The efficacy of an integrated neuromuscular inhibition technique on upper trapezius trigger points in subjects with non-specific neck pain: a randomized controlled trial

Currently, large levels of practice variability exist regarding the clinical deactivation of trigger points. Manual physical therapy has been identified as a potential means of resolving active trigger points; however, to date the ideal treatment approach has yet to be elucidated. The purpose of this clinical trial was to compare the effects of two manual treatment regimens on individuals with upper trapezius trigger points. Sixty patients, 19–38 years of age with non-specific neck pain and upper trapezius trigger points, were randomized into one of two, 4 week physical therapy programs. One group received muscle energy techniques while the second group received an integrated neuromuscular inhibition technique (INIT) consisting of muscle energy techniques, ischemic compression, and strain–counterstrain (SCS). Outcomes including a visual analog pain scale (VAS), the neck disability index (NDI), and lateral cervical flexion range of motion (ROM) were collected at baseline, 2 and 4 weeks after the initiation of therapy. Results revealed large pre–post-effect sizes within the INIT group (Cohen’s d  =  0.97, 0.94 and 0.97). Additionally, significantly greater improvements in pain and neck disability and lateral cervical flexion ROM were detected in favor of the INIT group (0.29–0.57, 0.57–1.12 and 0.29–0.57) at a 95% CI respectively. The findings of this study indicate the potential benefit of an integrated approach in deactivating upper trapezius trigger points. Further research should be performed to investigate the long-term benefits of the current treatment approach.     

Chronic neck pain and muscle activation characteristics of the shoulder complex

IntroductionNeck pain is a very common musculoskeletal complaint in industrialized countries. Theoretically, chronic neck pain is thought to possibly change biomechanics and muscle activation patterns of the shoulder complex, causing its pain and dysfunction in the long term.PurposeThe present cross-sectional study was conducted to compare shoulder complex muscle activation characteristics in patients with chronic non-specific neck pain, compared to healthy participants.MethodTwenty patients with chronic neck pain and twenty healthy participants were recruited for the present study. Surface Electromyographic (sEMG) activity was recorded from four selected muscles (anterior and middle deltoid, upper and lower trapezius) during shoulder elevation with a predetermined load (25–30% of an individual's maximum voluntary exertion).ResultResults revealed only two significant increased onset delays in the anterior and middle deltoid,and a peak delay in the upper trapezius in chronic neck pain patients. Furthermore, increased onset delay for other muscles and decreased peak normalized amplitude (MVE%) for all muscles were found in chronic neck pain patients; however, these findings were not statistically significant.ConclusionThere were relationships between chronic non-specific neck pain and the shoulder muscle activation characteristic; hence, the alteration may be considered a predisposing factor for the shoulder dysfunction in future studies.     

Effect of muscle energy technique and static stretching on pain and functional disability in patients with mechanical neck pain: A randomized controlled trial

BackgroundMechanical neck pain is one of the common musculoskeletal disorders. Muscle energy technique (MET) may be a useful intervention for treating such disorder.ObjectiveThe aim of this study was to compare the effect of MET with passive stretching on pain and functional disability in people with mechanical neck pain.MethodsA randomized controlled trial was undertaken. Sixty patients with mechanical neck pain were randomly allocated to either the MET group or control group. The former group received MET, and the latter group received static stretching. Both groups received conventional therapy. Treatment was given once a day for 6 days. A visual analogue scale (VAS) was used to measure the intensity of pain, and functional disability was assessed using the neck disability index (NDI) was immediately before treatment and again on the 6^th day.ResultsVAS and NDI scores showed a significant improvement in both MET and stretching groups on the 6^th day postintervention (p < 0.05). However, both VAS and NDI scores showed better improvement in the MET group as compared to the stretching group (p < 0.025).ConclusionMuscle energy technique was better than stretching technique in improving pain and functional disability in people with mechanical neck pain.     

The study of respiratory muscles activation during respiratory muscle strength effort in adult females with chronic neck pain

[Purpose] This study aimed to compare maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP) values and muscle activity during MIP and MEP between chronic neck pain and healthy participants. [Participants and Methods] Twenty chronic neck pain and 20 non-symptomatic females participated in this study. Maximal airway pressure (MIP and MEP) and surface electromyography (sEMG) for both sides of the upper trapezius, anterior scalene, pectoralis major and 6th intercostal muscles were recorded simultaneously. [Results] Significant differences of MIP and MEP values were found between the groups. The muscle activities of both sides of upper trapezius and 6th intercostal muscles during MEP were significantly higher in the chronic neck pain group than the healthy group except both sides of anterior scalene and pectoralis major muscles. During MIP, the activities of upper trapezius, 6th intercostal muscles and anterior scalene were significantly different between the two studied groups. Higher activity of left pectoralis major was found in the chronic neck pain group. [Conclusion] Decreasing values of MEP and MIP as well as muscles activities elevation in chronic neck pain participants were clearly demonstrated. Besides the musculoskeletal treatment, we suggest breathing exercise training to be considered in treatment programs.     

