Effects of upper extremity neural mobilization on thermal pain sensitivity: a sham-controlled study in asymptomatic participants

Peripheral and central changes induced by neural mobilization in animal models of neuropathic pain: a systematic review

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.

Neural Mobilization for Reducing Pain and Disability in Patients with Lumbar Radiculopathy: A Systematic Review and Meta-Analysis

Lumbar radiculopathy causes lower back and lower extremity pain that may be managed with neural mobilization (NM) techniques. This meta-analysis aims to evaluate the effectiveness of NM in alleviating pain and reducing disability in patients with lumbar radiculopathy. We hypothesized that NM would reduce pain and improve disability in the lumbar radiculopathy population, leveraging the statistical power of multiple studies. Electronic databases from their inception up to October 2023 were searched for randomized controlled trials (RCTs) that explored the impact of NM on lumbar radiculopathy. Our primary outcome measure was the alteration in pain intensity, while the secondary one was the improvement of disability, standardized using Hedges' g. To combine the data, we employed a random-effects model. A total of 20 RCTs comprising 877 participants were included. NM yielded a significant reduction in pain intensity (Hedges' g = -1.097, 95% CI = -1.482 to -0.712, p < 0.001, I2 = 85.338%). Subgroup analyses indicated that NM effectively reduced pain, whether employed alone or in conjunction with other treatments. Furthermore, NM significantly alleviated disability, with a notable effect size (Hedges' g = -0.964, 95% CI = -1.475 to -0.453, p < 0.001, I2 = 88.550%), particularly in chronic cases. The findings provide valuable insights for clinicians seeking evidence-based interventions for this patient population. This study has limitations, including heterogeneity, potential publication bias, varied causal factors in lumbar radiculopathy, overall study quality, and the inability to explore the impact of neural pathology on NM treatment effectiveness, suggesting opportunities for future research improvements.

Effects of Complex Pain Control Programs on Taekwondo Athletes with Recurrent Low Back Pain: A Case Study

Background and Objectives: Practitioners of martial arts such as Taekwondo are likelier to experience back pain during training or competition. As the back pain of taekwondo athletes shows various symptoms depending on the athlete's characteristics, such as technique and movement, a case study was conducted to verify the intervention effect suitable for individual traits. We examined the effects of a complex pain control program on pain, mechanosensitivity, and physical function in a Taekwondo athlete with recurrent low back pain (LBP). Materials and Methods: A Taekwondo athlete with LBP was recruited from D University, Busan. The intervention program was performed for 45 min twice a week for 3 weeks, and the patient was followed up with after 2 weeks. The numerical rating pain scale (NRPS), pain pressure threshold, mechanosensitivity, and Oswestry Disability Index (ODI) scores were measured before and after the intervention. Therapeutic massage and nerve stimulation therapy were performed. Lumbar flexion, extension, and rotation were performed in the movement control exercise group, whereas the sliding technique, a neurodynamic technique of the tibial nerve, was applied in the neurodynamic technique group. This effect was verified by comparing the average measured values before and after the intervention. Results: Pain (NRPS) and mechanosensitivity reduced, range of motion and tactile discrimination abilities improved, and physical function (ODI) improved. The effect of the improved intervention lasted 2 weeks. Conclusions: These results indicate that application of complex pain control programs considering the four aspects of pain mechanisms for 3 weeks can be an effective intervention in Taekwondo athletes with recurrent LBP.

Acute effects of a single neurodynamic mobilization session on range of motion and H-reflex in asymptomatic young subjects: A controlled study

Neurodynamic techniques have yielded good clinical results in the treatment of various pathologies. The objective of this study is to examine the short-term effects of neurodynamic techniques of the sciatic nerve on hip ROM (range of motion) and on the amplitude and latency of the soleus H-reflex and M-waves, in young asymptomatic subjects. In a double-blind controlled trial design, 60 young asymptomatic participants were randomly assigned into six groups with different levels of manipulation of the sciatic nerve. The passive straight leg raise test was used to evaluate the hip ROM amplitude. All evaluations were performed before, 1 min after, and 30 min after intervention. For each time-point, spinal and muscle excitability were also tested. ROM increased in all groups, but none of the treatment groups had superior effects than the group with no treatment. This means that ROM testing maneuvers increased ROM amplitude, with no add-on effect of the proposed neurodynamic techniques. Neurophysiological responses changed similarly in all groups, showing that the aftereffects were not intervention-specific. We observed a significant negative association between the change in limb temperature and the change in latencies of all potentials. ROM-testing procedures performed repeatedly increase ROM amplitude. This observation should be considered when evaluating the aftereffects of therapeutic interventions on ROM amplitude. None of the explored neurodynamic techniques produced acute aftereffects on hip ROM amplitude, spinal or muscle excitability different to the induced by the ROM testing maneuver.

Comparison of neural mobilization and conservative treatment on pain, range of motion, and disability in cervical radiculopathy: A randomized controlled trial

OBJECTIVE

The objective of the study was to compare the effectiveness of neural mobilization technique with conservative treatment on pain intensity, cervical range of motion, and disability.

METHODS

It was a randomized clinical trial; data was collected from Mayo Hospital, Lahore. Eighty-eight patients fulfilling the sample selection criteria were randomly assigned into group 1 (neural mobilization) and group 2 (conventional treatment). Pain intensity was measured on a numeric pain rating scale, range of motion with an inclinometer, and functional status with neck disability index (NDI). Data were analyzed using SPSS, repeated measure ANOVA for cervical ranges and the Friedman test for NPRS and NDI were used for within-group analysis. Independent samples t-test for cervical ranges and Mann-Whitney U test for NPRS and NDI were used for between-group comparisons.

RESULTS

There was a significant improvement in pain, disability, and cervical range of motion after the treatment in both groups compared to the pre-treatment status (p < 0.001), and when both groups were compared neural mobilization was more effective than conventional treatment in reducing pain and neck disability (p < 0.001), but there was no significant difference present in the mean score of cervical range of motion between both groups. (p>0.05).

