Effect of leg dominance, gender and age on sensory responses to structural differentiation of straight leg raise test in asymptomatic subjects: a cross-sectional study

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.

Neural management plus advice to stay active on clinical measures and sciatic neurodynamic for patients with chronic sciatica: Study protocol for a controlled randomised clinical trial

Advice to stay active is the primary management strategy for sciatica. Other conservative treatments such as neural management techniques may also contribute to sciatica recovery, but currently, the effects have not been robustly assessed. Thus, the aim of this study is to compare the effects of adding neural management to advice to stay active versus advice to stay active alone in improving pain intensity and functional limitation. Secondarily, to compare the effects of the experimental intervention in the sciatic neurodynamic, pain modulation, and psychosocial factors. A parallel-group, controlled, examiner-blinded superiority clinical trial randomised at a 1:1 allocation will be conducted in 210 participants with chronic sciatica. Patients will be recruited from outpatient physiotherapy clinics and community advertisements. The experimental group will receive neural mobilisation techniques and soft tissue mobilisation techniques for 30 minutes per session, 10 weekly sessions, plus advice to stay active on their activities of daily living, information on physical activity, imaging tests, and sciatica for 5 biweekly sessions lasting 25-30 minutes. The control group will receive advice to stay active only. The re-evaluation will be performed out after 5 weeks, 10 weeks, and 26 weeks after randomisation and primary endpoints will be pain intensity and functional limitation at 10 weeks. Secondary outcomes will include neuropathic symptoms, sciatic neurodynamic, pain modulation, and psychosocial factors. Adverse events and patient satisfaction will be assessed. Ethical approval has been granted from an Institutional Human Research Ethics Committee. Trial registration: Trial was prospectively registered in the Brazilian Registry of Clinical Trials (number: RBR-3db643c).

Normal response to tibial neurodynamic test in asymptomatic subjects

BACKGROUND

The straight leg raise test (SLR) is one of the most performed physical tests for mechanosensitivity and impairment of the nervous system. According to the anatomy of the tibial nerve, ankle dorsiflexion and eversion movements could be used to perform the tibial neurodynamic test (TNT). To date, no study has documented the normal responses of the TNT.

OBJECTIVE

To document normal responses of the TNT in asymptomatic individuals and to investigate influences from sex and leg dominance.

METHODS

A cross-sectional study with 44 asymptomatic volunteer subjects, a total of 88 lower limbs, was carried out. The range of motion (ROM), quality, and distribution of sensory responses were recorded. The hip flexion ROM was measured when subjects reported an intensity of their symptoms of 2/10 (P1) and 8/10 (P2).

RESULTS

The mean ROM for hip flexion at P1 was 44.22 ± 13.13∘ and 66.73 ± 14.30∘ at P2. Hip flexion was significantly greater at P2 than P1 (p< 0.001). However, it was not different between sex or limbs (p> 0.05). The descriptor of the quality of sensory responses most often used by participants was stretching (88.6% and 87.5% for P1 and P2, respectively) in the popliteal fossa and posterior calf.

CONCLUSIONS

This study describes the sensory responses of asymptomatic subjects resulting from the TNT. Our findings indicate that TNT responses are independent of the influence of sex or leg dominance.

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.

Effect of cervical contralateral lateral flexion on displacement and strain in the median nerve and flexor digitorum superficialis at the wrist during the ULNT1 - Cadaveric study

INTRODUCTION

A key issue in neurodynamic testing is whether a manoeuvre designed to produce differential biomechanical behaviour (structural differentiation) of nerve compared to adjacent muscle is mechanically accurate. The aim of this study was to investigate the capacity of cervical contralateral lateral flexion to produce differential biomechanical behaviour of the median nerve at the wrist (mechanical specificity) in relation to the adjacent muscle (flexor digitorum superficialis) at different ranges of upper limb neurodynamic test 1 in cadavers.

MATERIAL AND METHODS

A cross-sectional study was carried out. In fresh frozen cadavers, with microstrain devices and Vernier calipers, strain and excursion in the median nerve and flexor digitorum superficialis muscle were measured during cervical contralateral lateral flexion at 0°, 30°, 60° and 90° of elbow flexion of the upper limb neurodynamic test 1.

RESULTS

The cervical movement resulted in proximal excursion and significant changes in strain in the median nerve at 0°, 30° and 60° of elbow flexion during the upper limb neurodynamic test 1 (p < 0.05). In contrast, the structural differentiation manoeuvre did not affect the strain nor the excursion in the muscle at any position of the elbow (p > 0.05).

CONCLUSION

Adding CCLF to each ULNT1 median elbow angle increased strain and created proximal excursion of the median nerve at the wrist. Neck movement produced no changes in strain nor excursion of the flexor digitorum superficialis. This study adds to evidence that, in certain circumstances, neck movement may be used in differentiation of nerve and muscle disorders in the wrist.

Healthy Pain-Free Individuals with a History of Distal Radius Fracture Demonstrate an Expanded Distribution of Experimental Referred Pain Toward the Wrist

OBJECTIVE

Nociception caused by injuries may sensitize central mechanisms causing expanded pain areas. After recovery, the status of such pain distribution and sensitivity mechanisms is unknown. The present study investigated whether individuals who have fully recovered from a distal radius fracture demonstrate increased pain sensitivity and expanded distribution of pressure-induced pain.

DESIGN

Cross-sectional single-blinded study.

SETTING

Clinical setting.

