Effects of neural mobilizations through movement representation techniques for the improvement of neural mechanosensitivity of the median nerve region: a randomized controlled trial

Matesanz-García, Luis; Cáceres-Pajuelo, Julio Eduardo; Cuenca‐Martínez, Ferrán; Goicoechea, Carlos; Fernández‐Carnero, Josué

doi:10.1080/08990220.2021.1964463

Cited by 4 publications

(5 citation statements)

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“…a form of manual therapy, improved CPM in a similar patient population [ 16 ]. Indeed, several studies have shown a general normalizing effect of treatment on the CPM response both in NSCNP [ 20 , 59 , 66 ] and other pain conditions [ 67 , 68 ] regardless of the therapeutic approach. It thus appears that restoration of the CPM response to normal levels is a frequent outcome of treatment, and little dependent on the type of treatment or target population.…”

Section: Discussionmentioning

confidence: 99%

Restoration of normal central pain processing following manual therapy in nonspecific chronic neck pain

Mata,

Azkue,

Bialosky

et al. 2024

PLoS ONE

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Objective To determine if a 4-week manual therapy treatment restores normal functioning of central pain processing mechanisms in non-specific chronic neck pain (NSCNP), as well as the existence of a possible relationship between changes in pain processing mechanisms and clinical outcome. Design Cohort study. Methods Sixty-three patients with NSCNP, comprising 79% female, with a mean age of 45.8 years (standard deviation: 14.3), received four treatment sessions (once a week) of manual therapy including articular passive mobilizations, soft tissue mobilization and trigger point treatment. Pressure pain thresholds (PPTs), conditioned pain modulation (CPM) and temporal summation of pain (TSP) were evaluated at baseline and after treatment completion. Therapy outcome was measured using the Global Rating of Change Scale (GROC), the Neck disability Index (NDI), intensity of pain during the last 24 hours, Tampa Scale of Kinesiophobia (TSK) and Pain Catastrophizing Scale (PCS). Two sets of generalized linear mixed models with Gaussian response and the identity link were employed to evaluate the effect of the intervention on clinical, psychological and psychophysical measures and the association between psychophysical and clinical outcomes. Results Following treatment, an increased CPM response (Coefficient: 0.89; 95% credibility interval = 0.14 to 1.65; P = .99) and attenuated TSP (Coefficient: -0.63; 95% credibility interval = -0.82 to -0.43; P = 1.00) were found, along with amelioration of pain and improved clinical status. PPTs at trapezius muscle on the side of neck pain were increased after therapy (Coefficient: 0.22; 95% credibility interval = 0.03 to 0.42; P = .98), but not those on the contralateral trapezius and tibialis anterior muscles. Only minor associations were found between normalization of TSP/CPM and measures of clinical outcome. Conclusion Clinical improvement after manual therapy is accompanied by restoration of CPM and TSP responses to normal levels in NSCNP patients. The existence of only minor associations between changes in central pain processing and clinical outcome suggests multiple mechanisms of action of manual therapy in NSCNP.

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Section: Discussionmentioning

confidence: 99%

Restoration of normal central pain processing following manual therapy in nonspecific chronic neck pain

Mata,

Azkue,

Bialosky

et al. 2024

PLoS ONE

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show abstract

“…a form of manual therapy, improved CPM in a similar patient population 27 . Indeed, several studies have shown a general normalizing effect of treatment on CPM response in NSCNP (26,54,57) and in other pain conditions (58,59) regardless of the therapeutic intervention. It thus appears that the normalizing effects of interventions on CPM are frequent, and less dependent on the type of treatment or target population.…”

Section: Discussionmentioning

confidence: 99%

Restoration of normal central pain processing following manual therapy in nonspecific chronic neck pain

Mata,

Azkue,

Bialosky

et al. 2023

Preprint

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Objective: to determine if a 4-week manual therapy treatment restores normal functioning of central pain processing mechanisms in non-specific chronic neck pain (NSCNP), as well as the existence of a possible relationship between changes in pain processing mechanisms and clinical outcome. Design: cohort study. Methods: sixty-three patients with NSCNP received four treatment sessions (once a week) of manual therapy. Pressure pain thresholds (PPTs), conditioned pain modulation (CPM) and temporal summation of pain (TSP) were evaluated at baseline and after treatment completion. Therapy outcome was measured using the Global Rating of Change Scale, the Neck disability Index, intensity of pain during the last 24 hours, Tampa Scale of Kinesiophobia and Pain Catastrophizing Scale. Results: Following treatment, an increased CPM response and attenuated TSP were found, along with amelioration of pain and improved clinical status. PPTs at trapezius muscle on the side of neck pain were increased after therapy, but not those on the contralateral trapezius and tibialis anterior muscles. Only minor associations were found between normalization of TSP/CPM and measures of clinical outcome. Conclusion: Clinical improvement after manual therapy is accompanied by restoration of CPM and TSP responses to normal levels in NSCNP patients. The existence of only minor associations between changes in central pain processing and clinical outcome suggests multiple mechanisms of action of manual therapy in NSCNP.

