ARTICLE 1

The effects of neural mobilization on cervical radiculopathy patients’ pain,

disability, ROM, and deep flexor endurance

Authors- Dong-Gyu Kima;_, Sin Ho Chungb and Ho Bal Jungc

Year-2017

Objective - The purpose of this study was to examine the effects of neural mobilization with
manual cervical traction (NMCT) compared with MCT on pain, functional disability, muscle
endurance, and ROM in individuals with cervical radiculopathy patients.

Method - A blinded randomized clinical trial was conducted. Thirty cervical radiculopathy (CR)
patients were divided into two groups – those who received NMCT and those who received
MCT. The intervention was applied three times per week for eight weeks. It was measured in
order to determine the pain and functional disability in patients with CR. The numeric pain rating
scale (NPRS), neck disability index (NDI), ROM, and deep flexor endurance of patients were
measured prior to the experiment, four weeks, and eight weeks after the experiment to compare
the time points. For eight weeks, they received NMCT and MCT treatment with conservative
physical treatment three times per week. They received conservative treatment for 35 minutes
and MCT treatment for 10 minutes each time. The experimental group received MCT
accompanied by NM and the control group received MCT. Conservative treatment - A hot pack
for 20 minutes and TENS was administered at a frequency of 60 Hz for 15 min. For MCT, a
manual therapist stood at the head of the treatment table facing the patient and covered the
backside of the patient’s head with both hands hands. The therapist bent his or her trunk back to
apply traction power to the cervical spine for one minute (Kaltenborn Grade 2). Grade 2 traction
(tighten or “take up the slack”) that effectively separates the articulating surfaces and takes up
the slack or eliminates play in the joint capsule. After one minute of traction power, the patient
rested for 30 seconds. MCT was repeated six times for a total of 10 minutes. For NMCT Two
manual therapists with more than five years of experience in the treatment and evaluation of the
musculoskeletal system participated. This study was performed by the same therapist. For
manual therapy, one manual therapist applied MCT (Kaltenborn Grade 2) for one minute while
the other manual therapist applied neural mobilization using a slider technique in a smooth and
rhythmic manner. A repeated-measures analysis of variance was used to compare differences
within each group prior to the experiment.
Result - The result of the present study is that significant decrease in pain and NDI, and a
significant increase in ROM and deep flexor endurance were observed following NMCT for
eight weeks, when compared to MCT. These results suggest that the NMCT can pain relief,
recovery from neck disability, ROM, and deep flexor endurance for patients with CR.
ARTICLE 2
The neural mobilization technique modulates the expression of endogenous opioids in the
periaqueductal gray and improves muscle strength and mobility in rats with neuropathic pain

Authors – Fabio Martinez Santos1,2,3,4, Leandro Henrique Grecco2, Marcelo Gomes Pereira3,
Mara Evany Oliveira1, Priscila Abreu Rocha1, Joyce Teixeira Silva1, Daniel Oliveira Martins1,
Elen Haruka Miyabara3 and Marucia Chacur1*
Year -2014

Objective – The aim of this study was to analyze whether neural mobilization (NM) alters the
expression of the mu-opioid receptor (MOR), the delta-opioid receptor (DOR) and the Kappa-
opioid receptor (KOR) in the periaqueductal gray (PAG) and improves locomotion and muscle
force after chronic constriction injury (CCI) in rats.

Method - The CCI was imposed on adult male rats followed by 10 sessions of NM every other
day, starting 14 days after the CCI injury. The NM technique used here has been described by
Butler (1989) was used. The right knee joint was then positioned in full extension (at 0 degrees)
and remained so throughout the session. Moreover, the right hip joint was bent between 70 to 80
degrees with the knee in extension until a small resistance was induced by stretching the muscles
from the compartimentum posterius femoris (biceps m., femoris m., semimembranosus m., and
semitendinosus m.). At the end of the sessions, the PAG was analyzed using Western blot assays
for opioid receptors. Locomotion was analyzed by the Sciatic functional index (SFI), and muscle
force was analyzed by the BIOPAC system.

Result - An improvement in locomotion was observed in animals treated with NM compared

with injured animals. Animals treated with NM showed an increase in maximal tetanic force of
the tibialis anterior muscle of 172% (p < 0.001) compared with the CCI group. We also observed
a decrease of 53% (p < 0.001) and 23% (p < 0.05) in DOR and KOR levels, respectively, after
CCI injury compared to those from naive animals and an increase of 17% (p < 0.05) in KOR
expression only after NM treatment compared to naive animals. There were no significant
changes in MOR expression in the PAG.
These data provide evidence that a non-pharmacological NM technique facilitates pain relief by
endogenous analgesic modulation.
ARTICLE 3
The effect of cervical traction combined with neural mobilization on
pain and disability in cervical radiculopathy. A case report

Authors – Christos Savva a,*, Giannis Giakas b

Year – 2013

Objective - the objective of this case study is to present the effect of cervical traction combined
with neural mobilization on pain and disability in a patient experiencing cervical radiculopathy
(CR).

