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Chen Q, Wang Z, Chen X, Du J, Zhang S. Efficacy of neuromobilization in the treatment of low back pain: Systematic review and meta-analysis. PLoS One 2024; 19:e0302930. [PMID: 38713706 PMCID: PMC11075829 DOI: 10.1371/journal.pone.0302930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 04/16/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND Low back pain (LBP) is a leading cause of disability. Neuromobilization (NM) as a physical therapy technique, offers some degree of symptom improvement. However, some studies have shown that NM can significantly reduce the symptoms of LBP, while others have failed to find similar positive effects. OBJECTIVE This study aims to investigate the effectiveness of NM for LBP. DATA SOURCES A literature search was conducted across five databases (MEDLINE, Embase, Cochrane Library, PubMed, and Web of Science) from their inception to December 2023. Study main measures assessed pain, disability, and straight leg raise angle to determine the degree of improvement in patients. RESULTS Seven randomized controlled trials were included in the analysis. The findings indicated that NM interventions in patients with LBP were more effective than control groups in improving Visual Analog Scale scores (mean difference = 0.62, 95% CI (0.03, 1.21)) and Oswestry Disability Index scores (mean difference = 7.54, 95% CI (4.98, 10.10)). There was no significant difference in straight leg raise results (mean difference = 0.18, 95% CI (-0.08, 0.44)). CONCLUSIONS NM demonstrated effectiveness in improving Visual Analog Scale and Oswestry Disability Index outcomes in patients with LBP, but straight leg raise outcomes are still uncertain and until more high-quality studies are included, the effectiveness of NM for SLR remains unknown.
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Affiliation(s)
- Quanzheng Chen
- Department of Physical Education and Health, Guangxi Normal University, Guilin, China
| | - Zhenshan Wang
- Department of Physical Education and Health, Guangxi Normal University, Guilin, China
| | - Xian Chen
- Department of Physical Education and Health, Guangxi Normal University, Guilin, China
| | - Jinchao Du
- Department of Rehabilitation Medicine, Shandong Second Medical University, Weifang, China
| | - Shuna Zhang
- Department of Physical Education and Health, Guangxi Normal University, Guilin, China
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Effects of a preoperative neuromobilization program offered to individuals with carpal tunnel syndrome awaiting carpal tunnel decompression surgery: A pilot randomized controlled study. J Hand Ther 2021; 34:37-46. [PMID: 32151500 DOI: 10.1016/j.jht.2019.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 10/31/2019] [Accepted: 12/31/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Pilot randomized controlled trial with parallel groups. INTRODUCTION Engaging individuals with carpal tunnel syndrome (CTS) awaiting carpal tunnel decompression surgery in a preoperative rehabilitation program may mitigate pain and sensorimotor impairments, enhance functional abilities before surgery, and improve postoperative outcomes. PURPOSE OF THE STUDY To assess the feasibility and the efficacy of a novel preoperative neuromobilization exercise program (NEP). METHODS Thirty individuals with CTS were randomly allocated into a four-week home-based neuromobilization exercise group or a standard care group while awaiting surgery. Outcome measures included feasibility (ie, recruitment, attrition, adherence, satisfaction, and safety) and efficacy metrics (ie, median nerve integrity and neurodynamics, tip pinch grip, pain, and upper limb functional abilities) collected before (ie, at the baseline and about four weeks later) and four weeks after surgery. RESULTS Thirty individuals with CTS were recruited (recruitment rate = 11.8%) and 25 completed the study (attrition rate = 16.7%). Adherence (94%) and satisfaction with the program (eg, enjoy the exercises and likeliness to repeat the NEP (≥4.2/5) were high and no serious adverse event was reported. NEP-related immediate pre- and post-surgery beneficial effects on pain interference were documented (P = .05, η2 = .10), whereas an overall increased neurodynamics (P = .04, η2 = .11) and decreased pain severity (P = .01, η2 = .21) were observed. DISCUSSION Engaging in the proposed NEP has limited beneficial effect as a stand-alone intervention on pre- and post-surgery outcomes for individuals with CTS. Expanding the program's content and attribute by adding other components including desensitization maneuvers and novel therapies promoting corticospinal plasticity is recommended. CONCLUSION A preoperative NEP completed by individuals with CTS awaiting surgery is feasible, acceptable, and safe. However, given the limited beneficial effectsof the program, revision of its content and attributes is recommended before proceeding to large-scale trials.
