Nociceptive: “Pain that arises from actual or threatened tissue damage and is due to activation of nociceptors” (International Association for the Study of Pain Taxonomy)
Neuropathic: “Pain caused by a lesion or disease of the somatosensory nervous system” (International Association for the Study of Pain Taxonomy)
Every patient you see can be classified using the McKenzie system. However, not every patient can be treated exclusively with MDT procedures. Many clinicians also use neurodynamic techniques for patients with back related lower limb symptoms. This study sought to investigate the short-term effect of adding neurodynamic exercises to directional preference exercises.
How do the results compare with your clinical experience?
Luis Fernando Sousa Filho, , Marta Maria Barbosa Santos, , Danielle Brito Matos Vasconcelos, , Erilaine Araujo Soares, , Gabriel Henrique Freire dos Santos, and Walderi Monteiro da Silva Júnior
Journal of Bodywork & Movement Therapies, 2022-04-01, Volume 30, Pages 140-147,
Link: https://pubmed.ncbi.nlm.nih.gov/35500962/
Abstract:
Background
Chronic low back-related leg pain may involve mixed pain mechanisms. A strategy to address both neuropathic and nociceptive pain symptoms would be combining treatments.
Objective
To assess the effects of adding neurodynamic exercises to extension-oriented exercises in patients with chronic low back-related leg pain and a directional preference.
Design
Two arm, single blind, randomized clinical trial.
Method
Eligible participants were aged between 18 and 65 years, had low back pain radiating below gluteus for at least 3 months, pain intensity greater than 3 points in the numerical pain rating scale, positive SLR test and a directional preference for lumbar extension movements. Thirty-one participants were randomly allocated into one of two groups: extension-oriented exercises (EE) or extension exercises plus neurodynamic exercises (EEN). Primary outcomes were leg pain intensity and function at 3 weeks. Secondary outcomes were low back pain intensity, disability, global perceived effect and quality of life at 3 weeks and at 1 month.
Results
Retention rate was 100% (n = 14) in EE and 94% (n = 16) in EEN for primary outcome analysis. There was no between-group difference for the primary outcomes and for low back pain intensity, GPE and quality of life at 3 weeks. For some outcomes, EE was superior to EEN.
Conclusions
We found no benefits in adding neurodynamic exercises to extension-oriented exercises for patients with nerve-related leg pain and a directional preference. As this study has a small and very specific sample, results may be interpreted with caution.
Peter Schoch
Deputy Chairperson / Faculty