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J Orthop Sports Phys Ther. 2009 Jun;39(6):428-38. doi: 10.2519/jospt.2009.2954.

Effects of upper extremity neural mobilization on thermal pain sensitivity: a sham-controlled study in asymptomatic participants.

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1
Department of Physical Therapy, University of Florida, Gainesville, FL 32610-0154, USA. beneciuk@phhp.ufl.edu

Abstract

STUDY DESIGN:

A single-blinded, quasi-experimental, within- and between-sessions assessment.

OBJECTIVES:

To investigate potential mechanisms of neural mobilization (NM), using tensioning techniques in comparison to sham NM on a group of asymptomatic volunteers between the ages of 18 and 50.

BACKGROUND:

NM utilizing tensioning techniques is used by physical therapists in the treatment of patients with cervical and/or upper extremity symptoms. The underlying mechanisms of potential benefits associated with NM tensioning techniques are unknown.

METHODS AND MEASURES:

Participants (n = 62) received either a NM or sham NM intervention 2 to 3 times a week for a total of 9 sessions, followed by a 1-week period of no intervention to assess carryover effects. A-delta (first pain response) and C-fiber (temporal summation) mediated pain perceptions were tested via thermal quantitative sensory testing procedures. Elbow extension range of motion (ROM) and sensory descriptor ratings were obtained during a neurodynamic test for the median nerve. Data were analyzed with repeated-measures analysis of variance (ANOVA).

RESULTS:

No group differences were seen for A-delta mediated pain perception at either immediate or carryover times. Group differences were identified for immediate C-fiber mediated pain perception (P = .032), in which hypoalgesia occurred for the NM group but not the sham NM group. This hypoalgesic effect was not maintained at carryover (P = .104). Group differences were also identified for the 3-week and carryover periods for elbow extension ROM (P = .004), and for the participant sensory descriptor ratings (P = .018), in which increased ROM and decreased sensory descriptor ratings were identified in participants in the NM group but not the sham NM group.

CONCLUSION:

This study provides preliminary evidence that mechanistic effects of tensioning NM differ from sham NM for asymptomatic participants. Specifically, NM resulted in immediate, but not sustained, C-fiber mediated hypoalgesia. Also, NM was associated with increased elbow ROM and a reduction in sensory descriptor ratings at 3-week and carryover assessment times. These differences provide potentially important information on the mechanistic effects of NM, as well as the description of a sham NM for use in future clinical trials.

PMID:
19487826
DOI:
10.2519/jospt.2009.2954
[Indexed for MEDLINE]
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