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Neurodynamic Mobilization for Low Back Pain

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7 views4 pages

Neurodynamic Mobilization for Low Back Pain

Uploaded by

ameerasabbah1
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Chapter V

Discussion

The purpose of this study was comparison between the effects of


neuro dynamic in slump and supine position on improve ROM and
decrease pain in patient with low back pain with sciatica .

The current study revealed neuro mobilization in a slump position


for two weeks in patients. The results show that there is a significant
decrease in pain, increase ROM and improve functional disability, the
study also showed that neuro mobilization of patients in the supine
position for two weeks significantly reduced pain, increased range of
motion, and improved functional impairment. In addition, there was a
significant difference between the use of neuro mobilization in slump
position and supine position concerning the pain improvement in group
(A), increase ROM improve functional disability in a slump more than
supine position.

Ten patients with neuro mobilization aged 25 to 55 years, were


assigned into two groups, in group (A) received neuro mobilization in
slump position combined with exercises (6 session, 3 session per week).
in second group (B) received mobilization in supine position combined
with the same exercises (6 session, 3 session per week). Pain
severity ,lumber flexion and disability were assessed before and after two
weeks of treatment for both groups.

All patients in both groups had symptoms of neural mobilization


technique is more effective as compared to traditional treatment with
2005 (Salem ,2019). slump stretching has a positive effect More than
supine in reducing pain and disability(Mohammad et al.2019).

From statistical analysis of pre and post treatment of pain


assessment in patients who received slump position , there was a
significant difference at (α≤0.05) on all differences between pre and post
groups on slump position to post in supine position.
The present study systematically reviewed and performed meta-
analysis regarding the effectiveness of slump ,benefits of neural
mobilization for LBP. Ellis and Hing investigated the efficacy of neural
mobilization and reported that eight out of 11 clinical trials included
showed positive therapeutic effects on pain.( Ellis et al,2008).
Shancklock said that the slider and tensioner neuro dynamic mobilization
techniques in reducing pain intensity and improving functional disability
( Shancklock 2005). Neto said that the physical therapy interventions,
successfully decreased pain level and disability and increased ROM in
patients (Neto et al, 2017).

Pourahmadi said that is very low to moderate quality of evidence


that supine may have positive effects on pain in people with neuro
dynamic. However, the quality of evidence for the benefits of supine on
disability was very low (Pourahmadi et al.2019).

The present study showed that both interventions were equally effective
in reducing pain and disability. However, passive neural mobilization was
more effective in improving supine position compared active neural
mobilization(Nagulkar et al,.2016). Nar NH said that the Neuro dynamic
is used in the decreasing of pain and in increasing of range of motion due
to facilitations of nerve movements(Nar NH,.2014). Yamin said that the
Results of current study showed that neuro dynamics significantly
reduces pain and functional disability and improves supine position in
patients with neuro mobilization.(Yamin et al,.2016). reported that neural
mobilization is helpful in the reduction of disability, improving ROM,
and lumber flexion(Adl SM,.2011).

Comparison between groups after treatment:

Comparing between the effect of slump position and supine position on


low back pain with sciatica. After treatment there was significant
difference between slump position and supine position as regard to pain
reduction and range of motion and functional disability as slump position
allows a decreased pain level and disability and increased ROM than the
supine position for patients with low back pain with sciatica .

This difference in degree of pain relief can be explained and


supported by (Mohammad , et al 2018)who reported that slump position
allows a greater degree of pain relief than does the supine position for
patients with low back pain with sciatica . Significant pain relief with the
Slump stretching includes lumbar flexion, which can unload the facet
joints and increase central canal and neuroforaminal dimension.
Therefore, the pain intensity can be reduced, The results of the previous
study by (Mohammad , et al 2018) agree with the outcomes of the
current study.

In agreement with the results of the current study comparing of the two
groups showed significantly better improvement in pain and rom ,
functional disability in slump position when compared with supine
position. (Adnan M, et al ., 2022).

conventional rehabilitation program:

In the current study, The participants in both groups received the


conventional rehabilitation program for treatment of LBP with sciatica . It
consisted of: therapeutic ultrasonic: Ultrasound was applied to patient’s
lower back with a frequency of 1 MHz at a continuous mode and 0.5
W/Cm² for 5 min using moving sound head technique.