CONCLUSIONS

The present study concluded that both neural mobilization and conservative treatment were effective as an exercise program for patients with cervical radiculopathy, however, neural mobilization was more effective in reducing pain and neck disability in cervical radiculopathy.

TRIAL REGISTRATION

RCT20190325043109N1.

Comparison of Two Manual Therapy Programs, including Tendon Gliding Exercises as a Common Adjunct, While Managing the Participants with Chronic Carpal Tunnel Syndrome

Background

Carpal tunnel syndrome (CTS) is the symptomatic compression neuropathy of the median nerve at the wrist level that may become a reason for upper limb disability, in the women and men population.

Objective

This study aimed to compare the efficacy of the neurodynamic technique (NT) and carpal bone mobilization technique (CBMT) incorporated with tendon gliding exercises (TGE) as an effect-enhancing adjunct while managing the participants with chronic CTS.

Methods

The study followed a two-arm parallel-group randomized comparative design. Thirty participants (aged 30–59 years) with chronic CTS were recruited randomly to both the NT and CBMT groups. In addition to the TGE (a common adjunct), NT and CBMT were performed in the NT and CBMT groups, respectively, for three weeks. The primary outcome measures including pain intensity, functional status, grip strength, and motor nerve conduction study were assessed using a visual analogue scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), hand-held dynamometer, and electromyograph, respectively, at baseline, 3 weeks postintervention, and follow-up at one week post end of the intervention. Paired and unpaired t-test were used to calculate the differences in intervention effects within and between the groups with keeping the level of significance α at 0.05.

Results

The data analysis revealed a significant (95% CI, p < 0.05) difference for all outcomes within each group compared across different time intervals. Similarly, a significant difference was found for all outcomes except pain and grip strength compared between groups at 3 weeks postintervention and follow-up at one week post end of the intervention.

Conclusions

The NT revealed more effectiveness than the CBMT when incorporated with TGE to improve nerve conduction velocity and functional status of the hand. However, both NT and CBMT were equally effective in improving pain and grip strength while managing the participants with chronic CTS. In addition, the TGE contributed as a beneficial, effect-enhancing adjunct to the NT and CBMT differently. Significance. The study will guide the physiotherapist in applying either of the combination techniques suitable for achieving treatment objectives while managing the participants with chronic CTS.

Effects of Neural Mobilization on Pain Intensity, Disability, and Mechanosensitivity: An Umbrella Review With Meta-Meta-Analysis

OBJECTIVE

The purpose of this study was to assess the current evidence for the effects of neural mobilization (NM) treatments.

METHODS

Three umbrella reviews with meta-meta-analyses were conducted to determine the effects of NM on pain intensity and disability in people with musculoskeletal disorders and on mechanosensitivity in participants who were asymptomatic. The study used the grading criteria proposed by the Physical Activity Guidelines Advisory Committee to assess the quality of evidence.

RESULTS

One meta-meta-analysis revealed a statistically significant moderate effect on pain intensity (standardized mean difference [SMD] = -0.75, 95% CI = -1.12 to -0.38) but with evidence of heterogeneity (Q = 14.13; I2 = 65%). The study found a significantly large effect of NM on disability (SMD = -1.22, 95% CI = -2.19 to -0.26), again with evidence of heterogeneity (Q = 31.57; I2 = 87%). The third meta-meta-analysis showed a statistically significant moderate effect of NM on mechanosensitivity (SMD = 0.96, 95% CI = 0.35 to 1.57), with no evidence of heterogeneity (Q = 2.73; I2 = 63%). For all examined outcomes, the quality of evidence was limited.

CONCLUSION

Overall, the results indicated that although NM treatment had a moderate to large beneficial clinical effect on pain intensity and disability in people with musculoskeletal disorders and on mechanosensitivity in individuals who were asymptomatic, the quality of evidence was limited.

IMPACT

Neural mobilization treatments showed positive results on the pain intensity and disability in individuals with musculoskeletal conditions. Neural mobilization could be integrated into the physical therapy management, although more research is needed.

Investigating the effects of neuromobilization in lateral epicondylitis

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.

Update on Efficacy of Conservative Treatments for Carpal Tunnel Syndrome

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.

Median Nerve Neural Mobilization Adds No Additional Benefit When Combined with Cervical Lateral Glide in the Treatment of Neck Pain: A Randomized Clinical Trial

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.

Hypoalgesic and Motor Effects of Neural Mobilisation versus Soft-Tissue Interventions in Experimental Craniofacial Hyperalgesia: A Single-Blinded Randomised Controlled Trial

Objective: The present trial aimed to compare the effects of the mobilisation of the nervous system (NS) to those of a soft-tissue intervention in subjects exposed to an experimentally induced hyperalgesia of the masticatory muscles. Methods: The study was a single-blinded randomised controlled trial. A total of 49 participants (mean ± SD age: 41 ± 11 years; 61% female) with latent myofascial trigger points (LMTrPs) in the craniofacial region were randomly assigned to one of three groups: neural mobilisation (NM), soft-tissues techniques and stretching (STT-S), and control group (CG). An initial assessment (baseline) was performed before the provocation chewing masticatory test. The pre-treatment measurements were registered 24 h later. Next, the randomised intervention was applied, and afterwards, post-treatment data were obtained. Outcome measures included pain-free maximum mouth opening (MMO), pressure pain thresholds (PPTs) in the trigeminal and cervical region, and trigeminal and cervical two-point discrimination (TPD). Results: ANOVA revealed significant differences for the time × group interaction for pain-free MMO and PPTs. The results showed an improvement in the MMO and the PPTs for NM and STT-S groups but not for the CG. There were no differences between the NM and STT-S groups. However, the effect sizes were large for the NM and medium for the STT-S. No differences were found for TDP between groups nor over time. Conclusions: The results show that with NM and STT-S techniques, we could influence motor and sensory variables in asymptomatic subjects with LMTrPs after a masticatory provocation test. Both techniques increased MMO and PPTs in the short term. These beneficial effects lead us to consider the importance of including these methods in clinical practice.

