Neurodynamic Test Research Articles

Use of Neurodynamic or Orthopedic Tension Tests for the Diagnosis of Lumbar and Lumbosacral Radiculopathies: Study of the Diagnostic Validity.

Background: Lumbar radiculopathy is a nerve root disorder whose correct diagnosis is essential. The objective of the present study was to analyze the reliability diagnostic validity of eight neurodynamic and/or orthopedic tension tests using magnetic resonance imaging as the Gold Standard. Methods: An epidemiological study of randomized consecutive cases which was observational, descriptive, transversal, double blinded and was conducted following the Standards for Reporting Diagnostic accuracy studies (STARD) declaration. The sample size was 864 participants. Internal and external validity (CI = 95%) and reliability, were calculated for all tests performed independently. The diagnostic validity of the combined and multiple tests in parallel was also calculated. Results: The analysis indicated that only two tests performed independently had external validity, but neither had reliability or precision. The Straight Leg Raise test and the Bragard test performed in a multiple parallel way showed high sensitivity (97.40%), high negative predictive value (PV− 96.64%) and external validity (Likelihood Ratio− 0.05). The combined test of the Slump test and the Dejerine’s triad had internal and external validity. Conclusions: The Straight Leg Raise test and the Bragard test performed in a multiple parallel way and the combined test of the Slump Test and the Dejerine’s triad have clinical validity to discard lumbar or lumbar-sacral radiculopathy.

Somatosensory profiles in patients with non-specific neck-arm pain with and without positive neurodynamic tests

Despite normal neurological integrity tests, some patients with non-specific neck-arm pain (NSNAP) have heightened nerve mechanosensitivity upon neurodynamic testing. The aim of this study was to determine whether or not a nerve dysfunction is present in patients with positive neurodynamic tests compared to those with negative neurodynamic tests or healthy controls. Somatosensory profiling using quantitative sensory testing (QST) was established in 40 consecutive patients with unilateral NSNAP; 23 had positive upper limb neurodynamic tests (ULNTPOS) and 17 had negative neurodynamic tests (ULNTNEG) and in 26 healthy controls. QST included measurement of thermal and mechanical detection and pain thresholds in the maximal pain area on the symptomatic side as well as the corresponding contralateral area.Fifty-seven percent of patients with NSNAP had positive neurodynamic tests. Somatosensory profiling revealed a loss of function phenotype in NSNAP patients compared to healthy controls both in the maximal pain area and asymptomatic side. Hyperalgesia (cold, heat and pressure) was present bilaterally in both NSNAP groups. Direct comparison between the patient groups revealed no significant differences in somatosensory profiles. However, the ULNTPOS group demonstrated sensory loss compared to healthy controls in more parameters than the ULNTNEG group. The ULNTNEG subgroup represented an intermediate phenotype between ULNTPOS patients and healthy controls in most detection thresholds as well as thermal and pressure pain thresholds.Even though patients with NSNAP present as a spectrum, it remains unclear whether the sensory changes are indicative of a nerve dysfunction/lesion or rather a marker of altered central pain processing.

Normal response to sural neurodynamic test in asymptomatic participants. A cross-sectional study

BackgroundNeurodynamic tests (NDTs) consist of a combination of movements aimed to stress different parts of the nervous system and are considered to be able to detect increased nerve mechanosensitivity. Currently, there are no studies in healthy subjects that define the normal response to sural neurodynamic test (NDTSUR). ObjectivesThe main aim of this study was to document normal responses of the NDTSUR in asymptomatic participants. The secondary aim was to investigate potential gender and leg dominance influences. DesignA cross-sectional study was designed. MethodsNDTSUR was performed on 44 asymptomatic participants with a total of 88 lower limbs. The range of motion at the point of first appearance of symptoms (S1) and the point of pain tolerance (S2), quality and distribution of sensory responses were recorded. ResultsHip flexion was significantly greater (p < 0.001) at S2 (63.6 ± 13.1°) than S1 (42.5 ± 12°) and the mean difference was 21.8° (95% CI: 21.8; 22.8) (p < 0.001). However, hip flexion was not different between gender nor dominance (p > 0.05). The descriptor of the quality of the sensory responses more often used by participants was stretching (87% and 76% for S1 and S2, respectively) in the posterior knee and lateral leg. ConclusionsThis study describes the sensory responses of asymptomatic participants resulting from the NDTSUR. The findings indicate that NDTSUR responses are independent of the influence of gender or leg dominance.

