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Neurodynamic Exercises in College Athletes With Musculoskeletal Pain: A Critically Appraised Topic.

CLINICAL SCENARIO
Pain is a common complaint following an orthopedic injury; however, the exact cause of nociception can be complex. Multiple tissues can generate a patient's complaint of pain, such as the skin, muscle, ligaments, tendon, nerves, and bones. Regarding the somatosensory system, inflammation around the nerve can create pain and alter movement coordination; this information has resulted in increased awareness of neurodynamic assessments and exercises. Neurodynamic assessments and exercises provide a unique paradigm to effectively assess and treat neural tissue, which may not commonly be considered within the traditional orthopedic examination.


CLINICAL QUESTION
In college athletes with musculoskeletal pain and activity impairments, does the use of neurodynamic exercises improve pain or function?


SUMMARY OF KEY FINDINGS
Of the 5 studies, all consisted of chronic injuries with 3 involving upper-extremity pathologies and 2 focusing on lower-extremity pathologies. All 5 studies noted short- and long-term improvement following the incorporation of neurodynamic sliders or tensioners into the treatment plan. Four of the studies had follow-up periods greater than 30 days with sustained improvement on patient outcomes. Only 2 studies described a progression of neurodynamic exercises through sliders and tensioners. Three studies utilized a set/repetition format for exercise prescription, whereas a fourth used a time-based format, and a fifth article utilized both. Finally, 4 studies utilized neurodynamic assessments to identify whether there was a neural component to the patient's presentation (eg, peripheral nerve mechanosensitivity).


CLINICAL BOTTOM LINE
In individuals with musculoskeletal impairments, evidence exists to support the use of neurodynamic exercises, such as sliders and tensioners, to improve pain and pain-related disability when neural sensitivity exists.


STRENGTH OF RECOMMENDATION
Grade C evidence exists to support the use of neurodynamic exercises in college athletes with a musculoskeletal impairment.