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Context: A specific neurodynamic mobilization for the superficial fibular nerve (SFN) has been suggested in the reference literature for manual therapists to evaluate nerve mechanosensitivity in patients. However, no biomechanical studies examined the ability of this technique to produce nerve strain. Therefore, mechanical specificity of this technique is not yet established. Objective: The aim of our study was to test whether this examination and treatment technique was producing nerve strain in the fresh frozen cadaver and the contribution of each motion to total longitudinal strain. Design: Quantitative original research, controlled laboratory study Methods: A differential variable reluctance transducer was inserted in ten SFN from six fresh cadavers to measure strain during the mobilization. A specific sequence of plantar flexion (PF), ankle inversion (INV), straight leg raise (SLR) position and 30{degree sign} of hip adduction (ADD) was applied to the lower limb. The mobilization was repeated at 0°, 30°, 60° and 90° of Straight Leg Raise (SLR) position to measure the impact of hip flexion position. Findings: Compared to a resting position, this neurodynamic mobilization produced a significant amount of strain in the SFN (7.93% ± 0.51 P < 0.001). PF (59.34% ± 25.82) and INV (32.80% ± 21.41) accounted for the biggest proportion of total strain during the mobilization. No significant difference was reported between different hip flexion positions. Hip ADD did not significantly contribute to final strain (0.39% ± 10.42 P> 0,05) although high subject variability exists. Conclusion: Ankle motions should be considered the most important during neurodynamic assessment of the SFN for distal entrapment. These results suggest that this technique produces sufficient strain in the SFN and could therefore be evaluated In Vivo for correlation with mechanosensitivity

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Background The Cervical Flexion-Rotation Test (CFRT) is widely used in the assessment of upper cervical spine mobility impairments and in the diagnosis of cervicogenic headache (CGH) by physiotherapist. Many studies investigated its different properties, and the results show that the CFRT has good construct validity in the measurement of C1-C2 rotation as well as good to excellent reliability. Purpose In this theoretical paper, we explore the value and point out two methodological issues associated to the CFRT, one related to the procedures and another related to its diagnostic accuracy. Results Our analysis indicate that there are many confounding factors that could affect the CFRT cut-off’s accuracy, which are likely to overestimate the diagnosis properties of CFRT. Potential solutions are discussed. Moreover, the gold standard (manual examination) used to examine the validity of the CFRT for the diagnosis of CGH appears to be far from perfect - we could argue that the diagnostic properties of the CFRT for CGH might be biased and the likelihood ratios are likely to be overestimated. However, it could be relevant to explore if results of the CFRT could be considered as a treatment-effect modifier. Maybe the CFRT could be more valuable as a prognostic factor? Conclusion The quality of evidence supporting the validity of the CFRT is most likely biased. In the absence of a better gold standard, maybe the CFRT could be a more valuable test to establish the patient’s prognosis and help the clinician to choose the most appropriate treatment options.