Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Freynhagen R, Baron R, Gockel U, Tölle TR (2006) Screening of neuropathic pain components in patients with chronic back pain associated with nerve compression: a prospective observational study (MIPORT). Curr Med Res Opin 22:529–537

    Article  PubMed  Google Scholar 

  2. Grotle M, Brox JI, Glomsrod B, Lonn JH, Vollestad NK (2007) Prognostic factors in first-time care seekers due to acute low back pain. Eur J Pain 11:290–298

    Article  PubMed  Google Scholar 

  3. Ren XS, Selim AJ, Fincke G, Deyo RA, Linzer M, Lee A et al (1999) Assessment of functional status, low back disability, and use of diagnostic imaging in patients with low back pain and radiating leg pain. J Clin Epidemiol 52:1063–1071

    Article  PubMed  CAS  Google Scholar 

  4. Luijsterburg PA, Verhagen AP, Ostelo RW, van Os TA, Peul WC, Koes BW (2007) Effectiveness of conservative treatments for the lumbosacral radicular syndrome: a systematic review. Eur Spine J 16:881–899

    Article  PubMed  Google Scholar 

  5. Kent P, Mjosund HL, Petersen DH (2010) Does targeting manual therapy and/or exercise improve patient outcomes in nonspecific low back pain? A systematic review. BMC Med 8:22

    Article  PubMed  Google Scholar 

  6. Billis EV, McCarthy CJ, Oldham JA (2007) Subclassification of low back pain: a cross-country comparison. Eur Spine J 16:865–879

    Article  PubMed  Google Scholar 

  7. Delitto A, Erhard RE, Bowling RW (1995) A treatment-based classification approach to low back syndrome: identifying and staging patients for conservative treatment. Phys Ther 75:470–485 (discussion 485–489)

    PubMed  CAS  Google Scholar 

  8. McKenzie RA (1981) The lumbar spine: mechanical diagnosis and therapy. Spinal Publications, Waikanae, N.Z

  9. Brennan GP, Fritz JM, Hunter SJ, Thackeray A, Delitto A, Erhard RE (2006) Identifying subgroups of patients with acute/subacute “nonspecific” low back pain: results of a randomized clinical trial. Spine 31:623–631

    Article  PubMed  Google Scholar 

  10. Long A, Donelson R, Fung T (2004) Does it matter which exercise? A randomized control trial of exercise for low back pain. Spine 29:2593–2602

    Article  PubMed  Google Scholar 

  11. Woolf CJ, Bennett GJ, Doherty M, Dubner R, Kidd B, Koltzenburg M et al (1998) Towards a mechanism-based classification of pain? Pain 77:227–229

    Article  PubMed  CAS  Google Scholar 

  12. Schäfer A, Hall T, Briffa K (2009) Classification of low back-related leg pain—a proposed patho-mechanism-based approach. Man Ther 14:222–230

    Article  PubMed  Google Scholar 

  13. Schäfer A, Hall T, Lüdtke K, Mallwitz J, Briffa K (2009) Interrater reliability of a new classification system for patients with low back related leg pain. J Man Manip Ther 17:109–117

    Article  PubMed  Google Scholar 

  14. Bennett M (2001) The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. Pain 92:147–157

    Article  PubMed  CAS  Google Scholar 

  15. Hall TM, Elvey RL (2004) Management of mechanosensitivity of the nervous system in spinal pain syndromes. In: Boyling JD, Jull G (eds) Grieves modern manual therapy, 3rd edn. Churchill Livingstone, Edinburgh, pp 413–433

    Google Scholar 

  16. Panjabi MM, Takata K, Goel VK (1983) Kinematics of lumbar intervertebral foramen. Spine 8:348–357

    Article  PubMed  CAS  Google Scholar 

  17. Breig A, Troup JDG (1979) Biomechanical considerations in the straight-leg-raising test cadaveric and clinical studies of the effects of medial hip rotation. Spine 4:242–250

    Article  PubMed  CAS  Google Scholar 

  18. Coppieters MW, Butler DS (2008) Do ‘sliders’ slide and ‘tensioners’ tension? An analysis of neurodynamic techniques and considerations regarding their application. Man Ther 13:213–221

    Article  PubMed  Google Scholar 

  19. Pham T, van der Heijde D, Altman RD, Anderson JJ, Bellamy N, Hochberg M et al (2004) OMERACT-OARSI initiative: Osteoarthritis Research Society International set of responder criteria for osteoarthritis clinical trials revisited. Osteoarthr Cartil 12:389–399

