Subjective Nature of Lower Limb Radicular Pain

Bove, Geoffrey M.; Zaheen, Asia; Bajwa, Zahid H.

doi:10.1016/j.jmpt.2004.12.011

Cited by 29 publications

(26 citation statements)

References 7 publications

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“…6 In our study, a few subjects described minimal dull, ache, sore, or tenderness in the posterior hip, thigh, or leg at the start position, in which the knee was moved into full extension. It is likely that elongation of the soft tissue in the posterior limb provoked the symptoms.…”

Section: Symptom Qualitymentioning

confidence: 64%

“…In contrast, SLR testing in people with lower limb radicular pain has been found to provoke reports of "pain" in 83% of the symptomatic limbs at a mean of only 58° of hip flexion. 6 This study also identified the frequent report of deep symptoms that may follow a myotomal or sclerotomal pattern. 6 Some researchers have proposed the first onset of pelvic movement as an end point for SLR testing when used as a lower extremity flexibility assessment, 16,21,30,37 but it is unclear if this is an appropriate end point for SLR neurodynamic testing.…”

Section: Symptom Qualitymentioning

confidence: 97%

“…6 This study also identified the frequent report of deep symptoms that may follow a myotomal or sclerotomal pattern. 6 Some researchers have proposed the first onset of pelvic movement as an end point for SLR testing when used as a lower extremity flexibility assessment, 16,21,30,37 but it is unclear if this is an appropriate end point for SLR neurodynamic testing. One research study indicated that pelvic movement occurred simultaneously with hip flexion during the SLR test even when the pelvis was strapped to the table.…”

Section: Symptom Qualitymentioning

confidence: 97%

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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 Qualitymentioning

confidence: 64%

Section: Symptom Qualitymentioning

confidence: 97%

Section: Symptom Qualitymentioning

confidence: 97%

See 1 more Smart Citation

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

“…This is a methodological limitation in that there is not an appropriate test to determine if rats have the type of pain which humans with deep radiating pain report: patients who report radiating leg pain do not usually report cutaneous pain at rest or when provoked (Bove et al, 2005; Murphy et al, 2009), and, perhaps more importantly, patients with radiating limb pain do not report tenderness in the area of the pain (unpublished clinical observations). Since the common tests used for some pain conditions in rats use only cutaneous stimulation (von Frey filaments, thermal stimuli), such testing, even if positive, would be difficult to interpret.…”

Section: Discussionmentioning

confidence: 99%

A model for radiating leg pain of endometriosis

Bove

2016

Journal of Bodywork and Movement Therapies

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Endometriosis is a prevalent female health disorder that often leads to back pain and radiating leg pain. Patients with such pain often seek care from multiple health care professionals, including manual therapists. We hypothesized that endometrioma can induce nerve inflammation thus the radiating leg pain that often accompanies endometriosis. To model sciatic endometriosis in female Wistar rats, a section of uterine horn was autotransplanted to the sciatic nerve. Uterus sections with the endometrium removed and autotransplanted to the sciatic nerve served as controls. After 1, 3, and 15 months the nerves were harvested and processed for immune cell presence and for neural elements. Control nerves were harvested after 4 months. All autotransplants survived, resulting in a fusion of the uterus sections to the nerves. Macroscopically, turgid cysts apposed to the nerves characterized the complexes. Microscopically, the complexes contained recruited macrophages, indicating persistent inflammation, and were innervated by small diameter axons. Only 1 of 8 control rats developed a small cyst, presumably due to residual endometrium. The persistent immune response and innervation suggest the nerve-uterus complexes as sources of inflammation and persistent neural discharge, and thus pain. This model could shed light upon the radiating leg pain that often accompanies endometriosis. Manual therapists should be aware of the possibility of endometriosis causing symptoms and examination findings that mimic musculoskeletal etiologies.

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“…Travell stated that pain referred from myofascial trigger points does not follow a simple pattern and may not always occur within the same dermatome, myotome or sclerotome[19]. Also, Bove et al recently reported that radicular pain symptoms are perceived in deep structures rather than on the skin and that myotomal or sclerotomal patterns may be more diagnostic than traditional dermatomal charts[21]. …”

Section: Discussionmentioning

confidence: 99%

A case report of a patient with upper extremity symptoms: differentiating radicular and referred pain

Daub

2007

Chiropr Man Therap

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BackgroundSimilar upper extremity symptoms can present with varied physiologic etiologies. However, due to the multifaceted nature of musculoskeletal conditions, a definitive diagnosis using physical examination and advanced testing is not always possible. This report discusses the diagnosis and case management of a patient with two episodes of similar upper extremity symptoms of different etiologies.Case PresentationOn two separate occasions a forty-four year old female patient presented to a chiropractic office with a chief complaint of insidious right-sided upper extremity symptoms. During each episode she reported similar pain and parasthesias from her neck and shoulder to her lateral forearm and hand.During the first episode the patient was diagnosed with a cervical radiculopathy. Conservative treatment, including manual cervical traction, spinal manipulation and neuromobilization, was initiated and resolved the symptoms.Approximately eighteen months later the patient again experienced a severe acute flare-up of the upper extremity symptoms. Although the subjective complaint was similar, it was determined that the pain generator of this episode was an active trigger point of the infraspinatus muscle. A diagnosis of myofascial referred pain was made and a protocol of manual trigger point therapy and functional postural rehabilitative exercises improved the condition.ConclusionIn this case a thorough physical evaluation was able to differentiate between radicular and referred pain. By accurately identifying the pain generating structures, the appropriate rehabilitative protocol was prescribed and led to a successful outcome for each condition. Conservative manual therapy and rehabilitative exercises may be an effective treatment for certain cases of cervical radiculopathy and myofascial referred pain.

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Subjective Nature of Lower Limb Radicular Pain

Cited by 29 publications

References 7 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

A model for radiating leg pain of endometriosis

A case report of a patient with upper extremity symptoms: differentiating radicular and referred pain

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