Never a Nerve Stretch after Spine Surgery
Much is known about the benefits of physical therapy for chronic low back pain. It's also evident that patients who take part in a program of physical activity after spinal surgery fare best. Clearly, getting the joints and muscles moving and the heart and lungs pumping improve the health of patients with back pain.
If activities to get back patients moving are so helpful, what about treatments that get their nerves moving? This specialized form of treatment, called neural mobilizationÂ has gained popularity over the past ten years among physical therapists. It involves positioning and moving the spine and/or limbs to tug or stretch on nerve tissues. It is often helpful in relieving pain, especially chronic pain. Till recently, however, only one study addressed its ability to help patients after low back surgery.
The reason for doing nerve mobilization after spine surgery seems compelling at first. Patients sometimes heal by forming too much scar tissue where the nerve roots exit the spinal column. Nerves that are bound down by scar tissue may become sensitive, leading to more pain and problems. Keeping the nerve roots mobile, then, might improve surgery results.
Despite apparently sound reasoning, science shows otherwise. It is now evident that this type of treatment adds no additional benefit when used after lower spine surgery.
Patients having low back surgery were randomly placed in two groups. Starting on day one, both groups did standard exercises after surgery. One group also received neural mobilization treatments. Upon leaving the hospital, all patients were given a sheet of exercises to do. Those getting the nerve treatments were shown how to do the techniques on their own. Patients were instructed to keep up with their home program for another six weeks.
Several times over the course of a year, patients were asked about their pain and abilities, and whether they'd gotten back to work or other activities. Using these measures, the authors determined that neural mobilization had no benefit when added to standard care after spinal surgery. The results were not clear on whether nerve mobilization might even be harmful when used after spinal surgery.
The authors conclude that the nerve mobilizations described in their research should not be used on patients in the early weeks after low back surgery. Given these results, the authors insist that further studies of this nature need not be conducted.
Sally V. Scrimshaw, B App Sc Phty, and Christopher G. Maher, PhD. Randomized Control Trial of Neural Mobilization After Spinal Surgery. In Spine. December 15, 2001. Vol. 26. No. 24. Pp. 2647-2652.