Effect of cervical contralateral lateral flexion on displacement and strain in the median nerve and flexor digitorum superficialis at the wrist during the ULNT1 – Cadaveric study

IntroductionA key issue in neurodynamic testing is whether a manoeuvre designed to produce differential biomechanical behaviour (structural differentiation) of nerve compared to adjacent muscle is mechanically accurate. The aim of this study was to investigate the capacity of cervical contralateral lateral flexion to produce differential biomechanical behaviour of the median nerve at the wrist (mechanical specificity) in relation to the adjacent muscle (flexor digitorum superficialis) at different ranges of upper limb neurodynamic test 1 in cadavers. Material and methodsA cross-sectional study was carried out. In fresh frozen cadavers, with microstrain devices and Vernier calipers, strain and excursion in the median nerve and flexor digitorum superficialis muscle were measured during cervical contralateral lateral flexion at 0°, 30°, 60° and 90° of elbow flexion of the upper limb neurodynamic test 1. ResultsThe cervical movement resulted in proximal excursion and significant changes in strain in the median nerve at 0°, 30° and 60° of elbow flexion during the upper limb neurodynamic test 1 (p < 0.05). In contrast, the structural differentiation manoeuvre did not affect the strain nor the excursion in the muscle at any position of the elbow (p > 0.05). ConclusionAdding CCLF to each ULNT1 median elbow angle increased strain and created proximal excursion of the median nerve at the wrist. Neck movement produced no changes in strain nor excursion of the flexor digitorum superficialis. This study adds to evidence that, in certain circumstances, neck movement may be used in differentiation of nerve and muscle disorders in the wrist.

Normal response to tibial neurodynamic test in asymptomatic subjects

The straight leg raise test (SLR) is one of the most performed physical tests for mechanosensitivity and impairment of the nervous system. According to the anatomy of the tibial nerve, ankle dorsiflexion and eversion movements could be used to perform the tibial neurodynamic test (TNT). To date, no study has documented the normal responses of the TNT. To document normal responses of the TNT in asymptomatic individuals and to investigate influences from sex and leg dominance. A cross-sectional study with 44 asymptomatic volunteer subjects, a total of 88 lower limbs, was carried out. The range of motion (ROM), quality, and distribution of sensory responses were recorded. The hip flexion ROM was measured when subjects reported an intensity of their symptoms of 2/10 (P1) and 8/10 (P2). The mean ROM for hip flexion at P1 was 44.22 ± 13.13∘ and 66.73 ± 14.30∘ at P2. Hip flexion was significantly greater at P2 than P1 (p< 0.001). However, it was not different between sex or limbs (p> 0.05). The descriptor of the quality of sensory responses most often used by participants was stretching (88.6% and 87.5% for P1 and P2, respectively) in the popliteal fossa and posterior calf. This study describes the sensory responses of asymptomatic subjects resulting from the TNT. Our findings indicate that TNT responses are independent of the influence of sex or leg dominance.

Reliability of the beighton score and impact of generalized joint mobility and resting scapular position on Median Neurodynamic Test 1

IntroductionThere is a lack of understanding of the impact of generalized joint mobility, joint hypermobility, and resting scapular position on neurodynamic testing of the median nerve. The objectives of the study were to determine: 1) the reliability of the Beighton score (BS) with and without the cutoff score for general joint hypermobility (GJH); 2) if there are differences in the Median Neurodynamic Test 1 (MNT 1) based on the Beighton cutoff score for GJH; 3) if there are differences in the MNT 1 based on an assessment of resting scapular position; 4) if there are relationships between the BS with and without the cutoff score for GJH, resting scapular position, and MNT 1. MethodsTesting was performed by two testers at two-time intervals at least 1 week apart. The population of interest was healthy asymptomatic adults. The outcome measures included the BS, resting scapular position, and MNT 1. ResultsIntraclass correlation coefficients (ICC2,1) were 0.52 for intertester reliability at visit 1 and 0.86 at visit 2, with intratester reliability of 0.88 for Tester 1 and 0.71 for Tester 2 for the BS. Intertester prevalence-adjusted bias-adjusted kappa (PABAK) values for the Beighton GJH cutoff scores were 0.80–0.84 and 0.80 to 0.92 for intratester reliability. There were no statistically significant differences or relationships for any of the other variables of interest. ConclusionJoint mobility and resting scapular position are not confounding variables when performing MNT 1 in an asymptomatic population.

