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Salniccia F, de Vidania S, Martinez-Caro L. Peripheral and central changes induced by neural mobilization in animal models of neuropathic pain: a systematic review. Front Neurol 2024; 14:1289361. [PMID: 38249743 PMCID: PMC10797109 DOI: 10.3389/fneur.2023.1289361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Neural mobilization (NM) is a physiotherapy technique involving the passive mobilization of limb nerve structures with the aim to attempt to restore normal movement and structural properties. In recent years, human studies have shown pain relief in various neuropathic diseases and other pathologies as a result of this technique. Improvement in the range of motion (ROM), muscle strength and endurance, limb function, and postural control were considered beneficial effects of NM. To determine which systems generate these effects, it is necessary to conduct studies using animal models. The objective of this study was to gather information on the physiological effects of NM on the peripheral and central nervous systems (PNS and CNS) in animal models. Methods The search was performed in Medline, Pubmed and Web of Science and included 8 studies according to the inclusion criteria. Results The physiological effects found in the nervous system included the analgesic, particularly the endogenous opioid pathway, the inflammatory, by modulation of cytokines, and the immune system. Conclusion On the basis of these results, we can conclude that NM physiologically modifies the peripheral and central nervous systems in animal models.
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Affiliation(s)
- Federico Salniccia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | - Silvia de Vidania
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | - Leticia Martinez-Caro
- Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, Logroño, Spain
- Facultad de Ciencias Sociales Aplicadas y de la Comunicación, UNIE Universidad y Empresa, Madrid, Spain
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Alharbi R, Kashoo FZ, Ahmed M, Alqahtani M, Aloyuni S, Alzhrani M, Alanazi AD, Sidiq M, Alharbi BH, Nambi G. Effect of neural mobilisation in Bell's palsy: A randomised controlled trial. Hong Kong Physiother J 2023; 43:93-103. [PMID: 37583924 PMCID: PMC10423671 DOI: 10.1142/s1013702523500063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 01/17/2023] [Indexed: 03/12/2023] Open
Abstract
Background Neural mobilisation technique is effective in spinal nerve rehabilitation. However, no study has reported the effect of facial nerve mobilisation in acute Bell's palsy. Objectives The objective of our study was to evaluate the effect of facial neural mobilisation over conventional therapy in improving facial symmetry in patients with acute Bell's palsy. Methods A randomised controlled trial was conducted in the physical therapy department for 62 patients with acute Bell's palsy. The intervention included 10 days of drug therapy including 3 weeks of conventional therapy to the experimental and the control group. However, the experimental group received additional nerve mobilisation technique aimed at mobilising the facial nerve at the origin of external auditory meatus. All participants were assessed at baseline and after three weeks using the Sunnybrook facial grading system (SBS) and Kinovea Movement Analysis Software (KMAS). Results For primary outcome, analysis of covariance with baseline data as covariate showed a significant difference between groups for the post-test mean scores of SBS after 3 weeks (between-group difference, 9.2 [95% CI, 5.1-13.3], p = 0 . 001 . Importantly, the effect size calculated by partial η 2 for neural mobilisation was 0.258 (small effect size). For secondary outcomes, independent sample t-test showed a significant difference between groups for the scores on KMAS after 3 weeks for zygomatic muscle (between-group difference, - 27 . 2 [95% CI, - 31 to - 22 . 6 ], p = 0 . 001 ), frontalis muscle - 16 . 7 [95% CI, - 9 . 9 to - 23 . 4 ], p = 0 . 001 , and orbicularis oris muscle - 15 . 0 [95% CI, - 11 . 1 to - 18 . 8 ], p = 0 . 001 . Conclusion Facial neural mobilisation is likely to be an effective adjunctive intervention in addition to conventional therapy in improving facial symmetry in acute Bell's palsy.
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Affiliation(s)
- Raed Alharbi
- Department of Public Health, College of Applied Medical Sciences Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Faizan Zaffar Kashoo
- Department of Physical Therapy and Health Rehabilitation College of Applied Medical Sciences Majmaah University Al Majmaah 11952, Saudi Arabia
| | - Mehrunnisha Ahmed
- Department of Nursing, College of Applied Medical Sciences Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Mazen Alqahtani
- Department of Physical Therapy and Health Rehabilitation College of Applied Medical Sciences Majmaah University Al Majmaah 11952, Saudi Arabia
| | - Saleh Aloyuni
- Department of Public Health, College of Applied Medical Sciences Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Msaad Alzhrani
- Department of Physical Therapy and Health Rehabilitation College of Applied Medical Sciences Majmaah University Al Majmaah 11952, Saudi Arabia
| | - Ahmad Dhahawi Alanazi
- Department of Physical Therapy and Health Rehabilitation College of Applied Medical Sciences Majmaah University Al Majmaah 11952, Saudi Arabia
| | - Mohammad Sidiq
- Department of Physiotherapy, Medical and Allied Health Sciences Galgotias University, Greater Noida, Uttar Pradesh, 203201, India
| | - Bander Hamud Alharbi
- Director of Medical Records Department King Khalid Hospital Majmaah, Saudi Arabia
| | - Gopal Nambi
- Department of Health and Rehabilitation Sciences College of Applied Medical Sciences Prince Sattam Bin Abdulaziz University, Al kharj, Saudi Arabia
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The Effectiveness of Neuromobilization in Patients With Cervical Radiculopathy: A Systematic Review With Meta-Analysis. J Sport Rehabil 2023; 32:325-334. [PMID: 36395760 DOI: 10.1123/jsr.2022-0259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022]
Abstract
CONTEXT Neuromobilization exercises (NE) could be a useful therapeutic tool to induce analgesia and increase function and range of motion (ROM) in patients with musculoskeletal pathologies with neuropathic components; however, the effectiveness of this intervention in patients with cervical radiculopathy (CR) is unknown. OBJECTIVE To determine the effectiveness of NE in CR on pain, function, and ROM. DESIGN Systematic review and meta-analysis. EVIDENCE ACQUISITION An electronic search was performed in the MEDLINE, Scopus, PEDro, and EBSCO databases from inception until June 2022. The authors included randomized clinical trials that evaluated the effectiveness of NE against control groups or other interventions that aimed to treat patients with CR. EVIDENCE SYNTHESIS Seven clinical trials met the eligibility criteria, and for the quantitative synthesis, 5 studies were included. For the studies that compared NE with a control group, the standardized mean difference for pain was -1.33/10 (95% confidence interval [CI], -1.80 to -0.86; P < .01; I2 = 0%), for function with the Neck Disability Index was -1.21/50 (95% CI, -1.67 to -0.75; P < .01; I2 = 0%), and for neck flexion and extensions was 0.66 (95% CI, 0.23 to 1.10; P < .01; I2 = 0%) and 0.47 (95% CI, 0.04 to 0.90; P < .01; I2 = 0%), respectively, with evidence of clinical effectiveness. These findings were based on moderate-quality evidence according to the Grading of Recommendation, Assessment, Development, and Evaluation rating. In studies that compared NE with other interventions, the meta-analysis failed to demonstrate the statistical or clinical superiority of NE. CONCLUSIONS Moderate quality of evidence suggests that NE may be superior to no treatment for pain, function, and ROM in patients with CR. In contrast, NE are not superior to other interventions in the same outcomes, based on low- to very low-quality evidence. More high-quality research is needed to assess the consistency of these results.