Effect of adding stretching to standardized procedures on cervical range of motion,pain, and disability in patients with non-specific mechanical neck pain: A randomized clinical trial

Objectiveto investigate the benefit of adding stretching exercises to cervical joint mobilization and active rotation exercises for patients with non-specific mechanical neck pain.MethodsThirty-eight subjects with non-specific mechanical neck pain were randomly assigned to a standard procedure group (passive cervical mobilization and active cervical rotation range of motion exercise) or a combined procedure (passive cervical mobilization, active cervical rotation range of motion exercises, and stretching procedures). Mixed factorial analysis of variance was used to compare changes between groups over time in active cervical range of motion, Numeric Pain Rating Scale, Neck Disability Index, Global Rating of Change, and Pressure Pain Threshold.ResultsThere was a significant change in mean active range of motion in all directions, Pressure Pain Threshold, perceived pain, disability levels, and global rating of change over time (p < 0.001). There was a significant group by time interaction in mean active range of motion during extension (p = 0.01), right rotation (p = 0.004), right and left lateral flexion (p = 0.05, and p = 0.02 respectively). However, there was no significant group by time interaction in mean active range of motion during flexion, left rotation, pain intensity (p = 0.09), right and left pressure pain threshold (p = 0.30, 0.47, respectively), and disability (p = 0.07).ConclusionsBoth study groups improved significantly in all subjective and objective outcome measures. However, data from this study suggest that adding stretching to the standard procedures may be more effective than the standard procedure alone at improving cervical extension, right rotation, and lateral flexion active range of motion, but not pain and disability.     

Immediate effects of thoracic spine self-mobilization in patients with mechanical neck pain: A randomized controlled trial

ObjectivesTo investigate the immediate effects of thoracic spine self-mobilization in patients with mechanical neck pain.Study designRandomized, controlled trial.BackgroundThoracic spine self-mobilization is performed after thoracic spine thrust manipulation to augment and maintain its effects. To the best of our knowledge, no study has investigated the effects of thoracic spine self-mobilization alone in individuals with mechanical neck pain. The purpose of this randomized, controlled trial was to evaluate the immediate effects of thoracic spine self-mobilization alone without any other intervention on disability, pain, and cervical range of motion in patients with mechanical neck pain.MethodsFifty-two patients (39 females and 13 males) with mechanical neck pain were randomly allocated to either a thoracic spine self-mobilization group that was performing a thoracic spine active flexion and extension activity using two tennis balls fixed by athletic tape or a placebo thoracic spine self-mobilization group. Outcome measures were collected at pre-intervention and immediately after intervention, including the Neck Disability Index, visual analogue scale, and active cervical range of motion (ROM). The immediate effect of the intervention was analyzed using two-way repeated measures analysis of variance (ANOVA). If interactions were found, a simple main effect test was performed to compare the pre-post intra-group results.ResultsThe results of two-way repeated measures ANOVA indicated that the main effect of time was significant (p < 0.05) for all measurement outcomes. The main effect of group was not significant for all measurement outcomes (p > 0.05). The group × time interactions for cervical flexion active ROM (p = 0.005) and cervical extension active ROM (p = 0.036) were significant. The tests of simple main effect in cervical flexion active ROM (p < 0.0001) and cervical extension active ROM (p < 0.0001) showed a significant difference before and after intervention in the thoracic spine self-mobilization group.ConclusionPatients with mechanical neck pain who carried out thoracic spine self-mobilization showed increases in active cervical flexion and extension ROM.     

Reduction of cervical and respiratory muscle strength in patients with chronic nonspecific neck pain and having moderate to severe disability

Purpose: To investigate whether patients with chronic nonspecific neck pain and having moderate to severe disability have a greater cervical motor function impairment and respiratory disturbances compared with patients with chronic nonspecific neck pain having mild disability and asymptomatic subjects; and the association between these outcomes in patients with chronic nonspecific neck pain and healthy controls.

