Effects of simulated neural mobilization on fluid movement in cadaveric peripheral nerve sections: implications for the treatment of neuropathic pain and dysfunction.

BACKGROUND AND PURPOSE: Neural mobilization techniques are used clinically to treat neuropathic pain and dysfunction. While selected studies report efficacy of these techniques, the mechanisms of benefit are speculative. The purpose of this study was to evaluate the effects of in vitro simulated stretch/relax neural mobilization cycles on fluid dispersion within sections of unembalmed cadaveric peripheral nerve tissue. METHODS: Bilateral sciatic nerve sections were harvested from six cadavers. Matched pairs of nerve sections were secured in a tissue tester and injected with a plasma/Toluidine Blue dye solution. Once the initial dye spread stabilized, the experimental nerve sections underwent 25 stretch/relaxation cycles (e.g. simulated neural mobilization) produced by a mechanical tissue tester. Post-test dye spread measurements were compared to pre-test measurements as well as control findings (no simulated mobilization). Data were analyzed using paired t-tests. RESULTS: Individual dye spread measurements were reliable [ICC(3,1) = 0·99]. The post-test intraneural fluid movement (dye spread) in the experimental section increased significantly with simulated neural mobilization compared to pre-test measurements (3·2±2·1 mm; P = 0·015) and control measurements (3·3±2·7 mm; P = 0·013). CONCLUSION: Repetitive simulated neural mobilization, incorporating stretch/relax cycles, of excised cadaveric peripheral nerve tissue produced an increase in intraneural fluid dispersion. Neural mobilization may alter nerve tissue environment, promoting improved function and nerve health, by dispersing tissue fluid and diminishing intraneural swelling and/or pressure.

Chronic female pelvic pain--part 1: clinical pathoanatomy and examination of the pelvic region.

Chronic pelvic pain is defined as the presence of pain in the pelvic girdle region for over a 6-month period and can arise from the gynecologic, urologic, gastrointestinal, and musculoskeletal systems. As 15% of women experience pelvic pain at some time in their lives with yearly direct medical costs estimated at $2.8 billion, effective evaluation and management strategies of this condition are necessary. This merits a thorough discussion of a systematic approach to the evaluation of chronic pelvic pain conditions, including a careful history-taking and clinical examination. The challenge of accurately diagnosing chronic pelvic pain resides in the degree of peripheral and central sensitization of the nervous system associated with the chronicity of the symptoms, as well as the potential influence of the affective and biopsychosocial factors on symptom development as persistence. Once the musculoskeletal origin of the symptoms is identified, a clinical examination schema that is based on the location of primary onset of symptoms (lumbosacral, coccygeal, sacroiliac, pelvic floor, groin or abdominal region) can be followed to establish a basis for managing the specific pain generator(s) and manage tissue dysfunction.

The effect of isometric shoulder internal and external rotation on the acromiohumeral distance.

OBJECTIVE: This study aimed to determine the effect of isometric internal and external rotation at various degrees of shoulder abduction on the acromiohumeral distance (AHD). DESIGN: This was a prospective study that used a within-subject repeated-measures design and randomization of independent variables. Data from 29 of 58 (40 women, 18 men) prospectively enrolled healthy subjects were used for analysis. A still ultrasound image of the right subacromial space was taken to measure the AHD for each of three contraction conditions (rest, isometric internal, and external rotation) at three shoulder positions (neutral and 30 and 45 degrees of abduction). RESULTS: Intrarater reliability ranged from 0.86 to 0.99. At 45 degrees of shoulder abduction, the AHD was significantly smaller with isometric external rotation when compared with no contraction (P = 0.0015) and with isometric internal rotation (P = 0.0002). CONCLUSIONS: The AHD was not affected by resistive isometric internal rotation of the shoulder, although it decreased with resistive isometric external rotation at 45 degrees of shoulder abduction. Resistive isometric shoulder external rotation in a position of abduction should be used with caution when the goal is to maintain the AHD. Further research is required to determine the effects of isometric contraction in patients with subacromial impingement syndrome.

Chronic female pelvic pain--part 2: differential diagnosis and management.

