title: Short-term changes in median nerve neural tension after a suboccipital muscle inhibition technique in subjects with cervical whiplash: a randomised controlled trial.
abstract: OBJECTIVE
  To assess the immediate effect of a suboccipital muscle inhibition (SMI) technique on: (a) neck pain, (b) elbow extension range of motion during the upper limb neurodynamic test of the median nerve (ULNT-1), and (c) grip strength in subjects with cervical whiplash; and determine the relationships between key variables.
  
  
  METHODS
  Randomised, single-blind, controlled clinical trial.
  
  
  METHODS
  Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Spain.
  
  
  METHODS
  Forty subjects {mean age 34 years [standard deviation (SD) 3.6]} with Grade I or II cervical whiplash and a positive response to the ULNT-1 were recruited and distributed into two study groups: intervention group (IG) (n=20) and control group (CG) (n=20).
  
  
  METHODS
  The IG underwent the SMI technique for 4minutes and the CG received a sham (placebo) intervention. Measures were collected immediately after the intervention.
  
  
  METHODS
  The primary outcome was elbow range of motion during the ULNT-1, measured with a goniometer. The secondary outcomes were self-perceived neck pain (visual analogue scale) and free-pain grip strength, measured with a digital dynamometer.
  
  
  RESULTS
  The mean baseline elbow range of motion was 116.0° (SD 10.2) for the CG and 130.1° (SD 7.8) for the IG. The within-group comparison found a significant difference in elbow range of motion for the IG [mean difference -15.4°, 95% confidence interval (CI) -20.1 to -10.6; P=0.01], but not for the CG (mean difference -4.9°, 95% CI -11.8 to 2.0; P=0.15). In the between-group comparison, the difference in elbow range of motion was significant (mean difference -10.5°, 95% CI -18.6 to -2.3; P=0.013), but the differences in grip strength (P=0.06) and neck pain (P=0.38) were not significant.
  
  
  CONCLUSIONS
  The SMI technique has an immediate positive effect on elbow extension in the ULNT-1. No immediate effects on self-perceived cervical pain or grip strength were observed.
authors.affiliation: Madrid Osteopathic School, Madrid, Spain.
authors.forename: P J
authors.initials: PJ
authors.lastname: Antolinos-Campillo
authors.affiliation: Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Oliva-Pascual-Vaca
authors.affiliation: Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Rodríguez-Blanco
authors.affiliation: Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain. Electronic address: amheredia@us.es.
authors.forename: A M
authors.initials: AM
authors.lastname: Heredia-Rizo
authors.affiliation: Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain.
authors.forename: G V
authors.initials: GV
authors.lastname: Espí-López
authors.affiliation: Madrid Osteopathic School, Madrid, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Ricard
mesh_terms: D000293:Adolescent; D000328:Adult; D004551:Elbow Joint / Q000503:physiopathology; D005260:Female; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000503:physiopathology*; D008875:Middle Aged; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular / Q000502:physiology; D016037:Single-Blind Method; D014911:Whiplash Injuries / Q000503:physiopathology / Q000534:rehabilitation*
keywords: Manipulation, Spinal; Median nerve; Pain; Whiplash injuries