Neural Mobilization Techniques Research Articles

Effectiveness of Neural Mobilization Technique in Subjects with Lumbar Radiculopathy: A Randomized Controlled Trial

BACKGROUND AND OBJECTIVE: Radicular low back pain is a disorder involving the dysfunction of the lumbosacral nerve roots. Clinical rehabilitation approaches for Radicular LBA include kinesiotherapy, and physical therapy procedures: rest, heat, ultrasound, TENS, but evidences regarding their effectiveness are lacking. Previous studies found that neural mobilization is more effective in reducing pain. The aim of the study is to determine the effectiveness of Neural Mobilization on pain in subjects with lumbar radiculopathy. METHODS: 30 subjects were selected by simple random sampling and assigned into Experimental group (n=15) & Control group (n=15). The subjects in Experimental group were given Neural Mobilization in addition to traditional therapy and control group were given traditional therapy alone. All the participants were assessed with NPRS. RESULTS: After the analysis, the results were found to be effective in improvement of pain in both groups NPRS score (p<0.0001). But there is a high significance in Experimental group when compared to control group. CONCLUSION: This study concluded that Neural Mobilization along with traditional therapy is more effective in reducing pain in subjects with lumbar radiculopathy. Keywords: Neural Mobilization, Low back ache, Numerical pain rating scale.

Routine Physical Therapy with and without Neural Mobilization in Chronic Musculoskeletal Neck Disorders with Nerve-Related Symptoms: Systematic Review and Meta-Analysis.

No previous study has evaluated the effectiveness of routine physical therapy with and without neural mobilization for patients with chronic musculoskeletal neck disorders and cervical radiculopathy. The objective is to evaluate the effectiveness of routine physical therapy with and without neural mobilization on pain and mobility in patients with chronic musculoskeletal neck disorders and cervical radiculopathy. A systematic review with meta-analysis of randomized clinical trials involving the use of neural mobilization techniques for the treatment of chronic musculoskeletal neck disorders and cervical radiculopathy was conducted. Methodological quality was assessed by the Cochrane Risk of Bias Tool and PEDro scale. Data were pooled and a meta-analysis was performed using a random effects model with Review Manager 5 software. Seven articles were included in our review. Significant differences were found in mobility but not in pain in favor of using routine physical therapy with neural mobilization for the treatment of chronic musculoskeletal neck disorders and cervical radiculopathy. Our results show that routine physical therapy accompanied by neural mobilization is superior for improving mobility in comparison with routine physical therapy alone in patients with musculoskeletal neck disorders and cervical radiculopathy.

Neural Mobilization for Reducing Pain and Disability in Patients with Lumbar Radiculopathy: A Systematic Review and Meta-Analysis.

Lumbar radiculopathy causes lower back and lower extremity pain that may be managed with neural mobilization (NM) techniques. This meta-analysis aims to evaluate the effectiveness of NM in alleviating pain and reducing disability in patients with lumbar radiculopathy. We hypothesized that NM would reduce pain and improve disability in the lumbar radiculopathy population, leveraging the statistical power of multiple studies. Electronic databases from their inception up to October 2023 were searched for randomized controlled trials (RCTs) that explored the impact of NM on lumbar radiculopathy. Our primary outcome measure was the alteration in pain intensity, while the secondary one was the improvement of disability, standardized using Hedges' g. To combine the data, we employed a random-effects model. A total of 20 RCTs comprising 877 participants were included. NM yielded a significant reduction in pain intensity (Hedges' g = -1.097, 95% CI = -1.482 to -0.712, p < 0.001, I2 = 85.338%). Subgroup analyses indicated that NM effectively reduced pain, whether employed alone or in conjunction with other treatments. Furthermore, NM significantly alleviated disability, with a notable effect size (Hedges' g = -0.964, 95% CI = -1.475 to -0.453, p < 0.001, I2 = 88.550%), particularly in chronic cases. The findings provide valuable insights for clinicians seeking evidence-based interventions for this patient population. This study has limitations, including heterogeneity, potential publication bias, varied causal factors in lumbar radiculopathy, overall study quality, and the inability to explore the impact of neural pathology on NM treatment effectiveness, suggesting opportunities for future research improvements.

