Reliability of the straight leg raise test for suspected lumbar radicular pain: A systematic review with meta-analysis

Prevalence of positive neural findings in patients attending outpatient physical therapy: an exploratory study

INTRODUCTION

Neurological testing is commonly used in outpatient physical therapy (PT) for patients with suspected neurological involvement. However, limited data exist on the prevalence of abnormal neurological findings in patients without a peripheral neuropathic pain (PNP) diagnosis. Understanding the frequency of these findings may help refine screening practices and improve patient care. This study aimed to determine the prevalence of abnormal neurological findings in patients attending PT without a clinical PNP diagnosis.

METHODS

This observational study included 104 adult patients attending PT for upper or lower quadrant pain. Each patient underwent a series of clinical neurologic tests (strength, sensation, and reflexes) and neurodynamic (ND) tests. Patients were categorized as having either a clinical PNP diagnosis or a non-PNP diagnosis based on physician and/or physical therapist assessment.

RESULTS

Of the participants, 22% had a clinical PNP diagnosis. Among those without a PNP diagnosis, clinical neurologic test abnormalities were common, with 50.6% exhibiting abnormal reflexes, 48.1% showing strength deficits, and 21% having sensory impairments. ND test abnormalities were less frequent in this group, with 18.5% experiencing symptom reproduction during testing.

DISCUSSION

These findings suggest that abnormal neurological test results are not exclusive to patients with a clinical PNP diagnosis. The high prevalence of clinical neurologic test abnormalities in patients without a PNP diagnosis raises questions about the sensitivity of current screening approaches.

CONCLUSION

Neurological abnormalities may be overlooked when screening is based solely on clinical diagnosis or reported symptoms. Expanding neurological testing to a broader patient population may enhance diagnostic accuracy and treatment planning. Further research is needed to determine the clinical significance of these findings and the potential benefits of routine neurological screening in outpatient PT.

Straight leg raise versus knee extension angle: which structure limits the test in asymptomatic subjects?

OBJECTIVES

This study aimed to determine if the first onset of symptoms (discomfort) during the straight leg raise (SLR) (hip flexion with an extended knee) and the Knee Extension Angle (KEA) tests (knee extension with 90°of hip flexion) results from nervous or muscular structures in asymptomatic individuals. The secondary objective was to investigate if the gender influences the structure related to the discomfort.

METHODS

This cross-sectional study consisted of a single assessment session during which the structure related to participants' discomfort during the KEA and SLR was identified. For this identification, a structural differentiation (SD) was conducted during both tests using passive mobilization of the cervicothoracic spine in flexion and extension. Changes in participants' discomfort were monitored during the SD to determine whether a change or lack of change was consistent with variations in the load applied to the suspected structures either muscular or neural. If the structure related to the participants' discomfort could not be identified, two additional tests were conducted: the lateral SLR and the Slump test.

RESULTS

One hundred and seventy-eight individuals were included. Median [IQR] age was 21 years [20;23], and 57.3% were female. The structure related to participants' discomfort was similar for the SLR and the KEA (p = 0.451): neural for 72.5% of participants in the SLR and 75.8% in the KEA. Gender only influenced the structure identified in the KEA test, with a significantly higher rate of nerve-related discomfort in females than males and a significantly higher rate of muscle-related discomfort in males (p = 0.002).

CONCLUSION

In asymptomatic individuals, the discomfort induced by the SLR and the KEA tests could be related to either muscular or neural structures. Therefore, structural differentiation is necessary to identify the structure causing the discomfort in both research and clinical practice.

Development of a comprehensive clinical assessment protocol for low back and hip pain in powerlifters: a feasibility study

BACKGROUND

Low back and hip pain problems are frequent in powerlifting. There is a lack of information on the specific pain phenotypes and specific impairments in body function associated with these pain problems, as well as how to reach a clinical diagnosis relevant for powerlifters' pain problems. Therefore, the aim was to develop a comprehensive clinical assessment protocol for pain and function in powerlifters with low back and/or hip pain and evaluate its feasibility for use in further epidemiological or clinical studies of powerlifters.

METHODS

The study was conducted in two phases. In phase one, the protocol was developed according to literature regarding musculoskeletal assessment and sports injuries, and in phase two, feasibility was evaluated. Eight powerlifters with low back/hip pain were included in phase two. Four of them were examined independently by two physical therapists, and the other four were examined by one of the physical therapists. The time spent on the examination, whether the physical therapists could reach a clinical diagnosis without adding items to the protocol, and whether the two physical therapists were consistent in terms of the clinical diagnosis, were evaluated.

