Neurodynamic Mobilization Research Articles

The Impact of Neurodynamic Mobilization and Transcutaneous Electrical Nerve Stimulation on Pain Intensity in Cigarette Company Workers at Risk of Carpal Tunnel Syndrome

Indonesia is one of the largest cigarette producers and consumers in the world. Due to the repetitive activity and long hours experienced by cigarette manufacturer workers who roll the cigarettes, the risk of carpal tunnel syndrome (CTS) is high. They tend to experience pain, numbness and tingling through the hands and fingers. These symptoms occur following compression of the median nerve, which affects their functional ability. Neurodynamic mobilization (NDM) and transcutaneous electrical nerve stimulation (TENS) have been used as physical therapy in management of CTS. However, no studies have yet investigated the effect of the combination of both treatments and compared them. This was a quasi-experimental study with a pre-test post-test design, which compared the effect of a combination of NDM and TENS versus NDM only with cigarette company workers. The workers with the risk of CTS were divided into two groups: the combination NDM with TENS group and the NDM group. The interventions were applied 3 times a week for 1 month in both groups. The visual analogue scale (VAS) was used to measure the pain. The VAS scores were evaluated on the first day before the interventions were given and after 1 month. The Wilcoxon test was used to assess pre and post treatment. The Mann Whitney test was used to compare the effects of both interventions. According to the findings, both groups had a significant change in VAS measurement outcomes. The decrease in pain was larger in the NDM and TENS group than in the NDM group (p = 0.008). Carrying out a combination of NDM with TENS 3 times in a week for 1 month had a substantial impact on decreasing pain in cigarette workers with CTS risk
 Keywords: neurodynamic mobilization, TENS, carpal tunnel syndrome, pain, cigarette workers

Foam rolling and neurodynamic mobilization: an evaluation of pain perception dynamics among powerlifters

Pain and injury are common problems among athletes and recreational powerlifters who perform squats, bench presses and deadlifts. Data suggests that 43.3% of powerlifters experience pain in the course of their workout session. However, little is known with regards to the use of interventions including neurodynamic mobilization and foam rolling for improving the experience of pain among powerlifters. Five female and nine male powerlifters (M age27.14, SD=2.48), with no musculoskeletal injuries in the past 6 months were tested into two groups: 1) foam rolling group (FRG; n=7) and, 2) neurodynamic mobilization group (NMG; n=7). Interventions lasted a total of four weeks for both FRG and NMG. Relative to the subjects in FRG, subjects in NMG reported less pain following the completion of interventions. Regular foam rolling tends to reduce the intensity of moderate pain. However, in contrast to foam rolling, neurodynamic mobilization results in significantly less perception of pain.

Conservative therapy in ulnar neuropathy at the elbow (Review).

Ulnar neuropathy at the elbow (UNE) is the second most frequent entrapment syndrome in the upper limb after carpal tunnel syndrome. Clinical features are validated through electromyographic and sonographic examination. Although the two aforementioned entrapment syndromes share common pathophysiological traits, the conservative treatment approach for mild and moderate cases of UNE differs from that for median nerve entrapment. The present study identified 23 different types of scientific articles aimed to address this issue. The research stressed the importance of patient education and activity modification. Night splinting offers clinical and functional improvement. Although corticosteroid injections play a role in selected cases, their utility remains to be validated. Physiotherapy trials evaluated ultrasound, low-level laser therapy, diathermy, extracorporeal shock wave therapy and dry cupping. Neurodynamic mobilization may add value to therapeutic approaches and should be a part of it.

Comparison of Two Manual Therapy Programs, including Tendon Gliding Exercises as a Common Adjunct, While Managing the Participants with Chronic Carpal Tunnel Syndrome.

