EFFECTS OF NEURAL MOBILIZATION IN POSTERIOR MYOFASCIAL CHAIN FLEXIBILITY IN NORMAL SUBJECTS

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Int J Physiot her Res 2015;3(4):1122-25. ISSN 2321-1822 1122

Original Article

EFFECTS OF NEURAL M OBILIZATION IN POSTERIOR M YOFASCIAL

CHAIN FLEXIBILITY IN NORM AL SUBJECTS

Stuti Sharma

1

_{, Shiv Kumar Verma}

2

_{, Vaibhav Agarwal}

3

_.

1 _{P.G. M .P.T (Neurology) Dept . of Physiot herapy, Swami Ram a Himalaya Universit y, Dehradun,}

Ut t arakhand, India.

2,* 3_{Lect urer, Dept . Of Physiot herapy, Swami Rama Himalaya Universit y, Dehradun, Uttarakhand,}

India.

Aim s and objectives:The aim of t his r esear ch is t o see t he eff ect iveness of neural m obilizat ion on post er ior m yofascial chain flexi bi lit y.

M et hodology:Sam ples of 70 subject s w ere recruit ed for t he st udy. Pre m obilizat ion readings for finger floor dist ance, t ibiot arsal angle and finger floor grades w ere t aken for each individual, aft er w hom slum p m obilizat ion w as given and post m obilizat ion readings w ere again t aken in t he sam e sequence af t er m obilizat ion.

Results:Bot h finger floor dist ance and grades w ere significant ly changed, w hile t ibiot arsal angle show ed no significant diff erence.

Discussion:Neural m obilizat ion t ries t o rest ore t he nervous syst em ’s m ovem ent and elast icit y, rehabilitat ing it s nor m al funct ionsby relieving t he t ensions in t he m uscular chains t hereby increasing it s flexibilit y.

Conclusion: This st udy concludes t hat neural m obilizat ion can im prove post erior myofascial chain flexibilit y.

KEY W ORDS: M yofascial Chain, Neural M obilizat ion, Slum p, Flexibilit y.

ABSTRACT

INTRODUCTION

Address for correspondence: Dr. Vaibhav Agrawal, PT., Lect urer, Depart ment of Physiot herapy, Swami Rama Himalaya Universit y, Dehradun, Uttarakhand- 248 016, India.

E-M ail: vaibhavagarw alphysio@yahoo.in

International Journal of Physiotherapy and Research, Int J Physiother Res 2015, Vol 3(4):1122-25. ISSN 2321-1822 DOI: ht t p:/ / dx.doi.org/10.16965/ ijpr.2015.140

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International Journal of Physiotherapy and Research

ISSN 2321- 1822

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DOI: 10.16965/ ijpr.2015.140

Received: 05-05-2015 Peer Review : 05-05-2015 Revised: None

Accept ed : 21-05-2015 Published (O): 11-08-2015 Published (P): 11-08-2015

The h um an po st u r e co m p r i ses o f f asci as, muscular chains, ligament s, and bone st ruct ure, w hich are int erconnect ed and const it ut es t he w hole body. Any alterat ions in each of t hese st ruct ures can cause a post ural disequilibrium not only in t he above prescribed zones, but also in t he muscular chains of t he individual, since som e init ial t ension can lead t o a ser ies of combined t ension [1].

This t ension in t he myofascial chains may cause or may be caused by t he improper mechanical

and physiological responses in t he ner vous syst em, leading t o changes in t he elast icit y and amplitude of movement s, according to But ler [2]. Whereas, flexibilit y is relat ed t o t he ext ensibilit y of m usculot endinous unit s t hat cross a joint , based on their ability t o relax or deform and yield t o a st ret ch force [3].

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St ut i Sharma et al. EFFECTS OF NEURAL M OBILIZATION IN POSTERIOR M YOFASCIAL CHAIN FLEXIBILITY IN NORM AL SUBJECTS.

The nervous syst em adapt s t o and mechanically cont rols movement in t w o w ays t hat invariably overlap:

1. By t he development of pressure or t ension w it hin t he syst em

2. By m ovem ent relat ive t o it s m echanical int erface [4]

Co nsid er in g t hat t h e ner v ous syst em is a cont inuous t issue t hat adapt s it self t o t he body movements, this adapt ability can be transmit ted t o t he w hole body syst em . Ther ef or e, any change t hat alt er s it s m or phology m ay be t r ansm it t ed t hr o ugh it and ev en r esu lt in dysf unct ions in m usculoskelet al st ruct ures w hich receive innervat ion [1].

