The Effect of Neural Mobilization on Muscle Strength, Reaction Time And Pain Threshold

Öz

ABSTRACT (ENGLISH): Purpose: This study's objective was to assess the effectiveness of neural mobilization on asymptomatic, healthy volunteers' pain, muscle strength, and reaction time. Material and Methods: Hand grip strength, reaction time, and pain thresholds of 50 participiants’ were evaluated using a dynamometer, the Nelson Hand Reaction Test, and a digital algometer, respectively. While the dominant extremities of the participants constituted the neural mobilization group, the non-dominant extremities constituted the control group. The same measurements were repeated in both extremities by the blinded assessor after median nerve mobilization was applied to the dominant upper extremities of participants. Results: When the measurements before and after mobilization were compared in the neural mobilization group, it was seen that the hand grip strength increased (p<0.01) and the reaction time decreased (p<0.001) after mobilization; The differences in pain threshold score were not statistically significant (p> 0.05). There was no statistically significant difference in hand grip strength between the control group before and after neural mobilization (p> 0.05); however, a statistically significant decrease was found in reaction time and pain threshold score (p <0.05). There was no statistically significant difference between the groups in parameters before and after mobilization (p> 0.05). Conclusion: Neural mobilization may increase grip strength in healthy individuals but has no effect on pain threshold. Its effect on reaction time can be explained by motor learning. New studies are needed in different disease groups.

Anahtar Kelimeler

• neural mobilisation
• muscle strength
• reaction time
• pain threshold

Kaynakça

1. Alam, M., Khan, M., Ahmed, S., & Ali, S. S. (2018). Effectiveness of neural mobilization and ultrasound therapy on pain severity in carpal tunnel syndrome. Biomedical Research and Therapy, 5(4), 2187-2193. https://doi.org/10.15419/bmrat.v5i4.432
2. Aranha, V. P., Moitra, M., Saxena, S., Narkeesh, K.,Arumugam, N., & Samuel, A. J. (2017). Motor cognitive processing speed estimation among the primary schoolchildren by deriving prediction formula: A crosssectional study. Journal of neurosciences in rural practice, 8(1), 79–83. https://doi.org/10.4103/0976- 3147.193544
3. Ballestero-Pérez, R., Plaza-Manzano, G., Urraca-Gesto, A., Romo-Romo, F., Atín-Arratibel, M. L. Á., Pecos-Martín, D., Gallego-Izquierdo, T., & Romero-Franco, N. (2017).Effectiveness of Nerve Gliding Exercises on Carpal Tunnel Syndrome: A Systematic Review. Journal of manipulative and physiological therapeutics, 40(1), 50–59. https://doi.org/10.1016/j.jmpt.2016.10.004
4. Basson, C. A., Olivier, B., & Rushton, A. (2019). Neck pain in South Africa: An overview of the prevalence, assessment and management for the contemporary clinician. The South African journal of physiotherapy, 75(1), 1332. https://doi.org/10.4102/sajp.v75i1.1332
5. Beneciuk, J. M., Bishop, M. D., & George, S. Z. (2009). Effects of upper extremity neural mobilization on thermal pain sensitivity: a sham-controlled study in asymptomatic participants. The Journal of orthopaedic and sports physical therapy, 39(6), 428–438. https://doi.org/10.2519/jospt.2009.2954
6. Beddaa, H., Kably, B., Marzouk, B., Mouhi, I., Marfak, A., Azemmour, Y., Bouzekraoui Alaoui, I., & Birouk, N. (2022). The effectiveness of the median nerve neurodynamic mobilisation techniques in women with mild or moderate bilateral carpal tunnel syndrome: A single-blind clinical randomised trial. The South Africanjournal of physiotherapy, 78(1), 1823. https://doi.org/10.4102/sajp.v78i1.1823
7. Cuenca-Martínez F., La Touche R., Varangot-Reille C., Sardinoux M., Bahier J., Suso-Martí L., FernándezCarnero J. (2022) Effects of Neural Mobilization on Pain Intensity, Disability, and Mechanosensitivity: An Umbrella Review With Meta-Meta-Analysis. Phys Ther. 3;102(6):pzac040. https://doi.org/10.1093/ptj/pzac040
8. De Dios Pérez-Bruzón, J., Fernández-de-Las-Peñas, C.,Cleland, J. A., Plaza-Manzano, G., & Ortega-Santiago, R. (2022). Effects of neurodynamic interventions onpain sensitivity and function in patients with multiple sclerosis: a randomized clinical trial. Physiotherapy,115, 36–45. https://doi.org/10.1016/j.physio.2021.04.004