Methods: Cross-sectional study, 44 patients with chronic nonspecific neck pain and 31 healthy subjects participated. The neck disability index was used to divide the patients into 2 groups: 1) mild disability group (scores between 5 and 14 points); and 2) moderate to severe disability group (scores?>14 points). Cervical motor function was measured by cervical range of motion, forward head posture, neck flexor, and extensor muscle strength. Respiratory function and maximum respiratory pressures were also measured.

Results: Statistically differences were found between the patients with chronic nonspecific neck pain having a moderate to severe disability and the asymptomatic subjects for cervical and respiratory muscle strength. Comparisons between chronic nonspecific neck pain and the asymptomatic groups showed differences for all the variables, except for forward head posture. The regression model determined that strength of cervical flexion explained 36.4 and 45.6% of the variance of maximum inspiratory pressures and maximum expiratory pressures, respectively.

Conclusions: Only the chronic nonspecific neck pain group with moderate to severe disability showed differences compared with the healthy subjects. Neck muscle strength could be a good predictor of respiratory muscle function.

• Implications for rehabilitation

• Neck pain severity could be closely associated with decreased respiratory pressure in patients with chronic nonspecific neck pain.

• These findings suggest a new therapeutic approach for patients with moderate to severe disability, such as respiratory muscle training.

• The regression models show that a simple measurement of neck muscle strength could provide a reasonably accurate prediction for the respiratory function of these patients. Hence, this could provide an easy tool to assess respiratory function to physiotherapists without the need for sophisticated instrumentation.

     

The effects of pain neuroscience education and exercise on pain,muscle endurance,catastrophizing and anxiety in adolescents with chronic idiopathic neck pain: a school-based pilot,randomized and controlled study

Purpose: To compare the effectiveness of pain neuroscience education (PNE) and neck/shoulder exercises with no intervention in adolescents with chronic idiopathic neck pain (CINP). Methods: Forty-three adolescents with CINP were randomly allocated to receive PNE and shoulder/neck exercises (n = 21) or no intervention (n = 22). Data on pain intensity, neck flexor and extensor muscles endurance, scapular stabilizers endurance, pain catastrophizing, anxiety, and knowledge of pain neurophysiology were collected. Measurements were taken before and after the intervention. Results: All participants completed the study. Analysis using ANCOVA revealed a significant increase in the neck extensors endurance capacity (adjusted mean ± SE change = + 47.5 ± 13.5 s versus +14.2 ± 13.1 s) and knowledge of pain neurophysiology (adjusted mean ± SE change = + 9.8 ± 3.2 versus ?0.6 ± 0.6) in the group receiving the intervention. A higher mean decrease in pain intensity, pain catastrophizing and anxiety and a higher mean increase in the scapular stabilizers endurance capacity were also found in the intervention group, but differences did not reach statistical significance. Conclusions: Results suggest a potential benefit of PNE and exercise for adolescents with CINP. Further studies with larger sample sizes are needed.     

Stabilization exercises combined with neuromuscular electrical stimulation for patients with chronic low back pain: a randomized controlled trial

BackgroundOne proposed mechanism of chronic low back pain might be paraspinal muscle impairment. Commonly, this impairment is treated with stabilization exercises. However, the effect size of stabilization exercises has been previously reported to be small.DesignRandomized controlled trial.ObjectiveTo investigate the clinical benefit of using neuromuscular electrical stimulation as a supplement to stabilization exercises in patients with chronic low back pain.MethodsThirty participants with chronic low back pain were randomized into a stabilization exercise only group (n = 15) or a stabilization exercise plus neuromuscular electrical stimulation group (n = 15). The stabilization exercises included abdominal, side support, and quadruped exercises. The neuromuscular electrical stimulation was applied to the lumbar paraspinal muscles for 20 min each session. Both groups received their respective interventions twice a week for 6 weeks. Participant eligibility for inclusion was age between 18 and 60 years, body mass index ≤34, chronic low back pain ≥3 months, Numeric Pain Rating Scale ≥3, Modified Oswestry Disability Questionnaire score ≥20 and ability to understand English. Outcome measurements were self-reported neuromuscular electrical stimulation tolerability scale, Modified Oswestry Disability Questionnaire, Numeric Pain Rating Scale, Fear-Avoidance Beliefs Questionnaire and paraspinal muscle strength.ResultsThe neuromuscular electrical stimulation was reported to be tolerable. There were no significant between-group differences on any of the outcome measures (p > 0.05).ConclusionsThe application of neuromuscular electrical stimulation on the paraspinal muscles was reported to be tolerable. Supplementing stabilization exercises with neuromuscular electrical stimulation did not offer any additional clinical benefit for the chronic low back pain patients.     

