Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20200041
Brazilian Journal of Pain
Original Article

Effects of neural mobilization on individuals with chronic low back pain

Efeito da mobilização neural em indivíduos com dor lombar crônica

Marina Ramos; Caio A. H. Cruz; Moises F. Laurentino; Hazem Adel Ashmawi; Fabio M. Santos; Marucia Chacur

http://dx.doi.org/10.5935/2595-0118.20200041 BrJP, vol.3, n3, p.205-212, 2020
PDF English
PDF Português
SciELO
Downloads: 0
Views: 475

Abstract

BACKGROUND AND OBJECTIVES: The objective of this study was to evaluate the effect of neural mobilization technique on individuals with chronic low back pain, as well as analyze possible changes in pain, motor behavior and on cytokine quantification before and after treatment.

METHODS: Sixteen individuals with mean age of 30.45±10.32 years old were evaluated. The technique consisted of a total of 10 interventions, with a total duration of 10 minutes, divided into four series of 2 minutes each, with a 30-second interval between each series. The following outcomes were evaluated: pain intensity using the visual analog scale; mobility of the lumbar spine with the third finger to the ground test and hip goniometry; concentration of cytokines in serum with the multiplex technique; and quality of life with the Oswestry Disability Index, the Roland-Morris Disability Questionnaire and the World Health Organization Quality of Life Questionnaire-bref.

RESULTS: Results showed a reduction in pain intensity of approximately 70% between the assessments (p<0.001). Improvements in lumbar mobility of approximately 25.5% on the third finger to the ground test (p<0.04) and improvement in the hip joint angles (p<0.04) were also observed. A difference in cytokine concentrations, both pro-inflammatory (p<0.009) and anti-inflammatory (p<0.03), was also observed between the assessments.

CONCLUSION: The technique was able to reduce pain intensity and consequently increase the mobility of the volunteers. Additionally, a difference in cytokine concentration at the end of the treatment and an improvement in the individuals quality of life were observed.

Keywords

Low back pain, Pain, Quality of life

Resumo

JUSTIFICATIVA E OBJETIVOS: O objetivo deste estudo foi avaliar o efeito da técnica de mobilização neural em indivíduos com lombalgia crônica, assim como possíveis alterações na dor, no comportamento motor e na quantificação de citocinas antes e após o tratamento.

MÉTODOS: Foram avaliados 16 indivíduos com idade média de 30,45±10,32 anos. A técnica consistiu em um total de 10 intervenções, com duração total de 10 minutos, divididas em quatro séries de 2 minutos cada, com intervalo de 30 segundos entre cada série. Os desfechos a seguir foram avaliados: intensidade da dor utilizando a escala analógica visual; mobilidade da coluna lombar com o terceiro dedo ao solo e goniometria do quadril; concentração de citocinas no soro com a técnica multiplex; e qualidade de vida com o Oswestry Disability Index, Roland-Morris Disability Questionnaire and the World Health Organization Quality of Life Questionnaire-bref.

RESULTADOS: Os presentes resultados demonstraram uma redução na intensidade da dor de aproximadamente 70% entre as avaliações (p<0,001). Foram observadas melhoras na mobilidade lombar de aproximadamente 25,5% no teste do terceiro dedo ao solo (p<0,04) e nos ângulos da articulação do quadril (p<0,04). Também foi observada entre as avaliações diferença nas concentrações de citocinas, tanto pró-inflamatórias (p<0,009) quanto anti-inflamatórias (p<0,03).

CONCLUSÃO: A técnica foi capaz de reduzir a intensidade da dor e consequentemente aumentar a mobilidade dos voluntários. Além disso, foi observada uma diferença na concentração de citocinas no final do tratamento e uma melhoria na qualidade de vida dos indivíduos.

Palavras-chave

Dor, Dor lombar, Qualidade de vida

References

Briganó JU, Macedo CSG. Análise da mobilidade lombar e influência da terapia manual e cinesioterapia na lombalgia. Semina: Ciências Biológicas e da Saúde. 2005;26(2):75-82.

Kurt V, Aras O, Buker N. Comparison of conservative treatment with and without neural mobilization for patients with low back pain: a prospective, randomized clinical trial. J Back Musculoskelet Rehabil. 2020;28.

Lima ICM, Seguchi HHK, Imamura M, Saito ET, Pinho CP, Imamura ST. Tratamento da lombalgia crônica pela inativação de pontos-gatilho miofasciais - experiência da Divisão de Medicina Física da FMUSP. Acta Fisiátrica. 1999;6(1):10-3.

Teixeira MJ, Figueiró JAF, Yeng LT, Pimenta CAM. Tratamento multidisciplinar do doente com dor. Dor um Estudo Multidisciplinar. 1995;62(2):233-40.

Loney PL, Stratford PW. The prevalence of low back pain in adults: a methodological review of the literature. Phys Ther. 1999;79(4):384-96.

Antonio SF. Abordagem diagnóstica e terapêutica das dores lombares. Rev Bras Med. 2002;59(6):449-61.

Teixeira MJ, Teixeira WGJ, Santos FPS, Andrade DCA, Bezerra SL, Figueiró JB. Epidemiologia clínica da dor músculo-esquelética. Rev Med. 2001;80(ed.esp.pt 1):1-21.

Neto T, Freitas SR, Marques M, Gomes L, Andrade R, Oliveira R. Effects of lower body quadrant neural mobilization in healthy and low back pain populations: a systematic review and meta-analysis. Musculoskelet Sci Pract. 2017;27:14-22.

