Pragmatic neural tissue management improves short-term pain and disability in patients with sciatica: a single-arm clinical trial

ABSTRACT

Objectives: To evaluate the clinical effect of sciatic neural mobilization in combination with the treatment of surrounding structures for sciatica patients. Secondly, we were also interested in identifying possible baseline characteristics that may be associated with improvements in pain and disability for sciatica patients.

Methods: Twenty-eight patients with a clinical diagnosis of sciatica were treated with neural mobilization, joint mobilization and soft tissue techniques. Pain intensity and lumbar disability were assessed at baseline and after treatment using a Numerical Rating Scale (0–10) and the Oswestry Disability Index (0–100), respectively. The pre- and post-intervention data were compared. The research protocol was registered under the number NCT03663842.

Results: Participants attended an average of 16 (SD±5.6) treatment
sessions over an average of 12 weeks. Decrease in pain scores (before median = 8, after median = 2; p < 0.001) and improvement in lumbar disability scores (before median = 33.3%, after median = 15.6%; p < 0.001) were observed. A multiple linear regression analysis showed that duration of pain and age of the patient predicted the disability improvement: F (2, 24) = 4.084, p < 0.030, R² = 0.254.

Discussion: Patients with sciatica may benefit from neural mobilization in combination with manual therapy for pain and lumbar disability. Longer pain duration and younger age had a negative influence on lumbar disability improvement.

KEYWORDS:

• Lumbosacral plexus
• physical therapy modalities
• manual therapies
• disability evaluation

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported in part by National Council for Scientific and Technological Development (CNPq), Brazil. TPY and LACN are supported by the National Council for Scientific and Technological Development (CNPq), Brazil. RA was partially supported by the National Council for the Improvement of Higher Education (CAPES).

Notes on contributors

Renato Santos de Almeida

Renato Santos de Almeida, is a Physiotherapist with 15 years of clinical experience in a University Hospital. He is also professor in the Faculty of Physical Therapy at Serra dos Órgãos University Center (UNIFESO) and researcher at Rehabilitation Sciences Postgraduation Program at University Centre Augusto Motta (UNISUAM). His research interests include musculoskeletal pain, manual therapy, and patient centered care.

Eduardo Machado

Eduardo Machado, is a Physiotherapist with 10 years of clinical experience in a University Hospital. He has large experience as a clinical physiotherapist in musculoskeletal rehabilitation area.

Tiê Parma Yamato

Tie Parma Yamato, is an associate researcher at Centre for Pain, Health and Lifestyle and finished her postdoc at University of Newcastle, Australia where she still collaborates elaborating projects related to children and adolescent’s health. Tie has worked as a physiotherapist in Brazil between 2010 and 2013. After that, she has moved to Australia to do a PhD at University of Sydney and she was awarded in 2017. In the past 5 years Tie has published more than 45 manuscripts in peer-review journals. Tie is also one of the co-leaders of PEDrinho that has the aim of expanding the content of the Physiotherapy Evidence Database (PEDro) to Portuguese. Tie is also a co-leader of the International Collaboration for Early Career Researchers (ICECReam).

Luciano Santos De Melo

Luciano Santos De Melo, a physiotherapist from Brazil, moved to Australia in 2006 and was awarded a Masters in Musculoskeletal Physiotherapy by the University of Queensland. He has over 18 years of experience in health service delivery, clinical research and clinical education both overseas and in Australia. In the last 5 years, he has developed a keen interest in Knowledge Translation (KT) and was awarded a competitive grant to undertake KT studies in Canada, at the University of Toronto Medical School in 2016. Since then, he has applied those KT skills in developing and implementing evidence-based resources for consumers, healthcare providers, clinical researchers and policy makers as a knowledge broker. He is currently a PhD Candidate at the University of Sydney, Medical School.

More recently, he has been involved in the ongoing development and implementation of a multi professional and multi-centre collaboration National Strategy for the prevention and management of osteoarthritis, which is one of the most burdensome chronic diseases in Australia. He is also currently involved in other national projects that aim to impact the management of chronic MSK disorders in Australia by translating and implementing evidence into current clinical practice, such as the Lower Limb Health Care Awareness, the Experience and Preferences of consumers when using online support groups for osteoarthritis conditions project, as a Chair for the CRE and Program Training & Mentoring Committee for Early Career Researchers (ECR) and the OAChangeMap. He is interested in assisting people in making evidence-informed decisions about their health and contributing to an efficient healthcare system in Australia. He is currently responsible for developing a framework to allow the translation of the 45 and Up study evidence for policy and practice.

Leandro Alberto Calazans Nogueira

Leandro Alberto Calazans Nogueira, is a Physiotherapist and Osteopathy with 18 years of clinical experience and completed his post-doctoral fellowship at The University of Sydney in 2017. He is also Professor in the Faculty of Physical Therapy at Federal Institute of Rio de Janeiro and Researcher at Rehabilitation Sciences Postgraduation Program at Augusto Motta University Centre. His research interests include musculoskeletal pain, manual therapy, and motor control.

My ORCID number is: 0000-0002-0177-9816