A modified straight leg raise test to differentiate between sural nerve pathology and Achilles tendinopathy. A cross-sectional cadaver study

Coppieters, Michel W.; Crooke, Jennifer L.; Lawrenson, Peter; Khoo, Shin Jiun; Skulstad, Terje; Bet-Or, Yaheli

doi:10.1016/j.math.2015.01.013

Cited by 11 publications

(3 citation statements)

References 36 publications

(44 reference statements)

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“…Such findings have suggested that whereas the maximal dorsiflexion ROM may be primarily influenced by the passive stretch of plantar flexor muscle-tendon units in HIP-neutral (23,43,59), nonmuscular structures spanning multiple joints can potentially influence the dorsiflexion stretch amplitude in HIP-flexed position (3,43). Indeed, some stretching exercises or postures have been shown to load the sciatic nerve tract independently of surrounding mechanical interfaces such as muscle-tendon units (3,13,14,24).…”

Section: Discussionmentioning

confidence: 99%

Chronic effects of muscle and nerve-directed stretching on tissue mechanics

Andrade

Freitas

Hug

et al. 2020

Journal of Applied Physiology

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Tissue-directed stretching interventions can preferentially load muscular or non-muscular structures such as peripheral nerves. How these tissues adapt mechanically to long-term stretching is poorly understood. This randomized, single-blind, controlled study used ultrasonography and dynamometry to compare the effects of 12-week nerve-directed and muscle-directed stretching programs versus control on: maximal ankle dorsiflexion range of motion (ROM) and passive torque, shear wave velocity (SWV; an index of stiffness) and architecture of triceps surae and sciatic nerve. Sixty healthy adults were randomized to receive nerve-directed, muscle-directed stretching, or no intervention (control). The muscle-directed protocol was designed to primarily stretch the plantar flexor muscle group, while the nerve-directed intervention targeted the sciatic nerve tract. Compared with the control group (mean; 95% Confidence Interval), muscle-directed intervention showed increased ROM (+7.3°; 95% CI: 4.1-10.5), decreased SWV of triceps surae (varied from -0.8 to -2.3m/s across muscles), decreased passive torque (-6.8N.m; 95% CI: -11.9 to -1.7), and greater gastrocnemius medialis fascicle length (+0.4cm; 95% CI: 0.1 to 0.8). Muscle-directed intervention did not affect the SWV and size of sciatic nerve. Participants in nerve-directed group showed a significant increase in ROM (+9.9°; 95% CI: 6.2 to 13.6) and a significant decrease in sciatic nerve SWV (> -1.8m/s across nerve regions) compared with the control group. Nerve-directed intervention had no effect on the main outcomes at muscle and joint levels. These findings provide new insights into the long-term mechanical effects of stretching interventions, and have relevance to clinical conditions where change in mechanical properties has occurred.

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Section: Discussionmentioning

confidence: 99%

Chronic effects of muscle and nerve-directed stretching on tissue mechanics

Andrade

Freitas

Hug

et al. 2020

Journal of Applied Physiology

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“…11,15,16 Other manifestations of the SLR are emerging with bias to other terminal branches such as the sural nerve. 23 The same test positions and movements can be used as NDM treatment techniques with or without modifications. 15,16 However, a contemporary clinical evidence-supported practice model for the use of these manoeuvres in patients suffering from LBP or after spinal surgery is sparse and conflicting.…”

Section: Introductionmentioning

confidence: 99%

“…Initial considerations lead clinicians to suspect a mechanical influence. The perspective of movement and gliding may apply in the context of peripheral nerves within the limbs 23,28 ; however, Ridehalgh et al 29 indicated that the mobility of the lumbar roots were not available using their measurement techniques, and findings by Smith et al 30 were obtained incorporating significant dissection, specifically, laminectomy and facetectomy. Gilbert et al 31,32 found that an in situ SLR produced minimal displacement ( < 1.0 mm) of the L4, L5 and S1 nerve roots, with 60° of hip flexion needed to induce significant movement of the roots.…”

Section: Introductionmentioning

confidence: 99%

Effects of lower limb neurodynamic mobilization on intraneural fluid dispersion of the fourth lumbar nerve root: an unembalmed cadaveric investigation

Gilbert

Smith

Sobczak

et al. 2015

Journal of Manual & Manipulative Therapy

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Objectives: Manual and physical therapists incorporate neurodynamic mobilisation (NDM) to improve function and decrease pain. Little is known about the mechanisms by which these interventions affect neural tissue. The objective of this research was to assess the effects of repetitive straight leg raise (SLR) NDM on the fluid dynamics within the fourth lumbar nerve root in unembalmed cadavers. Methods: A biomimetic solution (Toluidine Blue Stock 1% and Plasma) was injected intraneurally, deep to the epineurium, into the L4 nerve roots of seven unembalmed cadavers. The initial dye spread was allowed to stabilise and measured with a digital calliper. Once the initial longitudinal dye spread stabilised, an intervention strategy (repetitive SLR) was applied incorporating NDMs (stretch/relax cycles) at a rate of 30 repetitions per minute for 5 minutes. Post-intervention calliper measurements of the longitudinal dye spread were measured. Results: The mean experimental posttest longitudinal dye spread measurement (1.1 ± 0.9 mm) was significantly greater (P = 0.02) than the initial stabilised pretest longitudinal dye spread measurement. Increases ranged from 0.0 to 2.6 mm and represented an average of 7.9% and up to an 18.1% increase in longitudinal dye spread. Discussion: Passive NDM in the form of repetitive SLR induced a significant increase in longitudinal fluid dispersion in the L4 nerve root of human cadaveric specimen. Lower limb NDM may be beneficial in promoting nerve function by limiting or altering intraneural fluid accumulation within the nerve root, thus preventing the adverse effects of intraneural oedema.

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