Management of acute neck pain: A case series describing immediate and short term clinical outcomes following use of the Multifidus Isometric Technique

BackgroundAcute facet capsular entrapment results in sudden onset of pain and reduced ability to perform active cervical motions. The Multifidus Isometric Technique (MIT) is a type of manual therapy intervention theorized to target the entrapped facet capsule and pull the entrapped synovial folds from the facet joint resulting in decreased pain and increased function.PurposeTo describe immediate MIT clinical outcomes for patients with acute neck pain.MethodsConsecutive patients (n = 30; 70% female) with sudden onset of neck pain received MIT within 48 hours of symptom onset. Clinical outcome measures included: 1) 11-point Numeric Pain Rating Scale (NPRS); 2) cervical AROM, and 3) the Neck Disability Index (NDI). Paired-sample t-testing was used to assess for within and between-session changes in outcome measure scores.ResultsWithin-session NPRS improvements were observed during all cervical AROM movements (p < .01), with initial treatment associated with greater improvements on average (M = 2.4 ± 1.6 points) compared to the second treatment (M = 0.6 ± 0.9 points). Similarly, most within-session AROM measures improved during both sessions (p < .01) with greater average improvements observed following the initial treatment session and for cervical rotation to the symptomatic side (M = 26.5 ± 9.6 vs. 8.0 ± 9.7°). Between-session NDI scores improved (M = 15.3 ± 9.8, p < .01) with approximately 60% of patients achieving a minimally clinically important difference of 14 percentage points.DiscussionThe MIT is a potentially beneficial intervention for patients with acute neck pain. Future studies consisting of longer follow-up time points and comparison treatment groups are needed to test MIT effectiveness.     

Effects of lumbosacral orthosis on dynamical structure of center of pressure fluctuations in patients with non-specific chronic low back pain: A randomized controlled trial

BackgroundA few clinical trials have examined the effect of treatment interventions on postural control in patients with chronic low back pain, all of which have exclusively evaluated postural stability using traditional linear measures of postural sway. However, postural control improvement cannot be determined by exclusively relying on linear measurements, because these parameters provide no information on underlying motor control mechanisms.ObjectiveThis study aimed to compare the effect of using lumbosacral orthoses (LSO) together with routine physical therapy, compared to routine physical therapy alone on postural control, using nonlinear analysis techniques.MethodsForty-four patients with low back pain were randomly allocated to the intervention and control groups. Both groups underwent 8 sessions of physical therapy twice weekly for 4 weeks. The intervention group received LSO in addition to routine physical therapy. Before and after the intervention, non-linear dynamical features of center of pressure fluctuations were assessed during quiet standing at 3 difficulty levels of postural tasks, including eyes open while standing on a rigid surface, eyes closed while standing on a rigid surface, and eyes closed while standing on a foam surface.ResultsThe results of this study showed that a 4-week intervention consisting of LSO and routine physical therapy modalities did not affect the temporal structure of postural sways in patients with low back pain.ConclusionTreatment strategies, such as routine physical therapy modalities or LSO, which exclusively focus on the correction of peripheral mechanics, fail to affect the behavior of the postural control system.     

Effects of myofascial trigger point dry cupping on pain and function in patients with plantar heel pain: A randomized controlled trial

ObjectiveTo investigate the effects of dry cupping on calf muscle myofascial trigger points (MTrPs) on pain and function in patients with plantar heel pain.MethodsSeventy-one patients were randomly divided into an intervention group or control group. Both groups performed stretching exercises for the calf muscle and plantar fascia and ankle dorsiflexion exercises. The intervention group also received dry cupping. The primary outcome measures were visual analogue scale (VAS), pressure pain threshold (PPT), and patient-specific functional scale (PSFS). The secondary outcomes were ankle dorsiflexion range of motion (ROM) and ankle plantar flexor strength. These measurements were performed at baseline, immediately after intervention, and after 2 days.ResultsCurrent VAS significantly decreased immediately in the intervention group (p = 0.002), but not in the control group (p ≥ 0.220). Morning VAS decreased significantly in both groups (p < 0.001) after 2 days, but decreased more in the intervention group (p = 0.006). Trigger point PPT significantly improved immediately in the intervention group (p = 0.003), but not in the control group (p = 0.112). Both groups improved significantly in PSFS (p < 0.001) and ankle dorsiflexion ROM (p < 0.001). Plantar flexor strength significantly increased immediately in the intervention group (p < 0.001), but not in the control group (p = 0.556).ConclusionAdding dry cupping on calf MTrPs to self-stretching and ankle dorsiflexion exercises for patients with plantar heel pain was superior to only self-stretching and active ankle dorsiflexion exercises in pain, ankle dorsiflexion ROM, and plantar flexor strength.     

