Neurodynamique
Stretching of roots contributes to the pathophysiology of radiculopathies
08.05.17-05:09
To perform a synthesis of articles addressing the role of stretching on roots in the pathophysiology of radiculopathy.An intraoperative microscopy study of patients with sciatica showed that in all patients the hernia was adherent to the dura mater of nerve roots. During the SLR (Lasègue's) test, the limitation of nerve root movement occurs by periradicular adhesive tissue, and temporary ischemic changes in the nerve root induced by the root stretching cause transient conduction disturbances. Spinal roots are more frail than peripheral nerves, and other mechanical stresses than root compression can also induce radiculopathy, especially if they also impair intraradicular blood flow, or the function of the arachnoid villi intimately related to radicular veins. For instance arachnoiditis, the lack of peridural fat around the thecal sac, and epidural fibrosis following surgery, can all promote sciatica, especially in patients whose sciatic trunks also stick to piriformis or internus obturator muscles. Indeed, stretching of roots is greatly increased by adherence at two levels.
As excessive traction of nerve roots is not shown by imaging, many physicians have unlearned to think in terms of microscopic and physiologic changes, although nerve root compression in the lumbar MRI is lacking in more than 10% of patients with sciatica. It should be reminded that, while compression of a spinal nerve root implies stretching of this root, the reverse is not true: stretching of some roots can occur without any visible compression.
...Afficher la suiteManual therapy in joint and nerve structures combined with exercises in the treatment of recurrent ankle sprains: A randomized, controlled trial
07.04.17-17:03
Recurrent ankle sprains often involve residual symptoms for which subjects often perform proprioceptive or/and strengthening exercises. However, the effectiveness of mobilization to influence important nerve structures due to its anatomical distribution like tibial and peroneal nerves is unclear. To analyze the effects of proprioceptive/strengthening exercises versus the same exercises and manual therapy including mobilizations to influence joint and nerve structures in the management of recurrent ankle sprains. A randomized single-blind controlled clinical trial. Fifty-six patients with recurrent ankle sprains and regular sports practice were randomly assigned to experimental or control group. The control group performed 4 weeks of proprioceptive/strengthening exercises; the experimental group performed 4 weeks of the same exercises combined with manual therapy (mobilizations to influence joint and nerve structures). Pain, self-reported functional ankle instability, pressure pain threshold (PPT), ankle muscle strength, and active range of motion (ROM) were evaluated in the ankle joint before, just after and one month after the interventions. The within-group differences revealed improvements in all of the variables in both groups throughout the time. Between-group differences revealed that the experimental group exhibited lower pain levels and self-reported functional ankle instability and higher PPT, ankle muscle strength and ROM values compared to the control group immediately after the interventions and one month later.
A protocol involving proprioceptive and strengthening exercises and manual therapy (mobilizations to influence joint and nerve structures) resulted in greater improvements in pain, self-reported functional joint stability, strength and ROM compared to exercises alone.
...Afficher la suiteEffectiveness of Nerve Gliding Exercises on Carpal Tunnel Syndrome: A Systematic Review
07.04.17-16:44
The objective of this study was to review the literature regarding the effectiveness of neural gliding exercises for the management of carpal tunnel syndrome (CTS). A computer-based search was completed through May 2014 in PubMed, Physiotherapy Evidence Database (PEDro), Web of Knowledge, Cochrane Plus, and CINAHL. The following key words were included: nerve tissue, gliding, exercises, carpal tunnel syndrome, neural mobilization, and neurodynamic mobilization. Thirteen clinical trials met the inclusion/exclusion criteria, which were: nerve gliding exercise management of participants aged 18 years or older; clinical or electrophysiological diagnostics of CTS; no prior surgical treatment; and absence of systemic diseases, degenerative joint diseases, musculoskeletal affectations in upper limbs or spine, or pregnancy. All studies were independently appraised using the PEDro scale. The majority of studies reported improvements in pain, pressure pain threshold, and function of CTS patients after nerve gliding, combined or not with additional therapies. When comparing nerve gliding with other therapies, 2 studies reported better results from standard care and 1 from use of a wrist splint, whereas 3 studies reported greater and earlier pain relief and function after nerve gliding in comparison with conservative techniques, such as ultrasound and wrist splint. However, 6 of the 13 studies had a quality of 5 of 11 or less according to the PEDro scale.
