The Effectiveness of Neural Mobilization for Neuromusculoskeletal Conditions: A Systematic Review and Meta-analysis

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• STUDY DESIGN: Systematic review with meta-analysis.

• OBJECTIVES: To determine the efficacy of neural mobilization (NM) for musculoskeletal conditions with a neuropathic component.

• BACKGROUND: Neural mobilization, 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.

• METHODS: A database search for randomized trials investigating the effect of NM on neuromusculoskeletal conditions was conducted, using standard methods for article identification, selection, and quality appraisal. Where possible, studies were pooled for meta-analysis, with pain, disability, and function as the primary outcomes.

• 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 Disability Questionnaire [0-50]: mean difference, -9.26; 95% confidence interval [CI]: -14.50, -4.01; P<.001) and pain (intensity [0-10]: mean difference, -1.78; 95% CI: -2.55, -1.01; P<.001) improved following NM. For chronic neck-arm pain, pain improved (intensity: mean difference, -1.89; 95% CI: -3.14, -0.64; P<.001) following NM. For most of the clinical outcomes in individuals with carpal tunnel syndrome, NM was not effective (P>.11) but showed some positive neurophysiological effects (eg, reduced intraneural edema). Due to a scarcity of studies or conflicting results, the effect of NM remains uncertain for various conditions, such as postoperative 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 on other conditions remains unclear. Due to the limited evidence and varying methodological quality, conclusions may change over time.

• LEVEL OF EVIDENCE: Therapy, level 1a.

• KEY WORDS:back pain, exercise, manual therapy, musculoskeletal conditions, neck pain, nerve mobilization, neurodynamics, physical therapy

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