Pain and muscular responses to a neural tissue provocation test in the upper limb

Heide, B. Van Der; Allison, Garry; Zusman, Max

doi:10.1054/math.2001.0406

Cited by 70 publications

(49 citation statements)

References 26 publications

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“…Progression of the SLR from P1 to P2 triggered cocontractions of antagonist muscle groups, as has been documented in an upper limb neurodynamic test. 36 Additionally, although the intensity of symptoms increased from P1 to P2, we did not observe a correlation between the increase in symptom intensity and the increase in muscle activation. This is in agreement with the work of Balster and Jull 2 in an upper limb neurodynamic test of healthy subjects.…”

Section: Symptom Qualitycontrasting

confidence: 74%

“…This criterion was more stringent than previously utilized thresholds of greater than 1, 2, or 3 standard deviations above the resting mean electrical activity. 22,33,34,36 In fact, the criterion used in our study led to a higher threshold for activation by an average of 1.5% MVC compared to the previously utilized methodology. It was expected that stretch-induced increases in muscle tone would be no greater than 25% MVC.…”

Section: Symptom Qualitymentioning

confidence: 65%

“…This is in agreement with the work of Balster and Jull 2 in an upper limb neurodynamic test of healthy subjects. In contrast, van der Heide et al 36 documented a correlation between the onset of pain and muscle activity in an upper limb neurodynamic test in healthy subjects. In this latter study, however, the correlation was determined using only the subjects who experienced pain consistently.…”

Section: Symptom Qualitymentioning

confidence: 90%

“…In this latter study, however, the correlation was determined using only the subjects who experienced pain consistently. It is possible that progression of the SLR from the first onset of symptoms to maximally tolerated symptoms results in a global attempt to stop the movement by stabilizing the joints with cocontractions, as hypothesized by van der Heide and colleagues 36 in their study of the response of biceps brachii, triceps brachii, and trapezius in an upper limb neurodynamic test.…”

Section: Symptom Qualitymentioning

confidence: 99%

“…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%

See 4 more Smart Citations

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: Symptom Qualitycontrasting

confidence: 74%