Effects of neural mobilizations through movement representation techniques for the improvement of neural mechanosensitivity of the median nerve region: a randomized controlled trial

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.

Upper limb neurodynamic testing with radial and ulnar nerve biases: An analysis of cervical spinal nerve mechanics

BACKGROUND

Clinical research supports a combination of upper limb neurodynamic testing (ULNT) strategies to rule out upper limb and cervical neurogenic pathology; however, knowledge of the biomechanical response of spinal nerves during ULNT is lacking for radial and ulnar nerve biases.

OBJECTIVE

To assess whether radial and ulnar nerve biased strategies of ULNT elicit significant displacement and strain of cervical spinal nerves.

STUDY DESIGN

Cross-sectional.

METHODS

Radiolucent markers were implanted into spinal nerves C5-C8 proximal and distal to the intervertebral foramen in nine unembalmed cadavers (six male; three female) age 80.1 ± 13.2 years. Fluoroscopic images were captured during ULNT with radial and ulnar nerve biases. Images at rest and maximum tension were digitized and displacement and strain were measured. All data were analyzed using one sample t-tests and a generalized linear mixed models approach.

RESULTS

Upper limb neurodynamic testing with radial nerve bias resulted in displacement (2.44-3.04 mm) and strain (7.99-11.98%) and ULNT with ulnar nerve bias resulted in displacement (2.16-4.41 mm) and strain (7.12 and 12.95%). Significant extraforaminal displacement occurred during radial and ulnar nerve biases for all spinal nerves (all P < 0.05) whereas significant strain occurred during ulnar nerve biases for all spinal nerves but only in C6-C8 during radial nerve bias.

CONCLUSION

Upper limb neurodynamic testing using both radial and ulnar nerve biases resulted in cervical spinal nerve displacement and strain. Such techniques could be used to tension load or mobilize or cervical spinal nerves to evaluate for pathology.

Influence of Tensioner's Mobilization on the Centralization of Symptoms in Cervicobrachial Pain Syndrome: A Randomized Controlled Trial

Study Design

This study was designed as a randomized controlled trial.

Purpose

The present study aimed to determine the impact of neural mobilization by tensioner’s technique (NMTT) on the centralization of symptoms and pain in patients with cervicobrachial pain syndrome (CBPS).

Overview of Literature

CBPS is a disabling condition of the neck that is characterized by pain and paresthesia in the upper quarter. Several techniques have successfully provided immediate and long-term relief in CBPS; however, few studies have evaluated the effect of these techniques on the centralization of symptoms.

Methods

Thirty patients aged 18–45 years with a complaint of pain in the neck that had persisted for 2–12 weeks radiating to the arm and fulfilling Elvey’s criteria were randomly selected and divided into two groups. Group A received NMTT plus conventional treatment (hot pack and postural advice with cervical lateral glide), and group B received only conventional treatment 3 times a week for 2 weeks. The outcome measures were Wernicke’s scale score for the centralization of symptoms and Visual Analog Scale score for pain intensity. Within- and between-group comparisons were made before initiating treatment and at the end of the 3rd and 6th sessions. Within group analyses for the centralization values were performed using Friedmann test, and between-group analyses were performed using Mann-Whitney test. A 2×3 mixed model of the analysis of variance was used for analyzing the pain levels.

Results

There was a significant difference (p<0.05) within and between the groups for both the measures at the end of the 3rd and 6th sessions. Thus, NMTT may be beneficial in decreasing the peripheralization of symptoms and pain intensity in patients with CBPS.

Conclusions

NMTT can be used as an alternative and effective treatment option for patients with CBPS.

Comparison between neurodynamic therapy and foam rolling in cool-down sessions for delayed onset muscle soreness in healthy individuals

BACKGROUND

Delayed onset of muscle soreness (DOMS) is a common finding in trained and untrained individuals post high intensity exercises which can lead to injuries. Foam rolling (FR) and neurodynamic therapy (NDT) are types of active cool-down which provides effective for treatment of DOMS. But their role in reduction of intensity of the same in cool down is not established.

STUDY DESIGN

Crossover study.

METHODOLOGY

Total 60 healthy individuals participated in the study. Pre intervention readings were taken of strength and tightness by Range of motion. Subjects performed both the types of cool-down separated by 4 weeks interval with random allocation. Post intervention readings of hamstring and quadriceps tightness, grade of tenderness and stand to sit VAS score was taken post 24 h and 48 h and strength post 48 h.

RESULTS

Analysis was done for using repeated measures ANOVA and Friedman's test. The difference of values for Straight Leg Raise and Prone knee Flexion between NDT and FR post 24 h were statistically significant (p < 0.05) while that of NDT post 24 h being similar to FR post 48 h (p > 0.05). There was a significant difference between strength, tenderness and VAS in NDT and FR (p < 0.05). With the mean of post 24 h as well as post 48 h being less in the FR intervention.

CONCLUSION

Foam rolling is a better option than Neurodynamic therapy for reduction of intensity of DOMS.

The effectiveness of routine physiotherapy with and without neuromobilization on pain and functional disability in patients with shoulder impingement syndrome; a randomized control clinical trial

Background

The objective of the study was to compare the effects of neuromobilization (NM) techniques and routine physiotherapy on pain and functional disability in patients having shoulder impingement syndrome (SIS). Present study was aimed to discover evidence based conservative and cost effective remedy on pain and functional disability.

Study design

Single blinded randomized control clinical trial.

Methods

A total of 80 patients with SIS were randomly assigned into care and experimental groups (40 in each group). After the baseline assessment routine physiotherapy was executed on both groups, while NM was applied additionally to experimental group. Pain and functional disability score were evaluated by Visual Analogue Scale and University of California at Los Angeles rating score at baseline, 5th and 11th week. Differences in outcome between groups were evaluated with clinical improvement.