Neural mobilization as a therapeutic option in the treatment of stroke.

Introduction: The neural mobilization is a technique aimed at functional recovery of the nervous system and structures innervated by it. However, little is known about its effects in patients affected by stroke (CVA). Objective: To review and integrate studies that investigated the effects of neural mobilization (NM) in the treatment of patients with stroke. Method: an integrative review of scientific studies with primary and secondary data, both addressing the NM in the treatment of spasticity, flexibility and functionality of stroke patients. The review was carried out by independent authors from July to October 2014. databases were consulted: LILACS, PEDRO, PUBMED and SCIELO. For the selection of manuscripts, we used the following key words: Neural Mobilization, Neurodynamics Mobilization, neurodynamic tests, stroke, spasticity Muscle, joint range of motion, flexibility and their counterparts in English. Studies were screened by reading the titles and objectives. Then deleted resumes in duplicate and performed the reading of articles to verify that met the inclusion criteria. Results: Six studies were selected, one being reviewed. In general, all the research has investigated the effects of NM in stroke patients. Four of the six articles were published in English. Only one study used a control group. As for treatment, there was divergence in relation to the NM application protocol. Conclusion: The reviewed studies indicate beneficial effects of neural mobilization in the control of muscle tone, range of motion and functionality of patients affected by stroke.

Effect of Neuro-Dynamic Technique on Repetitive Inward Ankle Rolls among Young Malaysian Athletes- A Randomized Controlled Trial

Inversion ankle sprains (IAS) are the most common injuries in sports and recreational activities. Incomplete rehabilitation among injured athletes may result in repetitive inward ankle rolls. Furthermore, inversion ankle sprain causes damage to the superficial peroneal nerve during repeated ankle inversion and plantar flexion. This results in positive neurodynamic tests in patients with sprained ankles. The purpose of this study was to find the effect of the neuro-dynamic technique on repetitive inward ankle rolls and compare it with standard physiotherapy on dynamic balance, pain score, peroneal longus, and tibialis anterior muscle activation response, knee range of motion (ROM), and functional ankle disability index (FADI) among young Malaysian athletes. Fourteen participants of age ranging from 17 to 35 years with repeated ankle sprains were recruited and randomized into Intervention Group A (Neurodynamic technique and Standard Physiotherapy-NDT+SP) and Intervention Group B (Standard Physiotherapy-SP). The participants of group A received NDT (4*30 s with 1-min rest) consisting of peroneal nerve mobilization began the day after the baseline and continued through the week for 3 sessions. In addition, the participants received standard physiotherapy (pain management and exercise) whereas the group B participants received only standard physiotherapy. The participants with repeated IAS were checked for FADI followed by pain score, dynamic balance (Y-balance), and knee ROM (using electro-goniometer). The peroneal longus and tibialis anterior muscle activity response was tested by Surface Electromyography (sEMG) (Noraxon Myo-Muscle) on the injured leg. The subjects of the two groups were tested on selected variables in baseline, mid, post and follow-up measurements. Repeated Measures Analysis of Variance (ANOVA) was computed to determine the interaction effects of time and between-subject factors. ANOVA results (NDT + SP) indicated that dependent variables FADI (F (1.148, 36) = 4701.14), pain score (F (1.98, 36) = 132.697), dynamic balance (F (1.409, 36) = 16.42), knee ROM (F (1.498, 36) = 62.232), peroneal longus peak activity (F (3, 36) = 25.727), and tibialis anterior peak activity (F (3, 36) = 17.563) had a significant effect (p<0.05) within the times of intervention among participants. Based on the post hoc test. FADI, pain score and knee ROM showed consistent improvement in intervention over the injured leg. The findings of this study show improvement in dynamic balance, pain score, peroneal longus and tibialis anterior muscle activation response, knee ROM, and FADI in both groups. The neurodynamic technique together with standard physiotherapy intervention shows safe and similar effects between variables. As part of the ankle rehabilitation protocol, it also recommends the neurodynamic technique to prevent repetitive IAS.

