Neurodynamic treatment did not improve pain and disability at two weeks in patients with chronic nerve-related leg pain: a randomised trial

Abstract

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 than 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 G, Stieven F, Araujo F, Wiebusch M, Rosa C, 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 Physiotherapy62: 197-202].

Keywords: Low back pain; Manual therapy; Neurodynamic treatment; Sciatica; Slump test.