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.