Results

The experimental group compared with care group at 11th week had lower mean pain score 2.15(1.66–2.64) vs 4.90(4.41–5.40); between group difference, 1.82; 95% (CI), − 2.38 to − 1.25; P < 0.001 and Partial ƞ² = 0.33, similarly functional disability score 28.58(27.32–29.83) vs 20.10(18.84–21.36); between group difference,5.62; 95%CI, (4.32–6.92); P< 0.001 and Partial ƞ² = 0.49 respectively. In experimental group NM was a more effective technique to reduce the pain severity and disability in SIS patients as compare to care group.

Conclusion

Neuromobilization techniques in addition to routine physiotherapy were significantly effective for the treatment of SIS.

Trial registration

IRCT20190121042445N1, Registered 19 February 2019.

Cervical traction combined with neural mobilization for patients with cervical radiculopathy: A randomized controlled trial

BACKGROUND

Although both neural mobilization (NM) and cervical traction (CT) are widely used interventions in cervical radiculopathy (CR), there is limited clinical data to support their use.

OBJECTIVE

To evaluate the effects of CT, with or without the addition of NM, on pain, function, and disability in patients with CR.

DESIGN

A randomized, double-blinded, placebo-controlled clinical trial.

METHODS

66 patients with CR were randomly allocated to: a group (n = 22) received CT combined with NM (CT + NM), a group (n = 22) received CT combined with sham NM (CT + shamNM) and a wait-list control (WLC) group (n = 22). The Neck Disability Index (NDI), the Patient-Specific Functional Scale, the Numeric Pain Rating Scale (NPRS), grip strength and cervical spine mobility were used as outcome measures. A two-way analysis of variance was used to evaluate differences between the three groups at baseline and at 4-week follow-up.

RESULTS

Statistically and clinically significant between-group differences at 4-week follow-up were found between CT + NM and WLC groups in favor of CT + NM group in NDI scores (d = 1.30), NRPS (d = 1.94), and active cervical rotation towards the opposite arm (d = 1.18) and between CT + NM and CT + shamNM groups in favor of CT + NM group in NRPS (d = 1.21). No significant differences were observed between CT + shamNM and WLC groups in all outcome measures. Clinically significant within-group improvements were found only for the CT + NM group.

CONCLUSION

At 4-week follow-up, CT in combination with NM resulted in improved outcomes in pain, function and disability in patients with CR.

The immediate effect of neurodynamic techniques on jumping performance: A randomised double-blind study

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.

Comparison of two manual therapy techniques in patients with carpal tunnel syndrome: A randomized clinical trial

Background

Manual therapy techniques are part of physiotherapy treatment of carpal tunnel syndrome (CTS) which are classified into two groups including nerve mobilization and mechanical interface mobilization. The aim of the study was to find which manual therapy method-technique directed to mechanical interface and nerve mobilization-has superior beneficial effects on clinical and electrophysiological findings in conservative management of patients with CTS.

Methods

Thirty patients with CTS participated into two groups namely: mechanical interface and nerve mobilization in this randomized clinical trial. The intervention was performed three times weekly for 4 weeks. Mechanical interface mobilization was directed to structures around the median nerve at the forearm and wrist. Techniques of median nerve gliding and tension were used in the nerve mobilization group. The outcome measures included visual analogue scale (VAS), symptom severity scale (SSS), hand functional status scale (FSS) and motor and sensory distal latencies of median nerve. Paired t-test and ANCOVA were used for statistical analysis.

Results

At the end of the 4^th week of the treatment, the mean of VAS, SSS and FSS significantly improved in both groups (p<0.05), but the difference was not significant between the two groups (P>0.05). Although the mean of motor and sensory distal latencies of median nerve at the end of the treatment period only improved in the nerve mobilization group (p<0.05), the difference was not significant between the two groups (P>0.05).

Conclusion

Mechanical interface mobilization and nerve mobilization techniques are not superior to each other in reducing pain and improving hand symptoms and functional status.

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.

A brief report on the clinical trial on neural mobilization exercise for joint pain in patients with rheumatoid arthritis

BACKGROUND

In rheumatoid arthritis (RA) synovitis, activation of synoviocytes and infiltration of adaptive immune cells leads to synovial hyperplasia and joint swelling. Under the elevated extra-neural pressure, free nerve endings release neuropeptides, calcitonin gene-related peptide, and substance P, thus promoting neurogenic inflammation.

OBJECTIVE

This study aimed to assess the effect of therapeutic neural mobilization (NM) exercises targeting the nervous system on disease impact in RA patients.

METHODS

A total of 21 RA patients were randomized into NM (n = 11) and control (n = 10) groups. NM group patients performed NM exercises targeting the median, musculocutaneous, femoral, and saphenous nerve, as well as the entire nervous system twice daily for 4-8 weeks. Control RA patients performed gentle joint mobilization exercises targeting the same joints. Primary outcome was the change in pre-/post-treatment score in the validated Rheumatoid Arthritis Impact of Disease (RAID). Secondary outcome was erythrocyte sedimentation rate (ESR).

RESULTS

There were no significant differences between the groups at baseline. No adverse events were observed and compliance was over 90%. Post-treatment, favorable changes were observed in the NM group RAID score: -5.1 vs. -0.8; weighted RAID score: -0.79 vs. -0.15. ESR was reduced in the NM group, albeit non-significantly. Regarding the RAID score domains, the NM group demonstrated significant improvements in pain and coping.

CONCLUSION

The current data indicate a beneficial effect of NM exercises on pain and self-efficacy in our RA patients. Larger clinical studies are warranted to determine the clinical effectiveness of NM as a treatment for pain for RA patients and simultaneously address immune and neuropeptide modulation through NM.

Neural gliding and neural tensioning differently impact flexibility, heat and pressure pain thresholds in asymptomatic subjects: A randomized, parallel and double-blind study

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.

The Effect of Spinal Mobilization With Leg Movement in Patients With Lumbar Radiculopathy-A Double-Blind Randomized Controlled Trial

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.

