Adverse Neural Tension Research Articles

Frequency of Adverse Neural Tension and Its Association With Functional Disability in Upper Extremity Musculoskeletal Pain Syndromes: A Cross-sectional Study

Frequency of Adverse Neural Tension and Its Association With Functional Disability in Upper Extremity Musculoskeletal Pain Syndromes: A Cross-sectional Study

Optimal duration of stretching of the hamstring muscle group in older adults: a randomized controlled trial.

"Flexibility" is defined as "the range of movement or motion of a single or multiple joints." Its limits decline significantly with age, reaching maximum flexibility in the mid-to-late twenties for males and females, respectively. Conclusions regarding appropriate stretching time duration are mainly based on mechanical factors such as range of motion (ROM) and flexibility and tend to ignore the adverse neural mechanical tension that may be created during stretching exercises. It appears that longer-duration stretching increases flexibility for geriatric populations. To explore the effect of variable stretching intervals on neural function and ROM. Double blind randomized controlled trial. University research laboratory. One hundred participants, 60-65 years old, with a diagnosis of tight hamstring muscles, bilaterally, were randomly assigned to either a control group or one of three intervention groups. Participants who were randomly placed in one of the three intervention groups, were further randomized by selection of right or left limb for intervention. Intervention groups consisted of either 15-, 30-, or 60-s stretches to hamstring muscles; whereas the control group was given a sham stretch for 20 seconds. Main Outcome Measures included the neurophysiological outcome measures; peak to peak amplitude of somatosensory evoked potential for dermatomes L4, L5, and S1. Secondary outcome measures included knee ROM. All outcome measures were assessed before, immediately after, and 24 hours after the treatment session. Mixed linear model analysis was used to evaluate group, time, and group x time interaction effects for outcome measures. Stretching for 30 and 60 s gave significant increase in ROM compared to control (4.64 [95% CI: 3.35, 5.93]; P<0.01) (10.30 [95% CI: 9.01, 11.6]; P<0.01) and the improvement was persistent at 24-hours' follow-up (P<0.01). However, the analysis showed significant reduction in dermatomal somatosensory evoked potentials' amplitudes for L4 (-1.19 [95% CI: -1.35, 1.02]; P<0.01), L5 (-1.34 [95% CI: -1.56, -1.13]; P<0.01), S1 (-0.99 [95% CI: -1.16, -0.83]; P<0.01) after 60-s static hamstring muscle stretch. The reduction was persistent at 24-hours' follow-up (P<0.01). Stretching hamstring for 30 seconds was optimal in increasing the knee range of motion and minimizing the negative effects on the neural function of the involved nerve roots. Thus, 60-second static hamstring muscle stretching, places increased stress and strain on the nervous system and should be avoided. It is well established that stretching is an effective intervention to treat many neuromuscular and musculoskeletal problems. However, which exact parameters to follow during stretching procedures remains controversial. Our findings indicate that 60-s static stretching of hamstring at end ranges of motion, likely place increased stress and strain on the nerve roots and central nervous system, and should be avoided.

The effect of straight leg raise with lumbar stabilization exercises in subjects of low back pain with adverse neural tension between the age group 20–50 years

Low back pain is a common disorder which involves muscles, nerves, and bones of the back. About 70% to 85% of population has low back pain at some point in life. Adverse neural tension is defined as physiological or mechanical response produced when structures of the nervous system exceed their normal range of movement. Mechanically or chemically sensitized nerves show abnormal mechano sensitivity. Purpose: purpose of the study was to find the effect of Straight Leg Raise With lumbar stabilization exercises in reducing pain, improving ROM and physical functions in low back pain subjects with adverse neural tension. Aim: To find the effect of Straight Leg Raise with lumbar stabilization exercises in reducing pain, improving ROM, and physical functions in low back pain subjects with adverse neural tension. Objective: To study the effect of straight leg raise with lumbar stabilization exercises in reducing pain, improving ROM, and physical functions in low back pain subjects with adverse neural tension between the age group 20-50 years. Method: This study was conducted on 30 lower back pain patients, age 20-50 years were taken from NDMVP Hospital and research centre, physiotherapy opd . Convenience sampling method was used. ROM, Numerical pain rating scale- pain and Modified oswestry disability questionnaire- disability was assessed. Results: P value is less than 0.05 for NPRS, ROM and modified ODI .The NPRS, PSLR and Modified ODI Questionnaire scores improved significantly by SLR with lumbar stabilization exercises after 3 weeks in subjects of low back pain with adverse neural tension. Conclusion: SLR with lumbar stabilization exercises is effective in reducing pain improving ROM, and physical functions in low back pain subjects with adverse neural tension.

