Control Condition, Stretching
Conditions
Keywords
stretching, stiffness, nerve, muscle, flexibility
Brief summary
Neurodynamic mobilization techniques are widely applied in rehabilitation and physiotherapy to enhance the mobility and function of peripheral nerves. Two main approaches are distinguished. Nerve tensioning and nerve flossing. They both involve proximal and distal joint movements to induce greater neural sliding while avoiding excessive tensile stress. However, contradictory findings on neurodynamic techniques highlighted the current lack of consensus regarding these techniques. Moreover, neurodynamic techniques are of interest for patients, it appeared it could also be applied in healthy individuals and more particularly in athletes. Accordingly, the primary objective of the present study was to determine the immediate effect of two neurodynamic mobilization techniques (flossing vs. tensioning) on the sciatic nerve and hamstring tissues using the shear wave elastography (SWE, a form of ultrasonography).
Detailed description
Neurodynamic mobilization techniques are frequently applied in rehabilitation settings to enhance the mobility and function of peripheral nerves, particularly in the management of neuropathic pain such as carpal tunnel syndrome, radiculopathies, or sciatica. Two main approaches are distinguished. Nerve tensioning involves maintaining the nerve stretched at the end of the joint range of motion with relatively limited excursion. It is similar to a static stretching intervention but with distal (ankle) and proximal (cervical) tensions. Nerve flossing (also termed gliding or sliders), consists of alternating proximal and distal joint movements to induce greater neural sliding while avoiding excessive tensile stress. However, contradictory findings on neurodynamic techniques highlighted the current lack of consensus regarding the acute effects of the different possible neurodynamic techniques on sciatic nerves, particularly in healthy tissues. Moreover, neurodynamic techniques are of interest for patients, it appeared it could also be applied in healthy individuals and more particularly in athletes. Performed in patients, healthy or athletes, no study has compared both tensioning or flossing techniques. Moreover, because these techniques involved nerve mobilisation, the intensity should have a main effect of its efficiency. Accordingly, the primary objective of the present study was to determine the immediate effect of two neurodynamic mobilization techniques (flossing vs. tensioning) on the sciatic nerve and hamstring tissues using the shear wave elastography (SWE). This method has been shown reliable to provide non-invasive real-time assessments of soft tissues elastic properties. The secondary aim was to determine the effects of stretching intensity (at the point of pain threshold or below).
Interventions
OTHERMaximal static stretching
Static stretching was applied at pain threshold on hamstring muscles and repeated 5 times during 60s at the point of pain. Static stretching mainly focused muscle-tendon tissues.
OTHERSubmaximal static stretching
Static stretching was applied 10% below pain threshold on hamstring muscles and repeated 5 times during 60s at the point of pain. Static stretching mainly focused muscle-tendon tissues.
OTHERMaximal neurodynamic tensioning
Neurodynamic tensioning was applied at pain threshold on hamstring muscles and repeated 5 times during 60s at the point of pain. During the neurodynamic conditions, head and ankle movement permitted to mobilize nerve tissues. Tensioning is maintaining the position.
OTHERSubmaximal neurodynamic tensioning
Neurodynamic tensioning was applied 10% below pain threshold on hamstring muscles and repeated 5 times during 60s at the point of pain. During the neurodynamic conditions, head and ankle movement permitted to mobilize nerve tissues. Tensioning is maintaining the position.
Neurodynamic flossing was applied at pain threshold on hamstring muscles and repeated 5 times during 60s at the point of pain. During the neurodynamic conditions, head and ankle movement permitted to mobilize nerve tissues. Flossing is the alternation of these movements every 2 seconds.
OTHERSubmaximal neurodynamic flossing
Neurodynamic flossing was applied 10% below pain threshold on hamstring muscles and repeated 5 times during 60s at the point of pain. During the neurodynamic conditions, head and ankle movement permitted to mobilize nerve tissues. Flossing is the alternation of these movements every 2 seconds.
Sponsors
University of Burgundy
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
OTHER
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* healthy * physical active * no injuries (lower limb or back pain) in the past 3 months
Exclusion criteria
* Specific lower limb (hamstring) injuries in the past 2 years * Not restraining activity 24h before participation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Nerve shear wave velocity using elastography | Before the intervention and at the end (immediately after) the intervention | Shear wave velocity of the sciatic nerve will be evaluated by using an ultrasound (echography) device with a specific mode called shear wave elastography. Briefly, the ultrasound probe will deliver an ultrasound wave. The propagation speed (called 'shear wave velocity) will be measured by the same probe. The greater the velocity is, the harder the tissue is. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hamstring force | Before the intervention and at the end (immediately after) the intervention | Maximal torque during a maximal voluntary hamstring contraction |
| Biceps femoris activity | Before the intervention and at the end (immediately after) the intervention | Electromyographic activity of biceps femoris muscle |
| Semitendinosus activity | Before the intervention and at the end (immediately after) the intervention | Electromyographic activity of semitendinosus |
| Muscle shear wave velocity using elastography | Before the intervention and at the end (immediately after) the intervention | Shear wave velocity of the biceps femoris muscle will be evaluated by using an ultrasound (echography) device with a specific mode called shear wave elastography. Briefly, the ultrasound probe will deliver an ultrasound wave. The propagation speed (called 'shear wave velocity) will be measured by the same probe. The greater the velocity is, the harder the tissue is. |
| Global flexibility | Before the intervention and at the end (immediately after) the intervention | the stand and reach test to evaluate flexibility (in centimeters) |
| Slump test | Before the intervention and at the end (immediately after) the intervention | Seated flexibility using the slump test (in degrees) |
| discomfort | At the end (immediately after) the intervention | rating of perceived discomfort during the intervention (from 1 to 10, no discomfort to maximal discomfort, respectively) |
| passive knee extension | Before the intervention and at the end (immediately after) the intervention | The final passive range of motion of the hamstring muscles |
Countries
France
Outcome results
None listed