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- Issue 55
- The effectiveness of slider and tensioner…
The effectiveness of slider and tensioner neural mobilization techniques in the management of upper quadrant pain: a systematic review of randomized controlled trials
Key Points
- Neural mobilization seems to be effective in reducing pain for carpal tunnel syndrome and cervical radiculopathy.
- Neural mobilization has not been shown to be an effective stand-alone treatment for upper quadrant pain.
BACKGROUND & OBJECTIVE
Neural mobilization (NM) is a commonly used intervention to treat people with a variety of musculoskeletal complaints. Sliders and tensioners are two types of NM that can be applied to many different musculoskeletal complaints, though there is a more robust body of evidence to support their use in lower extremity conditions.
The aim of this systematic review was to summarize the available evidence regarding the use of slider and tensioner NM in the management of upper quadrant pain (UQP).
This paper suggests that sliders provided more analgesic effect on acute pain and tensioners provided more analgesic effect on chronic pain.
METHODS
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The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to conduct this research. A comprehensive search was performed to identify randomized controlled trials evaluating slider or tensioner NM techniques in adult patients targeting UQP.
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974 articles were found in the initial search. After removal of duplicates and abstracts screened for inclusion, the remaining full text articles were screened by two researchers, and rationale for exclusion and inclusion criteria was clarified.
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Ultimately, 25 articles were included in the analysis. Data was extracted and the risk of bias was assessed using the Physiotherapy Evidence Database (PEDro) score tool. Included studies were summarized descriptively and a qualitative analysis was performed.
RESULTS
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The 25 articles were categorized by musculoskeletal conditions in the upper quadrant (i.e. carpal tunnel syndrome, cubital tunnel syndrome, cervical radiculopathy, and lateral elbow tendinopathy).
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Regardless of the musculoskeletal condition, or if tensioners, sliders, or both were used as an intervention, most subjects reported improvement over the course of care, though improvement did not always reach statistical significance.
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Many of the studies combined NM with other interventions such as exercises or modalities making it difficult to determine if NM should be recommended as a stand-alone intervention.
LIMITATIONS
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The lack of standardized terminology regarding the approach investigated increases the likelihood that RCTs were not included due to using different terminology to describe NM interventions.
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Pain was the only outcome considered in this study, so the impact of NM on functional activities was not assessed in this review.
CLINICAL IMPLICATIONS
Neural mobilization (NM) is an intervention aiming to “restore homeostasis around the nervous system” (1). NM has been used clinically to address many issues related to pain and loss of function. While the exact mechanism of how or why NM may be helpful is not known, many studies looking at NM have found it to be useful, however with limitations. Sliders and tensioners provide distinctly different movement through the peripheral nervous system. Sliders result in increased nerve excursion, while tensioners elongate the nerve bed (2).
This systematic review specifically looked at upper quadrant conditions. Overall, a treatment plan including NM did result in improvement. It is important to note that most of the interventions were multimodal, so it is not possible to tell how much the NM intervention added to the other interventions in the study.
This systematic review found that sliders seemed to provide more analgesic effect on acute UQP, while tensioners provided more analgesic effect on chronic conditions. While there was not enough evidence to recommend the addition of NM to a treatment plan for cubital tunnel syndrome, lateral elbow tendinopathy or shoulder impingement syndrome, NM may be an intervention to consider including in a treatment plan for carpal tunnel syndrome or cervical radiculopathy.
+STUDY REFERENCE
SUPPORTING REFERENCE
- Basson, A, Olivier, B, Ellis, R, Coppieters, M, Stewart, A & Mudzi, W 2017, ‘The Effectiveness of Neural Mobilization for Neuromusculoskeletal Conditions: a Systematic Review and Meta-analysis’, Journal of Orthopaedic & Sports Physical Therapy, vol. 47, no. 9, pp. 593–615.
- Coppieters, MW, Hough, AD & Dilley, A 2009, ‘Different Nerve-Gliding Exercises Induce Different Magnitudes of Median Nerve Longitudinal Excursion: an in Vivo Study Using Dynamic Ultrasound Imaging’, Journal of Orthopaedic & Sports Physical Therapy, vol. 39, no. 3, pp. 164–171.
