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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 following neurodynamic stretching highlighted the current lack of consensus regarding the position that should be used. 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 hip positions (adduction vs. abduction) during neurodynamic flossing techniques 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. Both techniques appear efficient. However, contradictory findings following neurodynamic stretching highlighted the current lack of consensus regarding the angular position that could be used. For instance, hip rotations or hip adduction could impact muscle or nerve tissue changes, 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 different hip positions. Accordingly, the primary objective of the present study was to determine the immediate effect of two hip positions (adduction vs. abduction) during neurodynamic flossing techniques on the sciatic nerve and hamstring tissues using the shear wave elastography (SWE, a form of ultrasonography). This method has been shown reliable to provide non-invasive real-time assessments of soft tissues elastic properties.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| No intervention (neutral) | No Intervention | No intervention with measurements in neutral position | |
| No intervention (adduction) | No Intervention | No intervention with measurements in adduction position | |
| No intervention (abduction) | No Intervention | No intervention with measurements in abduction position | |
| Neurodynamic (neutral) | Active Comparator | The hip was positioned neutral (alignment between the lower limb and the trunk). |
|
| Neurodynamic (adduction) | Experimental | The hip was positioned in adduction and the neurodynamic stretch was applied. |
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| Neurodynamic (abduction) | Experimental | The hip was positioned in abduction and the neurodynamic stretch was applied. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| 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. |
| Measure | Description | Time Frame |
|---|---|---|
| Nerve shear wave velocity using elastography in neutral position | 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. The hip position was neutral (alignment between the lower limb and the trunk). | Before the intervention and at the end (immediately after) the intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Nerve shear wave velocity using elastography in experimental position | 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. The hip position was the experimental position (i.e., adduction or abduction depending on the randomisation). |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Nicolas Babault | Contact | +33380396743 | nicolas.babault@ube.fr | |
| Carole Cometti | Contact | +33389396789 | carole.cometti@ube.fr |
| Name | Affiliation | Role |
|---|---|---|
| Nicolas Babault | universite bourgogne europe | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Universite Bourgogne Europe - faculty of sports sciences | Recruiting | Dijon | France |
data freely available in online websites
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| Before the intervention and at the end (immediately after) the intervention |
| Muscle shear wave velocity using elastography in neutral position | 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. The hip position was neutral (alignment between the lower limb and the trunk). | Before the intervention and at the end (immediately after) the intervention |
| Muscle shear wave velocity using elastography in the experimental position | 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. The hip position was the experimental position (i.e., adduction or abduction depending on the randomisation). | 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 electromyographic activity | Electromyographic activity of biceps femoris muscle | Before the intervention and at the end (immediately after) the intervention |
| Semitendinosus electromyographic 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 |