Effectiveness of median nerve neural mobilization versus oral ibuprofen treatment in subjects who suffer from cervicobrachial pain: a randomized clinical trial

INTRODUCTION

Oral ibuprofen (OI) and median nerve neural mobilization (MNNM) are first line treatments for patients who suffer cervicobrachial pain (CP). OI may produce side effects which are not tolerated by all subjects who suffer CP, whereas MNNM has no known side effects. Therefore, the aim of this study was to assess the effectiveness of both treatments (OI vs. MNNM) in CP.

MATERIAL AND METHODS

This investigation was a blinded parallel randomized clinical trial (NCT02593721). Sixty-two participants diagnosed with CP were recruited and randomly assigned to 2 groups (n = 31), which received MNNM or 1200 mg/day OI treatment for 6 weeks. The numeric rating scale for pain intensity was the primary outcome. The cervical rotation range of motion (CROM) and the upper limb function were the secondary outcomes.

RESULTS

The results showed that OI treatment (η2 = 0.612-0.755) was clearly superior to MNNM (η2 = 0.816-0.821) in all assessments (p < 0.05) except for the CROM device results, which were equivalent to those of the MNNM group (p > 0.05). Three subjects were discharged because of OI side effects.

CONCLUSIONS

Oral ibuprofen may be superior to MNNM for pain reduction and upper limb function increase of subjects with CP. Nevertheless, both treatments were effective. Median nerve neural mobilization may be considered an effective non-pharmaceutical treatment option in subjects with CP. Regarding OI adverse effects, our findings challenge the role of pharmacologic versus manual therapy as possible treatments that may improve pain intensity and upper limb functionality in subjects with CP.

Is pharmacologic treatment better than neural mobilization for cervicobrachial pain? A randomized clinical trial

Purpose: This study aim was to compare the effectiveness of the median nerve neural mobilization (MNNM) and cervical lateral glide (CLG) intervention versus oral ibuprofen (OI) in subjects who suffer cervicobrachial pain (CP). Methods: This investigation was a, multicenter, blinded, randomized controlled clinical trial (NCT02595294; NCT02593721). A number of 105 individuals diagnosed with CP were enrolled in the study and treated in 2 different medical facilities from July to November 2015. Participants were recruited and randomly assigned into 3 groups of 35 subjects. Intervention groups received MNNM or CLG neurodynamic treatments, and the (active treatment) control group received an OI treatment for 6 weeks. Primary outcome was pain intensity reported through the Numeric Rating Scale for Pain (NRSP). Secondary outcomes were physical function involving the affected upper limb using the Quick DASH scale, and ipsilateral cervical rotation (ICR) using a cervical range of motion (CROM) device. Assessments were performed before and 1 hour after treatment for NRSP (baseline, 3 and 6 weeks) and CROM (baseline and 6 weeks), as well as only 1 assessment for Quick DASH (baseline and 6 weeks). Results: Repeated-measures ANOVA intergroup statistically significant differences were shown for CP intensity (F(2,72) = 22.343; P < .001; Eta2 = 0.383) and Quick DASH (F(2,72) = 15.338; P < .001; Eta2 = 0.299), although not for CROM (F(2,72) = 1.434; P = .245; Eta2 = 0.038). Indeed, Bonferroni´s correction showed statistically significant differences for CP intensity (P < .01; 95% CI = 0.22 - 3.26) and Quick DASH reduction (P < .01; 95% CI = 8.48 - 24.67) in favor of the OI treatment at all measurement moments after baseline. Conclusions: OI pharmacologic treatment may reduce pain intensity and disability with respect to neural mobilization (MNNM and CLG) in patients with CP during six weeks. Nevertheless, the non-existence of between-groups ROM differences and possible OI adverse effects should be considered.

Entrapment Neuropathies: Challenging Common Beliefs With Novel Evidence

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.

Effects of Median Nerve Neural Mobilization in Treating Cervicobrachial Pain: A Randomized Waiting List-Controlled Clinical Trial

BACKGROUND

There is a current lack of sufficiently high-quality randomized controlled clinical trials that measure the effectiveness of neural tissue mobilization techniques such as median nerve neural mobilization (MNNM) and their specific effects on cervicobrachial pain (CP). The aim of this study was to compare the effectiveness of MNNM in subjects with CP vs. a waiting list control group (WLCG).

METHODS

A single-blinded, parallel, randomized controlled clinical trial was performed (NCT02596815). Subjects were recruited with a medical diagnosis of CP corroborated by magnetic resonance imaging. In total, 156 individuals were screened, 60 subjects were recruited, and 51 completed the trial. Pain intensity reported using the Numeric Rating Scale for Pain (NRSP; primary outcome), cervical range of motion (CROM), and functionality using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scale were the outcome measurements. Assessments were conducted at baseline and 1 hour after treatment (intervention days 1, 15, and 30). Therefore, MNNM was implemented with 30 days of follow-up.

RESULTS

The NRSP values of the MNNM group were significantly (P < 0.0001; 95% confidence interval [CI]) superior to those obtained in the WLCG. Subjects treated with MNNM reported an NRSP decrease of 3.08 points at discharge. CROM and QuickDASH outcome values were significantly (P ˂ 0.0001; 95% CI) improved only in the MNNM group. Hedges' g showed a very large effect of the MNNM intervention.

CONCLUSION

MNNM may be superior to no treatment in reducing pain and increasing function in the affected upper limbs of subjects with CP.