To Compare The Two Approaches Of Nerve Flossing Technique On Pain, Lumbar Mobility And Straight Leg Raise In Subjects With Sciatica

Background: Sciatica is one of the most common painful and disabling conditions. Nerve flossing technique commonly called as neural mobilization are the forms of manual therapy that are used in an effort to reduce radiating pain and improve range of motion. A wide range of physical therapy interventions have been proposed to be effective, however the efficacy of neural mobilization technique is still undetermined in developing countries like India. Purpose: A study to compare the two approaches of nerve flossing technique on pain, lumbar mobility and striaght leg raise in subjects with sciatica. Study design: Quasi- Experimental study, comparative in nature Methodology: A total of 45 subjects were selected for the study as per inclusion and exclusion criteria between age group of 20-55 years. Participants were divided into 3 groups of 15 subjects each. Group A (control), Group B (Experimental-1) and Group C (experimental-2). Group A was receive Transcutaneous Electrical Nerve Stimulation (TENS), Hydro-collateral pack, Group B was receive slider mobilization (Nerve Flossing Technique) and Group C was receive single joint mobilization on knee (Nerve Flossing Technique). The baseline data was recorded on 1th day (pre- intervention) and 5th day (post-intervention) and then on 10th day (post-intervention). Total 10 sessions per subject was given over 2 weeks i.e., 5 sessions per week. The collected Data was analyzed by using ANOVA and other statistical tests as appropriate Results: The result showed significant improvement in slider mobilization on pain, lumbar mobility and striaght leg raise in subjects with sciatica. Conclusion: The present study concludes that slider mobilization is most effective nerve flossing technique in improving pain, lumbar mobility and striaght leg raise in subjects with sciatica. Trial registration number (TRN): Not applicable.

Outcomes of the butler neural mobilization technique and manual therapy for chronic low back pain in patients with lumbar radiculopathy: A cross-sectional comparative study

Surgeries were considered the only effective treatment method for patients suffering from chronic low back pain with lumbar radiculopathy for a while. However, in the contemporary world, it is not regarded as the primary treatment method until other conventional pharmacological and physical therapy interventions have not proven effective. Therefore, this study compares the outcomes in terms of pain relief and perceived level of mobility in patients with chronic low back pain with lumbar radiculopathy, regardless of whether the butler neural mobilization technique or manual therapy is used. This comparative cross-sectional study was conducted in Lahore, recruiting 100 patients by rendering a purposive sampling technique undergoing any treatment method mentioned above. Observations were recorded pre- and postintervention with a follow-up of 7 days to assess the response to both techniques using a questionnaire. Face-to-face interviews were conducted to assess pain levels using the Numeric Pain Rating Scale (NPRS) and Modified Oswestry Disability Questionnaire (MODQ). Descriptive statistics, chi-square test, Mann‒Whitney U test, independent t test, and the Wilcoxon signed-rank test were used to analyze the data. The medical characteristics of patients who had opted for manual therapy and butler neural mobilization were not different (p &gt; 0.05), except for the quality of pain (p &lt; 0.05). However, pre- and postintervention NPRS scores, pain intensity during the last 24 hours using NPRS scores, and MODQ scores were significantly different among the groups, indicating postintervention pain reduction for both groups comprising patients who had opted for manual therapy (p = 0.001) and butler neural mobilization technique (p = 0.001). Moreover, patients who had opted for either technique had improved their disability levels compared with the preintervention disability levels (p = 0.001). The study concluded that both techniques significantly reduce pain and disability levels, including butler neural mobilization and manual therapy, among patients suffering from chronic low back pain with lumbar radiculopathy.

Combined Effect of Constraint Induced Movement Therapy and Neural Mobilization Technique on Upper Extremity Function in Spastic Hemiplegic Patient – A Single Case Study

Purpose: A single case study was performed carried to understand the benefit of constraint movement therapy and neural mobilization technique and neural mobilization technique on upper extremity function in spastic hemiplegic patient. Design/Methodology/Approach: Numerous advanced researches have been done throughout the world in various study designs including systematic reviews and randomized control trials to analyse the significance of constraint induced movement therapy or neural mobilization technique on upper extremity function spastic hemiplegic patients. But there were very limited research publications on the combined effect of both in the improvement of upper extremity function. In this single case study combined intervention of constrained induced movement therapy and neural mobilization therapy was given to the patient to measure the effect in the form of functional arm reach distance of affected upper extremity. Data was recorded, kept for analysis and reported. The respondent of this single case study was patient encountered with left side hemiplegia with spastic upper extremity. Finding/Result: This case study shown significant improvement in the outcome of modified ashworth scale grades and upper extremity functional arm reach distance in spastic hemiplegic patient after intervention of combined movement of constrained induced movement therapy with neural mobilization for 24 weeks. Originality/Value: Constrained Induced Movement Therapy for improving hand functions in stroke treatment. Paper Type: Case Study Research