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Alshami AM, Alshammari TK, AlMuhaish MI, Hegazi TM, Tamal M, Abdulla FA. Sciatic nerve excursion during neural mobilization with ankle movement using dynamic ultrasound imaging: a cross-sectional study. J Ultrasound 2021; 25:241-249. [PMID: 34036554 DOI: 10.1007/s40477-021-00595-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/19/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Ankle movement is used as a sensitizing maneuver for sciatica during neurodynamic techniques. In vivo studies on the sciatic nerve biomechanics associated with ankle movement during different positions of neighboring joints are scarce. The aim of this study was to investigate sciatic nerve excursion during ankle dorsiflexion in different positions in a healthy population. METHODS This is a cross-sectional study. High-resolution dynamic ultrasound imaging was used to measure longitudinal excursion of the sciatic nerve in the posterior thigh of 27 healthy participants during ankle dorsiflexion in six positions of the neck, hip, and knee. Both the long and short distance of the nerve excursion were measured. Wilcoxon signed-rank tests were used for data analysis, and Eta squared (r) was used to quantify the effect size. RESULTS Ankle dorsiflexion resulted in distal sciatic nerve excursion that was significantly higher in positions in which the knee was extended (median 0.7-1.6 mm) than in positions in which the knee was flexed (median 0.5-1.4 mm) (P ≤ 0.049, r ≥ 0.379). There were no significant differences in nerve excursion between positions where the neck was neutral compared with positions where the neck was flexed (P ≥ 0.710, r ≤ 0.072) or between positions where the hip was neutral compared with positions where the hip was flexed (P ≥ 0.456, r ≤ 0.143). CONCLUSION The positions of adjacent joints, particularly the knee, had an impact on the excursion of the sciatic nerve in the thigh during ankle movement.
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Affiliation(s)
- Ali M Alshami
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, P.O. Box 2435, Dammam, 31441, Saudi Arabia.
| | - Tadhi K Alshammari
- Physical Therapy Department, Prince Sultan Military Medical City, Riyadh, 11564, Saudi Arabia
| | - Mona I AlMuhaish
- Department of Radiology, Imam Abdulrahman Bin Faisal University, PO BOX 1982, Dammam, 31441, Saudi Arabia
| | - Tarek M Hegazi
- Department of Radiology, Imam Abdulrahman Bin Faisal University, PO BOX 1982, Dammam, 31441, Saudi Arabia
| | - Mahbubunnabi Tamal
- Department of Biomedical Engineering, College of Engineering, Imam Abdulrahman Bin Faisal University, PO Box 1982, Dammam, 31441, Saudi Arabia
| | - Fuad A Abdulla
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, P.O. Box 2435, Dammam, 31441, Saudi Arabia
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Paquette P, Higgins J, Gagnon DH. Peripheral and Central Adaptations After a Median Nerve Neuromobilization Program Completed by Individuals With Carpal Tunnel Syndrome: An Exploratory Mechanistic Study Using Musculoskeletal Ultrasound Imaging and Transcranial Magnetic Stimulation. J Manipulative Physiol Ther 2020; 43:566-578. [PMID: 32861518 DOI: 10.1016/j.jmpt.2019.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 10/11/2019] [Accepted: 10/22/2019] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Neuromobilization exercises are increasingly advocated in the conservative management of individuals with carpal tunnel syndrome (CTS), as they may mitigate CTS-related signs and symptoms via potential peripheral (ie, musculoskeletal) and central (ie, neurophysiological) adaptations. However, the mechanisms underlying these adaptations have not been studied extensively. Hence, this exploratory and mechanistic study aims to evaluate the potential peripheral and central adaptations that may result in individuals with CTS who have completed a neuromobilization program. METHODS Fourteen individuals with CTS were evaluated before and 1 week after the completion of a 4-week neuromobilization program that incorporated median nerve sliding exercises. Pain and upper limb functional abilities were assessed using standardized questionnaires. The biological integrity and mechanical properties of the median nerve and the corticospinal excitability were quantified using musculoskeletal ultrasound imaging and transcranial magnetic stimulation, respectively. RESULTS Upon completion of the program, participants reported both large and moderate improvements in pain (P ≤ .03) and upper limb functional abilities (P = .02), respectively. The biological integrity and mechanical properties of the median nerve remained unchanged (P ≥ .22), whereas a small significant increase in corticospinal excitability (P = .04) was observed. CONCLUSION The proposed neuromobilization program appears promising to improve pain and upper limb functional abilities in individuals with CTS. These improvements may be preferentially mediated via central, rather than peripheral, adaptations. Future studies, especially with a larger sample size, longer intervention duration, and additional measurement times, are needed to strengthen current evidence.