Background Carpal tunnel syndrome (CTS) is the symptomatic compression neuropathy of the median nerve at the wrist level that may become a reason for upper limb disability, in the women and men population. Objective This study aimed to compare the efficacy of the neurodynamic technique (NT) and carpal bone mobilization technique (CBMT) incorporated with tendon gliding exercises (TGE) as an effect-enhancing adjunct while managing the participants with chronic CTS. Methods The study followed a two-arm parallel-group randomized comparative design. Thirty participants (aged 30–59 years) with chronic CTS were recruited randomly to both the NT and CBMT groups. In addition to the TGE (a common adjunct), NT and CBMT were performed in the NT and CBMT groups, respectively, for three weeks. The primary outcome measures including pain intensity, functional status, grip strength, and motor nerve conduction study were assessed using a visual analogue scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), hand-held dynamometer, and electromyograph, respectively, at baseline, 3 weeks postintervention, and follow-up at one week post end of the intervention. Paired and unpaired t-test were used to calculate the differences in intervention effects within and between the groups with keeping the level of significance α at 0.05. Results The data analysis revealed a significant (95% CI, p < 0.05) difference for all outcomes within each group compared across different time intervals. Similarly, a significant difference was found for all outcomes except pain and grip strength compared between groups at 3 weeks postintervention and follow-up at one week post end of the intervention. Conclusions The NT revealed more effectiveness than the CBMT when incorporated with TGE to improve nerve conduction velocity and functional status of the hand. However, both NT and CBMT were equally effective in improving pain and grip strength while managing the participants with chronic CTS. In addition, the TGE contributed as a beneficial, effect-enhancing adjunct to the NT and CBMT differently. Significance. The study will guide the physiotherapist in applying either of the combination techniques suitable for achieving treatment objectives while managing the participants with chronic CTS.

Timing of Evidence-Based Nonsurgical Interventions as Part of Multimodal Treatment Guidelines for the Management of Cervical Radiculopathy: A Delphi Study.

Conservative management of cervical radiculopathy (CR) is a first treatment option because the risk-benefit ratio for surgery is less favorable. Systematic reviews and clinical practice guidelines reporting on the effectiveness of nonsurgical management have not considered the timing of management. The aim of this study was to establish consensus on effective nonsurgical treatment modalities at different stages (ie, acute, subacute, or chronic) of CR using the Delphi method approach. Through an iterative multistage process, experts within the field rated their agreement with a list of proposed treatment modalities according to the stage of CR and could suggest missing treatment modalities. Agreement was measured using a 5-point Likert scale. Descriptive statistics were used to measure agreement (median, interquartile ranges, and percentage of agreement). Consensus criteria were defined a priori for each round. Consensus for Round 3 was based on ≥2 of the following: a median Likert scale value of ≥4, interquartile range value of ≤1, and/or a percentage of agreement ≥70%. Data analysis produced a consensus list of effective treatment modalities in different stages of recovery. According to experts, the focus of multimodal management in the acute stage should consist of patient education and spinal manipulative therapy, specific (foraminal opening) exercises, and sustained pain-relieving positions. In the subacute stage, increasing individualized physical activity including supervised motor control, specific exercises, and/or neurodynamic mobilization could be added. In the chronic stage, focus should shift to include general aerobic exercise as well as focused strength training. Postural education and vocational ergonomic assessment should also be considered. Multimodal conservative management of individuals with CR should take the stage of the condition into consideration. The focus of therapeutic interventions should shift from passive pain-relieving intervention in the acute stage to increasingly more individualized physical activity and self-management in the chronic stage.

Difference between Neurodynamic Mobilization and Stretching Exercises for Chronic Discogenic Sciatica

Abstract Background: Sciatica has noxious symptoms and critical functional disabilities, which disturbs people lives. Physio-therapy modalities play the most important role in the con-servative management of sciatica. Aim of Study: To compare the effectiveness of the slider, tensioner neurodynamic mobilization techniques and stretching exercises on pain intensity, range of motion (ROM) of ankle dorsiflexion, and functional disability in patients with chronic discogenic sciatica. Patients and Methods: Thirty-six patients with unilateral chronic discogenic sciatica from both sexes, their ages ranged from 21-50 years, were randomly allocated into three equal groups. Group (A) received slider neurodynamic mobilization technique only, while group (B) received tensioner neurody-namic mobilization technique only, and group (C) received stretching exercises of back extensors, hamstrings and gas-trocnemius muscles only. In addition to ergonomic advice given to all the three groups. Treatment was given three days per week for two consecutive weeks. The outcome measures were assessed pre and post treatment. Pain intensity was measured using visual analogue scale. ROM of ankle dorsi-flexion was measured using the universal goniometer. Func-tional disability was measured using the Oswestry disability index. Results: There were found significant differences in both; the slider and tensioner neurodynamic mobilization techniques as compared to stretching exercises in pain intensity and functional disability. There were found no significant differ-ences between the three groups in ankle dorsiflexion ROM. Conclusion: Slider and tensioner neurodynamic mobili-zation techniques are more effective than stretching exercises in terms of reducing pain intensity and improving functional disability without significant differences between them in improving ankle dorsiflexion ROM.

