Spinal and neurodynamic mobilisation for radiculopathy
Lumbar radiculopathy involves compromise of a lumbar nerve root resulting in sensory and/or motor deficits; it also can be associated with pain.
This study found that the addition of ‘Spinal Mobilisation with Leg Movement’ (SMWLM) to an exercise and electrotherapy program resulted in greater outcomes for people with lumbar radiculopathy.
A total of 60 participants were randomly allocated to the following interventions which were carried out for 6 sessions over a 2-week period:
- Neural mobilization exercises (4 point kneeling pelvic tilts and heel sitting) and transcutaneous electrical stimulation (TENS) (50 minutes)
- An identical program, with the addition of SMWLM (55 minutes)
As per the principles of the Mulligan technique, all participants in this study needed to demonstrate improvement in their Straight Leg Raise (SLR) range with one application of the SMWLM technique to be included in this study.
The SMWLM technique involved the participant lying on their unaffected side and moving their affected leg to their pain-free range of SLR. In the meantime, the therapist applied a transverse pressure on the spinous process above the affected spinal level. This was repeated for 2-3 sets of 6-8 repetitions with pain-free overpressure applied to the SLR range as a progression of the technique. This was followed by a passive hip/ knee flexion/ extension neural slider technique in the same position.
Both groups demonstrated improvements in symptoms, however the addition of SMWLM had significantly greater short and long-term outcomes in patient satisfaction, pain, disability and SLR ROM.
In conclusion, the results this study suggests that the addition of SMWLM on selected patients presenting with lumbar radiculopathy may be beneficial.
Expert opinion by Ann Le
This well designed trial provides promising support for Mulligan's SMWLT.
It would have been interesting to omit the TENS application in both groups to determine the effect of the neural mobilisation exercises.
It does need to be emphasized that like all Mulligan techniques, a trial of the technique of at least 1 repetition must result in some objective improvement to be worthwile continuing.
> From: Satpute, Arch Phys Med Rehabil 100 (2019) 828-836. All rights reserved to American College of Rehabilitation Medicine. Click here for the online summary.