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Affiliation(s)
- Philippe Paquette
- School of Rehabilitation, Université de Montréal, Montréal, Québec, Canada.
| | - Johanne Higgins
- School of Rehabilitation, Université de Montréal, Montréal, Québec, Canada
| | - Dany H Gagnon
- School of Rehabilitation, Université de Montréal, Montréal, Québec, Canada
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Gabison S, Mathur S, Verrier MC, Nussbaum E, Popovic MR, Gagnon DH. Quantitative ultrasound imaging over the ischial tuberosity: An exploratory study to inform tissue health. J Tissue Viability 2018; 27:173-180. [PMID: 29886122 DOI: 10.1016/j.jtv.2018.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 04/01/2018] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Characterization of ischial tissue health using a standardized diagnostic ultrasound protocol capturing thickness and gray scale analysis has not been established. OBJECTIVES This study evaluates inter-participant and inter-trial reliability of thickness and gray scale analysis of ultrasound images of tissues overlying the ischial tuberosity. It provides recommendations for the number of images required to minimize the standard error of measurement (SEM) and determines the number of images required for thickness, gray scale and contrast values that exceed an a-priori minimal detectable change (MDC) for repeated tissue assessment. METHODS Brightness mode ultrasound images using a 12 MHz linear probe were collected on the dominant limb in the side lying position for ten healthy participants and partitioned into three regions of interest: skin, subcutaneous tissue and muscle. Thickness and gray scale measures of skin, muscle and subcutaneous tissue were calculated using a customized MATLAB program. Contrast of each region of interest was calculated using the Gray Scale Level Co-Occurrence Matrix. Generalizability theory was used to quantify indices of dependability and corresponding SEMs and MDCs with 90% Confidence Intervals. RESULTS Participants accounted for most of the total variance (75.56% to 94.78%). Coefficient of dependability (ϕ) for thickness, grey scale and contrast measures was greater than 0.80 when more than two images were averaged. In order to detect a MDC of 21% in thickness and echogenicity measures, at least three images are required, while at least 5 images are required for a MDC of 25% for contrast measures. CONCLUSIONS Obtaining reliable thickness, echogenicity and contrast measures of tissue overlying the ischial tuberosity can be achieved from two ultrasound images by a single therapist on an individual participant however three and five images are required to use a MDC of 21% for thickness measures and MDC of 25% for contrast measures respectively.
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Affiliation(s)
- Sharon Gabison
- Department of Physical Therapy, University of Toronto, 500 University Avenue, Toronto, Ontario, M5G 1V7, Canada; SCI Mobility Lab, Lyndhurst Centre, Toronto Rehab-University Health Network, 520 Sutherland Drive, Room 236, Toronto, Ontario, M4G 3V9, Canada.
