Practical Neural Tissue Management enhances
Short-Term pain and disability in Sciatica patients
Sciatica, diagnosed in 36% of patients with non-specific low back pain, is more disabling and has a worse prognosis. Effective treatments are needed due to its high prevalence and negative impact on health.
Various treatment options, including medication, surgery, and physiotherapy, are commonly used for patients with sciatica. Certain procedures, such as disc surgery, epidural injections, non-opioid analgesia, manipulation, and acupuncture, have demonstrated better overall effectiveness compared to bed rest or conventional care.
Surgical procedures like discectomy, microdiscectomy, endoscopic discectomy, or nucleoplasty have shown short-term effectiveness. However, there is still debate regarding their efficacy, and the search for a more evidence-based therapeutic approach for managing sciatica continues.
Neural mobilization, a low-cost and safe non-surgical intervention, has been proposed as a viable option for these patients. In fact, a recent systematic review found that neural mobilization was superior to other commonly used physiotherapy interventions for individuals experiencing chronic musculoskeletal pain associated with nerves.
Recent systematic reviews reported by literature with meta-analysis have shown that neural mobilization treatment improves pain and disability in patients with low back pain. However, its effectiveness and clinical benefits for patients with sciatica are still uncertain.
Some studies suggest that adding sciatic neural mobilization to conservative treatment may improve pain scores for individuals with lumbar radiculopathy. However, neural mobilization is not widely considered as a therapeutic approach for sciatica based on current research.
Combining neural mobilization techniques with manual therapy can aid in the recovery of patients with sciatica by addressing nerve entrapment and related issues. Our study aims to evaluate the effectiveness of this approach in reducing pain and disability in sciatica patients and identify relevant baseline characteristics.
The findings of a study reported by literature have shown that neural tissue management has been beneficial in this group of patients with sciatica, improving short-term pain and lumbar disability.
The benefits observed in pain and disability have been clinically relevant, with higher values than the mean minimal important difference (MID). The results have also revealed that patients with a long history of pain duration have experienced a lesser improvement in lumbar disability following the neural tissue management intervention. To the best of our knowledge, this study has been the first to examine this topic.
This study reported by literature has been the first to explore the combined effect of neural tissue mobilization and treatment of surrounding tissues for managing sciatica. The results have shown clinical benefits of this approach, offering pain relief and improved function to patients.
The effectiveness of neural mobilization in reducing leg pain, lumbar pain, and improving function in sciatica patients has also been supported by previous case studies and a recent randomized controlled trial.
Shorter pain duration and higher age were associated with greater improvement in lumbar disability among patients with sciatica who received neural tissue management.
Prolonged neuropathic pain may lead to tissue hypersensitivity and central sensitization, resulting in more complex clinical presentation and less favorable rehabilitation outcomes for individuals with musculoskeletal pain.
Clinicians can address central sensitization signs, such as through pain neurophysiology education, to achieve better outcomes for patients with sciatica.
Further investigation is needed to understand the impact of aging on lumbar disability improvement with neural tissue management. It is important to note that the findings of this study cannot be generalized to all sciatica patients due to sample size and specific clinical profile limitations.
Other studies have shown that neural mobilization provides clinical advantages in various outcomes.
For instance, the combination of lumbar stabilization exercises with straight leg raise or slump mobilization has demonstrated greater efficacy in improving leg range of motion compared to stabilization exercises alone for individuals experiencing low back and leg pain.
Furthermore, the application of neural mobilization using a modified slump position with tensioning technique has resulted in increased straight leg raise range in healthy individuals.
In future studies, it would be valuable to investigate the range of motion as an outcome measure when employing a combination of soft tissue and neural mobilization for patients suffering from sciatica pain.
An effective approach for managing sciatica includes a combination of manual therapy, movement control techniques, leisure physical activity, and addressing patients’ expectations.
According to a systematic review conducted by Boogaard et al., negative outcome expectations and fear of movement due to pain are predictors of persistent radicular pain. Our findings further support the use of manual therapy techniques as a reasonable treatment option for sciatica.
It has been found that patients presenting with sciatica have shown a significant reduction in pain and lumbar disability after undergoing a combined management approach involving neural mobilization and manual therapy.
These findings, based on a small sample size, indicate that longer pain duration and younger age have had a negative impact on the improvement of lumbar disability scores.