A Combination of Manual Therapy, Movement Systems, and Biopsychosocial Approaches for the Treatment of Upper Limb Adverse Neural Tissue Tension: A Case Report

Background and Purpose: Peripheral nerve injuries can result from a multitude of causes including trauma, poor posture, and altered movement patterns. Adverse neural tension is a possible consequence to insult to the nervous system which can lead to dysfunction and fear avoidance behaviors. The purpose of this case report is to demonstrate the use of a multimodal approach in the physical therapy treatment of a patient who sustained an occupational upper extremity injury which resulted in adverse neural tissue tension of multiple peripheral nerves. Case Description: The patient was a 40- year-old female who sustained an injury to the second right metacarpophalangeal joint. Impairments included joint hypomobility, decreased muscle function, and movement system dysfunction. The patient was treated six times over a two-week period. Intervention: The physical therapy treatment administered to the patient included manual therapy, exercises focused on improving movement systems impairment, exercise focused on improving neural excursion, and patient education based on the biopsychosocial model. The treatments were focused on improving function of work-related activities to decrease disability to promote regular and full job duties. Outcomes: Outcome measures include the Numeric Pain Rating Scale (NPRS), Fear Avoidance Beliefs Questionnaire of Work and Physical Activity (FABQ-W and FABQ-PA, respectively), and the Quick Disability of the Arm, Shoulder and Hand (QuickDASH). After six visits there was an NPRS rating of 0/10 with rest and activity; the FABQ-W improved from 17/42 to 10/42; the FABQ-PA improved from 15/24 to 3/24; the QuickDASH improved from 22% symptom related disability to 9% and improved from 75% disability with work-related tasked to 0% disability. Discussion: Interventions of joints mobilization, neuromuscular reeducation using the movement systems approach, and concepts focused on the biopsychosocial approach were determined to be an integral combination in the patient’s successful return to full work-related duties.

Treatment for an Acute Occupational Hand Injury Utilizing a Manual Therapy and Biopsychosocial Approach: A Case Report

Manual therapy techniques for the spine have been found to be successful in relieving spinal joint dysfunction and pain; however, there is a lack of clinical evidence to support the effectiveness of manual therapy for the treatment of acute neural irritation of the upper extremity. Addressing fear avoidance beliefs (FABs) with a Fear Avoidance Belief Questionnaire has been found to be an effective tool to screen patients with low back pain; however, lack of clinical evidence also exists utilizing the FABQ for extremity pain in both screening and treatment. The purpose of this case study is to examine the effectiveness of manual therapy and biopsychosocial approach for treatment of an occupationally-injured patient with 1st digit ulnar collateral ligament injury and concomitant adverse neural tension (ANT).

The Effect of Adverse Neural Tension on Hamstring Strength in Rugby Players

The Effect of Adverse Neural Tension on Hamstring Strength in Rugby Players

The Relationship between Femoral Nerve Tension and Hip Flexor Muscle Length

Adverse neural tension is the inability for a nerve to glide freely in its mechanical interface. Studies demonstrate that there is relationship between muscular facilitation and adverse neural tension in the upper extremity and in the posterior thigh, but few examine a potentially similar interaction in the anterior hip. The purpose of this study was to determine the relationship between femoral nerve tension and hip flexor muscle tightness. The Prone Knee Bend test and the Thomas test were performed on a group of 20 normal subjects (40 unilateral lower extremities) without back pain or dysfunction, and on a group of 12 patients (21 unilateral lower extremities) treated with physical therapy for low back pain. The results demonstrated a significant correlation for the control and patient groups combined (r=0.530; p=0.0001); for the control group only (r=0.322; p=0.043) and the patient group only (r=0.601; p=0.002). This study indicates a correlation between the Thomas Test and the Prone Knee Bend Test suggesting a relationship between adverse neural tension of the femoral nerve and muscle length of the iliopsoas muscle. Increased femoral nerve tension may influence hip tightness in normal and patient populations. Likewise, adaptive shortening of the hip flexors may lead to adverse femoral nerve tension.