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Muacevic A, Adler JR. Physiotherapy for Piriformis Syndrome Using Sciatic Nerve Mobilization and Piriformis Release. Cureus 2022; 14:e32952. [PMID: 36712711 PMCID: PMC9879580 DOI: 10.7759/cureus.32952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/26/2022] [Indexed: 12/27/2022] Open
Abstract
Piriformis syndrome is also synonymous with sciatica or buttock pain. This is a condition where the muscle irritates the sciatic nerve. This nerve passes above, below, or in between the piriformis muscle piercing it. The muscle tightens or shortens, thus compressing the nerve and disturbing the impulses passing from it. The sciatic nerve is a combination of nerve roots from L4 to S3. Piriformis works as a lateral rotator and is a synergistic muscle of the flexor and abductor group. Females most commonly present with piriformis syndrome than males. Many causative factors are responsible for the compression or impingement of the sciatic nerve, one of which is piriformis syndrome. Tingling, numbness, and pain are most often felt by patients when they have compression of any of the nerves. Many physiotherapy techniques have been found to be effective in managing this problem. Techniques like nerve mobilization, stretching, myofascial release, deep friction massage, and many more have been studied by authors describing their effects in the treatment of piriformis syndrome. Neural mobilization consists of two techniques, nerve gliding and nerve tensioning. Studies have found that the gliding technique produces less strain on the nerve than the tensioning technique. Piriformis stretch reduces the tightening, which has caused the impingement. Two techniques have been used for this stretch, stretching with hip flexion over 90 degrees and hip flexion under 90 degrees. This review focuses on the different advances in treating piriformis syndrome.
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Carta G, Fornasari BE, Fregnan F, Ronchi G, De Zanet S, Muratori L, Nato G, Fogli M, Gambarotta G, Geuna S, Raimondo S. Neurodynamic Treatment Promotes Mechanical Pain Modulation in Sensory Neurons and Nerve Regeneration in Rats. Biomedicines 2022; 10:biomedicines10061296. [PMID: 35740318 PMCID: PMC9220043 DOI: 10.3390/biomedicines10061296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 05/24/2022] [Accepted: 05/29/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Somatic nerve injuries are a rising problem leading to disability associated with neuropathic pain commonly reported as mechanical allodynia (MA) and hyperalgesia. These symptoms are strongly dependent on specific processes in the dorsal root ganglia (DRG). Neurodynamic treatment (NDT), consisting of selective uniaxial nerve repeated tension protocols, effectively reduces pain and disability in neuropathic pain patients even though the biological mechanisms remain poorly characterized. We aimed to define, both in vivo and ex vivo, how NDT could promote nerve regeneration and modulate some processes in the DRG linked to MA and hyperalgesia. Methods: We examined in Wistar rats, after unilateral median and ulnar nerve crush, the therapeutic effects of NDT and the possible protective effects of NDT administered for 10 days before the injury. We adopted an ex vivo model of DRG organotypic explant subjected to NDT to explore the selective effects on DRG cells. Results: Behavioural tests, morphological and morphometrical analyses, and gene and protein expression analyses were performed, and these tests revealed that NDT promotes nerve regeneration processes, speeds up sensory motor recovery, and modulates mechanical pain by affecting, in the DRG, the expression of TACAN, a mechanosensitive receptor shared between humans and rats responsible for MA and hyperalgesia. The ex vivo experiments have shown that NDT increases neurite regrowth and confirmed the modulation of TACAN. Conclusions: The results obtained in this study on the biological and molecular mechanisms induced by NDT will allow the exploration, in future clinical trials, of its efficacy in different conditions of neuropathic pain.
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Affiliation(s)
- Giacomo Carta
- Department of Clinical and Biological Sciences, University of Torino, 10043 Torino, Italy; (G.C.); (B.E.F.); (G.R.); (S.D.Z.); (L.M.); (G.G.); (S.G.); (S.R.)
- Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Torino, 10043 Torino, Italy; (G.N.); (M.F.)
- Department of Rehabilitation, ASST (Azienda Socio Sanitaria Territoriali) Nord Milano, Sesto San Giovanni Hospital, Sesto San Giovanni, 20099 Milano, Italy
| | - Benedetta Elena Fornasari
- Department of Clinical and Biological Sciences, University of Torino, 10043 Torino, Italy; (G.C.); (B.E.F.); (G.R.); (S.D.Z.); (L.M.); (G.G.); (S.G.); (S.R.)
- Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Torino, 10043 Torino, Italy; (G.N.); (M.F.)
| | - Federica Fregnan
- Department of Clinical and Biological Sciences, University of Torino, 10043 Torino, Italy; (G.C.); (B.E.F.); (G.R.); (S.D.Z.); (L.M.); (G.G.); (S.G.); (S.R.)
- Correspondence: ; Tel.: +39-(0)1-1670-5433; Fax: +39-(0)1-1903-8639
| | - Giulia Ronchi
- Department of Clinical and Biological Sciences, University of Torino, 10043 Torino, Italy; (G.C.); (B.E.F.); (G.R.); (S.D.Z.); (L.M.); (G.G.); (S.G.); (S.R.)
- Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Torino, 10043 Torino, Italy; (G.N.); (M.F.)
| | - Stefano De Zanet
- Department of Clinical and Biological Sciences, University of Torino, 10043 Torino, Italy; (G.C.); (B.E.F.); (G.R.); (S.D.Z.); (L.M.); (G.G.); (S.G.); (S.R.)
| | - Luisa Muratori
- Department of Clinical and Biological Sciences, University of Torino, 10043 Torino, Italy; (G.C.); (B.E.F.); (G.R.); (S.D.Z.); (L.M.); (G.G.); (S.G.); (S.R.)
- Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Torino, 10043 Torino, Italy; (G.N.); (M.F.)
| | - Giulia Nato
- Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Torino, 10043 Torino, Italy; (G.N.); (M.F.)
- Department of Life Sciences and Systems Biology, University of Torino, 10124 Torino, Italy
| | - Marco Fogli
- Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Torino, 10043 Torino, Italy; (G.N.); (M.F.)
- Department of Life Sciences and Systems Biology, University of Torino, 10124 Torino, Italy
| | - Giovanna Gambarotta
- Department of Clinical and Biological Sciences, University of Torino, 10043 Torino, Italy; (G.C.); (B.E.F.); (G.R.); (S.D.Z.); (L.M.); (G.G.); (S.G.); (S.R.)
- Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Torino, 10043 Torino, Italy; (G.N.); (M.F.)
| | - Stefano Geuna
- Department of Clinical and Biological Sciences, University of Torino, 10043 Torino, Italy; (G.C.); (B.E.F.); (G.R.); (S.D.Z.); (L.M.); (G.G.); (S.G.); (S.R.)
- Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Torino, 10043 Torino, Italy; (G.N.); (M.F.)
| | - Stefania Raimondo
- Department of Clinical and Biological Sciences, University of Torino, 10043 Torino, Italy; (G.C.); (B.E.F.); (G.R.); (S.D.Z.); (L.M.); (G.G.); (S.G.); (S.R.)
- Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Torino, 10043 Torino, Italy; (G.N.); (M.F.)
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Yilmaz K, Yigiter Bayramlar K, Ayhan C, Tufekci O. Investigating the effects of neuromobilization in lateral epicondylitis. J Hand Ther 2022; 35:97-106. [PMID: 33563509 DOI: 10.1016/j.jht.2020.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 11/01/2020] [Accepted: 11/04/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Randomized controlled study. INTRODUCTION Lateral epicondylitis (LE) causes pain and loss of function in the affected limb. Different exercises have been used for the treatment of LE. In recent years, the technique of neuromobilization has been frequently used to treat tendinopathy. However, there is no study that demonstrates the effects of neuromobilization techniques on patients with LE. PURPOSE OF THE STUDY The aim of the present study was to determine the effects of neuromobilization techniques on pain, grip strength, and functional status in LE patients and to compare them with conservative rehabilitation treatment. METHODS A total of 40 patients (26 females and 14 males; age: 42.80 ± 8.91 years) with a history of LE participated in the study. The patients were randomly assigned to two groups: the neuromobilization group and the control group. The neuromobilization group completed a 6-week conservative rehabilitation and radial nerve mobilization program, whereas the control group received conservative rehabilitation therapy only. Both groups underwent a 7-day weekly conservative home rehabilitation program. Pain severity, grip strength, pinch strength, joint motions, and upper extremity functional level were assessed before treatment, at the third week after treatment, and at the sixth week after treatment. RESULTS There was a significant decrease in all pain scores in favor of the neuromobilization group at week 6 after treatment (at rest: P = .001, effect size (ES) = 0.84; at night: P = .001, ES = 0.91 and during activity: P = .004, ES = 1.06). No significant differences were found for grip strength, pinch strength, joint motions, and functional level in the neuromobilization group, although trends toward better improvement were observed. CONCLUSIONS Radial nerve mobilization techniques are more effective on pain than conservative rehabilitation therapy in LE patients, and this effect continues after treatment.
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Affiliation(s)
- Kamil Yilmaz
- Division of Physiotherapy and Rehabilitation, KTO Karatay University, School of Health Sciences, Konya, Turkey.
| | - Kezban Yigiter Bayramlar
- Division of Physiotherapy and Rehabilitation, Hasan Kalyoncu University, Faculty of Health Sciences, Gaziantep, Turkey
| | - Cigdem Ayhan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Osman Tufekci
- Physical Medicine and Rehabilitation, Konya Farabi Hospital, Konya, Turkey
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Alharmoodi BY, Arumugam A, Ahbouch A, Moustafa IM. Comparative Effects of Tensioning and Sliding Neural Mobilization on Peripheral and Autonomic Nervous System Function: A Randomized Controlled Trial. Hong Kong Physiother J 2022; 42:41-53. [PMID: 35782695 PMCID: PMC9244596 DOI: 10.1142/s1013702522500056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 12/24/2021] [Accepted: 01/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Although different types of neural mobilization (NM) exercises induce different amounts of longitudinal nerve excursion and strain, the question whether the increased longitudinal stress and nerve excursion from sliding or tensioning intervention may subtly affect the neural functions has not been answered yet. Objective: To compare the effects of tensioning NM versus sliding NM of the median nerve on peripheral and autonomic nervous system function. Methods: In this randomized controlled trial, 90 participants were randomly assigned to tensioning NM, sliding NM, or sham NM. The neurophysiological outcome measures included peak-to-peak amplitude of the dermatomal somatosensory evoked potential (DSSEP) for dermatomes C6, C7, C8, and T1. Secondary outcome measures included amplitude and latency of skin sympathetic response. All outcome measures were assessed pretreatment, immediately after the two weeks of treatment and one week after the last session of the treatment. Results: A 2-way repeated measures ANOVA revealed significant differences between the three groups. The post hoc analysis indicated that tensioning NM significantly decreased the dermatomal amplitude for C6, C7, C8, and T1 (p<0.005). Sympathetic skin responses in the gliding NM group showed lower amplitudes and prolonged latencies post-treatment when compared to tensioning NM group (p<0.05). In contrast, no significant changes were observed in the DSSEPs and skin sympathetic responses for participants in the sham treatment group (p>0.05). Conclusions: A tensioning NM on the median nerve had a possible adverse effect on the neurophysiology variables of the nerves involved in the neural mobilization. Thus, tensioning NM with the current parameters that place increased stress and strain on the peripheral nervous system should be avoided.
