing and Physical Therapy Department, Universidad Complutense de Madrid, Madrid, Spain; § Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coru~na, Coru~na, Spain Correspondence to: Ce´sar Calvo Lobo, PhD, MSc, PT Nursing and Physical Therapy Department, Faculty of Health Sciences, University of Leon, Av. Astorga, s/n, 24401 Ponferrada, Leon, Spain (e-mail: cecalvo19@ hotmail.com). Tel: 912-115-268, ext. 5268. Funding sources: None. Conflicts of interest: All authors have no conflicts of interest to report. None of the authors of the manu- script received any remuneration. Further, the authors have not received any reimbursement or honorarium in any other manner. The authors are not affiliated in any manner. Ethics committee board approval review of study protocol: The “Centro Policlinico Valencia” Research Ethics Committe approved the study (CE0072015). Public trial registry: Registered at Clinical Trials NCT02595294. Abstract Background. Cervicobrachial pain (CP) is a high- incidence and prevalent condition. Cervical lateral glide (CLG) is a firstline treatment of CP. There is a cur- rent lack of enough high-quality randomized controlled double-blind clinical trials that measure the effective- ness of neural tissue mobilization techniques such as the CLG and its specific effect over CP. Objectives. The aim of the present study was to as- sess the effect of CLG neural mobilization in treat- ing subjects who suffer from CP, compared with the complete absence of treatment. Study Design. This investigation was a single- center, blinded, parallel randomized controlled clin- ical trial (RCT). Setting. One hundred forty-seven individuals were screened in a medical center from July to November 2015. Fifty-eight participants were diagnosed with CP. Methods. Participants were recruited and randomly assigned into two groups of 29 subjects. The inter- vention group received CLG treatment, and the control group (CG) was assigned to a six-week waiting list to receive treatment. Randomization was carried out by concealed computer software randomized printed cards. The primary outcome was pain intensity, reported through the Numeric Rating Scale for Pain (NRSP). Secondary outcomes were physical function involving the affected upper limb using the Quick DASH scale and ipsilateral cervical rotation (ICR) using a CROM device. Assessments were made at baseline and one hour after treatment. Results. The CLG group NRSP mean value was sig- nificantly (P 0.0001) superior to those obtained by Pain Medicine 2017; 00: 1–12 doi: 10.1093/pm/pnx011 Open Journal of Therapy and Rehabilitation, 2016, 4, 132-145 Published Online August 2016 in SciRes. http://www.scirp.org/journal/ojtr http://dx.doi.org/10.4236/ojtr.2016.43012 How to cite this paper: Salt, E., Kelly, S. and Soundy, A. (2016) Randomised Controlled Trial for the Efficacy of Cervical Lat- eral Glide Mobilisation in the Management of Cervicobrachial Pain. Open Journal of Therapy and Rehabilitation, 4, 132-145. http://dx.doi.org/10.4236/ojtr.2016.43012 Randomised Controlled Trial for the Efficacy of Cervical Lateral Glide Mobilisation in the Management of Cervicobrachial Pain Emma Salt1*, Sue Kelly2, Andrew Soundy2 1 Physiotherapy Department, Queen’s Hospital Foundation Trust, Burton on Trent, UK 2 School of Sport, Exercise and Rehabilitation Sciences, The University of Birmingham, Birmingham, UK Received 26 May 2016; accepted 31 July 2016; published 3 August 2016 Copyright © 2016 by authors and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/ Abstract Objectives: To investigate the long-term efficacy of lateral glide mobilisation for patients with chronic Cervicobrachial Pain (CP). Methods: A randomised controlled trial which involved ninety- nine participants with chronic CP. Participants were randomised to receive either the lateral glide with self-management (n = 49) or self-management alone (n = 50). Four assessments were made (at baseline and 6, 26 and 52 weeks post intervention). The primary outcome measure was the Visual Analogue Scale (VAS) for pain. Patient perceived recovery used the Global Rating of Change score (GROC). Functional outcomes included the Neck and Upper Limb Index score (NULI) and the Short-From 36 (SF36). Costs and reported number of harmful effects in response to intervention