The Role of Lower Limb Neural Mobilization in Improving Balance and Performance

Overview

Neural mobilization (NM) is a technique used to enhance the mobility of peripheral nerves relative to surrounding tissues, aiming to reduce physiological tension and improve movement quality. While its effects are well-documented in clinical populations, recent studies have explored its use in healthy individuals to improve flexibility, balance, and functional performance. Evidence supports its positive impact on hamstring flexibility; however, findings on balance and performance remain inconclusive. This study aims to examine the effects of lower extremity NM techniques on balance, flexibility, and functional performance in healthy individuals, addressing current gaps in the literature.

Neural Mobilization (NM) is a therapeutic approach based on the movement of neural structures, applied either manually or through exercise. Neural tissue is mobilized relative to adjacent structures to reduce symptoms through mechanisms that may be mechanical or neurophysiological. The nervous system separates itself from surrounding tissues by considering its own mobility and the relationship with adjacent structures. NM can be applied through various stretching and mobilization maneuvers to either facilitate movement or maximize the sliding (gliding) of peripheral nerves relative to adjacent tissues. Studies on both humans and animals have reported that NM reduces intraneural edema, improves intraneural fluid distribution, decreases thermal and mechanical hyperalgesia, and reverses increased immune responses. Although NM is commonly used to improve the functionality of neural structures and alleviate symptoms associated with disease, recent research has explored its application in asymptomatic individuals to influence flexibility and performance parameters and to prevent injuries. Nunes et al. investigated changes in functional performance and balance parameters by applying lower extremity nerve mobilization to asymptomatic individuals. Their study concluded that a single session of NM (including both stretching and mobilization) applied to the sciatic, tibial, and femoral nerves in healthy subjects resulted in no significant changes in performance, suggesting that the dosage and duration of NM may influence the outcomes. In their study examining the acute effects of neural gliding exercises on athletic performance in healthy individuals, Waldhelm et al. found that bilateral sciatic nerve gliding exercises did not outperform a dynamic stretching protocol in terms of performance. However, they reported a greater improvement in hamstring flexibility. Based on these findings, they suggested that incorporating NM into warm-up routines may help prevent injuries. Similarly, Sharma et al. stated that adding neural stretching or mobilization to static stretching contributed more to hamstring flexibility than static stretching alone, although no dynamic performance assessment was included in the study. Another study investigated the effects of neurodynamic glide techniques on hamstring flexibility in healthy male football players aged. The results showed that the neurodynamic intervention group experienced significant improvements in hamstring flexibility one week later compared to the control group. D'souza et al. evaluated the short-term effects of different neural mobilization techniques on hamstring flexibility in recreational football players. While both the neural stretching and neural mobilization groups showed significant improvements, there was no significant difference between the groups in terms of sit-and-reach and active knee extension test results. Ferrera et al. investigated the acute effects of neural gliding and neural tensioning exercises on static postural control and jumping performance in football players. Both techniques resulted in significant improvements in measured parameters, though no significant differences were observed between the techniques. The positive effects were reported to last for approximately 30 minutes. Although literature suggests that NM techniques contribute to flexibility in asymptomatic individuals, their effects on functional performance, balance, and posture remain controversial. Furthermore, the limited number of studies conducted on healthy populations and methodological variations in existing research create uncertainty regarding the efficacy of NM techniques. Therefore, there is a need for studies that examine the effects of application dosage and duration and contribute to the understanding of NM. The aim of this study is to investigate the effects of lower extremity neural mobilization techniques on balance, flexibility, and functional performance in healthy individuals.