The Effects of Neurodynamic Mobilization Exercises on Upper Extremity Pain, Muscle Strength, and Functions in Patients With Multiple Sclerosis: a Randomised Controlled, Single Blinded Study

Abstract

Backround: Manual therapy techniques are available for pain management in Multiple Sclerosis (MS); however, the results of neurodynamic mobilization (NM) are not known. The aim of this study was to investigate the effects of NM exercises on pain, muscle strength and upper extremity functions in MS patients. Methods: Patients aged between 18 and 65 years diagnosed with Relapsing Remitting (RR) MS (n = 31) according to McDonald 2010 diagnostic criteria were included in the study. Patients were divided into the NM group (bilateral upper extremity NM and strengthening exercises) (n = 15) and the control group (bilateral strengthening exercises) (n = 16) by simple randomization. Visual Analog Scale (VAS) (most severe and average score) was used to assess pain intensity, and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) questionnaire was used to assess pain character. Muscle strength was evaluated with the digital muscle strength measurement device (Kforce Kinvent), manual skills were evaluated with the Nine Hole Peg Test (NHPT) and Manual Ability Measure-36 (MAM-36). Measurements were obtained from the most affected side, unilateral. Results: The mean of the most severe score of VAS (p < 0.001), the average score of VAS (p < 0.001), and the LANSS in both groups (p < 0.05) decreased significantly. Shoulder flexor muscle strength was increased significantly in both groups (p < 0.05). Shoulder extensors, elbow flexors, and elbow extensors was increased significantly in NM group (p < 0.05). MAM-36 scores was increased significanty in both groups (p < 0.05). NHPT scores showed significant decrease in the NM group (p < 0.05). There was no significant difference between the groups in terms of VAS, LANSS, muscle strength, MAM-36 and NHPT (p > 0.05). Conclusion: It was found that NM exercises added to upper extremity strengthening therapy in patients with MS reduced pain, increased muscle strength of shoulder extensors, elbow flexors, and elbow extensors, and improved manual dexterity. However, although positive effects were observed when NM exercises were added to the strengthening exercises, the results were found to be similar in these groups. © 2024 Elsevier B.V.