PATHOMECHANICS OF THE TIBIAL NERVE IN ASSOCIATION WITH LUMBAR RADICULOPATHY

Cinnamond, Sally (2024) PATHOMECHANICS OF THE TIBIAL NERVE IN ASSOCIATION WITH LUMBAR RADICULOPATHY. Doctoral thesis, Plymouth Marjon University.

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Abstract

Dysfunctional neural pathomechanics are thought to be an underlying feature of numerous spinal pathologies and peripheral nerve disorders, and have been shown to have a direct effect on patient pain and functional ability levels. In particular, a reduction in the ability of a peripheral nerve to slide and glide is associated with increased pain and disability and often occurs with lumbar disc herniation due to compression of the nerve root in the intervertebral canal. Consequently, tibial nerve pathomechanics are an essential consideration with respect to lumbar radiculopathy, however, this association has not been widely investigated. In particular, there is limited research involving neural pathomechanics in symptomatic patients who have been diagnosed with intervertebral disc disease. The research studies undertaken for this PhD all involved symptomatic patients with intervertebral disc disease, some who had undergone lumbar decompression surgery and others who had not received any surgical intervention. However, all participants had a confirmed diagnosis of lumbar spinal pathology. To my knowledge, each of the five studies undertaken for this PhD are all innovative studies involving the investigation of tibial nerve pathomechanics in symptomatic patients. The first aim of this thesis was to assess tibial nerve mobility in patients following lumbar decompression surgery, to determine if there was a relationship between nerve excursion and the development of Failed Back Surgery Syndrome (FBSS). A novel method of assessing and measuring tibial nerve excursion via diagnostic ultrasound at the popliteal fossa behind the knee had previously been developed and validated by our research group and this method was utilised throughout the research studies. The first three studies all involved patients who had previously undergone lumbar decompression and subsequently developed FBSS, with the first study identifying that FBSS was associated with decreased tibial nerve mobility. The second study investigated the effect of a nerve mobilisation exercise on nerve mobility in post-lumbar surgical patients who were suffering from FBSS. This study identified that a single session of a nerve mobilisation exercise could improve tibial nerve mobility and reduce tibial nerve mechanosensitivity as determined by a straight leg raise (SLR) test. The third study aimed to determine the strength of correlation between both the leg pain experienced by patients post-lumbar decompression surgery and the patient-reported global rate of change scale (GRCS) with specific biomechanical and clinical variables; lumbar flexion, hip flexion, nerve excursion (painful leg), straight leg raise angle (painful leg) and back pain (VAS). This study identified that there was a strong correlation between tibial nerve movement and lumbar flexion with both leg pain and GRCS, with hip flexion and back pain also significantly associated with post-surgical leg pain and GRCS. This has clear clinical implications for the management of patients following lumbar decompression surgery as the identified variables are all potentially modifiable by clinical interventions. The final two studies involved patients who had not undergone any lumbar surgery but whom all had a diagnosis of a single-level lumbar disc herniation and were all experiencing leg pain associated with the disc herniation. These studies aimed to investigate the potential effects of lumbar traction on leg pain and/or tibial nerve mobility. Study four investigated tibial nerve mobility during traction, measured at 5 minutes and then 30 minutes during continuous mechanical lumbar traction, and observed significantly increased tibial nerve excursion during traction in patients with a recently confirmed diagnosis of a lumbar disc herniation. These results suggested that traction could be a beneficial intervention with regard to improving tibial nerve mobility in symptomatic lumbar disc herniation patients that have not undergone surgery. These results led to the development of study five which consisted of a viability study to investigate the effects of a course of eight sessions of sustained, mechanical lumbar traction, with and without a nerve mobilisation exercise, on nerve mobility, leg pain, back pain, SLR angle, Oswestry Disability Index (a back and/or leg pain specific disability score) and the global rate of change scale (GRCS) in patients with a recently confirmed single-level lumbar disc herniation in patients aged 18-60 years inclusive. Study five identified that both treatment groups; traction and traction with a nerve mobilisation exercise, resulted in a significant increase in nerve mobility in patients with a confirmed diagnosis of a single-level lumbar disc herniation. In addition, leg and back pain levels were significantly reduced following treatment in both groups, SLR angle and GRCS significantly improved and ODI score significantly decreased in both traction treatment groups. However, there was no difference in outcomes between the two treatment groups which suggested that traction alone can improve symptoms in people with a herniated lumbar disc and it is not necessary to perform a nerve mobilisation exercise during the traction. All five studies in this thesis present innovative research that, to my knowledge, has not been previously investigated or reported. The findings of the five studies are relevant to clinical practice and also to the design of future research trials to further investigate the effect of sustained mechanical traction on people with a confirmed diagnosis of a lumbar disc herniation.

Item Type:	Thesis (Doctoral)
Depositing User:	Ms Raisa Burton
Date Deposited:	27 Feb 2025 09:46
Last Modified:	27 Feb 2025 09:46
URI:	https://marjon.repository.guildhe.ac.uk/id/eprint/17949

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