were evaluated. An intention to treat approach was followed for data analysis. Results: No statis- tically significant between-group differences were found for pain (using VAS) in the short-term at six weeks (p = 0.52; 95% CI −14.72 to 7.44) or long-term at one year (p = 0.37; 95% CI −17.76 to 6.61) post-intervention. The VAS outcomes correlated well with GROC scores (p 0.001). There was a statistically significant difference in NULI scores favouring self-management alone (p = 0.03), but no between-group differences for SF36 (p = 0.07). The cost of providing lateral glide and self-management was twice that of providing self-management alone. Minor harm was reported in both groups, with 11% more harm being associated with the lateral glide. Conclusion: In patients with chronic CP, the addition of a lateral-glide mobilization to a self-management program did not produce improved outcomes and resulted in higher health-care costs. Keywords Cervical Radiculopathy, Physiotherapy, Manual Therapy * Corresponding author. http://dx.doi.org/10.4236/ojtr.2016.43012 How to cite this paper: Salt, E., Kelly, S. and Soundy, A. (2016) Randomised Controlled Trial for the Efficacy of Cervical Lat- eral Glide Mobilisation in the Management of Cervicobrachial Pain. Open Journal of Therapy and Rehabilitation, 4, 132-145. http://dx.doi.org/10.4236/ojtr.2016.43012 Randomised Controlled Trial for the Efficacy of Cervical Lateral Glide Mobilisation in the Management of Cervicobrachial Pain Emma Salt1*, Sue Kelly2, Andrew Soundy2 1 Physiotherapy Department, Queen’s Hospital Foundation Trust, Burton on Trent, UK 2 School of Sport, Exercise and Rehabilitation Sciences, The University of Birmingham, Birmingham, UK Received 26 May 2016; accepted 31 July 2016; published 3 August 2016 Copyright © 2016 by authors and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/ Abstract Objectives: To investigate the long-term efficacy of lateral glide mobilisation for patients with chronic Cervicobrachial Pain (CP). Methods: A randomised controlled trial which involved ninety- nine participants with chronic CP. Participants were randomised to receive either the lateral glide with self-management (n = 49) or self-management alone (n = 50). Four assessments were made (at baseline and 6, 26 and 52 weeks post intervention). The primary outcome measure was the Visual Analogue Scale (VAS) for pain. Patient perceived recovery used the Global Rating of Change score (GROC). Functional outcomes included the Neck and Upper Limb Index score (NULI) and the Short-From 36 (SF36). Costs and reported number of harmful effects in response to intervention were evaluated. An intention to treat approach was followed for data analysis. Results: No statis- tically significant between-group differences were found for pain (using VAS) in the short-term at six weeks (p = 0.52; 95% CI −14.72 to 7.44) or long-term at one year (p = 0.37; 95% CI −17.76 to 6.61) post-intervention. The VAS outcomes correlated well with GROC scores (p 0.001). There was a statistically significant difference in NULI scores favouring self-management alone (p = 0.03), but no between-group differences for SF36 (p = 0.07). The cost of providing lateral glide and self-management was twice that of providing self-management alone. Minor harm was reported in both groups, with 11% more harm being associated with the lateral glide. Conclusion: In patients with chronic CP, the addition of a lateral-glide mobilization to a self-management program did not produce improved outcomes and resulted in higher health-care costs. Keywords Cervical Radiculopathy, Physiotherapy, Manual Therapy * Corresponding author. Open Journal of Therapy and Rehabilitation, 2016, 4, 132-145 Published Online August 2016 in SciRes. http://www.scirp.org/journal/ojtr http://dx.doi.org/10.4236/ojtr.2016.43012 Randomised Controlled Trial for the Efficac of Cervical Lateral Glide Mobilisation in the Management of Cervicobrachial Pain Emma Salt1*, Sue Kelly2, Andrew Soundy2 1 Physiotherapy Department, Queen’s Hospital Foundation Trust, Burton on Trent, UK 2 School of Sport, Exercise and Rehabilitation Sciences, The University of Birmingham, Birmingham, UK Received 26 May 2016; accepted 31 July 2016; published 3 August 2016 Copyright © 2016 by authors