Neurodynamic test of the peroneal nerve: Study of the normal response in asymptomatic subjects

Impact of Neurodynamic Sequencing on the Mechanical Behaviour of the Median Nerve and Brachial Plexus: An Ultrasound Shear Wave Elastography Study

BACKGROUND

When performing the Upper Limb Neurodynamic Test 1 (ULNT1), the order of joint movement can be varied to place more stress onto certain nerve segments. However, the mechanisms underlying this phenomenon are still unclear. This study aimed to analyze the differences in the stiffness of the median nerve (MN) and the brachial plexus (BP) using ultrasound shear wave elastography during three sequences of the ULNT1: standard (ULNT1-STD), distal-to-proximal (ULNT1-DIST), and proximal-to-distal (ULNT1-PROX).

METHODS

Shear wave velocity (SWV) was measured at the initial and final position of each sequence at the MN (wrist) and at the C5 and C6 nerve roots (interscalene level) in 31 healthy subjects.

RESULTS

A significant interaction was found between ULNT1 sequence and location (p < 0.001). The ULNT1-STD and ULNT1-DIST induced a greater stiffness increase in the MN (5.67 ± 0.91 m/s, +113.94%; 5.65 ± 0.98 m/s, +115.95%) compared to C5 and C6 (p < 0.001). The ULNT1-PROX resulted in a significantly smaller increase in stiffness at the MN (4.13 ± 0.86 m/s, +54.17%, p < 0.001), but a greater increase at C5 (4.88 ± 1.23 m/s, +53.39%, p < 0.001) and at C6 (4.87 ± 0.81 m/s, +31.55%). The differences for the ULNT1-PROX at C6 were only significant compared to the ULNT1-STD (p < 0.001), but not the ULNT1-DIST (p = 0.066).

CONCLUSIONS

BP and MN stiffness vary depending on the joint movement sequence during neurodynamic testing. However, the influence of the surrounding tissues may have affected SWV measurements; consequently, these results should be interpreted with caution.

Lumbar Spine and Neural Tissue Mobilizations Improve Outcomes in Runners Presenting With Foot/Ankle Pathology: A Case Series

CONTEXT

Foot/ankle pain is common among runners. Inadequate management of runners with foot/ankle pain can lead to lost training time, competition removal, and other activity limitations. Neurodynamics, which refers to the integrated biomechanical, physiological, and structural function of the nervous system during movement, can be overlooked in patients with foot/ankle pain. Although a link between the cervical spine, neurodynamics, and upper quarter pain has been studied, less is known about the relationship between the lumbar spine and lower quarter. This case series describes the successful management of 3 runners with foot/ankle pain.

CASE PRESENTATIONS

Three female runners (ages 23, 24, and 45 y) presented to physical therapy with foot/ankle pain and difficulty running. Each patient had positive examination findings with local foot/ankle testing. A comprehensive lumbar spine examination demonstrated impairments in range of motion and joint mobility that were hypothesized to be contributing. Positive lower quarter neurodynamic tests were also found.

MANAGEMENT AND OUTCOMES

All patients were treated with nonthrust lumbar spine mobilization and lower quarter neural tissue mobilization. Changes in the Patient-Specific Functional Scale, Numerical Pain Rating Scale, Lower Extremity Functional Scale, and Global Rating of Change occurred after intervention targeting the lumbar spine and lower-extremity neurodynamics in all patients.

CONCLUSIONS

This case series demonstrates the importance of including a thorough lumbar spine examination and neurodynamic testing to identify appropriate interventions while managing patients with foot/ankle pain, even when patients have signs indicative of local ankle/foot pathology. These examination procedures should be performed particularly when a patient is not responding to management targeting local foot/ankle structures.

Short-Term Effects of Three Types of Hamstring Stretching on Length, Neurodynamic Response, and Perceived Sense of Effort-A Randomised Cross-Over Trial

Background: Stretching techniques for hamstring muscles have been described both to increase muscle length and to evaluate nerve mechanosensitivity. Aim: We sought to evaluate the short-term effects of three types of hamstring stretching on hamstring length and report the type of response (neural or muscular) produced by ankle dorsiflexion and perceived sense of effort in asymptomatic subjects. Methods: A randomised cross-over clinical trial was conducted. A total of 35 subjects were recruited (15 women, 20 men; mean age 24.60 ± 6.49 years). Straight leg raises (SLR), passive knee extensions (PKE), and maximal hip flexion (MHF) were performed on dominant and non-dominant limbs. In addition, the intensity of the applied force, the type and location of the response to structural differentiation, and the perceived sensation of effort were assessed. Results: All stretching techniques increased hamstring length with no differences between limbs in the time*stretch interaction (p < 0.05). The perceived sensation of effort was similar between all types of stretching except MHF between limbs (p = 0.047). The type of response was mostly musculoskeletal for MHF and the area of more neural response was the posterior knee with SLR stretch. Conclusions: All stretching techniques increased hamstring length. The highest percentage of neural responses was observed in the SLR stretching, which produced a greater increase in overall flexibility.

Normal response to sural neurodynamic test in asymptomatic participants. A cross-sectional study

BACKGROUND

Neurodynamic tests (NDTs) consist of a combination of movements aimed to stress different parts of the nervous system and are considered to be able to detect increased nerve mechanosensitivity. Currently, there are no studies in healthy subjects that define the normal response to sural neurodynamic test (NDT_SUR).

OBJECTIVES

The main aim of this study was to document normal responses of the NDT_SUR in asymptomatic participants. The secondary aim was to investigate potential gender and leg dominance influences.

DESIGN

A cross-sectional study was designed.

METHODS

NDT_SUR was performed on 44 asymptomatic participants with a total of 88 lower limbs. The range of motion at the point of first appearance of symptoms (S1) and the point of pain tolerance (S2), quality and distribution of sensory responses were recorded.

RESULTS

Hip flexion was significantly greater (p < 0.001) at S2 (63.6 ± 13.1°) than S1 (42.5 ± 12°) and the mean difference was 21.8° (95% CI: 21.8; 22.8) (p < 0.001). However, hip flexion was not different between gender nor dominance (p > 0.05). The descriptor of the quality of the sensory responses more often used by participants was stretching (87% and 76% for S1 and S2, respectively) in the posterior knee and lateral leg.

CONCLUSIONS

This study describes the sensory responses of asymptomatic participants resulting from the NDT_SUR. The findings indicate that NDT_SUR responses are independent of the influence of gender or leg dominance.