Method- A 52-year-old woman presented with a 2 month history of neurological cervico-brachial

pain and whose presentation was consistent with cervical radiculopathy. Cervical traction and a
slider neural mobilization of the medial nerve were applied simultaneously to reduce the
patient’s pain and disability measured at baseline and at 2 and 4 weeks using the Numeric Pain
Rating Scale, the Neck Disability Index and the Patient-Specific Functional Scale. Grade III
intermittent cervical traction combined with a slider NMT of the medial nerve were selected to
decompress and eliminate the mechanical stimuli found around the C5 nerve root as well as to
normalize the structure and function of the particular nerve (Maitland et al., 2005; Butler, 2005).
Six sets of cervical traction performed simultaneously with neural mobilization were applied per
session. In every set, cervical traction was applied by an assistant physiotherapist and maintained
for 1 min and during this period neural mobilizations were given by the main author. Cervical
traction and neural mobilizations were given at the same time and they were followed by a rest
period of 30 s. The total time of treatment for each session was 10 min.

Result - Improvements in all outcome measures were noted over a period of four weeks. Scores
in all outcome measures revealed that the patient’s pain had almost disappeared and that she was
able to perform her household chores and job tasks without difficulties and limitations. In
conclusion, the findings of this study support that the application of cervical traction combined
with neural mobilization can produce significant improvements in terms of pain and disability in
cervical radiculopathy.
ARTICLE 4
Effects of active versus passive upper extremity neural mobilization combined
with mechanical traction and mobilization in females with cervical radiculopathy:
A randomized controlled trial

author – Afsah Ayuba, Muhammad Osamab;_, Shakil-ur-Rehmanc and Shakeel Ahmadc

year – 2019

objective - the purpose of the current study is to compare the effects of active and passive neural
mobilization in the management of cervical radiculopathy, in combination with mechanical
traction and joint mobilization.

Method - A double blind randomized controlled trial was conducted on 44 females were
included and randomized into 2 groups, receiving 12 treatment sessions in total. Group A
received active whereas Group B received passive UE neural mobilization, along with cervical
traction and Unilateral Posterior Anterior (UPA) glide regardless of the group. Numeric pain
rating scale (NPRS), Neck Disability Index (NDI) and cervical range of motion (ROM) were
used as outcome measurement tools. Non-parametric tests of significance were used for inter
group and intra group comparison (Mann-Whitney U test and Wilcoxon test).

Result - A statistically significant difference was observed between pre and posts NPRS, NDI
and ROM scores after 4 weeks of treatment for both groups (p < 0.05). However, no significant
differences were observed in post treatment scores of active and passive neural mobilization
groups (p > 0.05).
Both active and passive neural mobilization is effective in the management of cervical
radiculopathy. One of the interventions is not superior to the other.
ARTICLE 5

THE COMBINED EFFICACY OF NEURAL MOBILIZATION WITH

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) VERSUS
NEURAL MOBILIZATION ALONE FOR THE MANAGEMENT OF CERVICAL
RADICULOPATHY

Author – Dr. Pritam Deka (PT) ²Dr. Mrs. Sarulatha (PT) ³Dr. Shamik
Bhattacharjee(PT) *4Dr. Abhijit Dutta (PT)
Year – 2016

Method - This study was a comparative study with pre and post test design. 30 subjects were
randomly divided into two groups with a group receiving neural mobilization and TENS
(experimental group I) and a group receiving only neural mobilization (experimental group II)
with 15 patients in each group. The study was carried out in three stages: a) Pre-intervention
measurement b) Intervention c) Post-intervention measurement. Assessment was taken using
VAS and NDI prior to treatment. Treatment was continued for 14 days and at the end of 14 days
patients were reassessed using the same scales.
Intervention: Group I and group II subjects were assessed for nerve affection using upper limb
tension tests: ULTT 1 for Median nerve, ULTT 2a for Median nerve, ULTT 2b for Radial nerve,
ULTT 3 for Ulnar nerve. Depending on the affected nerve neural mobilization was given to both
Group I and Group II. (1)TENS: Frequency of 40-70 Hertz, Intensity as per patient’s tolerance,
Pulse duration of 10- 50 Micro secs for 20 min. Electrode Placement is at the area of greatest
intensity of pain. The treatment consisted of 14 sessions 7 times/week, for 2 weeks. (2) Neural
Mobilization: Depending on the affected nerve neural mobilization was given. The treatment
consisted of 14 sessions, 7times/week for 2 weeks. The patient was positioned in neurodynamic
test position according to the involved nerve and required sliding or gliding techniques were
used. Neurodynamic positions. (c) Post- intervention measurement: VAS and NDI were carried
out again on the 14th day of treatment procedure (post-treatment evaluation) for all the patients.