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Affiliation(s)
| | - Ashokan Arumugam
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Amal Ahbouch
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Ibrahim M. Moustafa
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, UAE
- Basic Science Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Baptista FM, Cruz EB, Afreixo V, Silva AG. Effectiveness of neural mobilization on pain intensity, disability, and physical performance in adults with musculoskeletal pain-A protocol for a systematic review of randomized and quasi-randomized controlled trials and planned meta-analysis. PLoS One 2022; 17:e0264230. [PMID: 35271600 PMCID: PMC8912212 DOI: 10.1371/journal.pone.0264230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 02/05/2022] [Indexed: 11/18/2022] Open
Abstract
Recent studies show that musculoskeletal conditions contribute significantly to years lived with disability considering the entire global population. Pain and functional disability are the main problems that people with these conditions suffer. Neural mobilization has been shown to be an effective intervention in the treatment of musculoskeletal pain within individual trials, also contributing to improved functionality. Some systematic reviews have been carried out during the last years with the aim of synthesizing the scientific evidence on the use of neural mobilization techniques in the treatment of musculoskeletal disorders. However, they varied a lot in the methodological approaches and, consequently, in the findings and conclusions. Thus, this document is a planned protocol of a comprehensive systematic review with meta-analysis that we intend to carry out to review the scientific literature regarding up-to-date evidence on the use of neural mobilization in the management of people suffering from musculoskeletal pain disorders. The study designs that we will consider as inclusion criteria will be randomized and quasi-randomized clinical trials. The target population will be adults and older adults with musculoskeletal pain. Any controlled trial using any neural mobilization technique as an intervention in one of the trial groups will be included. The main outcomes of interest will be pain, functional status, and physical performance tests (muscle strength, flexibility, and balance). There will be no restrictions on follow-up time or type of setting. The risk of bias of the included studies will be assessed by the RoB 2 tool and the certainty of the evidence will be evaluated using the comprehensive Assessment, Development and Assessment of Assessment Recommendation (GRADE) approach. We intend to present the findings through narrative descriptions and, if possible, through meta-analytic statistics. Trial registration: PROSPERO registration number. CRD42021288387.
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Affiliation(s)
| | - Eduardo Brazete Cruz
- Department of Physiotherapy, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
| | - Vera Afreixo
- CIDMA–Center for Research and Development in Mathematics and Applications, Department of Mathematics, University of Aveiro (UA), Aveiro, Portugal
| | - Anabela G. Silva
- Center for Health Technology and Services Research (CINTESIS.UA), School of Health Sciences, University of Aveiro, Aveiro, Portugal
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Karjalanen T, Raatikainen S, Jaatinen K, Lusa V. Update on Efficacy of Conservative Treatments for Carpal Tunnel Syndrome. J Clin Med 2022; 11:jcm11040950. [PMID: 35207222 PMCID: PMC8877380 DOI: 10.3390/jcm11040950] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 12/13/2022] Open
Abstract
Carpal tunnel syndrome (CTS) is the most common upper extremity compression neuropathy. Non-operative interventions are usually the first-line treatments, and surgery is reserved for those that do not achieve a satisfactory symptom state by non-operative means. This narrative review summarizes the current evidence regarding the efficacy of orthoses, corticosteroid injections, platelet-rich plasma injections, Kinesio taping, neurodynamic techniques, gabapentin, therapeutic ultrasound, and extracorporeal shockwave therapy in people with CTS. While many trials suggest small short-term benefits, rigorous evidence of long-term patient-important benefits is limited. To improve the utility of healthcare resources, research in this area should focus on establishing efficacy of each treatment instead of comparing various treatments with uncertain benefits.
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Affiliation(s)
- Teemu Karjalanen
- Department of Hand and Micosurgery, Tampere University Hospital, 33521 Tampere, Finland
- Monash Department of Clinical Epidemiology, Cabrini Institute, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Malvern, Melbourne 3144, Australia
- Correspondence:
| | - Saara Raatikainen
- Musculoskeletal and Plastic Surgery Department, University of Helsinki and Helsinki University Hospital, 00290 Helsinki, Finland;
| | - Kati Jaatinen
- Central Finland Healthcare District, 40620 Jyväskylä, Finland; (K.J.); (V.L.)
| | - Vieda Lusa
- Central Finland Healthcare District, 40620 Jyväskylä, Finland; (K.J.); (V.L.)
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Martin-Vera D, Fernández-Carnero J, Rodríguez-Sanz D, Calvo-Lobo C, López-de-Uralde-Villanueva I, Arribas-Romano A, Martínez-Lozano P, Pecos-Martín D. Median Nerve Neural Mobilization Adds No Additional Benefit When Combined with Cervical Lateral Glide in the Treatment of Neck Pain: A Randomized Clinical Trial. J Clin Med 2021; 10:5178. [PMID: 34768696 PMCID: PMC8584397 DOI: 10.3390/jcm10215178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND This study aimed to compare the effectiveness of cervical lateral glide (CLG) added to median nerve neural mobilization (MNNM) in patients with neck pain (NP). METHODS A single-blinded randomized controlled clinical trial was carried out in a Pain Management Unit from a Hospital. A total sample of 72 patients with NP was recruited from a hospital. Patients were randomized to receive isolated CLG (n = 36) or CLG + MNNM (n = 36). Bilateral elbow extension range of motion (ROM) on upper limb neurodynamic test 1 (ULNT1), bilateral pressure pain thresholds (PPT) on the median nerve at elbow joint, C6 zygapophyseal joint and tibialis anterior, Visual analogue scale (VAS), body chart distribution of pain, active cervical ROM (CROM), Neck Disability Index (NDI), and Tampa Scale of Kinesiophobia (TSK-11) were measured at baseline as well as immediately, 15 days, and 1 month after treatment. RESULTS There were no statistically significant interactions (p > 0.05) between treatment and time for median nerve mechanosensitivity outcomes, pain intensity, symptom distribution, and PPT of the widespread pain assessment, as well as cervical function, and kinesiophobia. CONCLUSIONS MNNM gave no additional benefit to CLG in patients with NP regarding pain intensity, symptom distribution, mechanosensitivity, functionality, and kinesiophobia. Only two treatment sessions and the short follow-up are important issues, therefore, justifying further studies to answer the research question with better methodology.