Effects of a Single Myofascial Induction Session on Neural Mechanosensitivity in Breast Cancer Survivors: A Secondary Analysis of a Crossover Study

ObjectivesThe purpose of this study was to investigate the short-term effects of myofascial induction on mechanosensitivity of upper limb nerves. MethodsIn this secondary analysis of a randomized, single-blind, placebo-controlled crossover study, 21 breast cancer survivors with stage I-IIIA cancer were randomly allocated to an experimental group (30 minutes of myofascial induction session) or placebo control group (unplugged pulsed 30 minutes of shortwave therapy), with a 4-week washout period between sessions that occurred in a physical therapy laboratory in the Health Science Faculty (University of Granada, Spain). Range of motion (universal goniometry), structural differentiation, symptoms (yes/no), and pressure pain thresholds (electronic algometry) were assessed during neurodynamic tests and attitude toward massage scale as covariate. ResultsAn analysis of covariance revealed significant time × group interactions for range of motion in affected upper limb nerves (median, P < .001; radial, P = .036; ulnar, P = .002), but not for nonaffected upper limb nerves (median, P = .083; radial, P = .072; ulnar, P = .796). A χ2 or Fisher exact test, as appropriate, also revealed a significant difference (P = .044) in sensitivity for the affected upper limb ulnar nerve in the experimental group, whereas the rest of the assessed nerves (affected and nonaffected upper limb nerves) showed no significant changes in either the experimental or control groups (P > .05). An analysis of covariance revealed no significant interactions on pressure pain thresholds over the nerves for affected (all P > .05) and nonaffected (all P > .05) upper limb nerves. ConclusionA single myofascial induction session may partially improve mechanosensitivity of median, radial, and ulnar nerves and yield positive effects on symptom mechanosensitivity, especially regarding the ulnar nerve in breast cancer survivors.

The validity of neurodynamic tests to identify nerve dysfunction in the upper limb

Purpose: Upper limb neurodynamic tests (ULNT) are used to examine patients with suspected cervical radiculopathy (CR), carpal tunnel syndrome (CTS) or cubital tunnel syndrome. Understanding the validity of these tests is critical if they are to be used to diagnose these conditions in clinical practice. The purpose was to critically and systematically assess the literature on the validity of ULNTs in identifying nerve dysfunction in the upper limb.

A comparison of the extent, intensity and distribution of pain during upper limb neurodynamic tests

Keywords Upper Limb Neurodynamic Testing, Pain drawing, Pain intensity

Discovering the Vagus: Validation and Inter-Rater Reliability of the Vagus Nerve Neurodynamic Test Among Healthy Subjects