SUBJECTS

Twenty-three pain-free individuals with a history of painful distal radius fracture and 22 nonfractured, age/gender-matched controls participated in two experimental sessions (day 0, day 1) 24 hours apart.

METHODS

Pressure pain thresholds (PPTs) were recorded bilaterally at the extensor carpi radialis longus (ECRL), infraspinatus, and gastrocnemius muscles. Spatial distribution of pain was assessed following 60-second painful pressure stimulation at the ECRL (bilateral) and the infraspinatus muscles on the fractured or dominant side. Participants drew pain areas on a body map. After day 0 assessments, prolonged pain was induced by eccentric exercise of wrist extensors on the fractured/dominant side.

RESULTS

Compared with controls, pressure-induced ECRL pain in the fracture group referred more frequently toward the distal forearm (P < 0.005) on day 0. Both groups showed larger pain areas on day 1 compared with day 0 (P < 0.005), although the fracture group showed a larger relative change between days (P < 0.005). The fracture group showed larger pain areas on the fracture side compared with the contralateral side on both days (P < 0.005).

CONCLUSIONS

Prolonged pain and recovered prior painful injuries like fractures may sensitize pain mechanisms manifested as expanded pain distribution. Pressure-induced referred pain can be a simple pain biomarker for clinical use.

Effect of ankle dorsiflexion on displacement and strain in the tibial nerve and biceps femoris muscle at the posterior knee during the straight leg raise: Investigation of specificity of nerve movement

BACKGROUND

A structural differentiation maneuver has been proposed to differentiate between muscle and nerve involvement during the straight leg raise test. However, to date, the mechanical specificity of this maneuver for the tibial nerve at the posterior knee has not been tested. The aim of this study was to investigate the specificity of ankle dorsiflexion as a differentiation maneuver between the tibial nerve and the biceps femoris muscle at the posterior knee during the straight leg raise in cadavers.

METHODS

A cross-sectional study was carried out. In fresh frozen cadavers, with microstrain devices and Vernier calipers, strain and excursion in the tibial nerve and distal biceps femoris muscle were measured during ankle dorsiflexion at 0°, 30°, 60° and 90° of hip flexion of the straight leg raise.

FINDINGS

Ankle dorsiflexion resulted in significant distal excursion and increased strain in the tibial nerve (p < 0.05) whilst the muscle was not affected by the dorsiflexion (p > 0.05) at all hip flexion angles.

INTERPRETATION

Ankle dorsiflexion was mechanically specific between the tibial nerve and biceps femoris during the straight leg raise. This study adds to evidence that, in certain circumstances, dorsiflexion may be used in differentiation of nerve and muscle disorders in the posterior knee.

Differential movement of the sciatic nerve and hamstrings during the straight leg raise with ankle dorsiflexion: Implications for diagnosis of neural aspect to hamstring disorders

INTRODUCTION

In hamstrings injuries, sciatic nerve and muscle disorders can coexist. Therefore, differential diagnosis to include or exclude nerve involvement is an important aspect of evaluation. The objective of this paper is to investigate the mechanical behaviour of the sciatic nerve and biceps femoris muscle in the proximal thigh with the ankle dorsiflexion manoeuvre at different degrees of hip flexion during the straight leg raise in cadavers.

MATERIAL AND METHODS

A cross-sectional study was carried out. Linear displacement transducers were inserted into the sciatic nerve and the biceps femoris muscle of 11 lower extremities from 6 fresh cadavers to measure potential strain of both structures during ankle dorsiflexion at 0°, 30°, 60° and 90° of hip flexion during the straight leg raise. Excursion was also measured with a digital calliper.

RESULTS

Ankle dorsiflexion resulted in significant strain and distal excursion of the sciatic nerve at all ranges of hip flexion during the straight leg raise (p < 0.05). In contrast, the ankle movement did not affect the strain in biceps femoris at any position of the hip (p > 0.05).

CONCLUSION

Ankle dorsiflexion at different degrees of hip flexion during the straight leg raise produces changes in the strain and excursion of the sciatic nerve in the upper thigh. In contrast, the biceps femoris muscle at the same location was not affected by ankle movement. These findings show differential behaviour between the nerve and muscle with ankle dorsiflexion at this location that could be used as differential diagnosis in posterior hip pain.

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

BACKGROUND

Neurodynamic tests (NDTs) have shown to be useful in evaluating neural tissue involvement. Peroneal nerve reaches high importance in ankle injuries. However, up to date, no study has documented the normal responses for this nerve.

OBJECTIVES

The objective of this study was to document normal responses of the peroneal neurodynamic test (NDT_PER) in asymptomatic subjects. Differences in sensory response depending on sex and leg dominance were also examined.

DESIGN

A cross-sectional study was designed.

METHOD

Forty-four asymptomatic subjects with a total of 88 lower limbs were tested. The range of motion (ROM) at the point of first appearance of symptoms (S1) and the point of symptoms tolerance (S2), quality and distribution of sensory responses were recorded.

RESULTS

Hip flexion was significantly higher at S2 than S1 (mean difference, 27.22°; 95% CI: 25.29°, 29.14°; p < 0.001). However, it was not different between sex, nor dominance (p > 0.05). The descriptor of the quality of sensory responses more often used by subjects was stretching (90.9%) in the external foot (74.6%).

CONCLUSIONS

This study provides the normal hip flexion angle and quality and distribution of sensory responses to the NDT_PER in asymptomatic subjects. Responses were independent of the influence of sex or leg dominance.