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“…Moreover, NM apparently generated biomechanical, physiological, and neuroimmune responses, but the exact mechanism differed greatly in human and animal studies. For example, NM decreased intra-neural oedema, activated analgesic neuronal pathways, induced anti-inflammatory changes, and desensitized mechanical compression by enhancing the median nerve excursion and nerve diameter [40]. Additionally, a recent systematic review of animal studies reported that NM predisposes a beneficial impact through modulating neurotrophins, neuroinflammation, and opioid systems, leading to decreased mechanical hyperalgesia [40].…”

Section: Discussionmentioning

confidence: 99%

“…For example, NM decreased intra-neural oedema, activated analgesic neuronal pathways, induced anti-inflammatory changes, and desensitized mechanical compression by enhancing the median nerve excursion and nerve diameter [40]. Additionally, a recent systematic review of animal studies reported that NM predisposes a beneficial impact through modulating neurotrophins, neuroinflammation, and opioid systems, leading to decreased mechanical hyperalgesia [40]. In addition, the application of NM on cadavers revealed physiological mechanisms of pain relief, concluding that it enhanced the intraneural dispersion as well as decreasing intra-neural oedema surrounding the tissues [41].…”

Section: Discussionmentioning

confidence: 99%

Neurodynamic Techniques in the Treatment of Mild-to-Moderate Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis

Zaheer

Ahmed

2023

JCM

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Carpal tunnel syndrome (CTS) is a condition that affects the main nerves in the wrist area that causes numbness, tingling, and weakness in the hand and arm. CTS affects 5% of the general population and results in pain in the wrist due to repetitive use, most commonly affecting women and office workers. Conservative management of CTS includes neurodynamic modulation to promote median nerve gliding during upper limb movements to maintain normal function. However, evidence for the benefits of neurodynamic modulation found disparities, and hence, the effectiveness of neurodynamic modulation remains unclear. This study aimed to systematically review the current evidence from randomized controlled trials (RCTs) to establish the effectiveness of neurodynamic techniques as a non-surgical treatment option for CTS. Using the PRISMA guidelines, two authors searched four electronic databases, and studies were included if they conformed to pre-established eligibility criteria. Primary outcome measures included outcomes from the Boston carpal tunnel syndrome questionnaire, while secondary outcomes included nerve conduction velocity, pain, and grip strength. Quality assessment was completed using the Cochrane RoB2 form, and a meta-analysis was performed to assess heterogeneity. Twelve RCTs met our inclusion/exclusion criteria with assessments on 1003 participants in the treatment and control arms. High heterogeneity and some risks of bias were observed between studies, but the results of the meta-analysis showed a significant reduction in our primary outcome, the Boston carpal tunnel syndrome questionnaire-symptom severity scale (mean difference = −1.20, 95% CI [−1.72, −0.67], p < 0.00001) and the Boston carpal tunnel syndrome questionnaire-functional severity scale (mean difference = −1.06, 95% CI [−1.53, −0.60], p < 0.00001). Secondary outcomes such as sensory and motor conduction velocity increased significantly, while motor latency was significantly reduced, all positively favoring neurodynamic techniques. Pain was also significantly reduced, but grip strength was not significantly different. Our systematic review demonstrates significant benefits of neurodynamic modulation techniques to treat CTS and specifically that it reduces symptom severity, pain, and motor latency, while at the same time improving nerve conduction velocities. Hence, our study demonstrates a clear benefit of neurodynamic techniques to improve recovery CTS.

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Effects of neural mobilizations through movement representation techniques for the improvement of neural mechanosensitivity of the median nerve region: a randomized controlled trial

Cited by 4 publications

References 50 publications

Restoration of normal central pain processing following manual therapy in nonspecific chronic neck pain

Restoration of normal central pain processing following manual therapy in nonspecific chronic neck pain

Restoration of normal central pain processing following manual therapy in nonspecific chronic neck pain

Neurodynamic Techniques in the Treatment of Mild-to-Moderate Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis

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