Mulligan Versus Conventional Neurodynamic Mobilization in Patients with Cervical Radiculopathy - A Randomized Controlled Trial

Background: Cervical radiculopathy is a type of neck disorder. Here a nerve root in the cervical spine becomes inflamed or impinged, resulting in neurological functions. They may radiate anywhere from the neck into the shoulder, arm, hand, or fingers. While the clinical diagnostic tests of cervical radiculopathy are well established in the literature, studies finding the usefulness of rehabilitation interventions are few. Therefore, the objective of the present study was to compare the effectiveness of mulligan mobilization versus conventional neurodynamics in cervical radiculopathy.Methods: 30 subjects with age group 30 – 55 years who were clinically diagnosed with cervical radiculopathy &amp;having one Upper Limb Tension Test positive were included in the study. They were randomized to Mulligan Neurodynamic Mobilization Group or Conventional Neurodynamics Group. The treatment sessions (3 repetitions, 3 sets) in both groups lasted for 5 consecutive days. Outcomes were measured using the Numerical Pain Rating Scale(NPRS) for pain, Cervical ranges, and patient-specific functional scale (PSFS) for disability.Results: Wilcoxon test was used for within-group whereas the Mann-Whitney test was used for between-group comparisons. The test revealed similar improvements in pain and disability in both groups (p&gt;0.05); however, the Mulligan Neurodynamic Mobilization Group showed better results in terms of cervical ranges (p&lt;0.05).Conclusion: Both the techniques were equally effective, but Mulligan Group had better cervical ranges, especially extension, rotation, and lateral flexion.

Excursion of the median nerve during a contra-lateral cervical lateral glide movement in people with and without cervical radiculopathy

BackgroundA segmental, contra-lateral cervical lateral glide (CCLG) mobilization technique is effective for patients with cervical radiculopathy (CR). The CCLG technique induces median nerve sliding in healthy individuals, but this has not been assessed in patients with CR. ObjectiveThis study aimed to 1) assess longitudinal excursion of the median nerve in patients with CR and asymptomatic participants during a CCLG movement, 2) reassess nerve excursions following an intervention at a 3-month follow-up in patients with CR and 3) correlate changes in nerve excursions with changes in clinical signs and symptoms. DesignCase-control study. MethodsDuring a computer-controlled mechanically induced CCLG, executed by the Occiflex™, longitudinal median nerve excursion was assessed at the wrist and elbow with ultrasound imaging (T0) in 20 patients with CR and 20 matched controls. Patients were re-assessed at a 3-month follow-up (T1), following conservative treatment including neurodynamic mobilization. ResultsThere was a significant difference between patients and controls in the excursion of the median nerve at both the wrist (Mdn = 0.50 mm; IQR = 0.13–1.30; 2.10 mm (IQR = 1.42–2.80, p < 0.05)) and elbow (Mdn = 1.21 mm (IQR = 0.85–1.94); 3.49 mm (IQR = 2.45–4.24, p < 0.05)) respectively at T0. There was also a significant increase in median nerve excursion at both sites between T0 and T1 in those with CR (Mdn = 1.96, 2.63 respectively). Wilcoxon Signed-Ranks Test indicated median pre-test ranks (Mdn = 0.5, 1.21; Z = - 3.82, p < 0.01; Z = −3.78, p < 0.01 respectively) and median post-test ranks. There was a strong correlation between improvement in median nerve excursion at the elbow at T1 and improvement in pain intensity (r = 0.7, p < 0.001) and functional limitations (r = 0.6, p < 0.01). ConclusionLongitudinal median nerve excursion differs significantly between patients with CR and asymptomatic volunteers at baseline, but this difference is no longer present after 3 months of conservative physiotherapy management. Improvement in nerve excursion correlates with improvement in clinical signs and symptoms.

Effectiveness of Neurodynamic Mobilization versus Conventional Therapy on Spasticity Reduction and Upper Limb Function in Tetraplegic Patients.