Efectos sobre la tensión neural adversa medida mediante test de Slump tras punción seca de punto gatillo miofascial del músculo gastrocnemio

ObjectiveTo determine the effect of dry needling (DN) in the myofascial trigger points (MTrP) of the gastrocnemius muscle on adverse neural tension (ANT) and perceived pain. Material and methods50 adults were selected for the study. After applying inclusion and exclusion criteria, we obtained a final sample of 45. They were randomly assigned to group 1 or experimental (n=23, mean age: 22.41±1.53) and group 2 or control (n=22, mean age: 21.15±1.34). Once allocated and confirmed by the blind assessor, deep dry needling technique on the MTrP was applied. For group 2 the same needle was used, differing in shrinkage capacity therefore without perforating the skin. The ANT was assessed using the Slump neurodynamic test and perceived pain by visual analogue scale (VAS) just before (pre-test) and in two subsequent times (immediately and 48hours). The data were processed with SPSS version 19.0. ResultsWe observed statistically significant differences (P<.05) in group 1 between pretest and immediate posttest and between immediate and delayed post-test (48hours) for the variable ANT. The perceived pain showed statistically significant differences between the pretest and the two later time points (P<.001), while group 2 showed no improvement. Differences between groups were observed in the immediate posttest perceived pain. ConclusionsThe dry needling in the MTrP latent on gastrocnemius muscle decreases perceived pain at least 48hours, not getting on the ANT significant changes measured by Slump test.

Neuromuscular strain as a contributor to cognitive and other symptoms in chronic fatigue syndrome: hypothesis and conceptual model

Individuals with chronic fatigue syndrome (CFS) have heightened sensitivity and increased symptoms following various physiologic challenges, such as orthostatic stress, physical exercise, and cognitive challenges. Similar heightened sensitivity to the same stressors in fibromyalgia (FM) has led investigators to propose that these findings reflect a state of central sensitivity. A large body of evidence supports the concept of central sensitivity in FM. A more modest literature provides partial support for this model in CFS, particularly with regard to pain. Nonetheless, fatigue and cognitive dysfunction have not been explained by the central sensitivity data thus far. Peripheral factors have attracted attention recently as contributors to central sensitivity. Work by Brieg, Sunderland, and others has emphasized the ability of the nervous system to undergo accommodative changes in length in response to the range of limb and trunk movements carried out during daily activity. If that ability to elongate is impaired—due to movement restrictions in tissues adjacent to nerves, or due to swelling or adhesions within the nerve itself—the result is an increase in mechanical tension within the nerve. This adverse neural tension, also termed neurodynamic dysfunction, is thought to contribute to pain and other symptoms through a variety of mechanisms. These include mechanical sensitization and altered nociceptive signaling, altered proprioception, adverse patterns of muscle recruitment and force of muscle contraction, reduced intra-neural blood flow, and release of inflammatory neuropeptides. Because it is not possible to differentiate completely between adverse neural tension and strain in muscles, fascia, and other soft tissues, we use the more general term “neuromuscular strain.” In our clinical work, we have found that neuromuscular restrictions are common in CFS, and that many symptoms of CFS can be reproduced by selectively adding neuromuscular strain during the examination. In this paper we submit that neuromuscular strain is a previously unappreciated peripheral source of sensitizing input to the nervous system, and that it contributes to the pathogenesis of CFS symptoms, including cognitive dysfunction.

