The impact of neurodynamic testing on the perception of experimentally induced muscle pain

An experimental pain model to investigate the specificity of the neurodynamic test for the median nerve in the differential diagnosis of hand symptoms

OBJECTIVE

To indirectly assess the specificity of the neurodynamic test for the median nerve using an experimental pain model.

DESIGN

Repeated-measures design.

SETTING

Laboratory setting.

PARTICIPANTS

Twenty asymptomatic participants in whom hand symptoms were induced by infusion of hypertonic saline into the thenar muscles.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Pain intensity of the induced hand symptoms and size of the painful area were evaluated in 8 different arm positions, which correspond with different stages of the neurodynamic test for the median nerve. These positions have a variable degree of median nerve provocation at the wrist.

RESULTS

Because the induced symptoms had a non-neural origin, changes in symptom provocation with the neurodynamic test would have indicated poor specificity. However, there were no statistically significant differences in pain perception (P> or =.22) and the recorded differences were negligible from a clinical perspective.

CONCLUSIONS

Taking into consideration the limitations of an experimental pain model, this study indirectly confirms the specificity of the neurodynamic test for the median nerve. The results of this study, together with previous studies that demonstrated a high sensitivity, support the use of the neurodynamic test for the median nerve to differentially diagnose neurogenic disorders, such as carpal tunnel syndrome, from other wrist and hand pathologies.

Return to work after two years of total disability: a case report

BACKGROUND

Little is specifically written regarding the details of clinical interventions with workers with chronic spinal pain. Specifically, the individual thought process behind the management of an injured worker is not often discussed except in clinical conferences or discussions with other clinicians. It is well known that once an injured worker is disabled from work for 2 years, successful return is unlikely. We thought it would be informative to illustrate the clinical approach we took with this case because of the history of long term pain and disability.

METHODS

This paper describes the conservative management of a patient who was disabled from work for 2 years, using an integrated approach including chiropractic manipulation, pain education, restricted duty and clear communications among all parties involved.

RESULTS

After 15 weeks, the patient returned to her previous occupation as a nurse, first part time, and subsequently full time.

CONCLUSION

This report is provided to illustrate a systematic approach diagnosis and treatment to assist this injured workers return to work. This case illustrates that even after 2 years successful return to work can be achieved.

Slump stretching in the management of non-radicular low back pain: a pilot clinical trial

The purpose of this study was to determine if slump stretching results in improvements in pain, centralization of symptoms, and disability in patients with non-radicular low back pain (LBP) with likely mild to moderate neural mechanosensitivity. Thirty consecutive patients referred to physical therapy by their primary care physician for LBP who met all eligibility criteria including a positive slump test but who had a negative straight-leg-raise test (SLR) agreed to participate in the study. All patients completed several self-report measures including a body diagram, numeric pain rating scale (NPRS), and the modified Oswestry Disability Index (ODI). Patients were randomized to receive lumbar spine mobilization and exercise (n = 14) or lumbar spine mobilization, exercise, and slump stretching (n = 16). All patients were treated in physical therapy twice weekly for 3 weeks for a total of 6 visits. Upon discharge, outcome measures were re-assessed. Independent t-tests were used to assess differences between groups at baseline and discharge. No baseline differences existed between the groups (P > .05). At discharge, patients who received slump stretching demonstrated significantly greater improvements in disability (9.7 points on the ODI, P < .001), pain (.93 points on the NPRS, P = .001), and centralization of symptoms (P < .01) than patients who did not. The results suggest that slump stretching is beneficial for improving short-term disability, pain, and centralization of symptoms. Future studies should examine whether these benefits are maintained at a longer-term follow-up.