Crossover effects of ultrasound-guided percutaneous neuromodulation on contralateral hamstring flexibility

Abstract

Background Crossover effects refer to the responses of a non-exercised contralateral limb. There is evidence of this effect, as it relates to muscle fatigue, strength, and stretch, but not as it relates to neuromodulation. Objectives To compare the crossover effects of percutaneous neuromodulation (PNM) on hip range of motion (ROM), observed in a straight leg raise (SLR) test, in asymptomatic participants with bilateral reduced hamstring flexibility, versus the neurodynamic sciatic sliding technique, hamstring stretching and mechanical stimulation of the sciatic nerve using a needle (without electrical stimulation). To evaluate the tensiomyographic changes between the two lower limbs after these interventions. Methods 80 participants with bilateral reduced hamstring flexibility were randomized into four groups: Stretching, Neurodynamic, PNM, and Needle groups. All interventions were performed on the right limb. Each participant’s leg was subjected to SLR testing and tensiomyography before and after the interventions. Results Each group improved their SLR values in the non-intervention limb compared to baseline values, but the PNM and Needle groups obtained higher values for the SLR test in the non-intervention limb compared with the Neurodynamic and Stretching groups. There were statistically significant differences for mean SLR measures between limbs pre- and post-intervention for all groups except the PNM group, suggesting crossover effects for PNM but not the other techniques studied. There were no differences in tensiomyographic assessments between groups or between sides, at baseline or upon completion of the study. Conclusion PNM produced benefits in the SLR test in the non-intervention limb and only 1.5 min was enough to obtain this effect. In addition, no technique interfered with muscle activation.

Ultrasound-Guided Percutaneous Neuromodulation in Patients with Unilateral Anterior Knee Pain: A Randomized Clinical Trial

“…However, the therapeutic benefits were produced independently of the stimulated femoral nerve. In line with this [21], these results confirmed the crossover effect of this technique because the US-guided PNM had a great effect on the painful knee when delivered to the contralateral limb. The data of this study showed the crossover effect of the PNM intervention regarding knee flexion ROM, but also pain and functionality.…”

“…Several authors have showed that unilateral stretching [16,17] and foam rolling [17] may have a crossover effect on the contralateral limb ROM; others [18,19] suggested that there were crossover fatigue effects in the contralateral knee extensors; and Regueme et al [20] did not support the existence of crossover effects after exhaustive stretch-shortening cycle exercise. Regarding the crossover effect after neural intervention, De-la-Cruz-Torres et al [21] showed that PNM in the sciatic nerve produced benefits in the hip flexion ROM, measured by a straight leg raise test, in the nonintervention limb.…”

Ultrasound-Guided Percutaneous Neuromodulation in Patients with Chronic Lateral Epicondylalgia: A Pilot Randomized Clinical Trial

“…As described earlier, subjects randomised to the control group were placed on a waiting list for treatment, therefore at the time of the study, these subjects did not receive any interventions. PNM protocol in the different studies is varied [ 13 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Most studies analyzed the effect of one single intervention on pain, range of motion or muscle strength and used low frequency (2–10 Hz) and high pulse width (240–250 µs).…”

“…To date, there is limited literature on US-guided PNM. It has been applied to treat lateral elbow pain [ 14 ], short hamstring syndrome [ 23 ], anterior knee pain [ 24 , 25 ], or lower back pain [ 26 ]; to improve the activity of the hallucis flexor longus [ 27 , 28 ] or quadriceps strength [ 29 ]; and to improve sport performance [ 30 ]. Regarding LE, Arias-Buría et al [ 14 ] described a case-report and they only treated a patient with LE by applying PNM to analyze its effect on pain.…”

Effects of Percutaneous Electrical Nerve Stimulation on Countermovement Jump and Squat Performance Speed in Male Soccer Players: A Pilot Randomized Clinical Trial

“…For instance, Álvarez-Prats et al have recently reported an increase in maximal quadriceps muscle strength after applying low-frequency PENS in the femoral nerve [16]. Similarly, de-la-Cruz-Torres et al have also shown that applying PENS is able to increase hamstring flexibility in healthy people [17]. To the best of the authors' knowledge, no study has investigated the effects of PENS targeting the femoral nerve to improve jump height or squat speed in soccer players.…”