Comparing the immediate effects of different neural mobilization exercises on hamstring flexibility in recreational soccer players

Background

Hamstring strain injuries remain a challenge for both athletes and clinicians given the high incidence rate, slow healing, and persistent symptoms. Increased tension in the neural structures is a known causative factor for hamstring tightness for which neural mobilization has emerged as a significant adjunct to routine stretching techniques.

Objective

To compare the short-term effects of neural sliding and neural tensioning on hamstring length in male recreational soccer players with hamstring tightness.

Methods

Sixty-two participants between ages 18 and 30 years were randomly assigned to one of the two groups viz. neural sliding or neural tensioning. Participants in either group performed the given stretching protocol in three sets. The Active Knee Extension Test (AKET) and Sit and Reach Test (SRT) were recorded before intervention, immediately after intervention, and after 60 min. between- and within group-analysis was done using analysis of variance.

Results

Between-group analysis showed that neural tensioning was more effective than neural sliding in improving hamstring length on both measures, however this difference was negligible. Within-group analysis demonstrated that the mean post-test scores on the AKET test and SRT were significantly greater than the pre-test scores in both groups (p < 0 . 05 ). A reduction in the post-test scores was observed after 60 min, irrespective of the type of stretching (p < 0 . 05 ).

Conclusion

There was no difference in short-term effects of neural sliding or neural tensioning on hamstring flexibility in male recreational soccer players. Both groups showed improved flexibility immediately after the intervention with reduction in the effect after 60 min.

Effects of neural mobilization of sciatic nerve and its branches in plantar foot pressures and stabilometry

Benefits of neural mobilization (NM) have been described in musculoskeletal patients. The effects of NM on balance appear to be unclear in research, and no studies have tested the possible effects of NM on plantar pressures. Eighteen subjects were evaluated pre and post bilateral gliding of the sciatic nerve and its branches posterior tibial nerve, lateral dorsocutaneous, medial and intermediate dorsocutaneous nerves. Static variables of the plantar footprint and stabilometric variables were measured in a pre-post study. We found no differences in plantar pressure variables, Rearfoot maximum pressure (p = 0.376), Rearfoot medium pressure (p = 0.106), Rearfoot surface (p = 0.896), Midfoot maximum pressure (p = 0.975), Midfoot medium pressure (p = 0.950), Midfoot surface (p = 0.470) Forefoot maximum pressure (p = 0.559), Forefoot medium pressure(p = 0.481), Forefoot surface (p = 0.234), and stabilometric variables either, X-Displacement eyes-open (p = 0.086), Y-Displacement eyes-open (p = 0.544), Surface eyes-open (p = 0.411), Medium speed latero-lateral displacement eyes-open (p = 0.613), Medium speed anteroposterior displacement eyes-open (p = 0.442), X Displacement eyes-closed (p = 0.126), Y-Displacement eyes-closed (p = 0.077), Surface eyes-closed (p = 0.502), Medium speed latero-lateral displacement eyes-closed (p = 0.956), Medium speed anteroposterior displacement eyes-closed (p = 0.349). All variables don´t have significant differences however the measurements had a high reliability with at least an ICC of 0.769. NM doesn´t change plantar pressures or improve balance in healthy non-athletes subjects. NCT05190900.

Immediate effects of lumbar fascia stretching on hamstring flexibility: A randomized clinical trial

BACKGROUND

The hamstring muscles have a great tendency to decrease their extensibility, a phenomenon that presents a distinct clinical entity called short hamstring syndrome (SHS), in addition to problems with adjacent structures.

OBJECTIVE

The objective of this study was to evaluate the immediate effect of lumbar fascia stretching on the flexibility of the hamstring musculature.

METHODS

A randomized controlled trial was carried out. Forty-one women between 18 and 39 years old were divided into two groups: the experimental group received a technique of fascial stretching in the lumbar area while the control group participated in a magnetotherapy machine that was turned off. Hamstring flexibility in both lower limbs was measured by the straight leg raising test (SLR) and the passive knee extension test (PKE).

RESULTS

The results showed statistically significant improvements (p< 0.05) in the SLR and the PKE for both groups. There was a large effect size (Cohen's d) for both tests. There was a statistically significant correlation between the International Physical Activity Questionnaire (IPAQ) and the SLR.

CONCLUSION

The inclusion of lumbar fascia stretching might be an effective part of a treatment protocol to increase the flexibility of the hamstring muscle observing an immediate result in healthy participants.