Study DesignThe study employed a pre- and post-test experimental design.PurposeThis study was designed to assess the effect of neurodynamic mobilization of the median nerve on upper limb spasticity in tetraplegic patients.Overview of LiteratureSpasticity is a common and potentially disabling and bothersome complication in patients with spinal cord lesion; this disorder can negatively influence the quality of life by restricting the patient’s ability to perform activities of daily living. Neural mobilization is currently used for reducing the spasticity in individuals with neurological disorders.MethodsTwenty subjects with traumatic spinal cord injury (level C5–C8) and upper limb spasticity in the finger and wrist flexors were enrolled. They were randomly allocated to two different groups using a computer-generated randomization schedule: group I comprised the neurodynamic mobilization group (n=11) and group II was the conventional therapy group (n=9); the subjects were administered therapy for 5 days every week for a period of 4 weeks. Upper limb spasticity was assessed using the Modified Ashworth Scale for wrist and finger flexors; F-wave amplitude, latency, and F-wave/M-wave amplitude ratio (F/M ratio) were examined using the F-wave scores of the median nerve; and upper limb function was determined using the Capabilities of Upper Extremity (CUE) Questionnaire.ResultsAfter 4 weeks of intervention, between-group comparisons showed a significant difference in the pre-intervention and postintervention scores on the Modified Ashworth Scale score for wrist flexors (−1.64±0.67), Modified Ashworth Scale score for finger flexors (−1.00±0.63), F-wave amplitude (−154.09±220.86), F/M ratio (−0.18±0.24), and CUE scores (17.82±13.49).ConclusionsThese results suggest that neurodynamic mobilization of the median nerve may be effective for upper limb spasticity control and upper limb functional improvement in tetraplegic patients.

Compare the effectiveness of neurodynamic mobilization and PNF program in improving sensorimotor function in diabetic neuropathy in lower limbs

Compare the effectiveness of neurodynamic mobilization and PNF program in improving sensorimotor function in diabetic neuropathy in lower limbs

Short-term Effectiveness of the Movement Direction in Neurodynamic Mobilization for Upper Limb Mobility and Pain

Background: Neurodynamic mobilization is divided into slider mobilization and tensioner mobilization. However, movement direction in neurodynamic mobi­lization has been overlooked in neurodynamic exercise program. Objective: To examine the effect of movement direction in neurodynamic mobilization on upper limb mobility and pain. Design: Quasi-experimental study Methods: Twenty-two adults positive for neurodynamic test for the median nerve were recruited for participation in this study. Twenty-two subjects were allocated to the applied neurodynamic mobilization at limited side group (ANTLS, n=7), the applied neurodynamic mobilization at contralateral limited side group (ANTCLS, n=7), and the applied neurodynamic mobilization at bilateral side group (ANTBS, n=8). Before the intervention upper limb limited was measured neurodynamic test for the median nerve, pain was measured using visual analogue scale (VAS), movement direction in neurodynamic mobilization was applied to each group, and then re-measured using neuro­dynamic test for the median nerve and VAS. Differences the Intra-groups before and between the intergroups after intervention were analyzed. Results: In the ANTLS and ANTBS groups, a statistically significant increase in ROM and decrease in VAS score in the population before and after interven­tion were indicated. Statistically significant differences in VAS and ROM from before to after intervention were found among the ANTLS, ANTCLS, and ANTBS groups. Conclusions: The results of the present study indicate that movement direction in neurodynamic mobilization must be considered within the limits of its select­ed range of the neurodynamic exercise program.

Algorithm for the use of physical therapy in patients with compression-ischemic neuropathies of the upper limb

Оlena Bismak Purpose: to develop an algorithm of rehabilitation measures in people with compression-ischemic neuropathies of the upper limb. Material & Methods: the study involved 67 patients with compression-ischemic neuropathy of the upper limb, among whom were 43 (64.2%) men and 24 (35.8%) women. The duration of the disease ranged from 3 to 18 months. The age of the examined varied from 18 to 67 years, on average 42,3±9,4 years. The study was conducted on the basis of the neurological department and the physiotherapy department of the Kiev city clinical hospital No. 4 of Kyiv in the period from 2017 to 2019. We used the following research methods: analysis and synthesis of literature data, content analysis of medical records, rehabilitation examination. Results: an important condition for the treatment of tunnel neuropathies is an integrated approach, which should have the following components: a comprehensive rehabilitation examination to determine the main rehabilitation problems; statement of tasks with prediction of the final result; selection of appropriate individual and optimal physical therapy means for each patient. An algorithm of physiotherapeutic intervention has been developed, including the use of the following measures: kinesitherapy with neurodynamic mobilization, taping, stimulating massage, instrumental physiotherapy, mechanotherapy and hydrotherapy. The proposed algorithm of physical therapy measures differed from standard programs in that it allowed to formulate the goals of the rehabilitation process taking into account a differentiated approach to solving the problem of rehabilitation of patients with compression-ischemic neuropathies of the upper limb with varying severity of motor function disorders; had a comprehensive, multidisciplinary approach to solving the problems of patients with this pathology. Conclusions: the development of an algorithm of physiotherapeutic intervention for people with compression-ischemic neuropathies of the upper limb is an urgent problem due to the fact that compression-ischemic neuropathies of the upper limb often lead to a decrease in the patient's quality of life and long-term disability. When developing an algorithm of rehabilitation measures, it is necessary to take into account: individual features of the functional state of patients with this pathology, the presence and severity of motor and sensory disturbances, which depend on which particular nerve of the arm is affected (median, ulnar or radiation), the nature of the lesion, age, professional activity and patient needs.