Neural Tissue Mobilisation Using ULTT2b and Radial Head Mobilisation v/s Exercise Programme in Lateral Epicondylitis

Background & Purpose: Lateral epicondylitis has been associated with adverse neural tension in radial nerve. Research also implicates the affection of radial head in this condition. Exercise program advocates claim that it is the most effective treatment for lateral epicondylitis. Thus comparison between Exercises alone and Neural tissue mobilisation along with Radial head mobilisation seems to give an insight into its different treatment strategy. Methodology: Total 40 subject with lateral epicondylitis were recruited. They were divided in 2 groups. 20 in Experimental Group and 20 in Control Group. In Experimental group, NDS + Radial Head Mobilisation + Exercise programme was given and in Control group only Exercise programme was given to the patient. The outcome measures were Visual Analogue Scale (VAS), Pain Free Grip Strength (GS), Pain Pressure Threshold (PPT) and Patient Rated Tennis Elbow Evaluation Questionnaire (PRTEE) were assessed Pre and Post treatment. Duration of treatment was 4 days/ week for 4 weeks. Results: Experimental group, have shown that Mulligan's MWM to Radial head and Neural tissue mobilisation have found to achieve favourable outcome as compared to exercise group and even Exercise group, have been shown to have significant effects. Conclusion: Neural tissue mobilization along with radial head mobilization was found to have a favourable outcome as compared to exercise programme.

Comparative Effectiveness of Straight Leg Raise and Slump Stretching in Subjects with Low Back Pain with Adverse Neural Tension

Background: Chronic low back pain is a common problem in the present time. It is commonly associated with altered mechanical tension in the peripheral nerves as tested by straight leg raising or slump tests. These maneuvers are used for treatment of such disorders. Both the straight leg raise and slump stretching techniques have been found to be beneficial in the treatment of low back pain with distal symptoms. A comparison of the two techniques will determine if one technique is better than the other. Also, it will add to the evidence for their effectiveness in managing symptoms in patients with low back pain. Objective: To evaluate the comparative effectiveness of straight leg raise and slump stretching on pain and range of passive straight leg raise in subjects with low back pain. Methods and measures: 50 patients with low back pain, satisfying the inclusion and exclusion criteria were randomly assigned to three groups. Group 1 was the straight leg raise group (n=15). Group 2 was the slump group (n=13). Group 3 was the control group (n=12). Baseline measurements of pain intensity as measured by the Numeric Pain Rating Scale (NPRS) and range of passive straight leg raise (PSLR) were taken. Group 1 received 6 sessions of straight leg raise stretching and lumbar stabilization exercises. Group 2 received 6 sessions of slump stretching and lumbar stabilization exercises. Group 3 received 6 sessions of lumbar stabilization exercises only. Statistical analysis: Paired t-test was used for within group analysis of NPRS and PSLR. ANOVA followed by post hoc analysis was employed for between group comparisons. Results: No significant difference was found in NPRS between straight leg raise and slump groups (p > 0.05) while they differed significantly in PSLR (p < 0.05). Both the groups showed significantly better results in PSLR when compared to the control group (P

Triangular interval syndrome: A differential diagnosis for upper extremity radicular pain

ABSTRACTThis case report describes a 57-year-old female who experienced symptoms of scapular pain with pain radiating into the right upper extremity. Initial medical referral suggested, nerve entrapment of a cervical origin. However, the patient did not fit the clinical prediction rule for cervical radiculopathy. Radial nerve bias was positive without cervical provocation, with symptom reproduction at the lateral scapular area. Treatment addressed mechanical dysfunction at the triangular interval formed by the teres major and triceps, comprising manual therapy, neural mobilization, corrective exercise and pain modalities. Reduction in symptoms was observed with a decrease in right scapular and arm pain and improved radial nerve mobility. The triangular interval is described as a predominant contributor to the symptomatology secondary to entrapment and adverse neural tension of the radial nerve. The anatomical and physiological basis is enumerated.