Result - Group 1 receiving both the treatments had shown more significant reduction in pain and
disability compared to Group 2 receiving only neural mobilization after 14 days of treatment.
Both neural mobilization and TENS are effective in reduction of pain and disability in patients
with cervical radiculopathy. And when compared, combined treatment is more effective than
only neural mobilization.

ARTICLE 6
Manual therapy intervention in the treatment of patients with
carpal tunnel syndrome: median nerve mobilization versus
medical treatment
authors - Faten I. Mohameda, Amal A. Hassana, Rasha A. Abdel-Magieda,
Reem N. Wagehb

Year – 2016

Objective - The aim of the present study was to investigate the effectiveness of median nerve
mobilization in relieving manifestations of CTS when compared with conventional medical
treatment.

Method - A total of 28 CTS patients were divided into two groups: patients in group I ( n = 18)
underwent median nerve mobilization, and those in group II (n = 10) underwent conventional
medical treatment. Median nerve mobilization consisted of 18 treatments (three/week for 6
weeks). Neurodynamic mobilization techniques (median nerve mobilization) include nerve-
gliding exercises and the upper limb tension test 2a mobilization of the median nerve for 20 min.
conventional medical treatment (NSAIDs, diclofenac 150 mg/day for 2 weeks and 1500 μg
vitamin B12 per day for 6 weeks). Patients were assessed for hand sensitivity, paresthesia,
strength, pain, night awakening, thenar eminence atrophy, and were subjected to Phalen’s test,
Tinel’s sign, Boston Carpal Tunnel Questionnaire’s Symptom Severity Scale (BCTQ-SSS) and
Functional Status Scale (BCTQ-FSS), and sensory and motor conduction studies for median
nerve at baseline and at 6 weeks after treatment.

Result - At baseline versus at 6 weeks, pain, sensation, paresthesia, tingling, Tinel’s signs, and
Phalen’s test outcomes were significantly improved in both groups; wrist flexion and extension
improved only in group I. The difference between group I and group II after 6 weeks was
significant as regards tingling, pain, wrist flexion, and extension. BCTQ-SSS and BCTQ-FSS
scores
improved after 6 weeks compared with baseline in patients in group I, whereas in group II the
improvement was observed in BCTQ-FSS; the difference between the groups was significant.
Sensory nerve conduction velocity, sensory distal latency, sensory amplitude, distal motor
latency, and motor amplitude were significantly improved after 6 weeks in group I. In addition,
there was a change in the grade of CTS, whereas in group II there was improvement only in
sensory nerve conduction velocity; the difference between the groups was not significant.
CTS improves after median nerve mobilization, which is better than conventional medical
treatment. It provides support for the use of manual therapy in conservative management of CTS
with satisfactory results.

ARTICLE 7
Effectiveness of median nerve neural mobilization
versus oral ibuprofen treatment in subjects who suffer
from cervicobrachial pain: a randomized clinical trial

authors - David Rodriguez Sanz1, Francisco Unda Solano2, Daniel López López3, Irene Sanz
Corbalan4,
Carlos Romero Morales1, Cesar Calvo Lobo5

Year – 2017

Objective - the purpose of the present study was to compare the effectiveness for pain intensity,
range of movement and functionality between median nerve neural mobilization (MNNM) and
oral ibuprofen in treating patients who suffer from cervicobrachial pain (CP).

Method - Sixty-two participants diagnosed with CP were recruited and randomly assigned to 2
groups (n = 31), which received MNNM or 1200 mg/day OI treatment for 6 weeks. The numeric
rating scale for pain intensity was the primary outcome. The cervical rotation range of motion
(CROM) and the upper limb function were the secondary outcomes. The MNNM was performed
by PT in the affected upper limb and consisted of initial supine neutral positioning of the patient,
shoulder girdle depression, glenohumeral 90o abduction with a lateral rotation component,
supination of the forearm, elbow and wrist flexion, thumb and finger extension followed by an
immediate second movement of elbow extension with wrist, thumb, and finger flexion, while
maintaining the initial shoulder girdle, glenohumeral and forearm positioning. This passive
movement sequence of upper limb flexion and extension was done repetitively at an approximate
speed of 1 complete repetition of upper limb flexion and extension movement every 2 s without
the reproduction of symptoms. The second group of individuals was named group B and
received an oral ibuprofen tablet treatment that was prescribed by the PMD who is familiar with
the proper use and side effects of OI in CP. The PMD was responsible for modulating the OI
dose to the subject’s tolerance whilst trying to achieve the maximum hypoalgesic desired effect.
The starting dose on the first day of treatment was a single dose of 400 mg. Doses were
increased in case of subjects’ adequate tolerance to a maximum dose of 1200 mg/day, divided
into 3 doses every 8 h.