Background: The Vagus Nerve (VN) neuropathies and autonomic peripheral neuropathies (APN) are responsible for neurodegenerative diseases and immune response alterations. Peripheral nerves selective tension tests (NDT) are clinical tools validated for neuropathies detection in lower and upper limbs. However, a validated NDT to assess VN is lacking. Methods: An estimated sample of 30 healthy subjects completed a questionnaire on vagal symptoms. The VN-NDT was administered, if neurological assessment of the cervical tract was negative. Symptoms and heart rate (HR) were monitored. The test validity was assessed using a motion capture analysis system and a real-time ultrasonography imaging (USI; C6-VN distance) during the test administrations. Inter-examiner accordance was tested (Cohen's Kappa) between two blinded assessors (one expert and one novice). Two-way analysis of variance (ANOVA) were performed with factors experience and side tested (2x2). A checklist with symptoms and signs of autonomic dysfunction was administered to all participants and accuracy, sensitivity, specificity, positive and negative likelihood ratios of the VN-NDT in autonomic dysfunction symptoms detection was calculated (ClinicalTrials.gov number, NCT04192877). The aim of the research was to define normtive data in order to establish a hallmark of physiological spectrum for pathology detection. Findings: The test induced a significant reduction of the C6-VN distance and of the HR (about 10 beats per minutes [bpm]; p< 0.01; d= .2; 95% confidence interval [CI]: 0.03–.3; p<0.001; d =.91; 95% CI: 0.63 – 1.03). Inter-examiner accordance was substantial and accuracy for gastrointestinal dysfunctions of the test was excellent (p<0.05; 95% CI:0.52–0.73; p<0.001; 95% CI:0.81–0.96). Interpretation: VN-NDT is a reliable and costless test that can be safely included in the bedside routine examination test. Reported normative data determine the hallmarks needed to screen clinical and preclinical conditions of Autonomic Peripheral Neuropathies (APN) and VN failures. Funding Statement: The authors stated: None. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study was previously approved by the Bioethics Committee of the University of Turin (protocol 139870-14/03/2019).

Incidence of postoperative cognitive dysfunction after simultaneous carotid surgery and coronary artery bypass grafting in patients with asymptomatic cerebral atherosclerosis

To evaluate the incidence of early postoperative cognitive dysfunction (POCD) after simultaneous carotid surgery and coronary artery bypass grafting (CABG) in patients with asymptomatic cerebral atherosclerosis. Fifty-three patients with polyvascular disease and asymptomatic cerebral atherosclerosis undergoing simultaneous unilateral carotid endarterectomy (CEE) and CABG were recruited in the study. Core cognitive functions were assessed with the Mini Mental State Examination (MMSE) and Frontal Assessment Battery (FAB) at days 2-3 before the indexed surgery and at days 7-10 after it. All the patients were assigned to two groups based on the baseline MMSE score: one group with mild cognitive impairment (MCI) and another one without MCI. Neurodynamic measurements were performed using the Status-PF hardware-software complex (certificate #2001610233 of the Russian Agency for Patents and Trademarks), followed by the calculation of the integral indicator of the main cognitive domains according to the corresponding algorithms. Attention, memory and neurodynamics were evaluated in all participants. POCD was diagnosed with a decrease from the initial indicators of memory, attention and neurodynamics by 20% in 20% of the tests. Patients had complications in the early postoperative period, regardless of the presence of MCI. A decline among the core cognitive functions was observed in both groups of patients at days 7-10 after the surgery. Patients demonstrated an increase in the reaction time while performing neurodynamic test battery compared with the baseline values. Alterations in memory and attention were not significant. Significant changes in the integral indicator of cognitive status were determined in both groups of patients. It increased by 14% in patients without MCI (0.34±0.2 in the preoperative period vs. 0.39±0.3 in the postoperative period, p=0.04), and by 36% in patients with MCI (0.25±0.19 vs. 0.39±0.3, p=0.003). Regardless of the presence or absence of MCI, all patients had low cognitive status or even that below the average in the perioperative period. Despite the increase in the average values of cognitive status indicators in the postoperative period, 56% of patients (n=14) without MCI and 71% of patients with MCI (n=20) had early POCD. Patients with polyvascular disease, regardless of the presence of MCI, had low cognitive status or even that below the average, probably contributing to the elimination of the expected positive effects of CEE. The absence of MCI at baseline does not guarantee the preservation of cognitive status after surgery. Patients with polyvascular disease after myocardial and cerebral revascularization remain at high risk of exacerbating cognitive impairment, and, therefore, require an individual approach and a reasonable choice of the optimal surgical strategy.

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.