Neuropathic pain in patients with compression-ischemic neuropathy of the upper limb: diagnosis and assessment of the effectiveness of rehabilitation measures

The purpose of the work is to assess the severity of neuropathic pain and determine the effectiveness of rehabilitation measures in people with compression-ischemic neuropathy of the upper limb in the subacute period.&#x0D; Material and methods. Analysis and synthesis of literature data, visual analogue pain scale (VAS), DN4 questionnaire for diagnosing the nature of pain, rehabilitation examination, methods of mathematical statistics. The study involved 73 patients with compression-ischemic neuropathy of the upper limb. Patients were divided into 2 groups: the main (37 people) and control (36 people). The duration of the disease ranged from 3 to 18 months. The age of the examined ranged from 18 to 57 years, an average of 39.4±6.7 years.&#x0D; Results. At the initial examination, we found that in patients of both groups, carpal tunnel syndrome was diagnosed more often than other tunnel syndromes. In patients of the main and control groups, VAS indicators were above average (6.62 ± 0.21 and 6.58 ± 0.18 points, respectively). No significant difference between the groups was found (p&gt; 0.05). In patients of the main group, we used the following rehabilitation measures: kinesitherapy with neurodynamic mobilization, taping, apparatus physiotherapy and mechanotherapy procedures. Patients in the control group were engaged in a standard rehabilitation program - physical exercises, apparatus physiotherapy, mechanotherapy. Upon repeated examination by YOUR, a decrease in pain was observed in both groups, however, in the main group, the severity of pain was significantly lower than in the control group (p &lt;0.001).&#x0D; Conclusions. The study confirmed that the inclusion of kinesitherapy with neurodynamic mobilization, taping, apparatus physiotherapy and mechanotherapy in the complex treatment of copression-ischemic neuropathies of the upper limb contributed to a significant reduction in pain in patients of the main group compared with the control group, in which the standard rehabilitation program was used.

Effect of Neuro Dynamic Mobilization on Pain and Hand Grip Strength in Cervical Radiculopathy Patients

AbstractBackground: Cervical Radiculopathy (CR) is a patholog-ical condition of the cervical roots, which results in sensory and motor deficits. There is evidence supporting the influence of neural mobilization in relieving CR symptoms.Aim of Study: The aim of the study was to evaluate the effect of neuro dynamic mobilization on hand grip strength and pain in patients with chronic cervical radiculopathy.Methods: Thirty participants with cervical pain radiating to the upper limb were recruited from the Outpatient Depart-ments of El-Menshawy General Hospital from 16-11-2019 till 4-4-2019, their age ranged between 30-50 years. Patients were divided into three equal groups Group (1) received neural mobilization for ulnar, median, and radial nerves in addition to selected physical therapy program. Group (2) received neural mobilization for ulnar and median nerves in addition to the selected physical therapy program while Group (3) received only the selected physical therapy program for four weeks. Assessment of pain using visual analogue scale (VAS) and hand grip using jamar hand-held dynamometer were done before and after treatment.Results: The findings revealed a statistically significant decrease of pain scores within each group and increase in hand grip strength within each group post-treatment (p 0.05).Conclusion: Addition of radial nerve mobilization to ulnar and median neuro dynamic mobilization technique is effective in improving symptoms of chronic CR.

Effects of Adding a Neurodynamic Mobilization to Motor Control Training in Patients With Lumbar Radiculopathy Due to Disc Herniation: A Randomized Clinical Trial.