result - Oral ibuprofen may be superior to MNNM for pain reduction and upper limb function
increase of subjects with CP. Nevertheless, both treatments were effective. Median nerve neural
mobilization may be considered an effective non-pharmaceutical treatment option in subjects
with CP. Regarding OI adverse effects, these findings challenge the role of pharmacologic versus
manual therapy as possible treatments that may improve pain intensity and upper limb
functionality in subjects with CP.
ARTICLE 8
 Contralateral versus ipsilateral neural mobilization of median nerve in patients with unilateral
carpal tunnel syndrome
Author - Mahmoud S. Asal1*, Mohamed H. Elgendy2, Olfat I. Ali2, and Amira A. Labib3
Year – 2018
Objective - The purpose of this study was to compare the effect of contralateral neural mobilization,
ipsilateral neural mobilization of the median nerve and conventional treatment on carpal tunnel
syndrome(CTS).

Method - forty-five patients from both genders diagnosed as unilateral mild or moderate CTS were
randomly assigned into three equaled study groups, each one included 15 patients, each group
received conventional treatment in the form of TENS, U.S and infra-red. The first group received
contralateral neural mobilization in the form of upper limb tension test 1 (ULTT-1) plus
conventional treatment, the second group received ipsilateral neural mobilization in the form of
(ULTT-1) plus conventional treatment and the third group received only conventional treatment.
Treatment in all groups was conducted for 3 sessions per week for 2 weeks. Pain level and
functional level were measured by visual analogue scale (VAS) and Upper Extremity Functional
Scale (UEFS), respectively. Each group received 5 minutes U.S OF 1 MHz, 1.0 W/cm2, 20 minutes
TENS and 15 minutes Luminous near-infrared radiation infrared at distance of 50 cm in each
session. Neural mobilization has been provided for roughly 10 minutes for every session including
30 sec hold and one-minute rest. The whole treatment was given for 6 sessions.

Result - conventional treatment (TENS, U.S and infra-red) has the upper hand in treating CTS
symptoms and both ipsilateral and contralateral neural mobilization have only a complementary
effect to the conventional treatment effect.

ARTICLE 9
Radial Nerve Mobilization Decreases Pain Sensitivity and Improves Motor Performance in
Patients With Thumb Carpometacarpal Osteoarthritis: A Randomized Controlled Trial
Authors - Jorge H. Villafañe, MSc, Guillermo B. Silva, PhD, Mark D. Bishop, PhD, Josue
Fernandez-Carnero, PhD
Year – 2012

Objective - To examine the effects of radial nerve mobilization on pain sensitivity and motor
performance in subjects with secondary thumb carpometacarpal osteoarthritis.

Method - The study was a double-blind, randomized controlled trial. Sixty participants aged 70
to 90 years volunteered for the present study. All subjects were right-hand dominant.
Interventions: Sliding mobilization of the proximal-distal radial nerve or intermittent ultrasound
therapy, used as placebo. Radial nerve mobilization (treatment group). Treatment was
performed in 6 sessions over 4 weeks and was applied to the dominant hand 3 times during a 4-
minute period, with 1-minute pauses between periods. The technique consisted of a sliding
mobilization of the proximal-distal radial
nerve. To begin the technique, the patient was positioned supine and the physiotherapist was
seated. The physiotherapist depressed the patient’s shoulder girdle, extended the patient’s elbow,
and then internally rotated the arm. The patient’s wrist, thumb, and all the fingers were flexed.
Finally, ulnar deviation of the hand was added. This combination of movements is hypothesized
to stress the radial nerve. Once the upper extremity was positioned, 2 movements were done as
follows: (1) shoulder depression was applied simultaneously with elbow flexion and wrist
extension; and (2) shoulder elevation was performed with elbow extension, wrist flexion, and
ulnar deviation. These motions are alternated at a rate of approximately 2 seconds per cycle (1s
into extension and 1s into flexion).Main Outcome Measures: they hypothesized that radial
nerve mobilization induces hypoalgesia and increases strength in secondary thumb
carpometacarpal osteoarthritis. They measured pressure pain threshold (PPT) at the
trapeziometacarpal joint, the tubercle of the scaphoid bone, and the unciform apophysis of the
hamate bone by algometry. Tip pinch strength and tripod pinch strength were measured by a
mechanical pinch gauge.

