Effects of a Novel Neurodynamic Tension Technique on Muscle Extensibility and Stretch Tolerance: A Counterbalanced Crossover Study.

CONTEXT: Neurodynamic tension affects hamstring extensibility and stretch tolerance and is considered important in hamstring injury management. Neurodynamic tension was postulated to affect segmental muscle extensibility and stretch tolerance and potentially also to demonstrate extrasegmental and contralateral effects. OBJECTIVES: To assess the effects of a novel sciatic-tibial neurodynamic tension technique, the modified long sit slump (MLSS), on segmental, extrasegmental, and contralateral muscle extensibility and stretch tolerance. STUDY DESIGN: Counterbalanced crossover study. SETTING: University research laboratory. PARTICIPANTS: 13 healthy and active subjects (mean ± SD age 24 ± 8 y; BMI, 23.1 ± 2.8 kg/m2). INTERVENTION: MLSS application (5 s, 5 repetitions, 3 sets) on 2 occasions with a 3-wk washout period, and either stance- or skill-leg treated in a counterbalanced manner. MAIN OUTCOME MEASURES: Segmental and extrasegmental muscle extensibility was measured using passive straight-leg raise (PSLR) and prone knee bend (PKB) at pre-, immediately post-, and 1 h postintervention. Stretch-intensity ratings were measured using a simple numerical rating scale (SNRS). RESULTS: MLSS significantly increased PSLR and PKB bilaterally (P < .001). The effect for PSLR was greater in the ipsilateral leg compared to the contralateral leg (baseline to 1 h post: +9° ± 6° and +5° ± 5°, respectively, P < .001) but not for PKB (baseline to 1 h post: ipsilateral leg +5° ± 5°, contralateral leg +5° ± 4°). For both PSLR and PKB the effect of the first session was retained at the start of the second session 3 wk later. SNRS data were consistent with increased stretch tolerance. CONCLUSIONS: Application of a novel sciatic-tibial neurodynamic tension technique, the MLSS, increases muscle extensibility and stretch tolerance segmentally, extrasegmentally and contralaterally. LEVEL OF EVIDENCE: 2C outcomes research.

Adhesive capsulitis: An age related symptom of metabolic syndrome and chronic low-grade inflammation?

Adhesive capsulitis (AC) is very poorly understood, particularly it's underlying etiology. Obesity and metabolic syndrome, which are strongly associated with chronic low grade inflammation, are becoming increasingly understood to underlie a raft of morbid states including upper limb pain syndromes, diabetes (DM), cardiovascular disease (CVD), cancer and central nervous system dysfunction and degeneration. Notwithstanding age, two of the strongest established risk factors for AC are DM and CVD. The hypothesis argues that similar to DM and CVD, the inflammation and capsular fibrosis seen in AC is precipitated by metabolic syndrome and chronic low grade inflammation. These pathophysiological mechanisms are highly likely to be perpetuated by upregulation of pro-inflammatory cytokine production, sympathetic dominance of autonomic balance, and neuro-immune activation. The hypothesis predicts and describes how these processes may etiologically underpin and induce each sub-classification of AC. An improved understanding of the etiology of AC may lead to more accurate diagnosis, improved management, treatment outcomes, and reduce or prevent pain, disability and suffering associated with the disease. The paper follows on with a discussion of similarities between the pathophysiology of AC to general systemic inflammatory control mechanisms whereby connective tissue (CT) fibrosis is induced as a storage depot for leukocytes and chronic inflammatory cells. The potential role of hyaluronic acid (HA), the primary component of the extracellular matrix (ECM) and CT, in the pathophysiology of AC is also discussed with potential treatment implications. Lastly, a biochemical link between physical and mental health through the ECM is described and the concept of a periventricular-limbic central driver of CT dysfunction is introduced.

Diagnosis and management of acute medial tibial stress syndrome in a 15 year old female surf life-saving competitor.

BACKGROUND AND PURPOSE: As the profound health and cost benefits of physical activity to society are established and participation guidelines implemented, health practitioners are increasingly expected to utilize efficacious and justified injury management and prevention strategies. The complex and multifactorial nature of sports injury makes elucidation of multiple risk factors and how they may subtly and variably interact, difficult. The purpose of this case report is to discuss the differential diagnosis, acute management and rehabilitation of a case of medial tibial stress syndrome (MTSS) in a surf life-saving athlete, in the context of sports injury prevention. CASE DESCRIPTION: The subject of this case study, a 15 year old female surf life-saving competitor, presented to the physiotherapist (PT) with recent onset, first episode, bilateral, diffuse posteromedial shin pain. Differential diagnosis, acute management, rehabilitation and preventative strategies for the subject are presented. DISCUSSION: Emerging injury surveillance research in surf life-saving suggests minor and major trauma as primary causative factors, however, the significance of high training volumes is likely underestimated. The influence of biomechanical, and subtle arthrokinematic dysfunctions on established risk factors for MTSS injury and prevention of re-injury for this subject, are also discussed. Furthermore, the concept of preventing tibial stress fracture (TSF) by successfully managing acute MTSS, is presented. Lastly, a critical analysis of reliability of clinical assessment methodologies utilised with the subject is provided. LEVEL OF EVIDENCE: Level 5; Single case report.

Diagnosis and management of atypical and persistent anterolateral knee pain in a 16-year-old triathlete: an iterative process.

INTRODUCTION AND BACKGROUND: The subject of this case study, a 16-year-old female triathlete, presented to physiotherapy reporting a 6 month history of anterior knee pain, with symptoms unchanged upon resuming a graduated triathlon training program, despite 3 months rest from all training. CASE DESCRIPTION: The case describes the differential diagnosis and management of patellofemoral pain syndrome (PFPS), iliotibial band syndrome (ITBS), and discoid lateral meniscus (DLM) in an adolescent female triathlete. Clinical reasoning and rehabilitation strategies are presented with respect to literature base. Final outcome was full resolution of symptoms and return to full athletic function, however, symptoms were relatively persistent and atypical. PURPOSE: This case report discusses the differential diagnosis and management of persistent and atypical anterior knee pain in a sixteen-year-old female triathlete. In such cases, the diagnostic process is often iterative, where intervention serves both therapeutic and diagnostic purposes. DISCUSSION: Recent changes in the understanding of the pathophysiology of ITBS and links between the anterior and lateral knee compartments through highly innervated knee synovial tissue assist the therapist's understanding of how these conditions may occur concomitantly, with resulting atypical symptoms. The potential influences of likely changes in the subject's peripheral and central nervous system on symptom perception is also discussed. LEVEL OF EVIDENCE: Level 5; Single case report.