The aim of the study was to investigate the effects of the inclusion of neural mobilization into a motor control exercise program on pain, related disability, neuropathic symptoms, straight leg raise, and pressure pain threshold in lumbar radiculopathy. This is a randomized clinical trial. Individuals with low back pain, with confirmed disc herniation, and lumbar radiculopathy were randomly assigned to receive eight sessions of either neurodynamic mobilization plus motor control exercises (n = 16) or motor control exercises alone (n = 16). Outcomes included pain, disability, neuropathic symptoms, straight leg raise, and pressure pain threshold at baseline, after four visits, after eight visits, and after 2 mos. There were no between-groups differences for pain, related disability, or pressure pain threshold at any follow-up period because both groups get similar and large improvements. Patients assigned to the neurodynamic program group experienced better improvements in neuropathic symptoms and the straight leg raise compared with the motor control exercise group (P < 0.01). The addition of neurodynamic mobilization to a motor control exercise program leads to reductions in neuropathic symptoms and mechanical sensitivity (straight leg raise) but did not result in greater changes of pain, related disability, or pressure pain threshold over motor control exercises program alone in subjects with lumbar radiculopathy. Future trials are needed to further confirm these findings because between-groups differences did not reach clinically relevance.

Median Nerve Excursion During Neurodynamic Mobilization

Median Nerve Excursion During Neurodynamic Mobilization

EFEKTIVITAS SHORTWAVE DIATHERMY DAN NEURODYNAMIC MOBILIZATION PADA RADIKULOPATI LUMBOSAKRAL

Radicular syndrome is one type of disease that is included in peripheral nervous system disorders that occur in the spinal roots causing a disturbance of sensory deficits, motor deficits, reflex deficits and damage to pain sensation. In lumbosacral radiculopathy patients, a condition known as fear avoidance belief is a fear to move or to feel pain as a result of doing an activity. This fear of moving causes patients to restrict its movement, so the muscles that should stabilize the inactive vertebral column and the global muscle become hyperactive and trigger muscle spasms. Conservative therapy approaches that may be given to lumbosacral radiculopathy include application of modalities and therapy by physiotherapy, giving modalities of electro physical agents, exercise therapy, and manual therapy interventions. The purpose of this literature review was to determine the effectiveness of intervention shortwave diathermy and neurodynamic mobilization in patients with lumbosacral radiculopathy. The research method used is the study of literature review by using secondary data in the form of study research journals related to the effectiveness of the use of shortwave diathermy and neurodynamic mobilization in patients with lumbosacral radiculopathy. Previous research has shown that the addition of SWD to treat the subjects with chronic back pain complaints can reduce pain. While neurodynamic mobilization is a clinical application to the physiological and mechanical concepts of the nervous system that integrate with the musculoskeletal system. The precise explanation for the improvement of functional disability and pain level experienced by patients with neurodynamic is that neurodynamic may affect the mechanical functioning of peripheral nerves and the change in neural mechanical function have a direct impact on the physiological changes of nerve structure. Based on the literature review, it can be concluded that: the combination of shortwave diathermy and neurodynamic mobilization is effective in improving the limitations of motion and function of lumbosacral radiculopathy patients.

KOMBINASI PULSED SHORTWAVE THERAPY DAN NEURODYNAMIC MOBILIZATION LEBIH EFEKTIF MENURUNKAN DISABILITAS PUNGGUNG DIBANDINGKAN KOMBINASI PULSED SHORTWAVE THERAPY DAN LUMBAR SPINE STABILIZATION EXERCISE PADA PASIEN HERNIA NUKLEUS PULPOSUS LUMBOSAKRAL