and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/ Abstract Objectives: To investigate the long-term efficacy of lateral glide mobilisation for patients w chronic Cervicobrachial Pain (CP). Methods: A randomised controlled trial which involved nin nine participants with chronic CP. Participants were randomised to receive either the lateral g with self-management (n = 49) or self-management alone (n = 50). Four assessments were m (at baseline and 6, 26 and 52 weeks post intervention). The primary outcome measure was Visual Analogue Scale (VAS) for pain. Patient perceived recovery used the Global Rating of Cha score (GROC). Functional outcomes included the Neck and Upper Limb Index score (NULI) and Short-From 36 (SF36). Costs and reported number of harmful effects in response to intervent were evaluated. An intention to treat approach was followed for data analysis. Results: No sta tically significant between-group differences were found for pain (using VAS) in the short-term six weeks (p = 0.52; 95% CI −14.72 to 7.44) or long-term at one year (p = 0.37; 95% CI −17.7 6.61) post-intervention. The VAS outcomes correlated well with GROC scores (p 0.001). Th was a statistically significant difference in NULI scores favouring self-management alone ( 0.03), but no between-group differences for SF36 (p = 0.07). The cost of providing lateral glide self-management was twice that of providing self-management alone. Minor harm was reporte both groups, with 11% more harm being associated with the lateral glide. Conclusion: In patie with chronic CP, the addition of a lateral-glide mobilization to a self-management program did produce improved outcomes and resulted in higher health-care costs. Keywords Open Journal of Therapy and Rehabilitation, 2016, 4, 132-145 Published Online August 2016 in SciRes. http://www.scirp.org/journal/ojtr http://dx.doi.org/10.4236/ojtr.2016.43012 How to cite this paper: Salt, E., Kelly, S. and Soundy, A. (2016) Randomised Controlled Trial for the Efficacy of Cervical Lat- eral Glide Mobilisation in the Management of Cervicobrachial Pain. Open Journal of Therapy and Rehabilitation, 4, 132-145. http://dx.doi.org/10.4236/ojtr.2016.43012 Randomised Controlled Trial for the Efficacy of Cervical Lateral Glide Mobilisation in the Management of Cervicobrachial Pain Emma Salt1*, Sue Kelly2, Andrew Soundy2 1 Physiotherapy Department, Queen’s Hospital Foundation Trust, Burton on Trent, UK 2 School of Sport, Exercise and Rehabilitation Sciences, The University of Birmingham, Birmingham, UK Received 26 May 2016; accepted 31 July 2016; published 3 August 2016 Copyright © 2016 by authors and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/ Abstract Objectives: To investigate the long-term efficacy of lateral glide mobilisation for patients with chronic Cervicobrachial Pain (CP). Methods: A randomised controlled trial which involved ninety- nine participants with chronic CP. Participants were randomised to receive either the lateral glide with self-management (n = 49) or self-management alone (n = 50). Four assessments were made (at baseline and 6, 26 and 52 weeks post intervention). The primary outcome measure was the Visual Analogue Scale (VAS) for pain. Patient perceived recovery used the Global Rating of Change score (GROC). Functional outcomes included the Neck and Upper Limb Index score (NULI) and the Short-From 36 (SF36). Costs and reported number of harmful effects in response to intervention were evaluated. An intention to treat approach was followed for data analysis. Results: No statis- tically significant between-group differences were found for pain (using VAS) in the short-term at six weeks (p = 0.52; 95% CI −14.72 to 7.44) or long-term at one year (p = 0.37; 95% CI −17.76 to 6.61) post-intervention. The VAS outcomes correlated well with GROC scores (p 0.001). There was a statistically significant difference in NULI scores favouring self-management alone (p = 0.03), but no between-group differences for SF36 (p = 0.07). The cost of providing lateral glide and self-management was twice that of providing self-management alone. Minor harm was reported in both groups, with 11% more harm being associated with the lateral glide. Conclusion: In patients with chronic CP, the addition of a lateral-glide mobilization to a self-management