9. Eckner, J. T., Whitacre, R. D., Kirsch, N. L., & Richardson, J. K. (2009). Evaluating a clinical measure of reaction time: an observational study. Perceptual and motor skills, 108(3), 717–720. https://doi.org/10.2466/PMS.108.3.717-720
10. González-Matilla, R., Abuín-Porras, V., Casuso-Holgado, M. J., Riquelme, I., & Heredia-Rizo, A. M. (2022). Effects of neural mobilization in disorders associated with chronic secondary musculoskeletal pain: A systematic review and meta-analysis. Complementary therapies in clinical practice, 49, 101618. https://doi.org/10.1016/j.ctcp.2022.101618
11. Gupta, R., & Chahal, A. (2021). Comparative Effect of Dry Needling and Neural Mobilization on Pain, Strength, Range of Motion, and Quality of Life in Patients with Lateral Epicondylitis: Protocol for Randomized Clinical Trial. Journal of chiropractic medicine, 20(2), 77–84. https://doi.org/10.1016/j.jcm.2021.09.001
12. Hartley, C., Goksan, S., Poorun, R., Brotherhood, K., Mellado, G. S., Moultrie, F., Rogers, R., Adams, E., & Slater, R. (2015). The relationship between nociceptive brain activity, spinal reflex withdrawal and behaviour in newborn infants. Scientific reports, 5, 12519. https://doi.org/10.1038/srep12519
13. Huang, B. Y., Shih, Y. F., Chen, W. Y., & Ma, H. L. (2015). Predictors for identifying patients with patellofemoral pain syndrome responding to femoral nerve mobilization. Archives of physical medicine and rehabilitation, 96(5), 920–927. https://doi.org/10.1016/j.apmr.2015.01.001
14. Jeong, U. C., Kim, C. Y., Park, Y. H., Hwang-Bo, G., & Nam, C. W. (2016). The effects of self-mobilization techniques for the sciatic nerves on physical functions and health of low back pain patients with lower limb radiating pain. Journal of physical therapy science, 28(1), 46–50. https://doi.org/10.1589/jpts.28.46
15. Kim, M. K., Cha, H. G., & Ji, S. G. (2016). The initial effects of an upper extremity neural mobilization technique on muscle fatigue and pressure pain threshold of healthy adults: a randomized control trial. Journal of physical therapy science, 28(3), 743–746. https://doi.org/10.1589/jpts.28.743
16. Kostopoulos D. (2004). Treatment of carpal tunnelsyndrome: a review of the non-surgical approaches with emphasis in neural mobilization. J Bodyw MovTher. ;8:2-8. https://doi.org/10.1016/S1360- 8592%2803%2900068-8
17. Kumar, P. S., Adhikari P, Jeganathan PS, D’Souza SC. (2010) Immediate effects of nerve sliders and nerve massage on vibration and thermal perception thresholds in patients with painful diabetic peripheral neuropathy-a pilot randomized clinical trial. Physiotherapy and Occupational Therapy Journal, 2010;3:5-19
18. Lalouni, M., Fust, J., Vadenmark-Lundqvist, V., Ehrsson, H. H., Kilteni, K., & Birgitta Jensen, K. (2021). Predicting pain: differential pain thresholds during self-induced, externally induced, and imagined self-induced pressure pain. Pain, 162(5), 1539–1544. https://doi.org/10.1097/j.pain.0000000000002151
19. Leblebicier, M. A., Yaman, F., ISaracoglu, I., Ozkaya D. B. (2022)The effects of tibial nerve mobilization in patients with tarsal tunnel syndrome: A randomized controlled trial,European Journal of Integrative Medicine, Volume (56). https://doi.org/10.1016/j.eujim.2022.102201
20. Meyer, P., Lintingre, P. F., Pesquer, L., Poussange, N., Silvestre, A., & Dallaudière, B. (2018). The Median Nerve at the Carpal Tunnel … and Elsewhere. Journal of the Belgian Society of Radiology, 102(1), 17. https://doi.org/10.5334/jbsr.1354
21. Nunes, M. K., Fontenele Dos Santos, G., Martins E Silva, D. C., Mota de Freitas, A. C., Henriques, I. F., Andrade, P. M., Machado, D.deC., Teixeira, S., Neves, M. O., Dias, G., Silva-Júnior, F., & Bastos, V. H. (2016). Acute effects of neural mobilization and infrared on the mechanics of the median nerve. Journal of physical therapy science, 28(6), 1720–1723. https://doi.org/10.1589/jpts.28.1720
22. Nunes, G.S., Uhlig S., Ribas L.M., Gonçalves F. B., Wageck B., De Noronha, M. (2017) Inguence of neural mobilization of lower limbs on the functional performanceand dynamic balance in asymptomatic individuals: a cross-over randomizedcontrolled trial.
23. Human Movement. 20;18(4):10-6. Nussbaum, E. L., & Downes, L. (1998). Reliability of clinical pressure-pain algometric measurements obtained on consecutive days. Physical therapy, 78(2), 160–169. https://doi.org/10.1093/ptj/78.2.160