Combined Effect of Constraint Induced Movement Therapy and Neural Mobilization Technique on Upper Extremity Function in Spastic Hemiplegic Patient – A Single Case Study

Combined Effect of Constraint Induced Movement Therapy and Neural Mobilization Technique on Upper Extremity Function in Spastic Hemiplegic Patient – A Single Case Study

Effect of Adding Neural Mobilization Techniques to the Conventional Physical Therapy Program in Treating Shoulder Impingement Syndrome

Effect of Adding Neural Mobilization Techniques to the Conventional Physical Therapy Program in Treating Shoulder Impingement Syndrome

The effect of neural tension technique versus neural sliding technique on pain and functional disability in cervical radiculopathy: A comparative study

Background: Neural mobilization techniques are widely used to evaluate, and improve the mechanical and neurophysiological integrity of peripheral nerves in clinical populations. This techniques includes combination of joint movements that promote either neural tensioning (through displacement of nerve endings in opposite directions), or sliding (through displacement of nerve endings in same direction). It is a movement-based therapy, applied manually or via exercise. The nerve is mobilized relative to adjacent structures, with the aim of reducing symptoms through mechanisms that may be mechanical or neurophysiologic. Aim and Objectives: To determine the better treatment option between neural tension technique and neural sliding technique on pain and functional disability in patients with cervical radiculopathy. Methods: Total 30 subjects had been participated in the study according to inclusion criteria, and then divided them into two groups (Group A and Group B). Outcome measure neck disability index, numerical pain rating scale and patient specific functional scale were taken before treatment. Group A was given neural tension technique and Group B was given neural sliding technique. After treatment outcome measure was taken. Statistical analysis was done by post outcome measures of both the techniques. Result: Subjects in the neural tension technique group showed more improvement than neural sliding technique group. Thus neural tension technique has more significant effect on reducing Edema, hypoxia and other associated symptoms. In this way, it shows the improvement in numerical pain rating scale, Neck disability index and patient specific functional scale. Conclusion: Based on the findings of the present study concludes that the neural tension technique is more effective than neural sliding technique in the reduction of pain and functional disability.

The effectiveness of slider and tensioner neural mobilization techniques in the management of upper quadrant pain: A systematic review of randomized controlled trials

BackgroundLittle attention has been given to support the use of slider and tensioner neural mobilization (NM) techniques for upper quadrant pain (UQP). The purpose of this study was to systematically review the effectiveness of these techniques in patients with UQP. MethodThe PubMed, Cochrane Library and EBSCOhost were searched without chronological restriction to identify randomized clinical trials (RCTs) that assessed pain changes following NM in the upper quadrant. Two researchers independently performed screening, full-text assessment, data extraction and risk of bias assessment of the studies. ResultsA total of 974 articles were identified, of which 25 were included in this systematic review. The score for methodological quality of studies included was between 5 and 10 with a mean score of 7.96 points. Results demonstrated that slider and tensioner NM techniques are considered beneficial in pain reduction of UQP in certain musculoskeletal conditions including carpal tunnel syndrome and cervical radiculopathy. Regarding other conditions such as subacromial impingement syndrome, lateral elbow tendinopathy and cubital tunnel syndrome, due to conflicting findings, various methodological limitations and/or inadequate information, the available evidence remains uncertain. Furthermore, slider NM was found to be more effective in acute conditions compared to tensioner NM that seems to provide further analgesic effect in chronic UQP. ConclusionsThis systematic review revealed that NM slider and tensioner techniques can be used as analgesic modalities for managing UQP resulting from cervical radiculopathy and carpal tunnel. There remain unanswered questions concerning other conditions, and, therefore, further well-designed RCTs are needed to examine the analgesic response of NM techniques in UQP.