Comparison of 2 Lumbar Manual Therapies on Temporal Summation of Pain in Healthy Volunteers

The purpose of this study was to compare the immediate change in temporal summation of heat pain (TSP) between spinal manipulation (SMT) and spinal mobilization (MOB) in healthy volunteers. Ninety-two volunteers (24 male; 23.8 ± 5.3 years) were randomized to receive SMT, MOB, or no treatment (REST) for 1 session. Primary outcomes were changes in TSP, measured at the hand and foot, immediately after the session. A planned subgroup analysis investigated effects across empirically derived TSP clusters. For the primary outcome there were no differences in the immediate change in TSP measured at the foot between SMT and MOB, however, both treatments were superior to the REST condition. In the subgroup analysis the response to a standard TSP protocol was best characterized by 3 clusters: 52% no change (n = 48, 52%); facilitatory response (n = 24, 26%), and inhibitory response (n = 20, 22%). There was a significant Time × Treatment group × Cluster interaction for TSP measured at the foot. The inhibitory cluster showed the greatest attenuation of TSP after SMT and MOB compared with REST. These data suggest lumbar manual therapies of different velocities produce a similar localized attenuation of TSP, compared with no treatment. Attenuation of localized pain facilitatory processes by manual therapies was greatest in pain-free individuals who show an inhibitory TSP response.

PERSPECTIVE

The attenuation of pain facilitatory measures may serve an important underlying role in the therapeutic response to manual therapies. Identifying patients in pain who still have an inhibitory capacity (ie, an inhibitory response subgroup) may be useful clinically in identifying the elusive "manual therapy" responder.

Neurodynamic mobilization and foam rolling improved delayed-onset muscle soreness in a healthy adult population: a randomized controlled clinical trial

Objectives

Compare the immediate effects of a Neurodynamic Mobilization (NM) treatment or foam roller (FR) treatment after DOMS.

Design

Double blind randomised clinical trial.

Setting

The participants performed 100 drop jumps (5 sets of 20 repetitions, separated by 2 min rests) from a 0.5-m high box in a University biomechanics laboratory to induce muscle soreness. The participants were randomly assigned in a counter-balanced fashion to either a FR or NM treatment group.

Participants

Thirty-two healthy subjects (21 males and 11 females, mean age 22.6 ± 2.2 years) were randomly assigned into the NM group (n = 16) or the FR group (n = 16).

Main Outcome Measures

The numeric pain rating scale (NPRS; 0–10), isometric leg strength with dynamometry, surface electromyography at maximum voluntary isometric contraction (MVIC) and muscle peak activation (MPA) upon landing after a test jump were measured at baseline, 48 h after baseline before treatment, and immediately after treatment.

Results

Both groups showed significant reduction in NPRS scores after treatment (NM: 59%, p < .01; FR: 45%, p < .01), but no difference was found between them (p > .05). The percentage change improvement in the MVIC for the rectus femoris was the only significant difference between the groups (p < 0.05) at post-treatment. After treatment, only the FR group had a statistically significant improvement (p < 0.01) in strength compared to pre-treatment.

Conclusion

Our results illustrate that both treatments are effective in reducing pain perception after DOMS whereas only FR application showed differences for the MVIC in the rectus femoris and strength.

Neurodynamic treatment did not improve pain and disability at two weeks in patients with chronic nerve-related leg pain: a randomised trial

QUESTION

In people with nerve-related leg pain, does adding neurodynamic treatment to advice to remain active improve leg pain, disability, low back pain, function, global perceived effect and location of symptoms?

DESIGN

Randomised trial with concealed allocation and intention-to-treat analysis.

PARTICIPANTS

Sixty participants with nerve-related leg pain recruited from the community.

INTERVENTIONS

The experimental group received four sessions of neurodynamic treatment. Both groups received advice to remain active.

OUTCOME MEASURES

Leg pain and low back pain (0, none, to 10, worst), Oswestry Disability Index (0, none, to 100, worst), Patient-Specific Functional Scale (0, unable to perform, to 30, able to perform), global perceived effect (-5 to 5) and location of symptoms were measured at 2 and 4 weeks after randomisation. Continuous outcomes were analysed by linear mixed models. Location of symptoms was assessed by relative risk (95% CI).

RESULTS

At 2 weeks, the experimental group did not have significantly greater improvement than the control group in leg pain (MD -1.1, 95% CI -2.3 to 0.1) or disability (MD -3.3, 95% CI -9.6 to 2.9). At 4 weeks, the experimental group experienced a significantly greater reduction in leg pain (MD -2.4, 95% CI -3.6 to -1.2) and low back pain (MD -1.5, 95% CI -2.8 to -0.2). The experimental group also improved significantly more in function at 2 weeks (MD 5.2, 95% CI 2.2 to 8.2) and 4 weeks (MD 4.7, 95% CI 1.7 to 7.8), as well as global perceived effect at 2 weeks (MD 2.5, 95% CI 1.6 to 3.5) and 4 weeks (MD 2.9, 95% CI 1.9 to 3.9). No significant between-group differences occurred in disability at 4 weeks and location of symptoms.

CONCLUSION

Adding neurodynamic treatment to advice to remain active did not improve leg pain and disability at 2 weeks.

TRIAL REGISTRATION

NCT01954199. [Ferreira G, Stieven F, Araujo F, Wiebusch M, Rosa C, Plentz R, et al. (2016) Neurodynamic treatment did not improve pain and disability at two weeks in patients with chronic nerve-related leg pain: a randomised trial.Journal of Physiotherapy62: 197-202].

Acute effects of neural mobilization and infrared on the mechanics of the median nerve

[Purpose] This study analyzed the acute effects of infrared and neural mobilization on the median nerve on the range of elbow extension of the dominant limb. [Subjects and Methods] Forty participants from university, neurologically asymptomatic, 12 males and 28 females (22.8 ± 1.9 years), were randomly divided into four groups: Group 1 (control) rested for 25 minutes in the supine position; Group 2 received the specific neural mobilization for the median nerve; Group 3 received an application of infrared for 15 minutes on the forearm; Group 4 received the same application of infrared followed by neural mobilization. The goniometric parameters of elbow extension were evaluated after the intervention. [Results] Significant differences of extension value were observed between Group 1 and Group 3 (15.75 degrees), and between Group 1 and Group 4 (14.60 degrees), and the average higher in Group 3 (26.35 degrees). [Conclusion] This research provides new experimental evidence that NM in relation to superficial heat produces an immediate effect on elbow range of motion versus NM isolated.

