Outcomes differ between subgroups of patients with low back and leg pain following neural manual therapy: a prospective cohort study

Abstract

The objective is to determine if pain and disability outcomes of patients treated with neural mobilisation differ for sub-classifications of low back and leg pain (LB&LP). Radiating leg pain is a poor prognostic factor for recovery in patients with LBP. To improve outcome, a new pathomechanism-based classification system was proposed: neuropathic sensitization (NS), denervation (D), peripheral nerve sensitization (PNS) and musculoskeletal (M). Seventy-seven patients with unilateral LB&LP were recruited. Following classification, all subjects were treated seven times with neural mobilisation techniques. A successful outcome was defined as achieving a minimal clinically important change in pain intensity (11-point numerical rating scale), physical function (Roland Morris disability questionnaire) and global perceived change (7-point Likert scale: from 1 = "completely recovered" to 7 = "worse than ever"). The proportion of responders was significantly greater in PNS (55.6%) than the other three groups (NS 10%; D 14.3% and M10%). After adjusting for baseline differences, mean magnitude of improvement of the outcome measures were significantly greater in PNS compared to the other groups. Patients classified as PNS have a more favourable prognosis following neural mobilisation compared to the other groups.

Figures

Fig. 1

Classification algorithm. *LANSS Leeds Assessment of Neuropathic Symptoms and Signs [14]. SLR straight leg raise test, PKBprone knee bend test

Fig. 2

Treatment technique aimed at mobilising neural structures in the intervertebral foramen. a Foraminal opening technique induced by ipsilateral lateral flexion, white arrow indicates direction of force, left thumb fixes the upper spinous process of the affected segment. b Sliding technique for the sciatic nerve incorporating hip and knee flexion followed by hip and knee extension, white arrows indicate directions of movement

Fig. 3

Flow diagram

Fig. 4

Patient perceived global change (Global Perceived Change scale) and improvement from baseline in pain and disability. Data are estimated marginal means (error bars represent standard error of measurement) adjusted for baseline pain intensity (Numerical Rating Scale) and disability (Roland Morris Disability Questionnaire). *p < 0.05; **p < 0.01 of pair-wise comparisons with post hoc LSD tests. Lower numbers for GPC indicate a more favourable outcome (1 = completely recovered to 7 = worse than ever)