Mobilization of the neurodynamic system using proprioceptive neuromuscular facilitation decreases pain and increases mobility in lower extremities and Spine-A case report.

INTRODUCTION: Different approaches are used in physical therapy when treating patients with peripheral nerve paralysis and pain syndrome, such as neuro-mobilization techniques, manual therapy, muscle strengthening, active mobilization and relaxation techniques. Proprioceptive neuromuscular facilitation (PNF) seems to be a promising therapy for mobilizing the neurodynamic system. This case report illustrates the clinical reasoning and feasibility of applying PNF based neuromobilization to a patient not responsive to standard physical therapy.

CASE DESCRIPTION: A 66-year-old male was diagnosed with neurofibrosarcoma grade II, paravertebral L4-L5 left (L) side. After laminectomy of the transverse process L4 and L5 L side and stent in the lumbar region, the patient presented pain and peripheral nerve paralysis. The patient's complaints 13 years later were chronic lower back, buttock and leg pain and weakness in the L leg.

PATIENT MANAGEMENT: Six treatment sessions with follow-up were provided during 3.5 months. The PNF-based-rehabilitation-approach applied the PNF philosophy, specific techniques, and facilitating principles and procedures using manual guidance in 3-dimensional PNF movement patterns in various positions, aiming to mobilize the neurodynamic system to decrease pain and achieve trunk and leg mobility.

DISCUSSION AND CONCLUSION: The PNF-based-rehabilitation-approach led to improvement in pain, nerve mobility and balance beyond or close to clinical relevance. This approach had positive effects, by supplying oxygen to the nerves, increasing nerve mobility and decreasing pain, hence restoring altered movement patterns, which all improved the patient's activities-of-daily-living. In a situation, where standard strengthening and mobilization techniques are not effective, PNF seems a feasible alternative to decrease chronic pain.