    Article  PubMed  CAS  Google Scholar 

  20. Ostelo RW, de Vet HC (2005) Clinically important outcomes in low back pain. Best Pract Res Clin Rheumatol 19:593–607

    Article  PubMed  Google Scholar 

  21. Cibulka MT, Aslin K (2001) How to use evidence-based practice to distinguish between three different patients with low back pain. J Orth Sports Phys Ther 31:678–688 (discussion 689–695)

    CAS  Google Scholar 

  22. Kitteringham C (1996) The effect of straight leg raise exercises after decompression surgery—a pilot study. Physiotherapy 82:115–123

    Article  Google Scholar 

  23. Kwan MK, Wall EJ, Massie J, Garfin SR (1992) Strain, stress and stretch of peripheral nerve. Rabbit experiments in vitro and in vivo. Acta Orthop Scand 63:267–272

    Article  PubMed  CAS  Google Scholar 

  24. Yoshizawa H, Kobayashi S, Morita T (1995) Chronic nerve root compression. Pathophysiologic mechanism of nerve root dysfunction. Spine 20:397–407

    Article  PubMed  CAS  Google Scholar 

  25. Fritz JM, Lindsay W, Matheson JW, Brennan GP, Hunter SJ, Moffit SD et al (2007) Is there a subgroup of patients with low back pain likely to benefit from mechanical traction? Results of a randomized clinical trial and subgrouping analysis. Spine 32:E793–E800

    Article  PubMed  Google Scholar 

  26. Dickenson AH, Bee LA (2008) Neurobiological mechanisms of neuropathic pain and its treatment. In: Castro-Lopes J, Raja S, Schmelz M (eds) Pain 2008: an updated review. IASP press, Seattle, pp 277–286

  27. Cleland JA, Childs JD, Palmer JA, Eberhart S (2006) Slump stretching in the management of non-radicular low back pain: a pilot clinical trial. Man Ther 11:279–286

    Article  PubMed  Google Scholar 

  28. Cleland JA, Hunt GC, Palmer JA (2004) Effectiveness of neural mobilization in the treatment of a patient with lower extremity neurogenic pain: a single case design. J Manual Manipul Ther 12:143–152

    Article  Google Scholar 

  29. George SZ (2002) Characteristics of patients with lower extremity symptoms treated with slump stretching: a case series. J Orthop Sports Phys Ther 32:391–398

    PubMed  Google Scholar 

  30. Allison GT, Nagy BM, Hall T (2002) A randomized clinical trial of manual therapy for cervico-brachial pain syndrome—a pilot study. Man Ther 7:95–102

    Article  PubMed  CAS  Google Scholar 

  31. Coppieters MW, Stappaerts KH, Wouters LL, Janssens K (2003) The immediate effects of a cervical lateral glide treatment technique in patients with neurogenic cervicobrachial pain. J Orthop Sports Phys Ther 33:369–378

    PubMed  Google Scholar 

  32. Cowell IM, Phillips DR (2002) Effectiveness of manipulative physiotherapy for the treatment of a neurogenic cervicobrachial pain syndrome: a single case study—experimental design. Man Ther 7:31–38

    Article  PubMed  CAS  Google Scholar 

  33. Hall T, Elvey R, Davies N, Dutton L, Moog M (1997) Efficacy of manipulative physiotherapy for the treatment of cervicobrachial pain. In: 10th Manipulative physiotherapists association of Australia conference, Melbourne, pp 73–74

  34. Ellis RF (2008) Neural mobilization: a systematic review of randomized controlled trials with an analysis of therapeutic efficacy. J Man Manip Ther 16:8

    Article  PubMed  Google Scholar 

  35. Fritz JM, Cleland JA, Childs JD (2007) Subgrouping patients with low back pain: evolution of a classification approach to physical therapy. J Orthop Sports Phys Ther 37:290–302

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Social Work and Health, Degree Programmes for Occupational Therapy, Speech and Language Therapy & Physiotherapy, HAWK University of Applied Science and Arts, Goschentor 1, 31134, Hildesheim, Germany

    Axel Schäfer

  2. School of Physiotherapy, Curtin Health Innovation Research Institute, Curtin University, Perth, Australia

    Axel Schäfer, Toby Hall & Kathryn Briffa

  3. Rückenzentrum am Michel, Ludwig Erhart Str. 18, 20459, Hamburg, Germany

    Gerd Müller

Authors
  1. Axel Schäfer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Toby Hall
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gerd Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kathryn Briffa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Axel Schäfer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schäfer, A., Hall, T., Müller, G. et al. Outcomes differ between subgroups of patients with low back and leg pain following neural manual therapy: a prospective cohort study. Eur Spine J 20, 482–490 (2011). https://doi.org/10.1007/s00586-010-1632-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-010-1632-2

Keywords

Search

Navigation