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Affiliation(s)
- Daniel Martin-Vera
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28005 Madrid, Spain; (D.M.-V.); (P.M.-L.)
| | - Josué Fernández-Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, 28922 Madrid, Spain;
- La Paz Hospital Institute for Health Research, IdiPAZ, 261, 28046 Madrid, Spain
- Grupo Multidisciplinar de Investigación y Tratamiento del Dolor, Grupo de Excelencia Investigadora, URJC-Banco de Santander, 28922 Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonóma de Madrid, 28049 Madrid, Spain
- Grupo de Investigación de Dolor musculoesqueletico y Control Motor, Universidad Europea de Madrid, 28005 Madrid, Spain
| | - David Rodríguez-Sanz
- School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28606 Madrid, Spain; (D.R.-S.); (C.C.-L.)
| | - Cesar Calvo-Lobo
- School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28606 Madrid, Spain; (D.R.-S.); (C.C.-L.)
| | | | - Alberto Arribas-Romano
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, 28922 Madrid, Spain;
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933 Alcorcón, Spain
| | - Pedro Martínez-Lozano
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28005 Madrid, Spain; (D.M.-V.); (P.M.-L.)
| | - Daniel Pecos-Martín
- Physiotherapy and Pain Research Center, General Foundation of the University of Alcalá, 28805 Madrid, Spain;
- Department of Physical Therapy, Alcalá University, 28805 Alcalá de Henares, Spain
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12
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Matesanz-García L, Cáceres-Pajuelo JE, Cuenca-Martínez F, La Touche R, Goicoechea-García C, Fernández-Carnero J. Effects of neural mobilizations through movement representation techniques for the improvement of neural mechanosensitivity of the median nerve region: a randomized controlled trial. Somatosens Mot Res 2021; 38:267-276. [PMID: 34404324 DOI: 10.1080/08990220.2021.1964463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The main objective was to compare the effects of neural mobilization (NM), NM performed through mirror therapy (MT), NM performed through action observation (AO) training and finally classic rehabilitation program (mobility and strength) exercises on neural mechanosensitivity, widespread of proximal and distal pain and pressure pain thresholds (PPT). The second objective was to assess the effects of these interventions on handgrip strength, conditioned pain modulation, motor imagery ability and temporal summation. MATERIALS AND METHODS Single-blinded randomized controlled trial. Fifty-four healthy subjects were randomly assigned to each group. Neural mechanosensitivity, widespread pain and PPT were the main variables. The secondary variables included handgrip strength, conditioned pain modulation, motor imagery ability and temporal summation. RESULTS All groups showed significant differences in time*factor for neural mechanosensitivity (p = 0.001), PPT in the dermatome of the median nerve (p = 0.007), PPT at carpal tunnel (p < 0.05) and proximal widespread (p = 0.01). No differences were found for distal widespread, conditioned pain modulation, handgrip strength motor imagery ability or temporal summation (p > 0.05). There is an absence of statistically significant differences between groups. CONCLUSIONS NM through movement representation techniques can reduce mechanosensitivity and mechanical hyperalgesia in the median nerve dermatome and forearm, although no differences were found between groups.
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Affiliation(s)
- Luis Matesanz-García
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | | | - Ferran Cuenca-Martínez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid, Madrid, Spain
| | - Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid, Madrid, Spain.,Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Spain
| | | | - Josué Fernández-Carnero
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid, Madrid, Spain.,Grupo Multidisciplinar de Investigación y Tratamiento del Dolor, Grupo de Excelencia Investigadora URJC-Banco de Santander, Madrid, Spain.,La Paz Hospital Institute for Health Research, IdiPAZ, Madrid, Spain.,Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain
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13
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Thomas E, Bellafiore M, Petrigna L, Paoli A, Palma A, Bianco A. Peripheral Nerve Responses to Muscle Stretching: A Systematic Review. J Sports Sci Med 2021; 20:258-267. [PMID: 34211318 PMCID: PMC8219270 DOI: 10.52082/jssm.2021.258] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/23/2021] [Indexed: 12/12/2022]
Abstract
Stretching is commonly used to increase range of motion and flexibility. Therefore, investigations are usually oriented towards the muscle-tendon unit. Limited evidence exists regarding potential effects of stretching on peripheral nerves which lie within muscles. The objective of this investigation will be to elucidate the responses of peripheral nerves to stretching. A literature search was performed using the following databases: Scopus, NLM Pubmed and ScienceDirect. Studies regarding the effects of stretching protocols on responses of peripheral nerves were retrieved for investigation. The NHLBI tool was used for quality assessment. Outcomes included nerve stiffness, nerve displacement, pain pressure thresholds and resistive torque. A total of 10 studies were considered eligible and were included in this investigation. The quality assessment of the studies revealed an overall "fair to good" methodological quality across the included studies. All studies except for one involved healthy participants. High heterogeneity of stretching protocols was retrieved. As a consequence of stretching, nerve stiffness (-15.6%) and pain pressure thresholds (-1.9kg) increased. Nerve displacements on each movement plane for all the considered nerves and nerve deformation were also frequently observed. Peripheral nerve responses to muscle stretching include decreased nerve stiffness and increased pain pressure thresholds. Nerve displacement also frequently occurs. It is still unclear if reduced nerve displacement may lead to clinical outcomes. There is a lack of longitudinal studies regarding peripheral nerve adaptations to stretching.
