Nerve mobilization exercises improve sensory parameters in TTS
MedWire News: Nerve mobilization exercises are an effective adjunct to physiotherapy and supportive inserts for treating patients with tarsal tunnel syndrome (TTS), suggest study findings.
Yasemin Kavlak (Eskisehir Osmangazi University, Turkey) and Fatma Uygur (Hacettepe University, Ankara, Turkey) say the results "imply that putting a controlled amount of stress on the tibial nerve via nerve mobilization exercises have no adverse effects and help in reinforcing sensory parameters… and alleviating the discomforting manifestations of TTS."
In total, 28 patients with TTS were randomly assigned to either conservative treatment with a program consisting of physiotherapy and supportive inserts, or nerve mobilization exercises in addition to conservative treatment exercises.
After 6 weeks follow-up, patients in both the conventional and conventional plus nerve mobilization groups showed significant improvements from baseline values for range of motion (36.14 to 29.07 and 32.00 to 26.64 degrees, respectively), muscle strength (37.68 to 39.22 and 37.73 to 39.66), and pain (53.44 to 37.45 and 55.54 to 28.70 mm).
No significant differences in improvement for any of the assessed parameters were seen between the groups.
Comparison of pre- and post-treatment values for two-point discrimination and light touch revealed significant improvements from baseline only among patients assigned to conventional plus nerve mobilization treatment for medial calcaneal nerve (1.75 to 1.46), medial plantar nerve (1.80 to 1.49), and for light touch of medial calcaneal nerve.
Furthermore, no significant differences in Tinel sign and positive tibial nerve stretch test were seen among patients in the conventional treatment group, although significantly more patients receiving additional nerve mobilization tested positive for both parameters before versus after treatment (100 vs 50% and 71.4 vs 21.4%, respectively).
The authors say that although the addition of nerve mobilization exercises to conventional treatment did not provide additional improvements in range of motion, muscle strength, or pain, the "decrease in Tinel sign and two-point discrimination values implies that sensory parameters may benefit from nerve mobilization."
Writing in the Journal of Manipulative and Physiological Therapeutics, the team concludes: "The recommendation for future research is to conduct larger randomized controlled trials to nerve mobilization exercises for TTS to determine clinical effects."
By Ingrid Grasmo