Comparative effects of tensioning and sliding neural mobilization on peripheral and autonomic nervous system function: A randomized controlled trial

Abstract

Background: Although different types of neural mobilization (NM) exercises induce different amounts of longitudinal nerve excursion and strain, the question whether the increased longitudinal stress and nerve excursion from sliding or tensioning intervention may subtly affect the neural functions has not been answered yet. Objective: To compare the effects of tensioning NM versus sliding NM of the median nerve on peripheral and autonomic nervous system function. Methods: In this randomized controlled trial, 90 participants were randomly assigned to tensioning NM, sliding NM, or sham NM. The neurophysiological outcome measures included peak-to-peak amplitude of the dermatomal somatosensory evoked potential (DSSEP) for dermatomes C6, C7, C8, and T1. Secondary outcome measures included amplitude and latency of skin sympathetic response. All outcome measures were assessed pretreatment, immediately after the two weeks of treatment and one week after the last session of the treatment. Results: A 2-way repeated measures ANOVA revealed significant differences between the three groups. The post hoc analysis indicated that tensioning NM significantly decreased the dermatomal amplitude for C6, C7, C8, and T1 ([Formula: see text]). Sympathetic skin responses in the gliding NM group showed lower amplitudes and prolonged latencies post-treatment when compared to tensioning NM group ([Formula: see text]). In contrast, no significant changes were observed in the DSSEPs and skin sympathetic responses for participants in the sham treatment group ([Formula: see text]). Conclusions: A tensioning NM on the median nerve had a possible adverse effect on the neurophysiology variables of the nerves involved in the neural mobilization. Thus, tensioning NM with the current parameters that place increased stress and strain on the peripheral nervous system should be avoided.

The effect of Neural Mobilization on sciatica pain: A systematic review

“…Morsi et al, (2021),Alshami et al, (2021) which was consistent with the literature as both slider and tensioner NM exercises are found to reduce sciatica pain and improve ROM(Alharmoodi et al, 2022;Papacharalambous et al, 2022). With the tensioner technique, NM is obtained by moving one or several joints to elongate the nerve bed, forcing the nerve to slide relative to its surrounding structures.Biomechanical studies have demonstrated that a joint movement that elongates the nerve bed can increase the strain (the ratio of elongation to the original length) in the nervous system, and this cumulative increase in strain occurs if several joint movements are combined.Alternatively, in the slider technique, at least two joints are moved simultaneously in such a manner that the movement in one joint counterbalances the increase in nerve strain caused by the other movement.…”

Effectiveness of Neural Mobilisation on Pain Intensity, Functional Status, and Physical Performance in Adults with Musculoskeletal Pain – A Systematic Review with Meta-Analysis

“…A significant effect favouring tensioning techniques but not sliding techniques conflicts with the findings of a recent study that compared the neurophysiological responses of sliding and tensioning and reported the tensioning technique to have adverse effects on the nerves, such as decreased amplitude of the dermatomal somatosensory evoked potential. 90 In addition, one of the studies included in this review, but not in the meta-analysis, compared the sliding against tensioning neural mobilisation and reported significant results favouring the sliding technique for both pain intensity and functional status. 69 Another trial, not included in this review because it included participants with neuropathic pain, found no differences between the two techniques for pain intensity.…”

Impact of the Order of Movement on the Median Nerve Root Function: A Neurophysiological Study with Implications for Neurodynamic Exercise Sequencing

“…The tensioning technique increase the potential for nerve adverse reactions [29]. Our decision was further supported by a desire to gather comprehensive data on the effects of neural mobilization on peripheral nervous system function while mitigating the potential for adverse events.…”

“…Dermatomal somatosensory evoked potentials (DSSEPs) were the primary outcome measure employed to assess the impact of the treatment. The higher the DSSEPs amplitude the better the implication it has for the neural effect [29].…”