Conclusion - Radial nerve mobilization produces significant mechanical hypoalgesia and

increases pinch strength in patients with dominant- hand thumb carpometacarpal OA. Because
nerve mobilization was used previously as a treatment in patients with this pathology, this may
serve as an alternative or complementary therapy with positive results. The sliding technique is
suggested to be used for a chronic pain condition such as OA pain, in which central or peripheral
sensitization has been found, because the technique is less aggressive than more direct
interventions.

ARTICLE 10
Radial Nerve Mobilization Reduces Lateral Elbow Pain and Provides
Short-Term Relief in Computer Users§
Authors - Vanitha Arumugam*,1, Senthil Selvam2 and Joy C. MacDermid3
Year – 2014

Objective - The purpose of this study was to evaluate the effect of neural mobilization of the
radial nerve on a single occasion in terms of its ability to reduce lateral elbow pain.

Method - Forty-one computer professionals who had experienced lateral elbow pain for a mean
of 2.87 months were recruited. The participants rated the pain using a verbal, numeric rating
scale (NRS). Radial nerve tension was tested using the Upper limb Tension Test (ULTT) for
radial nerve in both upper extremities. The radial nerve was mobilized using a series of 8
oscillations and repeated 3 times with a one minute rest in between. The participants were
positioned in a supine lying position. The physiotherapist assumed a standing position. The
shoulder girdle was depressed, elbow extended, arm internally rotated, wrist, thumb and fingers
were flexed. These movements stressed the radial nerve, and then shoulder depression was
maintained with elbow flexion and wrist extension. The wrist and fingers were fixed prior to the
elbow extension test that was performed gently, extending the elbow for approximately 2
seconds just into the range where the participant felt only the tension but no pain and then
flexing the elbow. Three sets of 6 to 8 oscillations were performed. NRS-P was re-assessed to
ascertain change. Measurements were performed by a single physiotherapist. The NRS and
ULLT were repeated after treatment and the scores compared using a paired t-test

Result - There was an immediate reduction in the pain reported by the participants post-
intervention. The mean NRS scores decreased significantly after the intervention from 5.7 (1.1)
to 3.8 (1.4) (p<0.000; t value=8.07). The results of the study indicate that the mobilization of the
radial nerve resulted in a significant short-term relief in the lateral elbow pain of computer users

ARTICLE 11
Excursion of the Sciatic Nerve During Nerve Mobilization Exercises: An In Vivo Cross-
sectional Study Using Dynamic Ultrasound Imaging
Author - MICHEL W. COPPIETERS, PT, PhD1,2 • LINE S. ANDERSEN, PT, MApplSc3 •
RUNAR JOHANSEN, PT, MApplSc4 PER K. GISKEGJERDE, PT, MApplSc5 • MONA
HØIVIK, PT, MApplSc6 • SIV VESTRE, PT, MApplSc7 • ROBERT J. NEE, PT, PhD8

Year – 2015

Objective - To determine whether different types of neurodynamic techniques result in differ-

ences in longitudinal sciatic nerve excursion.

Method - Controlled laboratory cross-sectional study using single-group, within-subject

comparisons. High-resolution ultrasound imaging was used to quantify longitudinal sciatic nerve
movement in the thigh of 15 asymptomatic participants during 6 different mobilization
techniques for the sciatic nerve involving the hip and knee. Healthy volunteers were selected to
demonstrate normal nerve biomechanics and to eliminate potentially confounding variables
associated with dysfunction. Repeated-measures analyses of variance were used to analyze the
data.

Result - The techniques resulted in markedly different amounts of nerve movement (P<.001).
The tensioning technique was associated with the smallest excursion (mean ±SD, 3.2 ± 2.1 mm;
P≤.004). The sliding technique resulted in the largest excursion (mean ± SD, 17.0 ±5.2 mm;
P<.001), which was approximately 5 times larger than that resulting from the tensioning
technique and, on average, twice as large as that resulting from individual hip or knee
movements.

ARTICLE 12
Effects of the Nerve Mobilization Technique on
Lower Limb Function in Patients with Poststroke
Hemiparesis
Authors - Hyun-Kyu Cha, PT, MS1), Hyuk-Shin Cho, PT, MS2), Jong-Duk Choi, PT, PhD3)*
Year – 2014
Objective - The purpose of the study was to determine the effects of a sciatic nerve mobilization
technique on improvement of lower limb function in patient with poststroke hemiparesis.