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Affiliation(s)
- Ewan Thomas
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Marianna Bellafiore
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Luca Petrigna
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Antonio Paoli
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Antonio Palma
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Antonino Bianco
- Department of Biomedical Sciences, University of Padova, Padova, Italy
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14
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Aksoy CC, Kurt V, Okur İ, Taspınar F, Taspinar B. The immediate effect of neurodynamic techniques on jumping performance: A randomised double-blind study. J Back Musculoskelet Rehabil 2020; 33:15-20. [PMID: 31282392 DOI: 10.3233/bmr-170878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Neurodynamic techniques are used to restore neural functions. However, there are few studies about the effects on performance. The aim of this study was to investigate the immediate effects on vertical jumping (VJ) and horizontal jumping (HJ) of 2 different tension loading techniques applied to young adults. MATERIAL AND METHOD In this randomised double-blind study, a total of 68 participants with a mean age of 21.31 ± 1.21 years were separated into 2 groups using the closed envelope system: the femoral nerve mobilization (FNM) group and the sciatic nerve mobilization (SNM) group. The FNM and SNM techniques were applied as 2 seconds stretching with 2 seconds resting for 10 repetitions. The VJ and HJ performance of the participants was evaluated before and after the interventions by a researcher blinded to the groups. RESULTS The mean VJ performance before and after interventions was measured as 34.56 ± 7.80 cm and 35.89 ± 8.15 cm in the FNM group (p< 0.05) and 31.74 ± 8.31 cm and 32.76 ± 8.45 cm in the SNM group (p< 0.05). The effects of the techniques on HJ performance were not statistically significant (p> 0.05). There was no superiority between the techniques (p> 0.05). CONCLUSION The neurodynamic techniques were found to provide an immediate increase in VJ performance. Neurodynamic techniques are generally used in patient populations to improve treatment outcomes. According to these study results, neurodynamic techniques can be safely used to provide an immediate increase in performances of individuals with no lower extremity problems.
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Affiliation(s)
- Cihan C Aksoy
- Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Kutahya Health Science University, Evliya Celebi Campus, 43444 Kutahya, Turkey
| | - Vedat Kurt
- Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Kutahya Health Science University, Evliya Celebi Campus, 43444 Kutahya, Turkey
| | - İsmail Okur
- Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Kutahya Health Science University, Evliya Celebi Campus, 43444 Kutahya, Turkey
| | - Ferruh Taspınar
- Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Izmir Democracy University, Izmir, Turkey
| | - Betül Taspinar
- Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Izmir Democracy University, Izmir, Turkey
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15
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Satkunskiene D, Khair RM, Muanjai P, Mickevicius M, Kamandulis S. Immediate effects of neurodynamic nerve gliding versus static stretching on hamstring neuromechanical properties. Eur J Appl Physiol 2020; 120:2127-2135. [PMID: 32728819 DOI: 10.1007/s00421-020-04422-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/15/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE We investigated the immediate effects of neurodynamic nerve gliding (ND) on hamstring flexibility, viscoelasticity, and mechanosensitivity, compared with traditional static stretching (ST). METHODS Twenty-two physically active men aged 21.9 ± 1.9 years were divided randomly into two equal intervention groups using ST or ND. An isokinetic dynamometer was used to measure the active knee joint position sense, perform passive knee extension, record the passive extension range of motion (ROM) and the passive-resistive torque of hamstrings. Stiffness was determined from the slope of the passive torque-angle relationship. A stress relaxation test (SRT) was performed to analyze the viscoelastic behavior of the hamstrings. The passive straight leg raise (SLR) test was used to evaluate hamstring flexibility. RESULTS A significant interaction was observed for ROM and passive ultimate stiffness, reflected by an increase in these indicators after ND but not after SD. SLR increased significantly in both groups. After ST, a significantly faster initial stress relaxation was observed over the first 4 s. than after ND. There was no significant change in the active knee joint position sense. CONCLUSIONS ND provided a slightly greater increase in hamstring extensibility and passive stiffness, possibly by decreasing nerve tension and increasing strain in connective tissues than ST. The ST mostly affected the viscoelastic behavior of the hamstrings, but neither intervention had a significant impact on proprioception.
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Affiliation(s)
- Danguole Satkunskiene
- Institute of Sports Science and Innovation, Lithuanian Sports University, Sporto g. 6, 44221, Kaunas, Lithuania
| | - Ra'ad M Khair
- Institute of Sports Science and Innovation, Lithuanian Sports University, Sporto g. 6, 44221, Kaunas, Lithuania
| | - Pornpimol Muanjai
- Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand
| | - Mantas Mickevicius
- Institute of Sports Science and Innovation, Lithuanian Sports University, Sporto g. 6, 44221, Kaunas, Lithuania.
| | - Sigitas Kamandulis
- Institute of Sports Science and Innovation, Lithuanian Sports University, Sporto g. 6, 44221, Kaunas, Lithuania
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16
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Fernández-Carnero J, Sierra-Silvestre E, Beltran-Alacreu H, Gil-Martínez A, La Touche R. Neural Tension Technique Improves Immediate Conditioned Pain Modulation in Patients with Chronic Neck Pain: A Randomized Clinical Trial. PAIN MEDICINE 2020; 20:1227-1235. [PMID: 29945245 DOI: 10.1093/pm/pny115] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To determine the immediate effect of neural tension technique (NTT) on conditioned pain modulation in patients with chronic neck pain. A secondary objective was to determine the immediate effect of neural tensioner technique on pain intensity and cervical range of movement. DESIGN Randomized clinical trial. SETTING University medical center. SUBJECTS Fifty-four patients with neck pain (13 males and 41 females; mean± SD age = 20.91 ± 2.64 years) were randomly allocated to two groups: NTT or sham technique. METHODS Participants received a visual analog scale (VAS) and neck disability index (NDI) after inclusion. Conditioned pain modulation (CPM) and active cervical range of motion were measured before and after the intervention. Each subject received one treatment session. RESULTS The results of the analysis of variance revealed a significant effect for the group × time interaction only for CPM (F = 11.09, P = 0.002, ηp2 = 0.176). No significant interactions were found for the other measures (VAS [F = 1.719, P = 0.195, ηp2 = 0.031], pressure pain threshold C2 [F = 0.731, P = 0.398, ηp2 = 0.018], flexion [F = 0.176, P = 0.677, ηp2 = 0.003], extension [F = 0.035, P = 0.852, ηp2 = 0.001], lateral flexions [F = 0.422, P = 0.519, ηp2 = 0.008], and rotations [F = 1.307 P = 0.258, ηp2 = 0.024]). Regarding CPM, intergroup interaction differences were found postintervention (P = 0.002) with a high effect size (d = 0.98). CONCLUSIONS This study suggests that neural tension technique enhances immediate conditioned pain modulation in patients with chronic neck pain, but not pain intensity or cervical range of movement.