Effects of Kinesio Taping on postural balance in patients with low back pain,a randomized controlled trial

Purpose: to identify postural balance changes in subjects with low back pain after the application of Kinesio Taping, which is then compared to a no treatment control group, using baropodometric evaluation. Methods: This randomized controlled trial was carried out on 50 individuals (both sexes) with chronic low back pain. They were then randomized into two groups: an experimental group - EG (treated with Kinesio Taping in the lumbar region) and a control group - CG (no intervention). Both groups underwent a baropodometric evaluation (mean plantar pressure, peak plantar pressure, plantar surface, mass distribution on right foot and left foot, mass distribution on forefoot and rear foot and base width) at four different moments: pre-intervention, 10 minutes, 48 hours, and 10 days after the intervention on the EG. The level of statistical significance was established at 5%. Results: Significant changes were observed in the EG compared to the CG. In the EG, peak pressure reduced on both right and left foot after Kinesio Taping application; the right base width was reduced, and the mass distribution between the forefoot and the rear foot normalized towards the ideal 50% distribution. These changes happened 48 hours after the Kinesio Taping application, with effects lasting up to 10 days. Conclusion: The use of Kinesio Taping in the lumbar region of subjects with chronic low back pain improved postural balance. This is proved by changes in peak plantar pressure, plantar surface, and mass distribution 48 h after Kinesio Taping application, with effects lasting up to 10 days.     

Development and proof of concept of a blended physiotherapeutic intervention for patients with non-specific low back pain

ObjectiveTo develop a blended physiotherapeutic intervention for patients with non-specific low back pain (e-Exercise LBP) and evaluate its proof of concept.DesignFocus groups with patients, physiotherapists, and eHealth and LBP experts were conducted to investigate values according to the development of e-Exercise LBP. Proof of concept was evaluated in a multicentre study.SettingDutch primary care physiotherapy practices (n = 21 therapists).ParticipantsAdults with non-specific LBP (n = 41).Interventione-Exercise LBP was developed based on clinical LBP guidelines and the focus groups, using the Center for eHealth Research Roadmap. Face-to-face physiotherapy sessions were integrated with a web application consisting of 12 information lessons, video-supported exercises and a physical activity module with the option to gradually increase individuals’ level of physical activity. The intervention could be tailored to patients’ risk of persistent disabling LBP, according to the STarT Back Screening Tool.Main outcome measuresFunctional disability, pain, physical activity, sedentary behaviour and fear-avoidance beliefs, measured at baseline and 12 weeks.ResultsAfter 12 weeks, improvements were found in functional disability [Quebec Back Pain Disability Scale: mean difference (MD) ?12.2/100; 95% confidence interval (CI) 8.3 to 16.1], pain (Numeric Pain Rating Scale: MD ?2.8/10; 95% CI 2.1 to 3.6), subjective physical activity (Short Questionnaire to Assess Health Enhancing Physical Activity: MD 11.5 minutes/day; 95% CI ?47.8 to 24.8) and objective sedentary behaviour (ActiGraph: MD ?23.0 minutes/day; 95% CI ?8.9 to 55.0). Small improvements were found in objective physical activity and fear-avoidance beliefs. The option to gradually increase physical activity was activated for six patients (15%). On average, patients received seven face-to-face sessions alongside the web application.ConclusionsThe results of this study provide the first indication of the effectiveness of e-Exercise LBP, particularly for disability and pain among patients with LBP. Future studies will focus on end-user experiences and (cost-) effectiveness.     

