Local and Widespread Hypoalgesic Effects of Neurodynamic Mobilization in Healthy Controls
Condition: Pain; Pain, Neuropathic
MeSH terms: Neuralgia
Study type: Interventional

Summary: 
      Background & Significance Pain is the primary reason many patients seek care from healthcare
      professionals who utilize various manual therapy techniques. Gaining further understanding of
      the hypoalgesic properties of such techniques can enable practitioners to more skillfully
      integrate them in managing patients presenting with pain. Previous research has revealed that
      various manual techniques result in both local and widespread hypoalgesic changes in
      asymptomatic controls and patients in pain. Much of this previous research has investigated
      thrust manipulation; however, there is a paucity of similar research investigating these
      effects in neurodynamic mobilization.

      Specific Aims Aim: To assess for immediate local and widespread hypoalgesic effects of
      neurodynamic mobilization applied to the upper extremity.

      Hypotheses:

        -  Subjects who receive neurodynamic mobilizations will exhibit greater positive changes in
           local and widespread Qualitative Sensory Testing (QST) measures compared to those who
           receive a sham mobilization.

        -  Subjects who receive neurodynamic mobilizations will exhibit greater positive changes in
           elbow ROM and reported sensation intensity with upper limb neurodyndamic testing as
           compared to those who receive a sham mobilization.

      Aim: To assess for differences in immediate local and widespread hypoalgesic effects of
      sliding vs tensioning neurodynamic mobilization techniques applied to the upper extremity

      Hypotheses:

        -  Subjects who receive sliding neurodynamic mobilizations will exhibit greater positive
           changes in local and widespread QST measures compared to those who receive tensioning
           neurodynamic mobilization

        -  Subjects who receive sliding neurodynamic mobilizations will exhibit greater positive
           changes in elbow range of motion (ROM) and reported sensation intensity with upper limb
           neurodynamic testing testing compared to those who receive a tensioning neurodynamic
           mobilization
    

Detailed description: 
      See protocol uploaded in documents section
    

Intervention name(s): Neurodynamic Slider Mobilization; Neurodynamic Tensioner Mobilization; Sham Neurodynamic Mobilization
Intervention type(s): Other; Other; Other
Intervention description(s): Subjects will be positioned in supine with the examiner supporting his/her arm and facing caudally. The arm will be taken into the ULNT2a position as described in Butler's text - so as to bias the median nerve. Once passive resistance is felt or a feeling of mild tension is reported in the median nerve field, a series of mobilizations will be performed to "slide" the nerve proximally and distally in an alternating manner via providing wrist extension with concurrent shoulder girdle elevation and then providing wrist flexion with concurrent shoulder girdle depression. This will be performed for 2 sets of 10 cycles at a rate of 6 seconds per cycle (3 sec in each position) - not moving further into described tension or passive resistance.; Subjects will be positioned in supine with the examiner supporting his/her arm and facing caudally. The arm will be taken into the ULND2a position as described in Butler's text - so as to bias the median nerve. Once passive resistance is felt or a feeling of mild tension is reported in the median nerve field, a series of mobilizations will be performed to "tension" the nerve in an alternating on/off manner via providing wrist extension with concurrent shoulder girdle depression and then providing wrist flexion with concurrent shoulder girdle elevation. This will be performed for 2 sets of 10 cycles at a rate of 6 seconds per cycle (3 sec in each position) - not moving further into described tension or passive resistance.; Subjects will be positioned in supine with the examiner supporting his/her arm and facing cranially - in a similar position as the UNLD1 test described previously. From here, the therapist will position the patient's arm in 45 deg. of shoulder abduction without scapular depression, 45 deg. of shoulder external rotation, 45 deg. of elbow flexion, and forearm pronation. From this position, a series of sham mobilizations will be performed by passively alternating flexion and extension of the wrist for 2 sets of 10 cycles at a rate of 6 seconds per cycle (3 sec in each position).
Other intervention name(s): ULNT2a Slider; MNT2 Slider; ULNT2a Tensioner; MNT2 Tensioner
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Each subject will be randomized to one of three groups:
Neurodynamic Slider Mobilization
Neurodynamic Tensioner Mobilization
Sham Neurodynamic Mobilization
Outcomes will be assessed immediately prior to and immediately following the intervention.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: neurodynamics; neurodynamic mobilization; quantitative sensory testing; median nerve; pressure pain threshold; thermal pain threshold; thermal pain tolerance