24. Oskay, D., Meriç, A., Kirdi, N., Firat, T., Ayhan, C., & Leblebicioğlu, G. (2010). Neurodynamic mobilization in the conservative treatment of cubital tunnel syndrome: long-term follow-up of 7 cases. Journal of manipulative and physiological therapeutics, 33(2),156–163. https://doi.org/10.1016/j.jmpt.2009.12.001
25. Peacock, M., Douglas S., Nair P. (2022). Neural mobilization in low back and radicular pain: a systematic review. J Man Manip Ther. 2023 Feb;31(1):4-12. https://doi.org/10.1080/10669817.2022.2065599
26. Pedersini, P., Valdes, K., Cantero-Tellez, R., Cleland, J. A., Bishop, M. D., & Villafañe, J. H. (2021). Effects of Neurodynamic Mobilizations on Pain Hypersensitivity in Patients With Hand Osteoarthritis Compared to Robotic Assisted Mobilization: A RandomizedControlled Trial. Arthritis care & research, 73(2), 232– 239. https://doi.org/10.1002/acr.24103
27. Pereira, A., Teixeira, C., Pereira, K., Ferreira, L., Marques, M., & Silva, A. G. (2021). Neural Mobilization ShortTerm Dose Effect on the Lower-Limb Flexibility and Performance in Basketball Athletes: A Randomized, Parallel, and Single-Blinded Study. Journal of sport rehabilitation, 30(7), 1060–1066. https://doi.org/10.1123/jsr.2020-0389
28. Plaza-Manzano, G., Cancela-Cilleruelo, I., Fernández-deLas-Peñas, C., Cleland, J. A., Arias-Buría, J. L., Thoomesde-Graaf, M., & Ortega-Santiago, R. (2020). Effects of Adding a Neurodynamic Mobilization to Motor Control Training in Patients With Lumbar Radiculopathy Due to Disc Herniation: A Randomized Clinical Trial. American journal of physical medicine & rehabilitation, 99(2), 124–132. https://doi.org/10.1097/PHM.0000000000001295
29. Sharma, S., Balthillaya, G., Rao, R., & Mâni, R. (2016). Short term effectiveness of neural sliders and neural tensioners as an adjunct to static stretching of hamstrings on knee extension angle in healthy individuals: A randomized controlled trial. Physical therapy in sport: official journal of the Association of Chartered Physiotherapists in Sports Medicine, 17, 30– 37. https://doi.org/10.1016/j.ptsp.2015.03.003
30. Souza R. L, Moriz K. R., Teixiera F. D. R., Fernandes A. A., da Costa Neto S. S., Oliveira M. D. D., Maciel T. D. S., Areas F. Z. D. S. (2020). Effect of neural mobilization on balance, flexibility, strength and gait in stroke patients. MTP Rehab J. 06;16:1–5.https://doi.org/10.17784/mtprehabjournal.2018.16.595
31. Sousa Filho, L. F., Barbosa Santos, M. M., Matos Vasconcelos, D. B., Soares, E. A., Dos Santos, G. H. F., & da Silva Júnior, W. M. (2022). Neurodynamic exercises provide no additional benefit to extension -oriented exercises in people with chronic low back-related leg pain and a directional preference: A randomized clinical trial. Journal of bodywork and movement therapies, 30, 140–147. https://doi.org/10.1016/j.jbmt.2022.01.007
32. Valente, P. de S., Valente, P. de S., Silva, A. da Arêas, G. P.T., Júnior, R. C. F., Maciel, T. dos S., & Arêas, F. Z. da S. (2014). The effect of neural mobilization of the brachial plexus on the flexibility of the lower limb: a double -blind trial. Manual Therapy, Posturology & Rehabilitation Journal, 1–5.
33. Villafañe, J. H., Valdes, K., Imperio, G., Borboni, A.,Cantero-Téllez, R., Galeri, S., & Negrini, S. (2017). Neural manual vs. robotic assisted mobilization to improve motion and reduce pain hypersensitivity in hand osteoarthritis: study protocol for a randomized controlled trial. Journal of physical therapy science, 29(5), 801–806. https://doi.org/10.1589/jpts.29.801
34. Villafañe, J. H., Silva, G. B., Bishop, M. D., & Fernandez-Carnero, J. (2012). Radial nerve mobilization decreases pain sensitivity and improves motor performance in patients with thumb carpometacarpal osteoarthritis: a randomized controlled trial. Archives of physical medicine and rehabilitation, 93(3), 396 –403. https://doi.org/10.1016/j.apmr.2011.08.045
35. Wang, Y., Ma, M., Tang, Q., Zhu, L., Koleini, M., & Zou, D. (2015). The effects of different tensile parameters for the neurodynamic mobilization technique on tricipital muscle wet weight and MuRf -1 expression in rabbits with sciatic nerve injury. Journal of neuroengineering and rehabilitation, 12, 38. https://doi.org/10.1186/s12984 -015-0034-4
36. Yilmaz, K., Yigiter Bayramlar, K., Ayhan, C., & Tufekci, O.(2022). Investigating the effects of neuromobilization in lateral epicondylitis. Journal of hand therapy. Official journal of the American Society of Hand Therapists, 35(1), 97 –106.https://doi.org/10.1016/j.jht.2020.11.003
37. Ylinen J. (2007). Pressure algometry. The Australian journal of physiotherapy, 53(3), 207.https://doi.org/10.1016/s0004 -9514(07)70032-6