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The Effectiveness of Neural Mobilization for Neuro-Musculoskeletal Conditions: A Systematic Review and Meta-Analysis.

J Orthop Sports Phys Ther. 2017 Jul 13;:1-76

Authors: Basson A, Olivier B, Ellis R, Coppieters M, Stewart A, Mudzi W

Abstract
Study Design Systematic review with meta-analysis. Background Neural mobilization (NM) or neurodynamics is a movement-based intervention aimed at restoring the homeostasis in and around the nervous system. The current level of evidence for NM is largely unknown. Objectives To determine the efficacy of NM for musculoskeletal conditions with a neuropathic component. Methods Databases were searched for randomised trials investigating the effect of NM for neuro-musculoskeletal conditions. Standard methods for article identification, selection and quality appraisal were used. Where possible, studies were pooled for meta-analysis. Primary outcomes were pain, disability and function. Results Forty studies were included in this review, of which 17 had a low risk of bias. Meta-analyses could only be performed on self-reported outcomes. For chronic low back pain, disability (Oswestry (0-50): mean difference -9.26; 95%CI: -14.50 – -4.01; p=0.0001) and pain (Intensity (0-10): mean difference -1.78; 95%CI: -2.55 – -1.01; p=0.0001) improved following NM. For chronic neck-arm pain, pain improved (Intensity (0-10): mean difference -1.89; 95%CI: -3.14 – -0.64; p=0.0003) following NM. For carpal tunnel syndrome, NM was not effective for most clinical outcomes (p>0.11), but showed positive neurophysiological effects (e.g., reduced intraneural oedema). Due to a scarcity of studies or conflicting results, the effect of NM remains uncertain for various conditions, such as post-operative low back pain, cubital tunnel syndrome and lateral epicondylalgia. Conclusion This review reveals benefits of NM for back and neck pain, but the effect of NM for other conditions remains unclear. Due to the limited evidence and varying methodological quality, conclusions may change over time. Level of Evidence Level 1. J Orthop Sports Phys Ther, Epub 13 Jul 2017. doi:10.2519/jospt.2017.7117.

PMID: 28704626 [PubMed – as supplied by publisher]