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.