Aberrant protective force generation during neural provocation testing and the effect of treatment in patients with neurogenic cervicobrachial pain

Coppieters, Michel W.; Stappaerts, Karel; Wouters, L; Janssens, Koen

doi:10.1067/mmt.2003.16

Cited by 72 publications

(64 citation statements)

References 31 publications

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“…18 This is consistent with findings in the upper limb, where passive neurodynamic testing has been shown to induce muscle activity from adjacent musculature. 2,11,14,36 No study to date has simultaneously explored the differences in range of motion, symptoms, and muscle responses for SLR neurodynamic testing at both the onset and maximally tolerated symptoms in healthy individuals. In addition, no study has provided statistical analysis of both proximal/distal and flexor/ extensor muscle activity during SLR neurodynamic testing.…”

Section: Clinical Assessment Sessionmentioning

confidence: 99%

Mechanosensitivity of the Lower Extremity Nervous System During Straight-Leg Raise Neurodynamic Testing in Healthy Individuals

Boyd

Wanek²,

Gray³

et al. 2009

J Orthop Sports Phys Ther

114

118

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respond to the mechanical stresses imposed upon them during movement. 27 Neurodynamic tests are used to assess the nervous system's mechanosensitivity through monitoring the response to movements that are known to alter the mechanical stresses acting on the nervous system. The most common lower quarter neurodynamic test is the passive straight-leg raise (SLR) test. 13,31 The basic SLR test consists of the tester performing passive hip flexion, with the patient in a supine position and the knee held in full extension. 9A recent systematic review of SLR testing indicated a lack of standardization, including the use of various criteria for determining the test end point. 31 The authors of this review reintroduced standardized methodology proposed by Breig and Troup 8 in 1979, including the use of the first onset of pain as the end point during the SLR test.31 Despite these recommendations, alternative end points, such as maximally tolerated symptom, are still utilized.17 Because SLR testing is performed in both symptomatic and C linical neurological examinations are an integral part of clinical decision making for determining neural involvement in individuals with altered physical function and activity participation. One aspect of a standard neurological examination involves assessing the sensitivity of peripheral nerves to limb movement, termed mechanosensitivity. Mechanosensitivity is thought to be a normal protective mechanism that allows the nerves to t STudy deSiGn: Cross-sectional, observational study.t objecTiveS: To explore how ankle position affects lower extremity neurodynamic testing. t backGround: Upper extremity limb movements that increase neural loading create a protective muscle action of the upper trapezius, resulting in shoulder girdle elevation during neurodynamic testing. A similar mechanism has been suggested in the lower extremities.t meThodS: Twenty healthy subjects without low back pain participated in this study. Hip flexion angle and surface electromyographic measures were taken and compared at the onset of symptoms (P1) and at the point of maximally tolerated symptoms (P2) during straight-leg raise tests performed with ankle dorsiflexion (DF-SLR) and plantar flexion (PF-SLR).t reSuLTS: Hip flexion was reduced during DF-SLR by a mean  SD of 5.5°  6.6° at P1 (P = .001) and 10.1°  9.7° at P2 (P.001), compared to PF-SLR. DF-SLR induced distal muscle activation and broader proximal muscle contractions at P1 compared to PF-SLR. t concLuSion: These findings support the hypothesis that addition of ankle dorsiflexion during straight-leg raise testing induces earlier distal muscle activation and reduces hip flexion motion. The straight-leg test, performed to the onset of symptoms (P1) and with sensitizing maneuvers, allows for identification of meaningful differences in test outcomes and is an appropriate end point for lower extremity neurodynamic testing.