Pelvic pain is a common condition. Treatment interventions have traditionally targeted biomedical conditions with variable success. Utilizing a systematic approach to examination of the pelvic girdle and related organ systems contained within the pelvis will aid the clinician in identifying the painful structure(s) as well as the associated impairments limiting functional recovery. From this, a complete management program can be instituted. The following description of gynecologic, urologic, gastrointestinal, musculoskeletal, and neurologic conditions that can cause or are associated with chronic pelvic pain leads to conservative management proposals based on the available evidence. Finally, nonoperative interventional strategies are described, which target the pain system from a cognitive behavioral perspective, address movement dysfunctions, and address interventional pain technique possibilities.

Immediate changes in spinal height and pain after aquatic vertical traction in patients with persistent low back symptoms: a crossover clinical trial.

OBJECTIVE: To investigate the effect of aquatic vertical traction on spinal height, pain intensity, and centralization response compared with a land-based supine flexion position for patients with low back pain and signs of nerve root compression. DESIGN: Single-blind, repeated-measures crossover design. SETTING: Outpatient physical therapy clinic. SUBJECTS: Ninety-eight subjects were recruited using consecutive sampling, with 28 men and 32 women of a mean ± standard deviation (SD) age of 59.6 ± 11.6 years completing testing. INTERVENTION: Each subject participated in 2 sessions that consisted of loaded walking for 15 minutes, followed by either 15 minutes of land-based supine position or 15 minutes of aquatic vertical traction. MEASUREMENTS: Spinal height change, measured using a commercial stadiometer, was determined after completing loaded walking and after each intervention. RESULTS: The mean ± SD height change of 4.99 ± 2.88 mm after aquatic vertical traction was similar to that of 4.21 ± 2.53 mm after the land-based supine flexion (P = .0969). Paired t-test indicated that both interventions resulted in significant increased height (P < .0001). Decreases in pain after aquatic intervention (2.7 ± 2.1 cm) were significantly greater than decreases after land intervention (1.7 ± 1.7 cm; P = .0034), and centralization of symptoms was more pronounced after aquatic vertical suspension compared with the supine land-based flexion condition (P < .0001). A significant correlation between height change and both pain reduction (r = 0.39; P = .001) and centralization (r = 0.29; P = .013) was observed for the aquatic intervention only. CONCLUSION: Although both the aquatic and land interventions produced significant increases in overall spinal height, the aquatic intervention produced greater pain relief and centralization response in subjects with low back pain and signs of nerve root compression.

Changes in transversus abdominis thickness with use of the abdominal drawing-in maneuver during a functional task.

OBJECTIVE: The purpose of this study was to examine an individual's ability to produce an increase in transversus abdominis (TrA) thickness during the performance of a functional task with the use of the abdominal drawing-in maneuver (ADIM). DESIGN: Within-subject repeated measures analysis of variance was used to examine the effects of the ADIM and a loaded forward-reaching activity on the dependent variable of TrA thickness. SETTING: Laboratory. PARTICIPANTS: Convenience sample of 8 women and 8 men, asymptomatic, with a mean age of 27.6 +/- 7.1 years. INTERVENTIONS: Ultrasound imaging measurements were recorded during 4 conditions: (1) while the patient was standing without the ADIM; (2) while the patient was standing with the ADIM; (3) during a loaded forward-reaching activity without the ADIM; and (4) during a loaded forward-reaching activity with the ADIM. MAIN OUTCOME MEASURES: Thickness of the TrA muscle. RESULTS: The measurement obtained by an investigator blinded to the condition revealed statistically significant differences in the thickness of the TrA between all uncontracted conditions as compared with all contracted conditions. No statistically significant difference in the thickness of the TrA in the contracted states during quiet standing versus loaded forward reach was observed. CONCLUSION: Subjects in this study demonstrated the ability to voluntarily activate the TrA during upright static and functional tasks. Additionally, the TrA thickness may change in a direction-specific manner. These findings support a protective role of the ADIM during functional activity and may add information to ways for promoting low back pain prevention. Future studies should include the effectiveness in the use of ADIM during functional tasks for the prevention of low back pain.

Evidence-supported rehabilitation of patellar tendinopathy.

Chronic tendinopathy is a common musculoskeletal disorder that frequently affects athletes who train and compete at all levels. This Clinical Commentary presents a review of the etiology, incidence, and contributory factors related specifically to patellar tendinopathy. Examination and differential diagnosis considerations are provided, and an evidence-based, staged rehabilitation program is described.