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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).
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).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control | No Intervention | Seated at rest during the same duration than the interventions | |
| Static stretching at pain threshold | Active Comparator | Static stretching at pain threshold of the right hamstring muscles 5x60s with 20s rest |
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| Neurodynamic tensioning at pain threshold | Experimental | Neurodynamic tensioning of the right hamstring muscles 5x60s with 20s rest at pain threshold |
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| Neurodynamic flossing at pain threshold | Experimental | Neurodynamic flossing of the right hamstring muscles 5x60s with 20s rest at pain threshold |
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| Static stretching at submaximal intensity | Active Comparator | Static stretching of the right hamstring muscles 5x60s with 20s rest at 10% below pain threshold |
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| Neurodynamic tensioning at submaximal intensity |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Maximal static stretching | Other | 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. |
| Measure | Description | Time Frame |
|---|---|---|
| Nerve shear wave velocity using elastography | 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. | Before the intervention and at the end (immediately after) the intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Muscle shear wave velocity using elastography | 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. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Nicolas Babault, PhD | Universite Bourgogne Europe - Sport Science Faculty | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Universite Bourgogne Europe - faculty of sports sciences | Dijon | France |
data freely available in online websites
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Neurodynamic tensioning stretching of the right hamstring muscles 5x60s with 20s rest at 10% below pain threshold |
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| Neurodynamic flossing at submaximal intensity | Active Comparator | Neurodynamic flossing stretching of the right hamstring muscles 5x60s with 20s rest at 10% below pain threshold |
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| Submaximal static stretching | Other | 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. |
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| Maximal neurodynamic tensioning | Other | 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. |
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| Submaximal neurodynamic tensioning | Other | 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. |
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| Maximal neurodynamic flossing | Other | 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. |
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| Submaximal neurodynamic flossing | Other | 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. |
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| Before the intervention and at the end (immediately after) the intervention |
| Hamstring force | Maximal torque during a maximal voluntary hamstring contraction | Before the intervention and at the end (immediately after) the intervention |
| Biceps femoris activity | Electromyographic activity of biceps femoris muscle | Before the intervention and at the end (immediately after) the intervention |
| Semitendinosus activity | Electromyographic activity of semitendinosus | Before the intervention and at the end (immediately after) the intervention |
| passive knee extension | The final passive range of motion of the hamstring muscles | Before the intervention and at the end (immediately after) the intervention |
| Global flexibility | the stand and reach test to evaluate flexibility (in centimeters) | Before the intervention and at the end (immediately after) the intervention |
| Slump test | Seated flexibility using the slump test (in degrees) | Before the intervention and at the end (immediately after) the intervention |
| discomfort | rating of perceived discomfort during the intervention (from 1 to 10, no discomfort to maximal discomfort, respectively) | At the end (immediately after) the intervention |