Infrared: Non-luminous infrared generators were applied for 30 min on


patient’s lower back, The I.R lamp was parallel to the back with a
distance from the skin about 60 to 90 Cm.

general exercises program : which include stretching and strengthening


exercises for back muscles for 3 days / week for 2weeks , The stretching
exercises were repeated for 5 times and each time was for 30 sec and the
strengthening exercises were done for 3 sets with 5 to 10 repetitions in
each set.
The results showed that exercise programme added to each
treatment variables three times per week for two weeks may give good
clinical results in a shorter period of time. This finding is supported by
the findings of (Hall et al.2005,2006)(Tambekar et al.2015,2016).

Common questions

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The study's methodological approach involved assigning ten patients with low back pain to receive neuro mobilization in either slump or supine positions over two weeks . A strength of this study is its use of a comparative design, allowing for direct assessment of each position's effects. However, limitations include a small sample size and short duration, which may affect generalizability and long-term validity of outcomes . Comprehensive statistical analysis supports findings but further research with larger samples is recommended for broader applicability.

The slump position offers greater improvements in pain relief, ROM, and functional disability, suggesting it may be a more effective intervention for patients with low back pain with sciatica than the supine position . However, despite the benefits seen in the slump position, the supine position also significantly reduces pain and improves function, suggesting both methods can be effective depending on patient circumstances .

Pain reduction through neuro mobilization correlates with improvements in ROM and functional disability by facilitating less restricted nerve movement, thereby allowing for greater flexibility and less muscular guarding . As pain decreases, patients are typically able to engage more in functional tasks, enhancing overall disability scores . This interlinked progression underlines the importance of addressing pain as a primary therapeutic goal to achieve broader functional improvements.

Functional improvements observed in patients undergoing neuro mobilization include reduced pain intensity, increased lumbar flexion, and decreased disability, particularly when using the slump position . These improvements are attributed to the enhanced facilitation of nerve movements and increased space within vertebral structures, allowing for better functional capacity and movement .

Neural mobilization helps decrease pain levels and disability while increasing ROM, particularly in the slump position, which facilitates nerve movement and lumbar flexion, thus unloading facet joints and increasing space for nerve roots . These benefits manifest as decreased pain intensity and improved functional capacity in patients .

Neuro mobilization likely offers psycho-physiological benefits by reducing pain, which may decrease stress and enhance psychological well-being. Improved ROM and functional capacity can contribute to greater autonomy and quality of life, impacting both psychological and physiological states positively . As pain and disability decrease, patients might experience fewer depressive symptoms and anxiety related to their condition, although specific psychological outcomes were not measured in this study .

Neuro mobilization in slump position is shown to decrease pain levels and disability more effectively, while also increasing range of motion (ROM) compared to the supine position . This significant difference can be attributed to the fact that the slump position allows for lumbar flexion, which may unload the facet joints and increase the dimensions of the central canal and neuroforamina, thus reducing pain intensity .

Therapists might choose the supine position due to factors such as patient comfort, specific contraindications to lumbar flexion, or the presence of conditions that make the slump position challenging. The supine position still offers benefits in reducing pain and disability , and individual patient needs and responses can dictate the choice of technique. Additionally, comfort during treatment can enhance patient compliance and outcomes .

Combining neuro mobilization techniques with traditional rehabilitation, including therapeutic ultrasound, infrared light, and exercises, can potentially enhance outcomes by concurrently addressing different aspects of low back pain with sciatica. Neuro mobilization aids in reducing nerve tension, while ultrasound and infrared therapies help in decreasing local inflammation and pain. This multi-modal approach may accelerate improvements in pain, ROM, and functional disability .

The current study's findings align with previous research indicating that the slump position is more effective than the supine position in reducing pain and improving ROM and functional disability . These outcomes are supported by Mohammad et al. (2018) and others who reported similar therapeutic effects of the slump position for patients with low back pain with sciatica .

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