Method - Twenty- two stroke patients participated in this study.They were randomly selected
based on selection criteria and divided into two groups. In the subject group (n=10), sciatic nerve
mobilization with conventional physical therapy was applied to patients. In the control group
(n=10), only conventional physical therapy was applied to stroke patients. All the subjects
received two daily 30-minute sessions of conservative physical therapy for the lower limb region
five times a week for four weeks. The conservative physical therapy was based on functional
treatment, including sitting to standing, climbing and descending stairs, and using an alternative
anteroposterior step. The experimental group received the sciatic nerve mobilization technique
for the lower limb after conservative physical therapy. The sciatic nerve mobilization technique
was conducted in three stages for relaxation of the sacral nerve. First, in a supine position, the
subject placed the neck and trunk in a neutral position. Both sides of the knee joint were then
fixed so that they did not bend. The lower limb on one side was placed in the maximum straight
leg raise position. In this state, a slight vibration was applied, held for 20 seconds, and repeated
three times. In the second stage, ankle joint dorsiflexion accompanied performance of the
straight leg raise, and hip joint adduction and internal rotation were applied. In the third stage,
cervical flexion was sequentially applied so that the sacral nerve became tense and reached the
maximum level. The second and the third stages were held for 20 seconds and were repeated six
times. All procedures were performed repeatedly for the contralateral lower limb. The
application time for all stages was about 10 minutes. Outcome measures - variables of sway,
total pressure, and angle of the knee joint. The functional reaching test and timed up go test were
also used as measurement instruments.

Result - Comparison of the measurement times in the experimental group showed significant
increases in all variables (p<0.05). The post hoc test results showed significant differences in the
measured values between before the intervention and after the interventions and between after
two weeks of intervention and after four weeks of intervention. On the other hand, the control
group showed significant differences in the angle of the knee joint and the functional reaching
test (p<0.05). The present study showed that sciatic nerve mobilization with conventional
physical therapy was more effective for lower limb function than conventional physical therapy
alone in patient with poststroke hemiparesis.

ARTICLE 13
Neural mobilization promotes nerve regeneration by nerve growth
factor and myelin protein zero increased after sciatic nerve injury
authors - Joyce Teixeira da Silva1, Fabio Martinez dos Santos1,2, Aline Caroline Giardini1,
Daniel de Oliveira Martins1,Mara Evany de Oliveira1, Adriano Polican Ciena1, Vanessa
Pacciari Gutierrez3, Ii-sei Watanabe1, Luiz Roberto G. de Britto4, and Marucia Chacur1

year – 2014

objective - The aim of this study was to analyze if neural mobilization (NM) can change the
expression of myelin protein zero (MPZ), neuralgrowth factor (NGF) and its influence on nerve
regeneration. The latter issue was evaluated by the analysis of the nerve fibers in the sciatic
nerve of adult neuropathic rats after chronic constriction injury (CCI).

Method - The CCI was performed on adult male rats, submitted to 10 sessions of NM, starting 14
days after CCI. Then,
the nerves were analyzed using transmission electron microscopy and western blot for neural
growth factor (NGF) and myelin protein zero (MPZ).

Result – they observed an increase of NGF and MPZ after CCI and NM. Electron microscopy
revealed that CCI-NM samples had high numbers of axons possessing myelin sheaths of normal
thickness and less inter-axonal fibrosis than the CCI. These data suggest that NM is effective in
facilitating nerve regeneration and NGF and MPZ are involved in this effect. .study reveal that
NM sessions are able to improve axonal regeneration in sciatic nerve and its mechanism could be
by NGF and MPZ upregulation after a physiotherapy treatment, showing the relevance of
nonpharmacological intervention.

ARTICLE 14
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
Authors - Ui-Cheol Jeong, MS1), Cheol-Yong Kim, PT, PhD2), Young-Han Park, PT, PhD3),
Gak Hwang-Bo, PhD1), Chan-Woo Nam, PT, MS1)*
Year – 2015

Objective - This study aimed to examine the effects of self-mobilization techniques for the
sciatic nerves on the quality of life in patients with chronic low back pain in the lower limbs
accompanied by radiating pain.