Non-pharmacological treatment for neuropathic pain in children with cancer

Neuropathic pain (NP) associated with childhood cancer is currently a difficult problem to control. It is treated with drugs that not only fail to provide the expected improvements, but which also have side effects. Therefore, the main aim of this pilot study is to assess whether non-pharmacological treatments, Graded Motor Imagery (GMI) and Neural Mobilization (NM), have a positive effect on this pain, thus improving the associated comorbid factors and, consequently, the quality of life of the children. In an n = 6, the results after 4 weeks of treatment show a 10-point improvement in the pain threshold and a 3.1-point improvement in the perception of pain.

Comparison of Dry Needling versus Orthopedic Manual Therapy in Patients with Myofascial Chronic Neck Pain: A Single-Blind, Randomized Pilot Study

Objective. The aim of this study was to compare the efficacy of three interventions for the treatment of myofascial chronic neck pain. Methods. Thirty-six patients were randomly assigned to one of three intervention groups: orthopedic manual therapy (OMT), dry needling and stretching (DN-S), and soft tissue techniques (STT). All groups received two treatment sessions with a 48 h time interval. Outcome measures included neck pain intensity measured using a visual analogue scale, cervical range of motion (ROM), pressure pain threshold for measuring mechanical hyperalgesia, and two self-reported questionnaires (neck disability index and pain catastrophizing scale). Results. The ANOVA revealed significant differences for the group × time interaction for neck disability, neck pain intensity, and pain catastrophizing. The DN-S and OMT groups reduced neck disability. Only the OMT group showed decreases in mechanical hyperalgesia and pain catastrophizing. The cervical ROM increased in OMT (i.e., flexion, side-bending, and rotation) and DN-S (i.e., side-bending and rotation) groups. Conclusions. The three interventions are all effective in reducing pain intensity. Reduction in mechanical hyperalgesia and pain catastrophizing was only observed in the OMT group. Cervical ROM improved in the DN-S and OMT groups and also neck disability being only clinically relevant for OMT group.

Management of Lateral Elbow Tendinopathy: One Size Does Not Fit All

Synopsis Clear guidelines for the clinical management of individuals with lateral elbow tendinopathy (LET) are hampered by many proposed interventions and the condition's prognosis, ranging from immediate resolution of symptoms following simple advice in some patients to long-lasting problems, regardless of treatment, in others. This is compounded by our lack of understanding of the complexity of the underlying pathophysiology of LET. In this article, we collate evidence and expert opinion on the pathophysiology, clinical presentation, and differential diagnosis of LET. Factors that might provide prognostic value or direction for physical rehabilitation, such as the presence of neck pain, tendon tears, or central sensitization, are canvassed. Clinical recommendations for physical rehabilitation are provided, including the prescription of exercise and adjunctive physical therapy and pharmacotherapy. A preliminary algorithm, including targeted interventions, for the management of subgroups of patients with LET based on identified prognostic factors is proposed. Further research is needed to evaluate whether such an approach may lead to improved outcomes and more efficient resource allocation. J Orthop Sports Phys Ther 2015;45(11):938-949. Epub 17 Sep 2015. doi:10.2519/jospt.2015.5841.

Comparison of Hypoalgesic Effects of Neural Stretching vs Neural Gliding: A Randomized Controlled Trial

OBJECTIVE

The purpose of this study was to evaluate the immediate mechanical hypoalgesic effect of neural mobilization in asymptomatic subjects. We also compared neural gliding vs neural stretching to see which produced greater hypoalgesic effects in asymptomatic subjects.

METHODS

Forty-five asymptomatic subjects (20 men and 25 women; mean ± SD age, 20.8 ± 2.83 years) were randomly allocated into 3 groups: the neural glide group, the neural stretch group, and the placebo group. Each subject received 1 treatment session. Outcome measures included bilateral pressure pain threshold measured at the trigeminal, cervical, and tibialis anterior points, assessed pre-treatment and immediately post-treatment by a blinded assessor. Three-way repeated-measures analysis of variance was used to evaluate changes in pressure pain threshold, with group (experimental or control) as the between-subjects variable and time (pre-, post-treatment) or side (dominant, nondominant) as the within-subjects variable.

RESULTS

Group differences were identified between neural mobilization groups and the placebo group. Changes occurred in all of the pressure pain threshold measures for neural gliding, and in all but the trigeminal point for neural stretch. No changes in the pressure pain threshold measures occurred in the placebo group.

CONCLUSIONS

This research provides new experimental evidence that neural mobilization produces an immediate widespread hypoalgesic effect vs placebo but neural gliding produces hypoalgesic effects in more body sites than neural stretching.

Onset and maximum values of electromyographic amplitude during prone hip extension after neurodynamic technique in patients with lumbosciatic pain: A pilot study

OBJECTIVE

The mechanisms underlying the effects of neurodynamic techniques are still unknown. Therefore, the aim of this study was to provide a starting point for future research on explaining why neurodynamic techniques affect muscular activities in patients with sciatic pain.

METHODS

A double-blind trial was conducted in 12 patients with lumbosciatica. Surface electromyography activity was assessed for different muscles during prone hip extension. Pre- and post-intervention values for muscle activity onset and maximal amplitude signals were determined.

RESULTS

There was a significant reduction in the surface electromyography activity of maximal amplitude in the erector spinae and contralateral erector spinae (p < 0.05). Additionally, gluteus maximus (p < 0.05) activity onset was delayed post-intervention.

CONCLUSIONS

Self-neurodynamic sliding techniques modify muscular activity and onset during prone hip extension, possibly reducing unnecessary adaptations for protecting injured components. Future work will analyze the effects of self-neurodynamic sliding techniques during other physical tasks.

Quantitative in vivo longitudinal nerve excursion and strain in response to joint movement: A systematic literature review

BACKGROUND

Neural system mobilization is widely used in the treatment of several painful conditions. Data on nerve biomechanics is crucial to inform the design of mobilization exercises. Therefore, the aim of this review is to characterize normal nervous system biomechanics in terms of excursion and strain.