ABTSRACT Introduction: Herniated Nucleus Pulposus (HNP) is a pathological condition in which there is protrusion of the annulus fibrosus and nucleus pulposus into the lumen of the vertebral canal. Objective: The goal of this study is to determine the effectiveness of combination of pulsed shortwave therapy and lumbar spine stabilization exercise with combination of pulsed shortwave therapy and neurodynamic mobilization in decreasing low back disability in lumbosacral herniated nucleus pulposus patients at Denpasar and Badung Physiotherapy Clinic. Methods: The study used was an experimental method. Pre-test and post-test control group design is the design of this study. This study used 28 subjects were divided into two groups. The control group consist of 14 subjects received a combination of pulsed shortwave therapy and lumbar spine stabilization exercise while the treatment group consist of 14 subjects received a combination of pulsed shortwave therapy and neurodynamic mobilization. Intervention is given 2 times a week for 4 weeks. Sampling methods used in this study was simple random sampling. The low back disability is measured by a modified oswestry disability index. Result: The normality test of the data was tested using Saphiro-Wilk Test and homogeneity test of the data was tested with Levene's Test. Wilcoxon sign rank test results obtained significant differences in the control group with the value of p = 0.001, as well as in the treatment group found a significant difference with the value of p = 0.001. Post-test results with mann-whitney u-test showed a significant difference between the control group and the treatment group where p = 0.044 with the percentage of 48.53% in the control group and 54.88% in the treatment group. Conclusion: Based on the results of this study it can be concluded that the combination of pulsed shortwave therapy and neurodynamic mobilization is more effective than the combination of pulsed shortwave therapy and lumbar spine stabilization exercise in reducing low back disability in patients with lumbosacral herniated nucleus pulposus at the Denpasar and Badung Physiotherapy Clinic.Keywords: lumbosacral herniated nucleus pulposus, low back disability, pulsed shortwave therapy, neurodynamic mobilization, lumbar spine stabilization exercise

Neurodynamic mobilization and foam rolling improved delayed-onset muscle soreness in a healthy adult population: a randomized controlled clinical trial.

ObjectivesCompare the immediate effects of a Neurodynamic Mobilization (NM) treatment or foam roller (FR) treatment after DOMS.DesignDouble blind randomised clinical trial.SettingThe participants performed 100 drop jumps (5 sets of 20 repetitions, separated by 2 min rests) from a 0.5-m high box in a University biomechanics laboratory to induce muscle soreness. The participants were randomly assigned in a counter-balanced fashion to either a FR or NM treatment group.ParticipantsThirty-two healthy subjects (21 males and 11 females, mean age 22.6 ± 2.2 years) were randomly assigned into the NM group (n = 16) or the FR group (n = 16).Main Outcome MeasuresThe numeric pain rating scale (NPRS; 0–10), isometric leg strength with dynamometry, surface electromyography at maximum voluntary isometric contraction (MVIC) and muscle peak activation (MPA) upon landing after a test jump were measured at baseline, 48 h after baseline before treatment, and immediately after treatment.ResultsBoth groups showed significant reduction in NPRS scores after treatment (NM: 59%, p < .01; FR: 45%, p < .01), but no difference was found between them (p > .05). The percentage change improvement in the MVIC for the rectus femoris was the only significant difference between the groups (p < 0.05) at post-treatment. After treatment, only the FR group had a statistically significant improvement (p < 0.01) in strength compared to pre-treatment.ConclusionOur results illustrate that both treatments are effective in reducing pain perception after DOMS whereas only FR application showed differences for the MVIC in the rectus femoris and strength.

Effect of neurodynamic mobilization on fluid dispersion in median nerve at the level of the carpal tunnel: A cadaveric study

ObjectivesTo evaluate the effect of neurodynamics mobilization (NDM) on an artificially induced edema in the median nerve at the level of the carpal tunnel in unembalmed cadavers and to assess whether NDM tensioning techniques (TT) and NDM sliding techniques (SLT) induce similar effects on intraneural fluid dispersion. DesignFourteen upper extremities of seven unembalmed cadavers were used in this study. A biomimetic solution was injected directly under the epineurium of the median nerve at the level of the proximal transverse carpal ligament. The initial dye spread was allowed to stabilize and measured with a digital caliper. Tensioning and sliding techniques were applied following a randomized crossover design to each upper extremity and were performed for a total of 5 min each. Post-intervention dye spread measurements were taken after each technique. ResultsAfter the first mobilization, the mean longitudinal dye spread (7.5 ± 6.6 mm) was significantly greater (p = 0.024) compared to the stabilized dye spread. There was a significant longitudinal diffusion effect with both, TT (p = 0.018) and SLT (p = 0.016), with no statistically significant difference between techniques (p = 0.976). The order in which techniques were administered did not influence the diffusion. ConclusionFive minute of passive NDM in the form of tensioning or sliding technique induced significant fluid dispersion in the median nerve at the carpal tunnel of unembalmed human cadavers. This study provides support for clinical mechanism of NDM in reducing intraneural edema.