Validity and Inter-rater Reliability fo the Vagus Nerve Neurodynamic Test Among Healthy Subjects

Validity and Inter-rater Reliability fo the Vagus Nerve Neurodynamic Test Among Healthy Subjects

Neurodynamic test of the peroneal nerve: Study of the normal response in asymptomatic subjects

BackgroundNeurodynamic tests (NDTs) have shown to be useful in evaluating neural tissue involvement. Peroneal nerve reaches high importance in ankle injuries. However, up to date, no study has documented the normal responses for this nerve. ObjectivesThe objective of this study was to document normal responses of the peroneal neurodynamic test (NDTPER) in asymptomatic subjects. Differences in sensory response depending on sex and leg dominance were also examined. DesignA cross-sectional study was designed. MethodForty-four asymptomatic subjects with a total of 88 lower limbs were tested. The range of motion (ROM) at the point of first appearance of symptoms (S1) and the point of symptoms tolerance (S2), quality and distribution of sensory responses were recorded. ResultsHip flexion was significantly higher at S2 than S1 (mean difference, 27.22°; 95% CI: 25.29°, 29.14°; p < 0.001). However, it was not different between sex, nor dominance (p > 0.05). The descriptor of the quality of sensory responses more often used by subjects was stretching (90.9%) in the external foot (74.6%). ConclusionsThis study provides the normal hip flexion angle and quality and distribution of sensory responses to the NDTPER in asymptomatic subjects. Responses were independent of the influence of sex or leg dominance.

Correlation of the self-reported Leeds assessment of neuropathic symptoms and signs score, clinical neurological examination and MR imaging in patients with lumbo-sacral radiculopathy

BackgroundLumbo-sacral radiculopathy (LSR) is a common musculoskeletal disorder for which patients seek medical care and referrals for advanced imaging. However, accurate diagnosis remains challenging. Neuropathic pain screening questionnaires, clinical neurological examination and magnetic resonance imaging (MRI) are used in the initial diagnosis. The utility of these tools in diagnosing LSR varies and their correlation has not been reported.MethodsA cross-sectional, multicentre, blinded design was used in six physiotherapy departments in Kenya. Each participant was blindly examined by three independent clinicians using the Self-Reported Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) score, clinical neurological examination (CNE) and MRI. Spearman’s rank coefficient (r) was used to examine the correlation between the three tests. Linear regression and odds ratios were used to establish correlations between socio-demographic, clinical and diagnostic parameters. The diagnostic accuracy of individual or combined sets of CNE tests in diagnosing LSR, with reference to MRI, was determined using Receiver Operating Characteristics (ROC) curves.ResultsWe enrolled 102 participants (44 males, 58 females; mean age: 44.7 years). Results indicated a significant positive correlation (r = 0.36, P = 0.01) between S-LANSS, CNE and MRI among patients with low back and radiating leg symptoms. Positive agreement existed between combined neuro-conduction tests (sensory, motor and reflex) and neuro-dynamic tests (NDT).The NDT component of CNE (Straight Leg Raise Test [SLRT] and Femoral Nerve Stretch Test [FNST]) was significantly associated (P = 0.05) with MRI: patients who had positive NDT results had higher odds (8.3) for positive nerve root compromise on MRI versus those who had negative NDT results.ConclusionThis was the first study to investigate the correlation between S-LANSS, CNE and MRI in patients presenting with low back and radiating leg symptoms. Results indicated a significant positive correlation. The strongest correlations to MRI findings of LSR were firstly, NDT (SLRT and FNST); secondly, the S-LANSS score; and thirdly, the CNE components of motor power and deep tendon reflex. The clinical implication is that clinicians can confidently use the S-LANSS score and CNE to diagnose and make therapeutic decisions in LSR, when MRI is medically contra-indicated, unaffordable or unavailable.