Method - The subjects of this study were patients with low back pain accompanied by radiating
pain who were between 30 and50 years of age. The subjects were divided into two groups: a
group receiving of lumbar segmental stabilization exercise training including sciatic nerve
mobilization techniques, which included 8 males and 7 females, and a group receiving lumbar
segmental stabilization exercise training, which included 8 males and 7 females. The patients
conducted the exercises by themselves under the supervision of a therapist who was skilled in
application of the treatment techniques.
(1) Lumbar Segmental Stabilization Exercise. The patient flexed the hip and knee joints, placed
the pressure biofeedback unit under the lumbar vertebra, lied completely relaxed, adjusted the
pressure gauge to 20 mmHg, and induced coordinated contraction of the multifidus and
transverse abdominis. They increased the pressure to 30 mmHg, held it there while continuing to
breathe for 10 seconds, and then decreased the pressure to 20 mmHg and rested for 10 seconds.
The patient repeated this motion 20 times.
(2) Sensomotoric exercise 1. The patient got into a quadruped position in which they maintained
the neutrality of the retroversion of the pelvis and slightly pushed on a ball.
(3) Bridge 1. The patient flexed the knee joint to 90 degrees and, in a prone position, placed both
hands on the abdomen, maintained a neutral position of the lumbar region, and raised the pelvis
from the floor.
(4) Sensomotoric exercise 2. The patient induced coordinated contraction of the multifidus and
transverse abdominis while maintaining neutrality of the lumbar region in a quadruped position,
triggered retroversion of the pelvis, and slightly raised both knees.
(5) Bridge 2. The patient completely flexed one knee and the hip joint and maintained them
toward the chest and held the other knee with both hands, lied in a supine position, maintained
neutral posture of the lumbar region, raised the pelvis from the floor with the other hip and knee
joints flexed at 90 degrees.
(6) Raising the opposite arm and leg in a quadruped posture. In a quadruped position, the patient
slowly raised the opposite arm and leg with the neutrality of the lumbar region maintained. For
exercise (2) to (6), the patient maintained respiration constant for six seconds and then took a rest
for 10 seconds. The patient repeated this motion 15 times. These five exercises were repeated in
a circular form for a total of three sets.

Mobilization techniques to relax the sciatic nerves were performed by the patient on his/her own
under the supervision of the therapist. The first step was for the patient to extend the knee joint
only to the range of pain. The second step was for the patient to extend the knee joint to the
range of no pain and to flex the top of the foot within the range of no pain. The third step was for
the patient to extend the knee joint to the range of no pain and to flex the top of the foot within
the range of no pain and flex the neck. As the steps progressed, the tension of the sciatic nerves
heightened, and the neck flexion in the third step was used as a method to induce maximal tone
of the nerves; all the steps were applied to the lower limb with radiating pain

Conclusion - According to the study results, application of the traditional lumbar segmental
stabilization exercise with mobilization techniques for the sciatic nerves improved the functions
and health of the subjects. Application for the mobilization techniques of the sciatic nerves may
promote healing of the soft tissues by stimulating the functions of the nervous system to improve
nervous system adaptability and decrease sensitivity, helping to alleviate symptoms. This method
may be selectively recommended for patients with low back pain accompanied by radiating pain.

ARTICLE 15
Motor and Sensory Nerve Conduction
Are Affected Differently by Ice Pack,
Ice Massage, and Cold Water
Immersion
AUTHORS - Esperanza Herrera, Maria C. Sandoval, Diana M. Camargo, Tania F. Salvini
YEAR – 2010
Objective - The purpose of this study was to compare the effects of 3 commonly used therapeutic
cold modalities (ice pack, ice massage, and cold water immersion) on the conduction parameters
of the sural nerve and tibial motor nerve in participants who were healthy.

Method - Thirty-six people who were healthy participated in the study. An experimental study
was conducted with 3 randomly assigned intervention groups. The independent variables were
cold modality type (ice pack, ice massage, and water immersion) and measurement time (pre-
and post-cooling). The dependent variables were skin temperature (degrees Celsius) and nerve
conduction parameters: NCV (meters per second), latency and duration (milliseconds), amplitude
of compound muscle (millivolts), and sensory action potentials (microvolts). Each group
received 1 of the 3 cold modalities, applied to the right calf region for 15 minutes. Skin
temperature and nerve conduction parameters were measured before and immediately after
cooling. The cold modalities were applied for 15 consecutive minutes. This duration is
frequently used for treatments because it is sufficient to achieve therapeutic effects and it avoids
complications from cold modalities. The ice massage and the ice pack were applied to a
previously determined rectangular area (18 _ 8 cm) on the calf . The ice pack was applied
directly to the skin and without compression. The ice massage was applied by continuous
longitudinal displacements. For the cold water immersion, the participants remained seated while
immersing the right leg as far as the top border of the rectangle determined for the previous
modalities. At the end of intervention, the leg was quickly dried without friction, and the
participant returned to the prone position for the post-cooling measurement.

Result - All 3 modalities reduced skin temperature (mean_18.2°C). There also was a reduction in
amplitude and an increase in latency and duration of the compound action potential. Ice massage,
ice pack, and cold water immersion reduced sensory nerve conduction velocity (NCV) by 20.4,
16.7, and 22.6 m/s and motor NCV by 2.5, 2.1, and 8.3 m/s, respectively. Cold water immersion
was the most effective modality in changing nerve conduction parameters.