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Affiliation(s)
- Josué Fernández-Carnero
- Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonóma de Madrid, Spain.,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain.,Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain.,Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Eva Sierra-Silvestre
- Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonóma de Madrid, Spain
| | - Hector Beltran-Alacreu
- Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonóma de Madrid, Spain.,Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain
| | - Alfonso Gil-Martínez
- Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonóma de Madrid, Spain.,Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
| | - Roy La Touche
- Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autonóma de Madrid, Spain.,Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain.,Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
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17
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Comparative Effects of Tensioning and Sliding Neural Mobilization on Static Postural Control and Lower Limb Hop Testing in Football Players. J Sport Rehabil 2019; 28:840-846. [PMID: 30222495 DOI: 10.1123/jsr.2017-0374] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 07/31/2018] [Accepted: 08/06/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT Sliding and tensioning neural mobilization are used to restore normal function of the nervous system, but they impose different stresses on it. Particularly, sliding induces greater nerve excursion than tensioning. Conceivably, they might impact nervous system function differently. OBJECTIVE To compare the effects of tensioning neural mobilization versus sliding neural mobilization of the dominant lower limb on static postural control and hop testing. DESIGN Randomized, parallel and double blinded trial. SETTING/PARTICIPANTS Thirty-seven football players. INTERVENTION(S) Participants were randomized into 2 groups: sliding neural mobilization (n = 18) or tensioning neural mobilization (n = 19) targeting the tibial nerve. MAIN OUTCOME MEASURES Static postural sway was assessed with a force plate and functional performance with hop tests. Measurements were taken at baseline, after the intervention, and at 30-minute follow-up. RESULTS There was a significant effect of time for the center of pressure total displacement and velocity (P < .05), for the single-leg hop test (P < .05), the 6-m timed hop test (P < .05), and the cross-over hop test (P < .05), but no significant effect of the intervention. CONCLUSIONS Sliding and tensioning neural mobilization improved postural control and hop testing in football players, and improvements remained 30 minutes after the intervention. Additional research examining the influence of neural mobilization on sensory motor impairments, postural control, and functional performance is needed.
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18
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Gamelas T, Fernandes A, Magalhães I, Ferreira M, Machado S, Silva AG. Neural gliding versus neural tensioning: Effects on heat and cold thresholds, pain thresholds and hand grip strength in asymptomatic individuals. J Bodyw Mov Ther 2019; 23:799-804. [DOI: 10.1016/j.jbmt.2019.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 04/22/2019] [Indexed: 12/20/2022]
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19
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Neural gliding and neural tensioning differently impact flexibility, heat and pressure pain thresholds in asymptomatic subjects: A randomized, parallel and double-blind study. Phys Ther Sport 2019; 36:101-109. [PMID: 30710858 DOI: 10.1016/j.ptsp.2019.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/18/2019] [Accepted: 01/18/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To compare the effect of neural gliding and tensioning on hamstring flexibility, nerve function (heat and cold thresholds) and pain sensitivity (pain intensity and pressure pain threshold) of the mobilized and non-mobilized lower limbs at post-intervention and 24 h follow up. DESIGN Randomized, parallel and double blinded trial. SETTING/PARTICIPANTS Forty-eight asymptomatic participants. INTERVENTION(S) Participants received neural gliding (n = 23) or tensioning (n = 25). Main Outcome Measures - Straight leg raising (SLR; in degrees), heat and cold threshold (ºC), pressure pain threshold (PPT; in Kgf) and pain intensity (visual analogue scale), taken at baseline, post-intervention and at 24 h follow up. RESULTS There was a significant interaction between time, intervention and limb for SLR (F2,45 = 3.83; p = 0.029). A significant interaction between time and intervention for PPT (F2,45 = 3.59; p = 0.036) and heat threshold (F2,45 = 5.10; p = 0.01). A significant effect of time (F2,45 = 9.42; p < 0.001) and of limb (F1,46 = 4.78; p = 0.035) for pain intensity during SLR, and a significant effect of time (F2,45 = 3.65; p = 0.034) for pain intensity during PPT. CONCLUSION Gliding and tensioning had similar and positive effects for flexibility in the mobilized limb, but tensioning was superior for the non-mobilized limb. Gliding was superior to tensioning for pressure pain and heat thresholds.
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20
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The Effect of Spinal Mobilization With Leg Movement in Patients With Lumbar Radiculopathy-A Double-Blind Randomized Controlled Trial. Arch Phys Med Rehabil 2018; 100:828-836. [PMID: 30521781 DOI: 10.1016/j.apmr.2018.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/02/2018] [Accepted: 11/05/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To evaluate the effect of spinal mobilization with leg movement (SMWLM) on low back and leg pain intensity, disability, pain centralization, and patient satisfaction in participants with lumbar radiculopathy. DESIGN A double-blind randomized controlled trial. SETTING General hospital. PARTICIPANTS Adults (N=60; mean age 44y) with subacute lumbar radiculopathy. INTERVENTIONS Participants were randomly allocated to receive SMWLM, exercise and electrotherapy (n=30), or exercise and electrotherapy alone (n=30). All participants received 6 sessions over 2 weeks. MAIN OUTCOME MEASURES The primary outcomes were leg pain intensity and Oswestry Disability Index score. Secondary variables were low back pain intensity, global rating of change (GROC), straight leg raise (SLR), and lumbar range of motion (ROM). Variables were evaluated blind at baseline, post-intervention, and at 3 and 6 months of follow-up. RESULTS Significant and clinically meaningful improvement occurred in all outcome variables. At 2 weeks the SMWLM group had significantly greater improvement than the control group in leg pain (MD 2.0; 95% confidence interval [95% CI], 1.4-2.6) and disability (MD 3.9; 95% CI, 5.5-2.2). Similarly, at 6 months, the SMWLM group had significantly greater improvement than the control group in leg pain (MD 2.6; 95% CI, 1.9-3.2) and disability (MD 4.7; 95% CI, 6.3-3.1). The SMWLM group also reported greater improvement in the GROC and in SLR ROM. CONCLUSION In patients with lumbar radiculopathy, the addition of SMWLM provided significantly improved benefits in leg and back pain, disability, SLR ROM, and patient satisfaction in the short and long term.
