Efficacy of Tibial Nerve Neurodynamic Mobilization for Neuropathic Pain in Type II Diabetes Mellitus- A Randomized Controlled Trial

To study the efficacy of tibial nerve neurodynamic mobilization as compared to control intervention on vibration thresholds, neuropathic pain severity, tibial nerve neurodynamic test range of motion and neuropathy specific quality of life (NeuroQoL) in type-II Diabetes Mellitus (DM) with neuropathic pain.

Methods

Thirty two patients of age (60.12 ± 11.41years), both gender (13 male, 19 female) were selected on convenient sampling. Subjects were selected based on following: Physician diagnosed type-II DM of atleast two years duration; complaint of neuropathic pain (screened using neuropathic pain questionnaire- NPQ) in the legs and feet; mechanical behavior of neuropathic pain (aggravated and/or relieved by movements); ability to understand and co-operate for instructions of tester. The independent blinded observer then recorded neuropathic pain intensity on NPQ, tibial nerve neurodynamic test range of motion at initial resistance R1, vibration thresholds by Biothesiometry and NeuroQoL. The subjects then were randomized to receive either of two interventions- control and experimental. The control group received drugs for glycemic control, analgesics for neuropathic pain, lifestyle modification and walking exercise prescription. The experimental group received in addition, tibial nerve neurodynamic mobilization consisting of nerve massage, sliders and tensioners. The treatment session was of 45 min duration on five sessions (one session per week) for total study duration of five weeks. Data was collected twice- pre and post intervention and analyzed using students’ t-test.

Results

The experimental group showed significant improvements post treatment in all the four study outcomes. The betweengroup mean differences were NPQ (18.89 ± 2.46), neurodynamic range of motion (4.00 ± 3.85 degrees), vibration threshold (5.94 ± 1.12 volts) and NeuroQoL (15.93 ± 2.85) in favour of experimental group.

Conclusion

Tibial nerve neurodynamic mobilization comprising of nerve massage, sliders and tensioners was shown to be an effective treatment adjunct for diabetic peripheral neuropathic pain.