Limited evidence is available on the effectiveness of neural gliding. Standard conservative care seems to be the most appropriate option for pain relief, although neural gliding might be a complementary option to accelerate recovery of function. More high-quality research is still necessary to determine its effectiveness and the subgroups of patients who may respond better to this treatment.
...Afficher la suiteEffectiveness of a Treatment Involving Soft Tissue Techniques and/or Neural Mobilization Techniques in the Management of Tension-Type Headache: A Randomized Controlled Trial
07.04.17-04:59
To evaluate the effects of a protocol involving soft tissue techniques and/or neural mobilization techniques in the management of patients with frequent episodic tension-type headache (FETTH) and those with chronic tension-type headache (CTTH). Randomized, double-blind, placebo-controlled before and after trial. Rehabilitation area of the local hospital and a private physiotherapy center. Patients (N=97; 78 women, 19 men) diagnosed with FETTH or CTTH were randomly assigned to groups A, B, C, or D. (A) Placebo superficial massage; (B) soft tissue techniques; (C) neural mobilization techniques; (D) a combination of soft tissue and neural mobilization techniques. The pressure pain threshold (PPT) in the temporal muscles (points 1 and 2) and supraorbital region (point 3), the frequency and maximal intensity of pain crisis, and the score in the Headache Impact Test-6 (HIT-6) were evaluated. All variables were assessed before the intervention, at the end of the intervention, and 15 and 30 days after the intervention. Groups B, C, and D had an increase in PPT and a reduction in frequency, maximal intensity, and HIT-6 values in all time points after the intervention as compared with baseline and group A (P<.001 for all cases). Group D had the highest PPT values and the lowest frequency and HIT-6 values after the intervention.
The application of soft tissue and neural mobilization techniques to patients with FETTH or CTTH induces significant changes in PPT, the characteristics of pain crisis, and its effect on activities of daily living as compared with the application of these techniques as isolated interventions.
...Afficher la suiteShort term effectiveness of neural sliders and neural tensioners as an adjunct to static stretching of hamstrings on knee extension angle in healthy individuals: A randomized controlled trial
26.02.17-16:15
Sixty healthy individuals (mean age = 22 ± 2.4 years) with reduced hamstring flexibility were randomized to three groups who received static stretching and neurodynamic sliders (NS-SS); static stretching with neurodynamic tensioner (NT-SS) and static stretching (SS) alone. Knee extension angle (KEA) in degrees. Baseline characteristics including demographic, anthropomorphic and KEA between groups were comparable. A significant interaction was observed between group (intervention) and time, [F (2,114) = 3.595; p = 0.031]. Post-hoc pairwise comparisons analyses revealed significant differences at post-intervention measurement time point between NS-SS and SS (mean difference: -6.8; 95%CI = -12, -1.5; p = 0.011) and NT-SS and SS (mean difference: -11.6; 95%CI = -16.7, -6.3; p < 0.001). However there was no significant difference between NS-SS and NT-SS groups (mean difference: 4.8; 95%CI = 0.4, 9.9; p = 0.074).
Neural sliders and tensioners are both effective in increasing hamstring flexibility as an adjunct to static hamstring stretching when compared to static stretching alone. No neural mobilization technique proved to be superior over another.
