Aberrant protective force generation during neural provocation testing and the effect of treatment in patients with neurogenic cervicobrachial pain.
BACKGROUND
Observation of the occurrence of protective muscle activity is advocated in assessment of the peripheral nervous system by means of neural provocation tests. However, no studies have yet demonstrated abnormal force generation in a patient population.


OBJECTIVE
To analyze whether aberrations in shoulder girdle-elevation force during neural tissue provocation testing for the median nerve (NTPT1) can be demonstrated, and whether possible aberrations can be normalized following cervical mobilization.


METHODS
A single-blind randomized comparative controlled study.


METHODS
Laboratory setting annex in a manual therapy teaching practice.


METHODS
Twenty patients with unilateral or bilateral neurogenic cervicobrachial pain.


METHODS
During the NTPT1, we used a load cell and electrogoniometer to record continuously the shoulder-girdle elevation force in relation to the available range of elbow extension. Following randomization, we analyzed the immediate treatment effects of a cervical contralateral lateral glide mobilization technique (experimental group) and therapeutic ultrasound (control group).


RESULTS
On the involved side, the shoulder-girdle elevation force occurred earlier, and the amount of force at the end of the test was substantially, though not significantly, greater than that on the uninvolved side at the corresponding range of motion. Together with a significant reduction in pain perception after cervical mobilization, a clear tendency toward normalization of the force curve could be observed, namely, a significant decrease in force generation and a delayed onset. The control group demonstrated no differences.


CONCLUSIONS
Aberrations in force generation during neural provocation testing are present in patients with neurogenic pain and can be normalized with appropriate treatment modalities.
Coppieters
Michel W
MW
Department of Rehabilitation Sciences, Faculty of Physical Education and Physiotherapy, University of Leuven, Heverlee, Belgium. michel.coppieters@flok.kuleuven.ac.be
Stappaerts
Karel H
KH
Wouters
Leo L
LL
Janssens
Koen
K
D000328:Adult; D020968:Brachial Plexus Neuritis / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D026882:Manipulation, Chiropractic / Q000379:methods*; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D017288:Pain Threshold; D016059:Range of Motion, Articular; D012720:Severity of Illness Index; D012785:Shoulder Joint / Q000503:physiopathology; D016037:Single-Blind Method