METHODS

Studies were sought from Pubmed, Physiotherapy Evidence Database, Cochrane Library, Web of Science and Scielo. Two reviewers' screened titles and abstracts, assessed full reports for potentially eligible studies, extracted information on studies' characteristics and assessed its methodological quality.

FINDINGS

Twelve studies were included in this review that assessed the median nerve (n=8), the ulnar nerve (n=1), the tibial nerve (n=1), the sciatic nerve (n=1) and both the tibial and the sciatic nerves (n=1). All included studies assessed longitudinal nerve excursion and one assessed nerve strain. Absolute values varied between 0.1mm and 12.5mm for median nerve excursion, between 0.1mm and 4.0mm for ulnar nerve excursion, between 0.7 mm and 5.2mm for tibial nerve excursion and between 0.1mm and 3.5mm for sciatic nerve excursion. Maximum reported median nerve strain was 2.0%.

INTERPRETATION

Range of motion for the moving joint, distance from the moving joint to the site of the lesion, position of adjacent joints, number of moving joints and whether joint movement stretches or shortens the nerve bed need to be considered when designing neural mobilization exercises as all of these factors seem to have an impact on nerve excursion.

Test-retest reliability of handgrip strength measurement using a hydraulic hand dynamometer in patients with cervical radiculopathy

OBJECTIVE

The purpose of this study was to evaluate the test-retest reliability of handgrip strength measurement using a hydraulic hand dynamometer in patients with cervical radiculopathy (CR).

METHODS

A convenience sample of 19 participants (14 men and 5 women; mean ± SD age, 50.5 ± 12 years) with CR was measured using a Jamar hydraulic hand dynamometer by the same rater on 2 different testing sessions with an interval of 7 days between sessions. Data collection procedures followed standardized grip strength testing guidelines established by the American Society of Hand Therapists. During the repeated measures, patients were advised to rest their upper limb in the standardized arm position and encouraged to exert 3 maximum gripping efforts. The mean value of the 3 efforts (measured in kilogram force [Kgf]) was used for data analysis. The intraclass correlation coefficient, SEM, and the Bland-Altman plot were used to estimate test-retest reliability and measurement precision.

RESULTS

Grip strength measurement in CR demonstrated an intraclass correlation coefficient of 0.976, suggesting excellent test-retest reliability. The small SEM in both testing sessions (SEM1, 2.41 Kgf; SEM2, 2.51 Kgf) as well as the narrow width of the 95% limits of agreements (95% limits of agreement, -4.9 to 4.4 Kgf) in the Bland-Altman plot reflected precise measurements of grip strength in both occasions.

CONCLUSIONS

Excellent test-retest reliability for grip strength measurement was measured in patients with CR, demonstrating that a hydraulic hand dynamometer could be used as an outcome measure for these patients.

Interventions in the disturbances in the motor and sensory environment

Treatment of peripheral nervous system (PNS) pathology presents intervention challenges to every therapist. Many of the current and future interventions will be directed at restoring the normal anatomy, function, and biomechanical properties of the PNS, restoring normal neural physiology and ultimately patient function and quality of life. Present interventions use mechanical (movement) or electrical procedures to affect various properties of the peripheral nerve. The purpose of this article was to apply basic science to clinical practice. The pathology and accompanying structural and biomechanical changes in the PNS will be presented in three specific areas commonly encountered in the clinic: nerve injury and laceration; compression neuropathies; and neuropathic pain and neural tension dysfunction. The intent is to address possible interventions exploring the clinical reasoning process that combines basic science and evidence-based best practice. The current lack of literature to support any one intervention requires a strong foundation and understanding of the PNSs' structure and function to refine current and develop new intervention strategies. Current evidence will be presented and linked with future considerations for intervention and research. During this interlude of development and refinement, best practice will rely on sound clinical reasoning skills that incorporate basic science to achieve a successful outcome when treating these challenging patients.

Comparison of longitudinal sciatic nerve movement with different mobilization exercises: an in vivo study utilizing ultrasound imaging

STUDY DESIGN

Controlled laboratory study using a single-group, within-subjects comparison.

OBJECTIVES

To determine whether different types of neural mobilization exercises are associated with differing amounts of longitudinal sciatic nerve excursion measured in vivo at the posterior midthigh region.

BACKGROUND

Recent research focusing on the upper limb of healthy subjects has shown that nerve excursion differs significantly between different types of neural mobilization exercises. This has not been examined in the lower limb. It is important to initially examine the influence of neural mobilization on peripheral nerve excursion in healthy people to identify peripheral nerve excursion impairments under conditions in which nerve excursion may be compromised.

METHODS

High-resolution ultrasound imaging was used to assess sciatic nerve excursion at the posterior midthigh region. Four different neural mobilization exercises were performed in 31 healthy participants. These neural mobilization exercises used combinations of knee extension and cervical spine flexion and extension. Frame-by-frame cross-correlation analysis of the ultrasound images was used to calculate nerve excursion. A repeated-measures analysis of variance and isolated means comparisons were used for data analysis.

RESULTS

Different neural mobilization exercises induced significantly different amounts of sciatic nerve excursion at the posterior midthigh region (P<.001). The slider exercise, consisting of the participant performing simultaneous cervical spine and knee extension, resulted in the largest amount of sciatic nerve excursion (mean ± SD, 3.2 ± 2.0 mm). The amount of excursion during the slider exercise was slightly greater (mean ± SD, 2.6 ± 1.5 mm; P = .002) than it was during the tensioner exercise (simultaneous cervical spine flexion and knee extension). The single-joint neck flexion exercise resulted in the least amount of sciatic nerve excursion at the posterior midthigh (mean ± SD, -0.1 ± 0.1 mm), which was significantly smaller than the other 3 exercises (P<.001).

CONCLUSION

These findings are consistent with the results of previous research that has examined median nerve excursion associated with different neural mobilization exercises. Such nerve excursion supports theories of nerve motion associated with cervical spine and extremity movement, as generalizable to the lower limb.