Treatment of chronic radiculopathy of the first sacral nerve root using neuromobilization techniques: A case study.

BACKGROUND AND OBJECTIVES: The engagement of the first sacral nerve root is one of the most common etiologies in Sciatic Pain Syndrome (SPS). Different interfering methods are used in the physical therapy of people with SPS including physical modalities, exercise therapy, traction, and joint and neuromobilization, depending on the symptoms and radiculopathy phase. The present case study attempts to describe neuromobilization methods in treating chronic radiculopathy of the first sacral nerve root, as well as its abnormal neurodynamic responses.

THE CASE: The patient was a 36-year-old man with lower back pain during construction work 9 months before, and presenting with complaint of burning pain and tingling in his left Posterior part of the thigh and leg. Active extension, rotation, and lateral flexion of the trunk in standing position had a complete range with no pain. SLR and Slump neurodynamic tests revealed that with increasing sensitive elements, there appeared to be abnormal sciatic nerve tension, and complaint due to returning burn and tingling in the posterior part of the thigh and leg. MRI findings revealed intervertebral disc dehydrations at L3-4, L4-5, and L5-S1 levels, as well as postero-lateral protrusion in L5-S1 intervertebral disc. Following three routine physical therapy sessions, with no improvement, neuromobilization technique was used for 6 sessions.

RESULTS: The usual routine physical therapy methods did have any visible impact in solving the patient's problems during daily-life activities and physical diagnosis findings, yet, following neuromobilization technique, the assessment at the beginning of the eleventh session and the patient's follow-ups two months later showed that his problems during daily-life activities and in neurodynamic tests were totally solved.

DISCUSSION AND CONCLUSION: Abnormal neurodynamic responses and consequently symptoms in patients with chronic radiculopathy may be due to a pathomechanic problem and deficiency in neural adjustment for movement and tension transfer. Neuromobilization techniques can increasingly useful in treatment of abnormal neural tensions and removing chronic radiculopathy symptoms.