Effects of neural mobilization in patients with radicular low back pain - literature review

Uvod: Radikularna bolečina spodnjega dela hrbta je opredeljena kot bolečina, ki nastane zaradi utesnitve in posledičnega draženja ledveno-križničnih korenin spinalnih živcev, kar posledično povzroči tipično izžarevajočo bolečino v spodnji ud. Bolečina lahko seva iz ledvenega dela hrbta pod glutealno gubo ter sledi poteku dermatoma, ki ga poškodovani živec oživčuje. Drugi simptomi so parestezija, oslabljenost refleksov, zmanjšan obseg giba in mišična oslabljenost. Zdravljenje vsebuje različne fizioterapevtske postopke, medikamentozno zdravljenje in operativni poseg. Namen: Namen diplomskega dela je bil na podlagi pregleda literature analizirati učinke mobilizacije živčevja pri pacientih z radikularno bolečino v ledvenem delu hrbta. Metode dela: Pregledane so bile podatkovne zbirke PubMed, PEDro in Google Scholar, iz katerih smo na podlagi vključitvenih in izključitvenih meril izbrali raziskave za podrobnejšo analizo. Rezultati: Analiziranih je bilo sedem randomiziranih kontroliranih raziskav, objavljenih med leti 2015 in 2023. Avtorji so primerjali učinke mobilizacije živčevja z drugimi fizioterapevtskimi postopki ali učinke kombinacije med njimi. Rezultati so pokazali, da mobilizacija živčevja zmanjša stopnjo jakosti bolečine, izboljša funkcijsko nezmožnost preiskovancev in živčno prevodnost perifernih živcev, poveča obseg fleksije kolčnega sklepa pri testu dvignjenega spodnjega uda in izometrično jakost mišic spodnjega dela hrbta ter zmanjša utesnitev živčne korenine. Razprava in zaključek: Obstajajo dokazi, da je mobilizacija živčevja učinkovit postopek za zdravljenje pacientov z radikularno bolečino v ledvenem delu hrbta kot samostojen postopek ali pa v kombinaciji s kinezioterapijo, instrumentalno fizioterapijo in mobilizacijo ter manipulacijo hrbtenice. Za določitev optimalnih parametrov mobilizacije živčevja so potrebne nadaljnje raziskave z večjimi vzorci udeležencev in jasnejšimi protokoli za proučevanje dolgoročnih učinkov.Introduction: Radicular pain in the lower back is defined as pain that arises due to compression and subsequent irritation of the lumbar-sacral nerve roots of the spinal nerves, which consequently results in typical radiating pain in the lower limb. The pain may radiate from the lumbar region below the gluteal fold, following the path of the dermatome innervated by the affected nerve. Other symptoms include paraesthesia, weakened reflexes, reduced range of motion, and muscle weakness. Treatment includes various physiotherapy procedures, medical therapy, and surgical intervention. Purpose: The aim of this thesis was to analyse the effects of nerve mobilization in patients with radicular pain in the lower back, based on a literature review. Methods: The PubMed, PEDro and Google Scholar databases were reviewed, and studies were selected for further analysis based on inclusion and exclusion criteria. Results: Seven randomized controlled trials published between 2015 and 2023 were analysed. Authors compared the effects of nerve mobilization with other physiotherapy procedures or the effects of their combination. The results indicate that nerve mobilization reduces the intensity of pain, improves the functional disability of the participants, enhances peripheral nerve conduction, increases hip flexion range in the straight leg raise test, improves isometric strength of the lower back muscles, and reduces nerve root compression. Discussion and conclusion: There are evidence that nerve mobilization is an effective procedure for treating patients with radicular pain in the lower back, either as a standalone approach or in combination with kinesiotherapy, instrumental physiotherapy, and spinal mobilization and manipulation. Further research with larger participant samples and clearer protocols to study long-term effects is needed to determine the optimal parameters of nerve mobilization