Effectiveness of neural mobilization on pain intensity, disability, and physical performance in adults with musculoskeletal pain-A protocol for a systematic review of randomized and quasi-randomized controlled trials and planned meta-analysis.

Recent studies show that musculoskeletal conditions contribute significantly to years lived with disability considering the entire global population. Pain and functional disability are the main problems that people with these conditions suffer. Neural mobilization has been shown to be an effective intervention in the treatment of musculoskeletal pain within individual trials, also contributing to improved functionality. Some systematic reviews have been carried out during the last years with the aim of synthesizing the scientific evidence on the use of neural mobilization techniques in the treatment of musculoskeletal disorders. However, they varied a lot in the methodological approaches and, consequently, in the findings and conclusions. Thus, this document is a planned protocol of a comprehensive systematic review with meta-analysis that we intend to carry out to review the scientific literature regarding up-to-date evidence on the use of neural mobilization in the management of people suffering from musculoskeletal pain disorders. The study designs that we will consider as inclusion criteria will be randomized and quasi-randomized clinical trials. The target population will be adults and older adults with musculoskeletal pain. Any controlled trial using any neural mobilization technique as an intervention in one of the trial groups will be included. The main outcomes of interest will be pain, functional status, and physical performance tests (muscle strength, flexibility, and balance). There will be no restrictions on follow-up time or type of setting. The risk of bias of the included studies will be assessed by the RoB 2 tool and the certainty of the evidence will be evaluated using the comprehensive Assessment, Development and Assessment of Assessment Recommendation (GRADE) approach. We intend to present the findings through narrative descriptions and, if possible, through meta-analytic statistics.Trial registration: PROSPERO registration number. CRD42021288387.

Chronic Low Back Pain and its Sustainable Management by Using Core Strengthening Exercise and Mechanical Traction

This experimental study was conducted to determine the effectiveness of neural mobilization and conventional physiotherapy technique in patients with chronic low back pain with a sample of 100. The study reveals that the mean age of the core muscle strengthening group was 33.88+(or)-10.77 years whereas mechanical traction group was 42.46+(or)-9.51 years of age. Study shows that mean BMI of core muscle strengthening group and mechanical traction group was 24.05+(or)-4.329 and 25.28+(or)-4.562. Study found that the mean severity of pain before treatment was 6.380+0.725 and after treatment was 2.74+(or)-0.921 of core muscle strengthening and the mean severity of pain before treatment was 7.100+(or)-0.839 and after treatment was 3.64+(or)-1.173. Study shows that mean score Oswestry low back pain disability index of core muscle strengthening before treatment was 20.54+3.7 and after treatment was 7.94+(or)-3.419, compare to mechanical traction before treatment was 22.88+(or)-3.127 and after treatment was 11.92+(or)-4.004. There was statistically highly significant findings of core muscle strengthening and mechanical traction where t-value was 35.665 and 26.938 which was measured by Universal pain Assessment Tool, another statistically highly significant finding of core muscle strengthening and mechanical traction where t-value were 21.995 and 19.039 which was measured by Oswestry low back pain disability index.

IMMEDIATE EFFECT OF NEURAL MOBILIZATION ON HAMSTRING FLEXIBILITY AND FUNCTIONAL PERFORMANCE AMONG FOOTBALL PLAYERS IN VADODARA

Background: Hamstring muscle injuries are a common occurrence in a wide range of sprint-based sports which accounts about 13-15% of injuries in football players. The predisposing factors for it are poor hamstring flexibility &amp; neural tension. Epidemiological research has cited reduced flexibility as an etiological factor in acute muscle strain injury and can influence functional performance. To prevent hamstring muscle injury, routine traditional intervention is used. Neural mobilization has been an emerging technique but its research on sports field is very limited. Thus, the need of the study was to examine the immediate effect of neural mobilization on hamstring flexibility and Functional performance using this new technique and also to prevent/decrease the risk of hamstring muscle injury. To Aim: evaluate the immediate effect of Sciatic Neural Mobilization technique on Hamstring Flexibility and Functional Performance among Football Players in Vadodara. Methodology: 48 Male Football Players who met the Inclusion Criteria were recruited from Baroda Football Academy (BFA) and Swarnim Gujarat Sports University (SGSU). There was a short session of 3 minutes warm up. The Baseline and post-intervention data collection was done in a sequential order (Bilateral Hamstring Flexibility, Vertical jump test, Four-Line Sprint Test) in which in between Vertical jump &amp; Four-Line Sprint Test 5 minutes break was provided to avoid fatigue. Following 5 minutes break, Sciatic neural sliding mobilization was given for bilateral lower limb to participants by physiotherapist. The Data were analyzed using Result: Paired t- Test, and there was statistically significant improvement in all the three outcome measures (P = &lt; 0.001) Conclusion: The present study showed that sciatic neural mobilization had a Positive effect on hamstring flexibility and functional performance among Football Players in Vadodara.