All 3 modalities were effective in reducing skin temperature and changing sensory conduction at
a physiological level that is sufficient to induce a hypoalgesic effect. The results suggest that
cold water immersion, as applied in this study, is the most indicated modality for inducing
therapeutic effects associated with the reduction of motor nerve conduction.
ARTICLE 16
A Randomized Prospective Study to Assess the
Efficacy of Two Cold-therapy Treatments
Following Carpal Tunnel Release
Author - John Hochberg, MD
Year -2001
Objective - The purpose of this outcome study was to evaluate and compare the effects of
controlled cooling blanket (CCT) and conventional ice therapy on pain, edema (wrist
circumference), and narcotic use during the postoperative period among patients who have
undergone carpal tunnel surgery.

Method - A prospective randomized study was performed comparing the efficacy of controlled
cold therapy (CCT) with the efficacy of ice therapy in the postoperative treatment of 72 patients
with carpal tunnel syndrome. Immediately after surgery, patients applied either a temperature-
controlled cooling blanket (CCT) or a standard ice pack over their surgical dressings. Pain was
assessed by visual analog scale and swelling by wrist circumference preoperatively, immediately
after surgery, and on postoperative day 3. Patients kept log books of daily treatment times.
Narcotic use (of Vicodin ES) was determined by pill count at day 3 and by daily log book
recordings.

Result - The results of this study suggest that CCT, in spite of its drawbacks, is more effective
than conventional ice therapy in providing efficient pain blockage and reduction of edema in
postoperative management of carpal tunnel surgery. The increased effectiveness of the CCT
device is most likely due to better efficiency in lowering temperatures at the wound site and
better compliance in the use of the CCT system, allowing patients to achieve maximum
therapeutic benefit. Greater reduction in narcotic use by CCT patients is consistent with more
efficient rain reduction effected by use of the CCT treatment regimen.

ARTICLE 17
Effects of Cryotherapy on Objective and Subjective Symptoms of Paclitaxel-Induced
Neuropathy: Prospective Self-Controlled Trial
Authors - Akiko Hanai, Hiroshi Ishiguro, Takashi Sozu, Moe Tsuda, Ikuko Yano, Takayuki
Nakagawa, Satoshi Imai, Yoko Hamabe, Masakazu Toi, Hidenori Arai, Tadao Tsuboyama

Year – 2018
Objective - investigated the effectiveness of cryotherapy against paclitaxel-induced peripheral
neuropathy in a prospective self-controlled trial with multiple end points (e.g., objective,
subjective, and functional assessments).

Method - Breast cancer patients treated weekly with paclitaxel (80mg/m2 for one hour) wore
frozen gloves and socks on the dominant side for 90 minutes, including the entire duration of
drug infusion. Symptoms on the treated sides were compared with those on the untreated
(nondominant) sides. The primary end point was CIPN (chemotherapy induced peripheral
neuropathy) incidence assessed by changes in tactile sensitivity from pretreatment baseline in a
monofilament test at a cumulative dose of 960mg/m2.We also assessed thermosensory deficits,
subjective symptoms (Patient Neuropathy Questionnaire [PNQ]), manipulative dexterity, and the
time to events and hazard ratio by PNQ.

Conclusions: Cryotherapy is useful for preventing both the objective and subjective symptoms of
CIPN and resultant dysfunction.

ARTICLE 18

Effect of Heat, Cold, and Pressure on the Transverse Carpal Ligament and
Median Nerve: A Pilot Study
Authors - Michael LaymoN, Jerrold Petrofsky, James McKivigan, Haneul
Lee, JongEun Yim
Year – 2015

Objective - This study quantified the effects of heat, cold, and pressure on the
median nerve and transverse carpal ligament in subjects without carpal tunnel
syndrome.

Method - Subjects were individuals ages 20–50 who had no symptoms of carpal
tunnel disease. Imaging ultrasound was used to measure the clearance around the
median nerve, transverse ligament elasticity, nerve conduction velocity, thickness
of the carpal ligament, and area of the median nerve. Pressure was applied to the
carpal ligament to assess the effects of increasing pressure on these structures. On
3 separate days, 10 subjects had ThermaCare heat or cold packs applied, for either
60 or 120 minutes for heat or 20 minutes for cold, to the palmer surface of the
hand.

Result - Tissue changes were recorded as a response to pressure applied at 0, 5,

10, and 20 N. The size of the nerve and ligaments were not significantly altered by
pressure with the hand at room temperature and after cold exposure. After heat, the
nerve, ligaments, and tendons showed significantly more elasticity.
Application of cold to the hand may reduce compression of the carpal ligament and
nerve.