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21
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Expressão de neurotrofinas e avaliação histomorfométrica em ratos Wistar submetidos à mobilização neural após compressão do nervo mediano. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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22
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Marcioli MAR, Silva JLDC, Ribeiro LDFC, Brancalhão RMC, Bertolini GRF. Neurotrophin expression and histomorphometric evaluation in Wistar rats subjected to neural mobilization after compression of the median nerve. Rev Bras Ortop 2018; 53:276-280. [PMID: 29892576 PMCID: PMC5993878 DOI: 10.1016/j.rboe.2018.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/16/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate the neurotrophin mRNA expression and axon count in the median nerve of Wistar rats submitted to neural mobilization (NM) after nerve compression. METHODS Eighteen animals were randomly divided into G1 (nerve compression only), G2 (NM for 1 min), and G3 (NM for 3 min). For NM, the animals were anesthetized and the right scapula received the mobilization, adapted as indicated for humans, on alternate days, from the third to the 13th postoperative (PO) day, totaling six days of therapy. On the 14th PO day, animals were anesthetized and euthanized. Fragments of the median nerve, distal to the compression procedure, were removed for histomorphometric analysis and expression of neurotrophins, nerve growth factor (NGF), and brain-derived neurotrophic factor (BDNF) by RT-PCR. RESULTS Histomorphometric analysis revealed differences in the number of axons in the injured side, which was significantly lower in the injured limb nerve compared to the control limb, whereas the RT-PCR analysis showed no significant differences in the expression of NGF or BDNF. CONCLUSION NM treatment did not affect median nerve regeneration, which maintained normal recovery rates.
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Abstract
Entrapment neuropathies are the most prevalent type of peripheral neuropathy and often a challenge to diagnose and treat. To a large extent, our current knowledge is based on empirical concepts and early (often biomechanical) studies. This Viewpoint will challenge some of the current beliefs with recent advances in both basic and clinical neurosciences. J Orthop Sports Phys Ther 2018;48(2):58-62. doi:10.2519/jospt.2018.0603.
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24
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Georgoudis G, Felah B, Nikolaidis P, Damigos D. The effect of myofascial release and microwave diathermy combined with acupuncture versus acupuncture therapy in tension-type headache patients: A pragmatic randomized controlled trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2017; 23:e1700. [PMID: 29266633 DOI: 10.1002/pri.1700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 10/06/2017] [Accepted: 11/18/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND PURPOSE Nonpharmacological therapies for tension-type headache (TTH) and cervicogenic cephalalgia are often a treatment choice, despite the weak to moderate evidence. The aim of this study was to compare the effectiveness of an acupuncture/stretching protocol versus acupuncture/stretching plus physiotherapy techniques, in patients with TTH cephalalgia. METHODS A single-blind, prospective, multicentre, randomized controlled trial was designed considering the pragmatic situation of administering such protocols and treating the 44 headache patients participating in this study. The patients were randomly assigned in 2 treatment groups (control group, n = 20, acupuncture/stretching; experimental group, n = 24, acupuncture/stretching plus physiotherapy) and completed 10 treatment sessions within 4 weeks with measurements taking place before treatment, after the fifth treatment and after the 10th treatment. The mechanical pressure pain threshold (PPT) was considered as the main outcome measure, using a mechanical algometer to measure 7 bilateral somatic points. Acupuncture in both groups included 17-20 acupuncture points, whereas stretching was initially taught and subsequently self-administered (self-stretches), following a standardized set of movements of the cervical spine. Physiotherapy consisted of microwave diathermy and myofascial release with hands-on techniques. RESULTS/FINDINGS An improvement was noted in both groups/treatments regarding the main outcome measure PPT, all the way from the first to fifth and the 10th treatment, at all measuring sites and at all measurements in both groups (p < .001). When comparing the 2 groups, differences were noted after the 10th treatment (p < .05). DISCUSSION In conclusion, patients with TTH headache were benefited from acupuncture and stretching but further PPT improvements were evidenced when physiotherapy hands-on techniques were added. In clinical terms, the combination of physiotherapy in the form of myofascial release and microwave diathermy with acupuncture and stretching in order to improve the analgesic effect (PPT) is strongly recommended.
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Affiliation(s)
- George Georgoudis
- Musculoskeletal & Chest Physiotherapy Research Laboratory, Department of Physiotherapy, Athens University of Applied Sciences, Greece.,PhysioPain Group, Pain Management & Physiotherapy, Athens, Greece
| | - Bledjana Felah
- PhysioPain Group, Pain Management & Physiotherapy, Athens, Greece.,MSc in Pain Management, Department of Social Medicine & Psychological Health, University of Ioannina, Greece
| | | | - Dimitrios Damigos
- MSc in Pain Management, Department of Social Medicine & Psychological Health, University of Ioannina, Greece
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25
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Ramos GA, Arliani GG, Astur DC, Pochini ADC, Ejnisman B, Cohen M. Rehabilitation of hamstring muscle injuries: a literature review. Rev Bras Ortop 2017; 52:11-16. [PMID: 28194375 PMCID: PMC5290083 DOI: 10.1016/j.rboe.2016.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 02/24/2016] [Indexed: 12/26/2022] Open
Abstract
Hamstring injuries are among the most frequent in sports. The high relapse rate is a challenge for sports medicine and has a great impact on athletes and sport teams. The treatment goal is to provide the athlete the same functional level as before the injury. Thus, functional rehabilitation is very important to the success of the treatment. Currently, several physical therapy modalities are used, according to the stage of the lesion, such as cryotherapy, laser therapy, therapeutic ultrasound, therapeutic exercise, and manual therapy. However, the evidence of the effectiveness of these modalities in muscle injuries is not fully established due to the little scientific research on the topic. This article presents an overview of the physiotherapy approach in the rehabilitation of hamstring muscle injuries.
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Affiliation(s)
- Gabriel Amorim Ramos
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Gustavo Gonçalves Arliani
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Diego Costa Astur
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Alberto de Castro Pochini
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Benno Ejnisman
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Moisés Cohen
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
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Ramos GA, Arliani GG, Astur DC, Pochini ADC, Ejnisman B, Cohen M. Reabilitação nas lesões musculares dos isquiotibiais: revisão da literatura. Rev Bras Ortop 2017. [DOI: 10.1016/j.rbo.2016.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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