Effects of Neural Mobilization Techniques on Painand Disabilityin PatientsWith Neurodynamic Dysfunction: A Systematic Review of Randomized Controlled Trials

Introduction: Neural mobilization is the most important technique used for the treatment of nervous system dysfunction. This study aimed to systematically review and evaluate the therapeutic efficacy of neural mobilization techniques in nervous system dysfunctions by assessing Randomized Controlled Clinical Trials (RCTs). Materials and Methods: We used all English papers published in five electronic databases from 2000 to 2020 using the following keywords: “neural mobilization”, “nerve mobilization”, “physical therapy”, “nerve glide exercises”, “neural stretching”, “neurodynamics”, and “neural physiotherapy”. The full text of the articles identified was reviewed to select papers specifically discussing neural mobilization as a treatment modality. The PEDro scale was used to assess the quality of these trials. The randomized clinical trials were selected that examined the therapeutic effect of neural mobilization. Results: Twelve RCTs were identified. Five RCTs used the same median nerve tensioning technique in patients with Carpal Tunnel Syndrome (CTS). In some studies, the methods of neural mobilization were different. Fourteen papers examined different neurodynamic dysfunctions such as lateral epicondylalgia, radicular neck pain, postoperative spinal surgery, radicular low back pain, and chronic tension-type headache. There is moderate evidence (Level 2) to support distal nerve tensioning and tendon gliding techniques in CTS Also, there was limited (Level 3) and insufficient (Level 4) evidence about using cervical lateral gliding away from their involved side and upper limb tension test mobilization and the use of slump stretches and combinations techniques in the treatment of neurodynamic dysfunction, respectively. Besides, all studies reported a positive effect compared to neutral effects. Conclusion: Although clinicians frequently use neuromobilization techniques for both diagnosis and treatment of nervous system dysfunctions, the quality assessment of 20 RCTs has shown insufficient evidence to support the efficacy of these techniques in the treatment of nervous system dysfunctions.

Effectiveness of Neural Mobilization Techniques in the Management of Musculoskeletal Neck Disorders with Nerve-Related Symptoms: A Systematic Review and Meta-Analysis with a Mapping Report.

The objective was to assess the effectiveness of neural mobilization (NM) techniques in the management of musculoskeletal neck disorders with nerve-related symptoms (MND-NRS). We conducted a systematic review with meta-analysis, using pain intensity, disability, perceived function, cervical range of motion, and mechanosensitivity as the main outcome measures. The systematic review included 22 studies (n = 978). More favorable outcomes were observed for NM on pain intensity compared with control interventions (standardized mean differences (SMDs) -0.92; 95% CI -1.66-0.18), but not compared with other treatments (OTs) (SMD 1.06; 95% CI -0.02 to 2.15). Regarding neck pain intensity, no significant differences were found in favor of NM compared with OTs (SMD 0.37; 95% CI -0.35 to 1.1). However, between-treatment differences were found in favor of OT on arm-pain intensity (SMD 0.57; 95% CI 0.08-1.05). In addition, the grouped MA did not show statistically significant differences between NM and OT outcomes on the cervical range of motion (SMD 0.16; 95% CI -0.06 to 0.38). However, compared with no intervention, NM was associated with significantly improved outcomes in cervical rotation (SMD 0.91; 95% CI 0.61-1.22). Similar results were found regarding disability (SMD -0.08; 95% CI -0.36-0.20, and SMD -1.44; 95% CI -2.28-0.6, respectively). Finally, NM was associated with more favorable outcomes on mechanosensitivity compared with OT (SMD 0.79; 95% CI 0.15-1.42) and greater improvements in function compared with no intervention (SMD 0.89; 95% CI 0.16-1.62). NM appeared to be effective to improve overall pain intensity when embedded in a physiotherapy treatment in the management of MND-NRS. When compared with no intervention, it was effective to improve neck rotation, disability, and function. However, it was not superior to other types of treatments in improving overall pain intensity, neck pain intensity, arm pain intensity, cervical range of motion and disability, except for mechanosensitivity.

