Effectiveness of Neural Mobilisation on Pain Intensity, Functional Status, and Physical Performance in Adults with Musculoskeletal Pain - A Systematic Review with Meta-Analysis.

Most included studies were rated high or critical risk of bias, and all effect estimates carry very low certainty. Many studies used multimodal interventions, so the specific contribution of neural mobilisation cannot be separated from the other treatments given alongside it. High methodological heterogeneity across trials (different comparison groups, patient characteristics, and intervention doses) limits how far the results can be generalised. For most musculoskeletal conditions other than low back and neck pain, there were too few studies to perform a meta-analysis, and the single-study results come from trials at high or critical risk of bias. Many studies did not describe the neural mobilisation technique, dose, or frequency in sufficient detail to compare across trials. Only three studies in the low back pain meta-analysis used sliding techniques, so the sliding-versus-tensioning subgroup comparison is underpowered. No included study reported data on neural morphological or neurophysiological changes, so the mechanism of any effect remains untested.

The authors declared no conflicts of interest. The work was supported by the Portuguese national research funding body (FCT) through the RISE Health Research Network.

Do not read the large effect sizes for low back pain as proof that neural mobilisation works on its own. The certainty is very low, most included studies had serious methodological problems, and the effect appeared only when neural mobilisation was bundled with other treatments, so its specific contribution cannot be separated from the rest of the package.