The Role Of Neural Tension In Hamstring Flexibility

PURPOSE: The Slump Test is used to assess adverse neural tension in patients with low back and hamstring injuries, and involves tensioning the neural tissues by flexing the cervical and thoracic spine during hamstring stretch. It is not known if this neural tension increases resistance to stretch. Therefore, the purpose of this study was to determine if neural tension, via the Slump Test, during passive hamstring stretch, affects maximum range of motion (ROM), stretch discomfort, resistance to stretch, or the electromyographic (EMG) response to stretch in healthy subjects. METHODS: Resistance to stretch, EMG response, ROM and stretch discomfort were measured bilaterally during passive hamstring stretches with and without neural tension (n=8, age 39±13 yr, weight 154±24 lb). Stretches were performed on an isokinetic dynamometer (5°/s) with subjects seated, the test thigh flexed 45° above the horizontal, and the seat back at 90° to the horizontal. Knees were passively extended from 90° flexion to maximum stretch tolerance. Starting leg (right or left) and test sequence (stretch with or without neural tension) were alternated between subjects (each stretch separated by 4 min). Stretch-induced EMG signals were normalized to maximum contractions performed prior to stretches. For neural tension stretches the cervical and upper thoracic spine were manually flexed by a physical therapist (Slump Test). RESULTS: Maximum ROM was 8±5° less for the stretches with neural tension versus stretches without neural tension (P<0.01). Stretch discomfort and EMG response were not different between stretches with and without neural tension (discomfort: 7±1 vs. 6±2, P=0.29; EMG: 3±5% vs. 5±5%, P=0.1). Resistance to stretch was progressively greater with increasing ROM for stretches with neural tension versus without neural tension (P<0.001). During the neural tension stretches resistance to stretch at maximum ROM was 12% greater than resistance at the same angle during stretches without neural tension (P<0.05). CONCLUSIONS: Maximum ROM was decreased and passive resistance to stretch was increased by increasing neural tension during passive hamstring stretch. This effect was not due to an increased EMG response to stretch. These data indicate that passive extensibility of neural tissues can limit hamstring flexibility.

Inclusion of Mechanical Diagnosis and Therapy (MDT) in the Management of Cervical Radiculopathy: A Case Report

Various interventions are used by physical therapists to treat neck conditions. Treatments may include exercises based on a direction of preference, cervical spine stabilization, neuromobilization, or traction. The purpose of this case study was to describe the use of mechanical diagnosis and therapy (MDT) in the management of a patient diagnosed with cervical radiculopathy. The case study involved a 39-year-old male (subject), classified with cervical derangement, hypermobility, and adverse neural tension. The subject's intervention included MDT, deep neck flexor muscle strengthening, and neuromobilization. This subject's scores on the Neck Disability Index, Numerical Pain Rating Scale (NPRS), and range of motion were assessed at initial examination, discharge, and 3-month follow-up. The subject improved on all outcome measures and was discharged after four visits with a NPRS of 0/10. Percent improvement per visit was 17.5%. This case describes a positive outcome for a patient diagnosed with cervical radiculopathy in which MDT, deep neck flexor strengthening, and neuromobilization were used as an alternative to cervical traction.

Relação entre tensão neural adversa e estudos de condução nervosa em pacientes com sintomas da sídrome do túnel do carpo

The purpose of this study was to evaluate, through a series of cases, the relationship between the adverse neural tension of median nerve (ANTm) and the electrophysiological involvement in 38 patients with symptoms of the carpal tunnel syndrome (CTS), submitted to nerve conduction studies (NCS). The main measures had been ANTm (in degrees) obtained through the test of neural tension provocation (TNTP) and parameters of the NCS, divided into three groups: normal, without severe electrophysiological alteration and with severe electrophysiological alteration. Significant correlations were found between ANTm and parameters of the NCS (p<0.05), as well as between ANTm and the three groups defined by the electrophysiologic alteration (rs=+0.437, p=0.002). The TNAm values were significantly higher in the arms with electrophysiologic diagnoses (p=0.007). It is suggested that the ANTm does have a participation in the physiopathology of the CTS, and the use of therapeutical procedures that diminish the development of neural tension.

Assessing Adverse Neural Tension in Athletes

Sports medicine assessment and treatment techniques are ever developing and becoming more holistic. Traditional musculoskeletal assessment is changing to incorporate neural tissue pathology. Neural tension tests assess the mobility of neural tissue in the extremities and spinal canal. Positive adverse neural tension tests suggest poor mobility of neural tissue. Athletes with adverse neural tension often present with pain and decreased range of motion. These disorders can occur individually or can be associated with sports injuries. Ankle sprains, hamstring strains, tennis elbow, and thoracic outlet syndrome are some conditions that respond well to treatment of adverse neural tension. Reports of improved treatment outcomes following neural tension assessment and treatment suggest that adverse neural tension should be considered as a possible source of pain and dysfunction. This paper outlines concepts necessary to understand adverse neural tension including neuroanatomy, pathology, assessment techniques, and common sports injuries that may have an adverse neural tension component.