Scheller J, Chalaris A, Schmidt-Arras D, Rose-John S. The pro- and anti-inflammatory properties of the cytokine interleukin-6. Biochim Biophys Acta. 2011;1813(5):878-88.

Coppieters MW, Butler DS. In Defense of Neural Mobilization. J Orthop Sports Phys Ther. 2001;31(9):520-1.

Cornelson SM, Johnnie ED, Kettner NW. Neural mobilization in a 54-year-old woman with postoperative spinal adhesive arachnoiditis. J Chiropr Med. 2018;17(4):283-8.

Basson A, Olivier B, Ellis R, Coppieters M, Stewart A, Mudzi W. The effectiveness of neural mobilizations in the treatment of musculoskeletal conditions: a systematic review protocol. JBI Database System Rev Implement Rep. 2015;13(1):65-75.

Lau YN, Ng J, Lee SY, Li LC, Kwan CM, Fan SM. A brief report on the clinical trial on neural mobilization exercise for joint pain in patients with rheumatoid arthritis. Z Rheumatol. 2018;78(5):474-8.

Sanz DR, Solano FU, López DL, Corbalan IS, Morales CR, Lobo CC. Effectiveness of median nerve neural mobilization versus oral ibuprofen treatment in subjects who suffer from cervicobrachial pain: a randomized clinical trial. Arch Med Sci. 2018;14(4):871-9.

Santos FM, Silva JT, Giardini AC, Rocha PA, Achermann AP, Alves AS. Neural mobilization reverses behavioral and cellular changes that characterize neuropathic pain in rats. Mol Pain. 2012;8:57.

Murphy DR, Hurwitz EL, Gregory AA, Clary R. A non-surgical approach to the management of lumbar spinal stenosis: a prospective observational cohort study. BMC Musculoskelet Disord. 2006;7:16.

Vigatto R, Alexandre NM, Correa Filho HR. Development of a Brazilian Portuguese version of the Oswestry Disability Index: cross-cultural adaptation, reliability, and validity. Spine. 2007;32(4):481-6.

Roland M, Fairbank J. The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire. Spine. 2000;25(24):3115-24.

Nusbaum L, Natour J, Ferraz MB, Goldenberg J. Translation, adaptation and validation of the Roland-Morris questionnaire - Brazil Roland-Morris. Braz J Med Biol Res. 2001;34(2):203-10.

Pedroso B, Pilatti LA, Gutierrez GL, Picinin CT. Cálculo dos escores e estatística descritiva do WHOQOL-bref através do Microsoft Excel. RBQV. 2010;2(1):31-6.

Serrano SC. A importância da mensuração da dor na escolha de opióides na dor crônica. âmbito Hosp. 2002;156(1):14-7.

Puppin MAFL, Marques AP, Silva AG, Futuro Neto HA. Alongamento muscular na dor lombar crônica inespecífica: uma estratégia do método GDS. Fisioter Pesqui. 2011;18(2):116-21.

Zhang JM, An J. Cytokines, inflammation and pain. Int Anesthesiol Clin. 2007;45(2):27-37.

Nee RJ, Butler D. Management of peripheral neuropathic pain: Integrating neurobiology, neurodynamics, and clinical evidence. Phys Ther Sport. 2006;7(1):36-49.

Vos T, Barber RM, Bell B, Bertozzi-Villa A, Biryukov S, Bolliger I. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743-800.

Stefane T, Santos AM, Marinovic A, Hortense P. Dor lombar crônica: Intensidade de dor, incapacidade e qualidade de vida. Acta Paul Enferm. 2013;26(1):14-20.

Rittner HL, Brack A, Stein C. The other side of the medal: how chemokines promote analgesia. Neurosci Lett. 2008;437(3):203-8.

Sweeney J, Harms A. Persistent mechanical allodynia following injury of the hand. Treatment through mobilization of the nervous system. J Hand Ther. 1996;9(4):328-38.

Barbosa APB, Leal SS. Analysis of the efficacy of neural mobilization of the sciatic nerve in improving ROM. ConScientiae Saúde. 2015;14(3):463-9.

Cui JG, Holmin S, Mathiesen T, Meyerson BA, Linderoth B. Possible role of inflammatory mediators in tactile hypersensitivity in rat models of mononeuropathy. Pain. 2000;88(3):239-48.

Puehler W, Zöllner C, Brack A, Shaqura MA, Krause H, Schäfer M. Rapid upregulation of µ opioid receptor mRNA in dorsal root ganglia in response to peripheral inflammation depends on neuronal conduction. Neuroscience. 2004;129(2):473-9.

Kraychete DC, Sakata RK, Issy AM, Bacellar O, Jesus RS, Carvalho EM. Proinflammatory cytokines in patients with neuropathic pain treated with tramadol. Braz J Anesthesiol. 2009;59(3):297-303.

Zhu GC, Tsai KL, Chen YW, Hung CH. Neural mobilization attenuates mechanical allodynia and decreases proinflammatory cytokine concentrations in rats with painful diabetic neuropathy. Phys Ther. 2018;98(4):214-22.

Submitted date:
02/18/2020

Accepted date:
05/25/2020

5f6a511d0e882568769fefc6 brjp Articles
2595-3192 (Electronic) 2595-0118 (Printed)
BrJP ©2024 All rights reserved.

BrJP

Share this page
Page Sections