RESULTS

The protocol was developed including subjective examination, physical examination, and a clinical diagnosis based mainly on signs and symptoms of associated neurophysiological pain mechanisms and the specific impairments in body functions associated with the powerlifter's pain problem. The protocol met the feasibility criteria. The examination lasted approximately 1 h, no items needed to be added, and both physical therapists were able to make a consistent clinical diagnosis. Visual observation and alteration of movement strategy of the squat/deadlift were thought to be crucial for assessing the powerlifters' pain problem.

CONCLUSIONS

This is the first comprehensive clinical assessment protocol developed to describe powerlifters' pain problems/injuries with a clinical diagnosis based on the dominating neurophysiological pain mechanism and impairments in body functions. However, before use in larger studies, it is recommended that the protocol be further evaluated by a larger number of physical therapists and powerlifters to evaluate its reliability and whether the content of the protocol should be further expanded.

The association of the STarT Back Screening Tool and type of leg pain with low back pain disability trajectories: a prospective cohort study

BACKGROUND

Multiple factors influence the recovery process of low back pain (LBP). The identification and increased knowledge of prognostic factors might contribute to a better understanding of the course of LBP. The purpose of this study is to investigate the association of the STarT Back Screening Tool (SBST) risk score and the type of leg pain (non-radiating LBP, referred non-radicular, and radicular radiating leg pain) with the disability trajectory (at baseline, the slope, and recovery at one year) in adults with low back pain.

METHODS

This is a prospective cohort study in 347 patients with low back pain who sought physiotherapy care at three primary care practices in the Netherlands. Linear mixed models were estimated to describe the association of the SBST risk score and the type of leg pain with disability at baseline, the slope in the disability trajectory, and at twelve months follow-up.

RESULTS

A medium/high risk score on the SBST is associated with higher baseline disability scores on the Oswestry Disability Index (ODI), faster initial recovery, and still a higher disability ODI score at 12 months follow-up. Non-radicular referred and radicular radiating leg pain were associated with worse baseline disability ODI scores in LBP. This association was not present for the initial recovery or at the 12 months follow-up.

CONCLUSION

The SBST is associated with the LBP recovery trajectory. The SBST might be a useful tool to predict the disability trajectory in a heterogeneous group of people with low back pain in primary care and might, therefore, be recommended in future clinical practice guidelines. The type of leg pain was not associated with the recovery trajectory of LBP. Future research might focus on evaluating different types of leg pain.

TRIAL REGISTRATION

Clinicaltrials.gov: 109,643.

In Vivo Effects of Joint Movement on Nerve Mechanical Properties Assessed with Shear-Wave Elastography: A Systematic Review and Meta-Analysis

Peripheral nerves are subjected to mechanical tension during limb movements and body postures. Nerve response to tensile stress can be assessed in vivo with shear-wave elastography (SWE). Greater tensile loads can lead to greater stiffness, which can be quantified using SWE. Therefore, this study aimed to conduct a systematic review and meta-analysis to perform an overview of the effect of joint movements on nerve mechanical properties in healthy nerves. The initial search (July 2023) yielded 501 records from six databases (PubMed, Embase, Scopus, Web of Science, Cochrane, and Science Direct). A total of 16 studies were included and assessed with a modified version of the Downs and Black checklist. Our results suggest an overall tendency for stiffness increase according to a pattern of neural tensioning. The main findings from the meta-analysis showed a significant increase in nerve stiffness for the median nerve with wrist extension (SMD [95%CI]: 3.16 [1.20, 5.12]), the ulnar nerve with elbow flexion (SMD [95%CI]: 2.91 [1.88, 3.95]), the sciatic nerve with ankle dorsiflexion (SMD [95%CI]: 1.13 [0.79, 1.47]), and the tibial nerve with both hip flexion (SMD [95%CI]: 2.14 [1.76, 2.51]) and ankle dorsiflexion (SMD [95%CI]: 1.52 [1.02, 2.02]). The effect of joint movement on nerve stiffness also depends on the nerve segment, the amount of movement of the joint mobilized, and the position of other joints comprised in the entirety of the nerve length. However, due to the limited number of studies, many aspects of nerve behavior together with the effect of using different ultrasound equipment or transducers for nerve stiffness evaluation still need to be fully investigated.