| | - Sunita Mathur
- Department of Physical Therapy, University of Toronto, 500 University Avenue, Toronto, Ontario, M5G 1V7, Canada
| | - Mary C Verrier
- Department of Physical Therapy, University of Toronto, 500 University Avenue, Toronto, Ontario, M5G 1V7, Canada; SCI Mobility Lab, Lyndhurst Centre, Toronto Rehab-University Health Network, 520 Sutherland Drive, Room 236, Toronto, Ontario, M4G 3V9, Canada
| | - Ethne Nussbaum
- MCISc Program in Field of Wound Healing, Western University, School of Physical Therapy, Elborn College, London, Ontario, M8G 1H1, Canada
| | - Milos R Popovic
- Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network, 520 Sutherland Drive, Room 236, Toronto, Ontario, M4G 3V9, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Rosebrugh Bldg, 164 Room 407, Toronto, Ontario, M5S 3G9, Canada
| | - Dany H Gagnon
- School of Rehabilitation, Université de Montréal, C.P. 6128, Succursale Centre-ville, Montreal, Quebec, H3C 3J7, Canada
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Paquette P, El Khamlichi Y, Lamontagne M, Higgins J, Gagnon DH. Comparison of longitudinal excursion of a nerve-phantom model using quantitative ultrasound imaging and motion analysis system methods: A convergent validity study. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2018; 25:143-149. [PMID: 29410689 DOI: 10.1177/1742271x17700452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/10/2017] [Indexed: 11/16/2022]
Abstract
Background Quantitative ultrasound imaging is gaining popularity in research and clinical settings to measure the neuromechanical properties of the peripheral nerves such as their capability to glide in response to body segment movement. Increasing evidence suggests that impaired median nerve longitudinal excursion is associated with carpal tunnel syndrome. To date, psychometric properties of longitudinal nerve excursion measurements using quantitative ultrasound imaging have not been extensively investigated. Methods This study investigates the convergent validity of the longitudinal nerve excursion by comparing measures obtained using quantitative ultrasound imaging with those determined with a motion analysis system. A 38-cm long rigid nerve-phantom model was used to assess the longitudinal excursion in a laboratory environment. The nerve-phantom model, immersed in a 20-cm deep container filled with a gelatin-based solution, was moved 20 times using a linear forward and backward motion. Three light-emitting diodes were used to record nerve-phantom excursion with a motion analysis system, while a 5-cm linear transducer allowed simultaneous recording via ultrasound imaging. Results Both measurement techniques yielded excellent association (r = 0.99) and agreement (mean absolute difference between methods = 0.85 mm; mean relative difference between methods = 7.48 %). Small discrepancies were largely found when larger excursions (i.e. > 10 mm) were performed, revealing slight underestimation of the excursion by the ultrasound imaging analysis software. Conclusion Quantitative ultrasound imaging is an accurate method to assess the longitudinal excursion of an in vitro nerve-phantom model and appears relevant for future research protocols investigating the neuromechanical properties of the peripheral nerves.
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Affiliation(s)
- Philippe Paquette
- Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal - Institut de réadaptation Gingras-Lindsay-de-Montréal, Montréal, QC, Canada
| | - Youssef El Khamlichi
- Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal - Institut de réadaptation Gingras-Lindsay-de-Montréal, Montréal, QC, Canada
| | - Martin Lamontagne
- Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal - Institut de réadaptation Gingras-Lindsay-de-Montréal, Montréal, QC, Canada
| | - Johanne Higgins
- Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal - Institut de réadaptation Gingras-Lindsay-de-Montréal, Montréal, QC, Canada
| | - Dany H Gagnon
- Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal - Institut de réadaptation Gingras-Lindsay-de-Montréal, Montréal, QC, Canada
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Kasehagen B, Ellis R, Pope R, Russell N, Hing W. Assessing the Reliability of Ultrasound Imaging to Examine Peripheral Nerve Excursion: A Systematic Literature Review. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1-13. [PMID: 29100792 DOI: 10.1016/j.ultrasmedbio.2017.08.1886] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 08/22/2017] [Accepted: 08/28/2017] [Indexed: 06/07/2023]
Abstract
Ultrasound imaging (USI) is gaining popularity as a tool for assessing nerve excursion and is becoming an important tool for the assessment and management of entrapment neuropathies. This systematic review aimed to identify current methods and report on the reliability of using USI to examine nerve excursion and identify the level of evidence supporting the reliability of this technique. A systematic search of five electronic databases identified studies assessing the reliability of using USI to examine nerve excursion. Two independent reviewers critically appraised and assessed the methodological quality of the identified articles. Eighteen studies met the eligibility criteria. The majority of studies were of "moderate" or "high" methodological quality. The overall analysis indicated a "strong" level of evidence of moderate to high reliability of using USI to assess nerve excursion. Further reliability studies with consistency of reporting are required to further strengthen the level of evidence.
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Affiliation(s)
- Ben Kasehagen
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, Queensland, Australia.
| | - Richard Ellis
- Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Rodney Pope
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, Queensland, Australia
| | - Nicholas Russell
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, Queensland, Australia
| | - Wayne Hing
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, Queensland, Australia
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