Changes in tibial nerve stiffness during ankle dorsiflexion according to in-vivo analysis with shear wave elastography

A more detailed assessment of pathological changes in the tibial nerve (TN) is needed to better assess how physical therapy influences TN pathologies. The cross-sectional nerve area can be used for TN assessment but may be influenced by individual differences in parameters, such as body height, body weight, and foot length. Therefore, there are no known reliable noninvasive quantitative methods for assessing TN neuropathy. Although recent ultrasonographic studies reported that TN stiffness changes could be used to assess TN neuropathies of the foot, these studies did not consider the joint position, and peripheral nerve tension can change with joint movement. Therefore, we considered that TN stiffness assessment could be improved by analyzing the relationship between ankle joint position and TN stiffness. This study aimed to investigate the relationship between TN stiffness and ankle angle changes using shear wave elastography. We hypothesized that the TN shear wave velocity significantly increases with ankle dorsiflexion and that the total ankle range or maximum dorsiflexion range correlates with the shear wave velocity. This cross-sectional study included 20 TNs of 20 healthy adults. Ultrasonography and shear wave elastography were used to evaluate the TN. TN stiffness was measured at 5 ankle positions as follows: maximum dorsiflexion (100% df), plantar flexion in the resting position (0% df), and 3 intermediate points (25% df, 50% df, and 75% df). TN shear wave velocity increased with an increase in ankle df angle. While total ankle range was significantly and negatively correlated with TN stiffness in all ankle positions, the maximum ankle df angle was significantly and negatively correlated only at 75% and 100% df. TN stiffness below 50% df may be affected by gliding or decreased nerve loosening, and TN stiffness above 75% df may be influenced by nerve tensioning. When measuring TN stiffness for diagnostic purposes, TN should be assessed at an ankle joint angle below 50% df.

The effect of different neural mobilization exercises on hamstring flexibility and functional flexibility in wrestlers

This study aimed to compare the short-term effects of sciatic nerve neural sliding and neural stretching exercises on hamstring muscle length and functional flexibility in wrestlers. The study participants included 74 wrestlers. The athletes were randomly divided into two groups: neural sliding and neural stretching groups. The hamstring flexibility and the functional flexibility were assessed using the active knee extension limitation (AKEL) angle and the sit and reach (SR) test one day before and immediately after the neural mobilization exercises, respectively. A three-way repeated measures analysis of variance was conducted that examined the effect of mobilization type, time, and gender on interest in AKEL right leg, AKEL left leg, and SR test. There is not a significant difference between the effect of two different mobilizations on AKEL right and left leg, and SR test (P>0.05). It was determined there is statistically significant differences between premobilization and post-mobilization outcome measures for AKEL right leg (F=59.886, P=0.001), AKEL left leg (F=31.896, P=0.001), and SR test (F=22.630, P=0.001). There is not a statistically significant difference between males and females by these three measures neural sliding and neural stretching exercises to the sciatic nerve in wrestlers were effective in increasing hamstring flexibility and functional flexibility and not superior to each other.

Comparative Effects of Tensioning and Sliding Neural Mobilization on Static Postural Control and Lower Limb Hop Testing in Football Players

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.

Effects of neurodynamic treatment on hamstrings flexibility: A systematic review and meta-analysis

OBJECTIVE

To provide detailed information on the effectiveness of neurodynamic treatment on hamstrings flexibility.

METHODS

Systematic review in the following databases: PubMed, Google Scholar, and ScienceDirect. Articles were included if the intervention followed a neurodynamic treatment and the study was a randomized clinical trial including at least one measurement related to hamstrings flexibility. Articles were independently screened for inclusion and data were extracted by two researchers. It was registered in the PROSPERO database (CRD42015020707).

RESULTS

Finally, 6 articles (n = 294 participants) were included. Neurodynamic treatment was compared with no treatment, placebo, and with other manual therapy techniques such as active and passive stretching, muscle inhibition and proprioceptive neuromuscular facilitation. Meta-analysis shows benefits of neurodynamic treatment for knee-extension range of motion (1 trials compared with no intervention, MD = -2.23, 95% CI = -3.02 to -1.44, and 4 trials compared to other techniques, MD = -0.40, 95% CI = -1.09 to 0.29, I² = 81.55%) and passive straight leg raise test measures (2 trials compared with no intervention, MD = 2.26, 95% CI = 1.78 to 2.74, I² = 0%, and 3 trials compared with other techniques MD = 2.26, 95% CI = 1.78 to 2.74, I² = 0%).

CONCLUSIONS

This review and meta-analysis shows the effectiveness of neurodynamic treatment on hamstrings flexibility compared with no intervention and other techniques.