Neurodynamic tests for patellofemoral pain syndrome: a pilot study

BackgroundPatellofemoral pain syndrome (PFPS) is a common musculoskeletal disorder. There is little consensus on the etiology, but one explanatory model suggests that PFPS can be caused by referred pain. Neurodynamic tests are used to explore the mechanosensitivity of peripheral nerves, and previous studies have shown a relationship between increased mechanosensitivity and anterior knee pain by using the femoral slump test (FST). Previously the prone knee bend test (PKB) does not appear to have been included. The main purpose of this pilot study was to examine whether there was an identifiable difference in mechanosensitivity between left and right sides that could be identified using both the PKB and FST tests for the femoral nerve in patients with unilateral PFPS.MethodsThis cross-sectional pilot study tested 12 patients with unilateral PFPS for altered mechanosensitivity using both PKB and FST. The pain-free knee was used as a control. The selected test procedures were similar to those clinicians use in everyday practice.Results8 and 4 of the 12 patients were found to have increased levels of mechanosensitivity in the PFPS leg using the PKB and FST, respectively. Both tests provoked stronger pain in the leg with PFPS compared with the asymptomatic leg (p < 0.05 Wilcoxon Signed Rank Test). The symptoms were more often located in the anterior knee, with structural differentiation by neck flexion appearing to increase the symptoms more when testing the leg with PFPS.ConclusionsAlthough the reliability of the tests is unknown and the study sample size was small, the PKB and FST test procedures used in clinical practice appear capable of revealing altered mechanosensitivity in unilateral PFPS patients. The PKB test appears to detect mechanosensitivity in more patients than the FST. We recommend including both tests in future larger blinded controlled studies which should also assess reliability of the tests.Trial registrationISRCTN 12473526. Registered 20 May 2015, retrospectively registered.

Upper Limb Neurodynamic Test 1 in patients with Acquired Brain Injury: a cross-sectional study

ABSTRACTIntroduction: Neurodynamic intervention is used in the treatment of patients with Acquired Brain Injury as a method to inhibit the spasticity or reduce the sensory impairment.Purpose of the study: Assess and compare bilateral median nerve mechanosensitivity and its relationship with physical and functional status in patients with hemiparesis or upper limb paresis after ABI.Materials and Methods: Volunteer Patients from the Brain Injury Rehabilitation Unit of the Hospital Universitario Central de Asturias were evaluated for six months. Taking into account inclusion and exclusion criteria, from the 98 original patients having treatment in the Unit included, only 32 were admitted to the final study. The assessment protocol incorporated as main outcomes: bilateral mechanosensitivity of the median nerve (sensory responses, structural differentiation and maximum range of movement in Upper Limb Neurodynamic Test 1) and as secondary outcomes: hypertonia, sensory impairment, upper limb motor function and Activities of Daily Living performance.Results: Significant differences were found when comparing the bilateral maximum range of movement in Upper Limb Neurodynamic Test 1. No relationship was found between the results of the neurodynamic test of the affected upper limb and the secondary outcomes.Conclusions: Mechanosensitivity disturbance observed in the affected upper limb may benefit from neurodynamic treatment.

The effects of spinal manipulative therapy on lower limb neurodynamic test outcomes in adults: a systematic review

ABSTRACTObjective: Spinal Manipulative Therapy (SMT) is a routinely applied treatment modality for various musculoskeletal conditions, including low back pain. The precise mechanisms by which SMT elicits its effects are largely unknown, but recent research supports a multi-system explanation recognizing both biomechanical and neurophysiological mechanisms. Although the evaluation of changes in clinical presentation is complex, objective neurophysiological measures of sensitivity to movement (e.g. neurodynamic tests) can be a valuable clinical indicator in evaluating the effects of SMT. This review aimed to synthesize current literature investigating the effects of SMT on lower limb neurodynamics.Method: Eight electronic databases were systematically searched for randomized controlled trials (RCT) that applied SMT (against any control) and evaluated lower limb neurodynamics (Passive Straight Leg Raise or Slump Test). Selection and data extraction were conducted by one researcher, reviewed by a second author. Risk of bias (RoB) was assessed using the Cochrane Back Review Group criteria.Results: Eight RCTs were included, one with high RoB. SMT produced a clinically meaningful (≥6⁰) difference in five of these studies compared with inert control, hamstring stretching, and as an adjunct to conventional physiotherapy, but not compared with standard care, as an adjunct to home exercise and advice, or when comparing different SMT techniques. Findings compared to sham were mixed. When reported, effects tentatively lasted up to 6 weeks post-intervention.Conclusion: Limited evidence suggests SMT-improved range of motion and was more effective than some other interventions. Future research, using standardized Neurodynamic tests, should explore technique types and evaluate longer-term effects.Level of Evidence: 1a