Effects of different strength training volumes and subsequent detraining on strength performance in aging adults

The purpose of the present study was to investigate the volume-dependence of upper-body strength performance improvement and the retention effects after detraining in aging adults. Eighteen healthy, untrained, middle-aged volunteers were randomized into two groups: low volume (LV), mean = 494 kg. and high volume (HV), mean = 686 kg. load. Participants were tested and retested before a 12-week (2 times/week) period of RT for baseline values (pre-); after 6 weeks (middle) and 12 weeks of training (post-), and 12 weeks after interruption (detraining – no systematic exercise). On each test day, a five-repetition maximum (5-RM) for the seated row; handgrip strength test (HGS); and local muscular endurance for elbow flexors (LME) were carried out. Participants performed seated row training 2 times per week with a rest interval of at least 48 h between sessions. After 24 sessions of RT (resistance training), LME significantly increased in both groups (p < 0.05), without differences between groups (14 vs. 18%, for LV and HV, respectively). In addition, 5-RM increased in both the LV (22%) and HV (20%) groups. There were no significant increases in HGS in either group (LV 3% and HV 6%). After detraining, both groups lost up to 15% of LME and 5-RM. In untrained, middle-aged adults, there is an increase in maximal dynamic strength and local muscular endurance, independent of volume chosen. Furthermore, after 12 weeks detraining, the loss does not decrease to baseline values.     

The prevalence of primary dysmenorrhea among students and its association with musculoskeletal and myofascial pain

ObjectivesTo examine the association between dysmenorrhea and musculoskeletal pain amongst university students aged 20–35 and the association between dysmenorrhea and the occurrence of MTrPs.MethodsThe study comprised two stages: a cross-sectional study evaluated the association between dysmenorrhea and musculoskeletal pain and a case-control study evaluated the association between dysmenorrhea and the occurrence of MTrPs in the abdominal and pelvic area. Initially, questionnaires such as demographics, menstruation characteristics, Numeric Pain Rating Scale (NPRS), measuring the average pain during menstruation and Nordic, were distributed to female students. Twenty subjects who suffered from menstrual pain of >3 on the NPRS (ones with the highest scores) were included in the second stage as cases. An additional 20 who had not suffered from menstrual pain (NPRS ≤3) were considered controls. All 40 subjects underwent an assessment of MTrPs by two examiners blinded to each other's results and to the group allocation of the subjects.ResultsWe found that dysmenorrhea is a very prevalent condition among young female students. Most frequent complaints were: lower abdomen and back pain, tiredness, breast tenderness, mood changes, and an increased appetite. Pain during menstruation indicated a significant positive association with neck, low back, and hip/thigh pain during the last 12 months. The results of the palpitation conclusively showed more active MTrPs in the rectus abdominis, quadratus lumborum and paraspinal muscles in women suffering from pain during menstruation than in those who were not in pain.ConclusionOur data provide an initial basis for the inclusion of a myofascial examination when evaluating women with dysmenorrhea.     

The effects of dry needling and neurodynamic exercise on idiopathic peripheral neuropathy: A case report

A single patient (male, 67) with a medical diagnosis of idiopathic peripheral neuropathy (G60.9) was referred to physical therapy. The patient presented with signs and symptoms consistent with peripheral neuropathy, including bilateral single leg balance deficits, sensation impairments, and antalgic gait. Treatment consisted of dry needling (DN) with electrical stimulation and a home exercise program involving a neurodynamic exercise to be performed daily. Dry needling included the use of thin filiform needles to stimulate the underlying structures directed at eliciting a change within the tissues. The needles were left in situ and connected to an electrical stimulation unit. The neurodynamic exercise used in this case study was designed to target the distal branches of the sciatic nerve. The patient was directed to complete 3 sets of 10 repetitions in the slumped position and moving between ankle plantar flexion and dorsiflexion. The patient was treated for a total of 4 visits over a 5-week period. The Foot and Ankle Ability Measure (FAAM), Numeric Pain Rating Scale (NPRS), Romberg Test, and sensation testing were collected at baseline and then again after the 4th treatment. A Global Rating of Change (GROC) score was obtained at the end of treatment. After the 4th visit, functional self-report scores were not improved (93.75%–86.9% at completion), while NPRS decreased to 2 from a baseline rating of 4. The eyes closed portion of the Rhomberg balance test improved from 5 s on the right limb to 15 s and from 8 s to 20 s on the left limb. Sharp/dull sensation testing of the L4 dermatome also improved from 2 out of 5 correctly selected on the left lower limb to 5 out of 5. At the S1 level, sensation improved on the left lower limb from 2 out of 5 to 4 out of 5 and from 2 out of 5 on the right lower limb to 5 out of 5. The patient's GROC score was rated as quite a bit better (+5). The outcomes of this case study suggest that clinicians may consider the addition of DN with electrical stimulation and neurodynamic exercises to the treatment of this patient population given the sizeable and rapid improvements in pain, balance, and sensation testing following only 4 treatments.