Effects of Lower Extremity Neural Mobilization on Gait Biomechanics and Spinal Alignment

Izmir Democracy University60 enrolled

Overview

This randomized single-blinded trial aimed to compare the immediate effects of lower extremity neural slider and neural tensioner exercises on gait parameters and spinal alignment in sedentary young adults. Sixty healthy sedentary individuals aged 18-30 years were randomly assigned to receive either a neural slider or neural tensioner intervention. Spatiotemporal gait parameters were assessed using a validated smartphone-based gait analysis application, and spinal alignment angles were measured with a bubble inclinometer before and immediately after a single exercise session. The primary outcome was the acute change in gait-related parameters, and secondary outcomes included changes in spinal alignment and pelvic inclination angles.

This randomized, single-blinded experimental study was conducted between February and April 2024 to investigate the acute effects of lower extremity neural mobilization techniques on gait biomechanics and spinal alignment in sedentary individuals. Sixty healthy sedentary participants (30 females, 30 males) aged 18-30 years were enrolled. Participants were randomly allocated to either a neural slider group or a neural tensioner group using a sealed-envelope randomization method. Allocation concealment was ensured by an independent researcher, and all outcome assessments were performed by a blinded physiotherapist. Each participant underwent baseline (pre-test) assessments followed by a single session of neural mobilization exercise (3 minutes total, 3 sets of 30 repetitions). Post-intervention measurements were performed five minutes after completion of the exercise. The primary outcome was the immediate change in spatiotemporal gait parameters, including gait speed, cadence, step length, step length asymmetry, base of support, single and double support times, and gait score. Gait was assessed using the OneStep smartphone application, which has demonstrated high validity compared to laboratory-based gait analysis systems. Secondary outcomes included changes in spinal alignment and pelvic inclination angles, measured using a bubble inclinometer. Cervical lordosis, thoracic kyphosis, lumbar lordosis, total spinal mobility, and pelvic tilt angles were evaluated in a neutral standing position. No adverse events were reported during or after the interventions.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Interventions

Lower Extremity Neural Slider ExerciseOTHER

A lower extremity neural slider technique applied in supine position. The movement sequence involved alternating cervical extension with simultaneous knee extension and ankle dorsiflexion, followed by cervical flexion combined with knee flexion and ankle plantarflexion. The intervention was performed for a total of 3 minutes, consisting of 3 sets of 30 repetitions (90 repetitions total). Each repetition included a 1-second hold at end range. The technique was administered by a physiotherapist under standardized conditions.

Lower Extremity Neural Tensioner ExerciseOTHER

A lower extremity neural tensioner technique applied in supine position. The movement sequence involved simultaneous cervical flexion with knee extension and ankle dorsiflexion to increase neural tension, followed by return to neutral position with cervical extension and knee flexion. The intervention lasted 3 minutes and consisted of 3 sets of 30 repetitions (90 repetitions total), with a 1-second hold at end range. The technique was administered by a physiotherapist under standardized conditions.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 30 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Age between 18 and 30 years * Sedentary lifestyle (no regular structured exercise within the past 6 months) * No history of lower extremity or spinal surgery * No diagnosed neurological disorder * No diagnosed musculoskeletal disorder * No current lower extremity pain or functional limitation * Willingness to participate and provide written informed consent Exclusion Criteria: * History of hamstring injury * Current low back, hip, or knee pain * Known peripheral nerve injury or neurological condition * Any condition limiting safe participation in neural mobilization exercises * Inability to complete the intervention protocol * Withdrawal from the study before post-intervention assessment

Outcomes

Primary Outcomes

Gait Speed

Gait speed expressed in meters per second (m/s), calculated as total walking distance divided by time during a 1-minute walk on a straight, level surface. Measurements were obtained using the OneStep smartphone application, with the smartphone securely attached to the lateral aspect of the thigh to capture inertial motion data. Speed was derived from step detection and stride timing algorithms. The outcome represents the change from pre- to post-intervention.

Time frame: baseline and 5 minutes after the intervention

Gait Cadence

Cadence expressed in steps per minute (steps/min), calculated as the total number of detected steps divided by walking time. Step events were identified through thigh-mounted inertial sensor data captured by the OneStep application during a 1-minute walking trial. The outcome represents the change from pre- to post-intervention.

Time frame: baseline and 5 minutes after the interventio

Step Length

Step length expressed in centimeters (cm), defined as the linear distance between the initial contact of one foot and the subsequent initial contact of the contralateral foot. Step length was estimated using validated gait algorithms based on stride time and thigh kinematics recorded by the OneStep application. The outcome represents the change from baseline to post-intervention.

Time frame: baseline and 5 minutes after the intervention

Stride Length

Stride length expressed in centimeters (cm), defined as the linear distance between two successive initial contacts of the same foot. Stride length was derived from inertial sensor data captured from the thigh during standardized walking. The outcome represents the change between pre- and post-intervention.

Time frame: baseline and 5 minute after interventions.

Step Length Asymmetry

ep length asymmetry expressed as a percentage (%), calculated as the normalized difference between right and left step lengths during walking. Values were automatically derived from spatiotemporal gait data recorded by the thigh-mounted smartphone. The outcome represents the change from pre- to post-intervention.

Time frame: baseline and 5 minute later interventions

Step Width

step width expressed in centimeters (cm), defined as the mediolateral distance between the center points of the heels during consecutive foot contacts. This parameter was estimated using validated spatial gait algorithms within the OneStep application. The outcome represents the change from baseline to post-intervention.

Time frame: baseline and 5 minutes later interventions

Single Support Time

Right single support time expressed as a percentage of the gait cycle (%), defined as the duration during which only the investigated limb is in contact with the ground. Gait cycle phases were automatically detected using thigh-based inertial motion data. The outcome represents the change from pre- to post-intervention.