Effect of Neural Mobilization Techniques on Pain, and Hip and Knee Range of Motion on Lumbosacral Radiculopathy Patients with Peripheral Sensitization

Abstract

Background: Lumbosacral radiculopathy is common with low back pain (LBP) patients. Lumbosacral radiculopathy can be classified into several subgroups which include, but not limited to, peripheral sensitization. Neural mobilization techniques, such as slider and tensioner techniques, were suggested in the treatment of patients with radicular LBP. Studies that have examined the effects of these techniques in patients with radicular LBP with predominant peripheral sensitization are lacking. Objective: The primary purpose of this study was to investigate the effects of slider and tensioner techniques on pain, hip and knee ROM in lumbosacral radiculopathy patients with peripheral sensitization. A secondary purpose was to evaluate the correlation between these outcomes measurements. Study design: Double-blind case-control trial. Methods: Fifty-one male lumbosacral radiculopathy patients with peripheral sensitization, were divided into one of the three groups: slider, tensioner, and control. The primary outcome measurements were visual analog scale (VAS) for pain, hip range of motion (ROM) during SLR test, and knee flexion ROM during slump test. The measurements were taken at baseline, after 1st, 3rd, and 6th session. Statistical Analysis: A two-way mixed design analysis of variance (MANOVA) with post-hoc (Bonferonni Correction) was used to calculate the differences with Time (baseline, 1st,3rd,6th sessions) as a within-group factor and Group (control, slider, and tensioner) as a between-group factor. The effect size was calculated with Cohen’s d. Pearson's correlation was used for correlation analysis. Results: There were no significant differences between the groups in all the demographic variables at baseline. Pain decreased significantly at all session in the tensioner group (high effect size) and at sessions 3 and 6 in the slider group (moderate to high effect size), but only at session 6 in the control group (moderate effect size). In addition, there were significant differences between the control group and both the slider and tensioner groups at session 6 in favor of the later groups, without any significant differences between the slider group and the tensioner group at any stage. Hip flexion ROM during SLR test increased significantly at all sessions in both the slider (moderate to high effect size) and tensioner groups (high effect size), and in the control group at session 1 and 3 (moderate effect size). There were no significant differences between all the groups at any stage. Knee flexion ROM during slump test decreased significantly (high effect size) at all sessions in both slider and tensioner groups, but not in the control group. This decreased in knee flexion ROM indicate improvement in the knee extension ROM associated with the slump test. There were no significant differences between the slider and tensioner group at any stage. There was moderate to high negative correlation hip flexion ROM during SLR test and knee flexion ROM during slump test at all stages in all groups. Conclusion: The results showed a great impact of both the slider and tensioner techniques in reducing pain and improving mobility in lumbosacral radiculopathy patients with peripheral sensitization. The tensioner technique demonstrated a trend of superiority over the slider technique.