Neurodynamic exercises provide no additional benefit to extension-oriented exercises in people with chronic low back-related leg pain and a directional preference: A randomized clinical trial

Background: Chronic low back-related leg pain may involve mixed pain mechanisms. A strategy to address both neuropathic and nociceptive pain symptoms would be combining treatments. Objective: To assess the effects of adding neurodynamic exercises to extension-oriented exercises in patients with chronic low back-related leg pain and a directional preference. Design: Two arm, single blind, randomized clinical trial. Method: Eligible participants were aged between 18 and 65 years, had low back pain radiating below gluteus for at least 3 months, pain intensity greater than 3 points in the numerical pain rating scale, positive SLR test and a directional preference for lumbar extension movements. Thirty-one participants were randomly allocated into one of two groups: extension-oriented exercises (EE) or extension exercises plus neurodynamic exercises (EEN). Primary outcomes were leg pain intensity and function at 3 weeks. Secondary outcomes were low back pain intensity, disability, global perceived effect and quality of life at 3 weeks and at 1 month. Results: Retention rate was 100% (n = 14) in EE and 94% (n = 16) in EEN for primary outcome analysis. There was no between-group difference for the primary outcomes and for low back pain intensity, GPE and quality of life at 3 weeks. For some outcomes, EE was superior to EEN. Conclusions: We found no benefits in adding neurodynamic exercises to extension-oriented exercises for patients with nerve-related leg pain and a directional preference. As this study has a small and very specific sample, results may be interpreted with caution.