Effect of Combined Neural Mobilization and Intermittent Traction in Patients with Cervical Radiculopathy

Purpose: Cervical radiculopathy is one of the common musculoskeletal condition affecting a wide range of population from people involves in desk job to small scale jobs, from a young student to old age population. So it has been of great importance to find out evidence based effective treatment of cervical radiculopathy along with conventional treatment. This study is designed to find out the combined effect of neural mobilization and intermittent traction on cervical radiculopathy Materials and methods: 30 patients were included in the study and randomly divided into two equal groups. In group A conventional physiotherapy treatment was given along with neural mobilization and in group B only conventional physiotherapy which include intermittent traction and isometric neck exercises treatment was given.NDI (Neck disability index) and VAS (Visual analogue scale) assessment was done on 2nd, 14th and 28th day of treatment. Results: There was improvement in symptoms in both the group but was more in group A. Conclusion: The study demonstrated that patients experiencing cervical radiculopathy can improve much earlier and more effectively after neural mobilization technique and therefore provides support to include this technique in conservative management methods of treating patients with cervical radiculopathy for better results.

Validation of a sham novel neural mobilization technique in patients with non-specific low back pain: A randomized, placebo-controlled trial

BackgroundThere is no validated sham neural mobilization (NM) intervention for lower quadrant conditions. A suitable sham NM comparator will allow to blind patients with low back pain (LBP) and reduce bias by limiting the confounding effects of expectations. ObjectiveThe primary aim was to develop a sham NM technique in patients with non-specific LBP and assess its validity in supplying a suitable blinding. Secondly, we compared the short-term effects of NM and the sham comparator on pain and the straight leg raise. DesignA randomized placebo-controlled trial in which participants and assessors were blinded. MethodFifty one patients (20 men,31 women), aged 22–65 years (43 ± 12y) were allocated randomly to a NM group (n = 26) or a sham NM group (n = 25). The primary outcome of believability of the sham technique was measured one week after the intervention. Secondary outcomes of pain intensity and the straight leg raise range-of-motion were assessed at baseline, immediately after the intervention and one week after. ResultsThe believability of the sham technique in terms of the frequencies of perceived group assignment showed no differences between groups. Eighteen participants believed they had received the experimental NM technique in the experimental group (69.2%) and 14 in the placebo NM group (56%). Pain and the straight leg raise changes did not show differences between groups. ConclusionsThe novel sham NM demonstrated to be a believable intervention, capable of supplying a suitable blinding. Both groups showed similar short term perceived effects on pain and the straight leg raise.

Comparison of Ipsilateral Versus Contralateral Lower Limb Neural Mobilization in Unilateral Lumbar Radiculopathy- A Randomized Clinical Trial

Background: Neural tissue mobilization is a movement-based intervention aimed at restoring homeostasis in and around the nervous system. However, there are limited studies on the effects of contralateral lower extremity neural mobilization in lumbar radiculopathy.Aim/Objective: To compare and evaluate the immediate effect of neural slider mobilization on contralateral versus ipsilateral lower extremity pain and hip range of motion (ROM) during straight leg raise (SLR) in unilateral lumbar radiculopathy.Methods: Thirty-six individuals with subacute and chronic back pain during SLR, resulting from unilateral lumbar radiculopathy in the sciatic nerve and its branches, were randomized to two groups: ipsilateral and contralateral. They received a single session of neural slider mobilization in the ipsilateral and contralateral lower extremity, respectively. The numeric pain rating scale was used to measure pain, and for hip flexion ROM during straight leg raise digital goniometer was used for assessment.Results: Pre- and post-treatment values showed a statistically significant difference within the groups in terms of pain (P=0.00001 for both ipsilateral and contralateral group). However, there was no significant difference between the groups (P=0.00001). For hip ROM during SLR, a significant difference was found within as well as between the groups (P=0.00088 for the ipsilateral group and P=0.3476 for the contralateral group; and between-group comparison P=0.00047).Conclusions: Both the ipsilateral and contralateral slider neural mobilization technique was effective in reducing lower extremity pain. However, the ipsilateral neural mobilization technique was superior to the contralateral technique in reducing pain. Ipsilateral slider neural mobilization alone showed improvement in hip ROM during SLR.