...Afficher la suiteChanges in Hamstring Range of Motion Following Neurodynamic Sciatic Sliders: A Critically Appraised Topic
26.02.17-16:07
Clinical Scenario: Hamstring tightness is a common condition leading to dysfunctional or restricted movement that is often treated with stretching. Neurodynamics has been proposed as an alternative to stretching by targeting the neural system rather than muscle tissue. Focused Clinical Question: In an active population, what is the effect of using neurodynamic sliders compared to stretching on traditional measures of range of motion? Summary of Key Findings: The authors of a well-designed study identified that neurodynamic sliders were more effective than static stretching, while the authors of two less well-designed studies reported no difference with static stretching or that proprioceptive neuromuscular facilitation stretching was more effective than neurodynamic sliders. Clinical Bottom Line: Evidence exists to support the use of neurodynamic sliders to increase measures of hamstring ROM in patients who present with limited hamstring flexibility; however, the effectiveness of neurodynamic sliders compared to traditional stretching is inconclusive. Strength of Recommendation: Grade B evidence exists that neurodynamic sliders perform as well as traditional stretching techniques at increasing measures of hamstring ROM on patients with limited hamstring flexibility.
...Afficher la suiteA Randomised, Placebo-Controlled Trial of Neurodynamic Sliders on Hamstring Responses in Footballers with Hamstring Tightness
26.02.17-16:01
Neurodynamics intervention is known to increase apparent muscle extensibility, but information regarding hamstring responses after a neurodynamic sliders (NS) technique is scarce. The aim of this study was to evaluate the effects of NS on apparent hamstring extensibility and activity in footballers with hamstring tightness.Forty eligible healthy male footballers with hamstring tightness were each randomly allocated to either a 4-week NS technique or a control group (CG) receiving placebo shortwave intervention. Knee extension angles were measured with the passive knee extension test, and maximal voluntary isometric contraction (MVIC) of hamstrings was measured by a surface electromyography at baseline and after intervention sessions. The results showed that NS produced a statistically and clinically significant increase in knee extension angle compared to CG (P < 0.001); however, there was no difference between the groups receiving MVIC of hamstrings. Within group comparison, NS also provided a significant increase in knee extension angle (P < 0.001), whereas the control group did not. There was no change in hamstring MVIC in either group after intervention.
The findings of this study reveal that four weeks of NS technique improved apparent hamstring extensibility but did not change the hamstring activity in footballers with hamstring tightness.
...Afficher la suiteEffects of lower body quadrant neural mobilization in healthy and low back pain populations: A systematic review and meta-analysis
03.02.17-05:59
Neural mobilization (NM) is widely used to assess and treat several neuromuscular disorders. However, information regarding the NM effects targeting the lower body quadrant is scarce. To determine the effects of NM techniques targeting the lower body quadrant in healthy andlow back pain (LBP) populations. Systematic review with meta-analysis. Randomized controlled trials were included if any form of NM was applied to the lower body quadrant. Pain, disability, and lower limb flexibility were the main outcomes. PEDro scale was used toassess methodological quality. Forty-five studies were selected for full-text analysis, and ten were included in the meta-analysis, involving 502 participants. Overall, studies presented fair to good quality, with a mean PEDro score of 6.3 (from 4 to 8). Five studies used healthy participants, and five targeted people with LBP. A moderate effect size (g . 0.73, 95% CI: 0.48e0.98) was determined, favoring the use of NM to increase flexibility in healthy adults. Larger effect sizes were found for the effect of NM in pain reduction (g . 0.82, 95% CI 0.56e1.08) and disability improvement (g . 1.59, 95% CI: 1.14e2.03), in people with LBP. Evidence suggests that there are positive effects from the application of NM to the lowerbody quadrant.
Specifically, NM shows moderate effects on flexibility in healthy participants, and large effects on pain and disability in people with LBP. Nevertheless, more studies with high methodological quality are necessary to support these conclusions.
...Afficher la suiteRelationship of the Lateral Rectus Muscle, the Supraorbital Nerve, and Binocular Coordination with Episodic Tension-Type Headaches Frequently Associated with Visual Effort.
02.02.17-05:52
