Effect of lower limb Neurodynamic exercises on pain,flexibility, balance, and quality of life in diabetic neuropathy–A Randomized Controlled Trial

Diabetic Neuropathy is defined by the symmetrical distal degeneration of peripheral nerves. Patients typically feels pain caused by an insult to the neural tissue, which leads to neurovascular insufficiency and the collection of toxins, that further causes neuronal damage. Patients may also experience muscle weakness due to motor nerve degeneration and balance impairment. Decrease in joint position sense and delayed reaction time to sudden change in center of mass leads to postural instability. This further increased risk of falls and affect activities of daily living. Thereby, affecting the quality of life. So, aim of this study was to determine the effect of lower limb neurodynamic exercises on pain, flexibility, balance, and quality of life in diabetic neuropathy. Study was approved from Institutional Ethical Committee and registered in CTRI/2022/10/046116. 30 participants of both genders within age group of 50 to 70 years with diabetes for > or = 5 years and LANSS score >12 were included and randomly allocated into 2 groups. Group A was treated by conventional therapy which lasted for 60 minutes. Group B was treated by bilateral sciatic Neurodynamics lasting for 12 minutes along with conventional therapy. Intervention was given for four times a week for 3 weeks. Pre and post (immediately after therapy, after 1st week, after 2nd week, after 3rd week of therapy) readings of DN4 questionnaire, SLR, POMA, FACIT Fatigue Scale were taken. Data collected was entered in excel spreadsheet and analyzed by SPSS software version 28.1. In within group analysis done by paired t test Group A showed pain reduction and balance improvement post 2nd week of intervention, improvement in hamstring flexibility and improvement in quality-of-life post 1st session, post 1st week   of intervention respectively.  Group B within group analysis suggested pain reduction and improvement in hamstring flexibility post 1st session of intervention whereas improvement in balance and quality-of-life post was seen post 1st week of intervention.  Between group analysis done by independent sample t test resulted in more improvement in Group B than Group A for pain reduction, balance, and quality-of-life improvement. Hence, study concluded that both groups were effective in improving pain, flexibility, balance and quality of life in patients with Diabetic Neuropathy, but Neurodynamics group showed more improvements in DN4, POMA, FAICT Fatigue scale rather than the conventional physiotherapy group.