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Section: Clinical Assessment Sessionmentioning

confidence: 99%

Mechanosensitivity of the Lower Extremity Nervous System During Straight-Leg Raise Neurodynamic Testing in Healthy Individuals

Boyd

Wanek²,

Gray³

et al. 2009

J Orthop Sports Phys Ther

114

118

View full text Add to dashboard Cite

show abstract

“…56,65 A recent systematic review of randomized controlled trials involving NM has suggested that there is limited evidence for the use of NM in the treatment of certain upper-quarter conditions. 24 Specifically, incorporating NM in the treatment of patients with carpal tunnel syndrome, 1,3,47 cervicobrachial pain, 21,20 and lateral A single-blinded, quasi-experimental, within-and between-sessions assessment.…”

mentioning

confidence: 99%

Effects of Upper Extremity Neural Mobilization on Thermal Pain Sensitivity: A Sham-Controlled Study in Asymptomatic Participants

Beneciuk¹,

Bishop²,

George³

2009

J Orthop Sports Phys Ther

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“…13,15,[19][20][21][22]24 Some investigations have used up to seven different neurodynamic techniques consisting of one to seven sets lasting 5-60 seconds, 9,15,[19][20][21][22][23][24] with one study adapting treatment dose based on patients' responses. 13 To the authors' knowledge, there have been no published studies that have compared different treatment durations; therefore, all treatment doses selected in clinical practice are based on anecdotal evidence and empirical evidence is needed to validate their efficacy.…”

Section: Treatment Durationmentioning

confidence: 99%

“…6 Similar findings have also been documented in upper limb neurodynamic studies. 8,9 It has previously been reported that less extensible participants have significantly higher (P,0.05) EMG activity of upper trapezius during the Upper Limb Neurodynamic Test One (ULNT1). 8 Balster and Jull 8 suggest that EMG activity increased to enable shoulder girdle elevation, especially in less extensible participants, and therefore protect the nervous system from excessive tensile forces.…”

Section: Introductionmentioning

confidence: 99%

The effects of neurodynamic straight leg raise treatment duration on range of hip flexion and protective muscle activity at P1

Hanney

Ridehalgh

Dawson

et al. 2016

Journal of Manual & Manipulative Therapy

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2Maidstone and Tunbridge Wells NHS Trust, UK, 3 Beckenham Physiotherapy, Sports and Acupuncture Clinic, UK, 4 Frimley Park Hospital NHS Foundation Trust, UK Study design: Randomized, single blind, same subject crossover trial. Objectives: To compare the effects of two neurodynamic treatment doses on range of hip flexion (ROM HF) and electromyographic (EMG) activity of semitendinosus, at first onset of pain (P1). Methods: A total of 26 healthy participants without low back or leg pain received each treatment in a random order with at least 48 hours between sessions. Baseline ROM HF and EMG magnitude of semitendinosus at P1 were collected. Subjects then received either 361 or 362 minutes of oscillating end of range (grade IVz) straight leg raise (SLR) neurodynamic treatment and were re-assessed for baseline measures.Results: There was no significant difference between groups in EMG magnitude (P50.190) and ROM HF (P50.739) at P1. There was also no significant difference within groups in EMG magnitude at P1 (P50.182); however, there was a significant improvement in ROM HF at P1 in both groups compared to baseline readings (P50.000), with increases of 6.7u and 5.1u for the 361-and 362-minute groups, respectively. Conclusion: Findings indicate that 362 minutes of oscillating grade IVz SLR neurodynamic treatment has no additional benefit over 361 minute, on ROM HF or EMG magnitude of semitendinosus at P1. Using an oscillating SLR treatment may, however, help to increase pain-free ROM HF, although further studies are necessary to confirm this.

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Aberrant protective force generation during neural provocation testing and the effect of treatment in patients with neurogenic cervicobrachial pain

Cited by 72 publications

References 31 publications

Mechanosensitivity of the Lower Extremity Nervous System During Straight-Leg Raise Neurodynamic Testing in Healthy Individuals

Mechanosensitivity of the Lower Extremity Nervous System During Straight-Leg Raise Neurodynamic Testing in Healthy Individuals

Effects of Upper Extremity Neural Mobilization on Thermal Pain Sensitivity: A Sham-Controlled Study in Asymptomatic Participants

The effects of neurodynamic straight leg raise treatment duration on range of hip flexion and protective muscle activity at P1

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