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International Journal of Neurology and Neurosurgery

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A Systematic Review on Neurodynamics and Neuropathic Pain in Diabetic Peripheral Neuropathy: Revisiting the Evidence for “Chicken or Egg?

Kumar Senthil P. , Kumar Senthil P. , Adhikari Prabha , Jeganathan P.S. , Sisodia Vaishali , D’Souza Sydney , Misri Z.K

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International Journal of Neurology and Neurosurgery 6(2):p 55-63, July - December 2014. | DOI:

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Abstract

Background: Neurodynamics is the concept based on a close interaction of mechanics and physiology of the nervous system which is focused on mechanical properties of peripheral nerves to be considered while assessing and treating patients’ neuropathic symptoms via nervous system mobilization and manual therapy. Purpose: The objective of this study was to evaluate the existing evidence for neurodynamics in Diabetic peripheral neuropathy (DPN) from a research-informed perspective. Methods: A systematic review using search terms “neurodynamics and diabetic neuropathy” in PubMed, CINAHL and Google Scholar was done and the obtained articles were descriptively synthesized into examination and treatment of neurodynamics in DPN population. Results: Out of the 12 included studies, there were four studies on healthy subjects which found neurodynamic techniques to have desirable neurophysiological effects and they were safe to use without any reported major detrimental effects on neurological function. The three evaluation studies, unanimously found altered responses to lower extremity neurodynamic testing in DPN population when tested to initial pain, in terms of range of motion changes during structural differentiation, and these studies found that neural mechanosensitivity was high among people with painful diabetic neuropathy compared to painless DN, or type-2 diabetes or normal persons, and correlated to neuropathic pain, sensory perception thresholds and quality of life. The five intervention studies (one on all three nerves, two on tibial nerve, one each on tibial and sciatic nerves) that studied community-based weekly intervention of neurodynamic mobilization in addition to standard care demonstrated beneficial effects in favor to the NDM group compared to standard care and/or sham intervention. Conclusion: There is limited evidence for altered neurodynamics in DPN population, and that neurodynamic mobilization was an effective therapeutic adjunct to standard care, although population-based pragmatic clinical trials are yet to done to provide effective recommendations for practice.

Keywords: Diabetic peripheral neuropathy; Neurodynamics; Nerve palpation; Nerve massage; Nerve mobility.

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