Effect of neurodynamic techniques on radiating symptoms and mechanosensitivity of neural tissue in subjects with lumbosacral radiculopathy: A double-blind randomized controlled trial

Background: Lumbosacral radiculopathy has a prevalence ranging from 1.2% to 43%. It is associated with altered mechanosensitivity of the neural tissue and symptoms of pain and paresthesia radiating to the lower extremity. Neurodynamic techniques described by Shacklock have shown beneficial results clinically in subjects with radiculopathy. However, there is lack of research on systematic protocol of neurodynamic techniques in lower limb radiculopathy. Objectives: The objectives of the present study were to evaluate the effect of neurodynamic techniques including treatment of neural tissues and interface dysfunctions as advocated by Michael Shacklock. Materials and Methods: A double-blind randomized controlled trial on 108 subjects with lumbosacral radiculopathy was conducted using computer generated block randomization after taking ethics approval. They were divided into two equal groups of 54. The treatment for both groups was given in six sessions, thrice a week for 2 weeks. Interventional group received neurodynamic techniques based on diagnosis of neural and interface dysfunctions and control group received sham neurodynamic techniques. Both groups additionally received hydrocollator packs for 20 min and 10 repetitions of isometric back exercises. The outcome measures were Sciatica Bothersomeness Index and Sciatica Frequency Index for Bothersomeness and frequency of radiating symptoms, pain site codes on overlay template for centralization of radiating symptoms and active knee extension range of motion in slump posture using universal goniometer for mechanosensitivity of neural tissue. The outcome assessor and the subjects were blinded to the treatment allocation. Results: Wilcoxon signed-ranks test showed a statistically significant difference in all the outcome measures in both groups (P < 0.05). Mann–Whitney U-test showed that the interventional group had better improvement compared to the control group (P < 0.05). Conclusion: Neurodynamic techniques are effective in reducing the Bothersomeness and frequency of radiating symptoms, producing centralization, and reducing mechanosensitivity of the neural tissue in subjects with lumbosacral radiculopathy.