program did not produce improved outcomes and resulted in higher health-care costs. Keywords Cervical Radiculopathy, Physiotherapy, Manual Therapy * Corresponding author. • Issues: – C5/6 only – CBP, not specific PNS – Did not target neural cssue – Did not progress – Did not eliminate +ve LANSS – Max 6 Rx sessions over 6/52! – 3 x 60 seconds How to cite this paper: Salt, E., Kelly, S. and Soundy, A. (2016) Randomised Controlled Trial for the Efficacy of Cervical Lat- eral Glide Mobilisation in the Management of Cervicobrachial Pain. Open Journal of Therapy and Rehabilitation, 4, 132-145. http://dx.doi.org/10.4236/ojtr.2016.43012 of Cervical Lateral Glide Mobilisation in the Management of Cervicobrachial Pain Emma Salt1*, Sue Kelly2, Andrew Soundy2 1 Physiotherapy Department, Queen’s Hospital Foundation Trust, Burton on Trent, UK 2 School of Sport, Exercise and Rehabilitation Sciences, The University of Birmingham, Birmingham, UK Received 26 May 2016; accepted 31 July 2016; published 3 August 2016 Copyright © 2016 by authors and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/ Abstract Objectives: To investigate the long-term efficacy of lateral glide mobilisation for patients with chronic Cervicobrachial Pain (CP). Methods: A randomised controlled trial which involved ninety- nine participants with chronic CP. Participants were randomised to receive either the lateral glide with self-management (n = 49) or self-management alone (n = 50). Four assessments were made (at baseline and 6, 26 and 52 weeks post intervention). The primary outcome measure was the Visual Analogue Scale (VAS) for pain. Patient perceived recovery used the Global Rating of Change score (GROC). Functional outcomes included the Neck and Upper Limb Index score (NULI) and the Short-From 36 (SF36). Costs and reported number of harmful effects in response to intervention were evaluated. An intention to treat approach was followed for data analysis. Results: No statis- tically significant between-group differences were found for pain (using VAS) in the short-term at six weeks (p = 0.52; 95% CI −14.72 to 7.44) or long-term at one year (p = 0.37; 95% CI −17.76 to 6.61) post-intervention. The VAS outcomes correlated well with GROC scores (p 0.001). There was a statistically significant difference in NULI scores favouring self-management alone (p = 0.03), but no between-group differences for SF36 (p = 0.07). The cost of providing lateral glide and self-management was twice that of providing self-management alone. Minor harm was reported in both groups, with 11% more harm being associated with the lateral glide. Conclusion: In patients with chronic CP, the addition of a lateral-glide mobilization to a self-management program did not produce improved outcomes and resulted in higher health-care costs. Keywords Cervical Radiculopathy, Physiotherapy, Manual Therapy * Corresponding author. Summary Neural mobilisacon is likely to be more effeccve for PNS, with a negacve LANSS Slider or tensioner? • Inflammacon blocks axoplasmic transport • C fiber axonal mechanical sensicvity distal to inflammacon – 1 week maximum sensicvity (18% of axons) – 4 weeks (12%) 8 weeks (2%) • Important for treatment? Dilley, 2008b Dilley, 2008
  10. 10. Relevance to intervencon? • How to resolve axonal mechanical sensitivity? – “Tensioners” • Raise intraneural pressure reduce axoplasmic flow • Increased nerve conduction failure, Sodium channel block (CTS) • Gianneschi, 2015 • 3% change in length triggers ectopic impulse generation – “Sliders” • Minimal change in length intraneural pressure but greater excursion of the nerve • promotes de-sensitization What about compressive neuropathy? Song, 2007 Equivalent in Humans • Case series – lumbar spinal stenosis n=57 – Distraction manipulation neural mobilization + exercise – Mean 13 treatments (2-50) – Clinically meaningful improvement in pain disability after treatment and long-term follow-up • Murphy, 2006
  11. 11. Are “opening” techniques beaer for CN? Thank you!
  • RuchiSaggar

    Aug. 13, 2017
  • TimJanvanHazel

    Apr. 8, 2017
  • ChristinaCommerschei

    Apr. 8, 2017

Toby hall

Vistas

Total de vistas

1.433

En Slideshare

0

De embebidos

0

Número de embebidos

17

Acciones

Descargas

70

Compartidos

0

Comentarios

0

Me gusta

3

×