Efficacy and efficiency of a new therapeutic approach based on activity-oriented proprioceptive antiedema therapy (TAPA) for edema reduction and improved occupational performance in the rehabilitation of breast cancer-related arm lymphedema in women: a controlled, randomized clinical trial

BackgroundBreast cancer (BC) is a major public health issue. More than one out of five women treated for breast cancer will develop lymphedema in an upper extremity. Current evidence advocates transdisciplinary oncological rehabilitation. Therefore, research in this area is necessary since limited consensus having been reached with regard to the basic essential components of this rehabilitation.Consensus has, however, been reached on the use of decongestive lymphedema therapy (DLT), but due to a lack of tests, the necessary dosages are unknown and its level is moderately strong.This study attempts to verify both the efficacy of activity-oriented proprioceptive antiedema therapy (TAPA), as compared to conventional treatments such as DLT or Complex Physical Therapy (CPT), as well as its efficiency in terms of cost-effectiveness, for patients affected by breast cancer-related arm lymphedema.MethodsControlled, randomized clinical trial with dual stratification, two parallel arms, longitudinal and single blind. 64 women with breast cancer-related arm lymphedema will take part in the study. The experimental group intervention will be the same for stage I and II, and will consist of neuro-dynamic exercises oriented to the activity, proprioceptive neuromuscular facilitation activities and proprioceptive anti-edema bandaging. The control group intervention, depending on the stage, will consist of preventive measures, skin care and exercise-prescribed training in the lymphedema workshop as well as compression garments (Stage I) or conservative Complex Decongestive Therapy treatment (skin care, multi-layer bandaging, manual lymphatic drainage and massage therapy) (Stage II).ResultsSociodemographic and clinical variables will be collected for the measurement of edema volume and ADL performance. Statistical analysis will be performed on intent to treat.DiscussionIt has been recommended that patient training be added to DLT, as well as a re-designing of patient lifestyles and the promotion of health-related aspects. In addition, clinical trials should be undertaken to assess neural mobilization techniques and proprioceptive neuromuscular facilitation should be included in the therapy. Cohesive bandaging will also be performed as an early form of pressotherapy. The proposed study combines all of these aspects in order to increased comfort and promote the participation of individuals with lymphedema in everyday situations.LimitationsThe authors have proposed the assessment of the experimental treatment for stages I and II. One possible limitation is the lack of awareness of whether or not this treatment would be effective for other stages as well as the concern for proper hand cleansing during use of bandages, given the current COVID-19 pandemic situation.Trial registrationThis trial was registered in ClinicalTrials.gov (NCT03762044). Date of registration: 23 November 2018. Prospectively Registered.

Efficacy of Neural Mobilization and Cervical Stabilization in Cervicobrachial Pain: A Randomized Controlled Trial

Objective: To analyze the efficacy of neural mobilization technique in cervicobrachial pain. To analyze theefficacy of cervical stabilization exercise in cervicobrachial painBackground of the Study: Cervical radiculopathy is a pathological process of involving the cervicalnerve root as a result of compression and inflammation of the nerve root near the cervical neural foramen.Cervicobrachial pain syndrome is term that describes pain and stiffness of the cervical spine with symptomsin the shoulder girdle and upper extremity.Methodology: This was conducted in the Outpatients Physiotherapy department in ACS medical college andhospitals. Group A Received Neural mobilization technique and Group B Cervical stabilization exercise for12 weeks. Pre and post-test taken by using primary outcome measure such as Pain DETECT Questionnaire,Disability of arm shoulder and hand DASH Questionnaire, Fear avoidance beliefs Questionnaire and cervicalROM.Results: The comparison revealed that neural mobilization group A had a great increase in cervical range ofmotion flexion and extension (P ? 0.001), Decreasing pain intensity (P ? 0.001) and also shows significantdecrease in the neural mobilization (P ? 0.001) than the cervical stabilization exercise. The significantdifference between Group A seems to be more effective than Group B.