Subst ant ial m obilit y in t he nervous syst em is n eed ed f o r an in d i vi d u al t o m o v e d u r i n g f un ct i on al act i v it ies. Th e n er v ou s syst em p o ssesses a n at u r al ab i li t y t o m o v e an d w it hst and mechanical forces that are generat ed by daily movement s. This capacit y is essent ial in t he prevent ion of injury and malfunct ion. The neural m obilizat ion causes t he ret urn of t he norm al funct ions since it is a t echnique t hat restores movement and elasticit y of t he nervous syst em [2].

Neur al m o bi lizat ion can be used f or bo t h evaluat ion and t reat ment purposes, w hen it is used in t he t reat ment ; it s main purpose is t o re est ablish t he dynamic equilibrium of t he neural t issues, normalizing it s physiologic funct ion [1]. The nervous syst em can be effect ively and safely mobilized, t he ult imat e aim of t reat ment is t o rest ore t he pat ient ’s range of nervous system m o vem ent & st r et ch cap ab i l it i es an d t o normalize t he sensit ivit y of t he syst em [5-11]. How ever, limited evidence exist s t o support t he effect iveness of using t he neural mobilizat ion as a t reat m ent approach and has only been present ed in t he form of case report s or case st ud i es. Becau se o f t h e sm all n um b er o f resear ches in t his field and considering t he relat ion bet w een neural connect ive t issue and underlying t issue, t he m ain object ive of t his r esear ch w as t o ev al u at e t he p ost er i o r m yof asci al ch ain ’s f l exi b i l it y af t er n eur al mobilizat ion.

M ETERIALS AND M ETHODS

st udy aft er t aking t he inform ed consent . Pre mobilizat ion readings for finger floor dist ance, t ibiot arsal angle and finger floor grades w ere t aken for each individual, after w hom slum p mobilizat ion w as given and readings w ere again taken in t he same sequence after mobilizat ion. Each part icipant w as given 1 minut e cont inuous sust ained st ret ch in slump posit ion.

Inclusion Criteria: Follow ing w as t he inclusion criteria for subjects- Age: 18 t o 30 years, Gender: females, Asympt omat ic individuals, Grade 1 t o 7 on finger floor t est .

Exclusion Criteria: Follow ing w as t he exclusion cr it er ia- The pr esence of any congenit al or acquired deformity of vertebral column, Syst emic disorders, Pregnancy, Piriformis syndrome, Any t raumat ic injury or surgery of spine, upper limb and low er limb, back pain.

Procedure

70 su b j ect s w er e scr eened based o n t h e inclusion & exclusion crit er ia. An infor m ed co nsen t w as o b t ai n ed f r o m each su b j ect part icipat ing in t his st udy & t he procedure w as explained t o t he part icipant s.

In t he first st ep, pre mobilizat ion readings of all t he part icipant s w it h goniomet er and inch t ape w ere taken, for t ibiotarsal angle & finger t o floor dist ance in t w o different posit ions. Aft er t hat 1 minut e slump st ret ching w as given & t hen post mobilizat ion readings w ere taken in t he same sequence & posit ioning. For measurement of t ibiot arsal angle, fibular head, lat eral malleolus & f if t h m et at arsal w ere t aken as reference poi nt s & m ar kin gs w er e d one acco r din gly [ 12,13] . Fo r m easu r em en t o f f i nger f l oo r dist ance, dist ance bet w een t he t ip of m iddle finger & floor w as measured [15].

Finger floor distance was taken in t w o posit ions, first w it h cervical column relaxed and t hen w it h cervical colum n bent t o increase t he neural t ension. The durat ion of t he procedure for each part icipant w as 10 minut es

A sample of 70 subject s w as recruit ed for t he

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St ut i Sharma, et al. EFFECTS OF NEURAL M OBILIZATION IN POSTERIOR M YOFASCIAL CHAIN FLEXIBILITY IN NORM AL SUBJECTS.

Fig. 2: Inch tape used for t he st udy.

Data Analysis: In order t o compare variables betw een tw o periods (pre and post mobilization) paired t t est w as used in which mean & standard deviat ion (M ean±S.D) of t he variables w ere calculat ed. The significant level is p<0.05.

Graph 1: Com par ison of m ean st andard deviat ion of pre and post int ervent ion f or FFD1.

Graph 2: Com parison of m ean st andar d deviat ion of pre and post int er vent ion f or FFD2.

Graph3 : Com parison of m ean st andard deviat ion of pre and post int ervent ion for TTA

Graph 4: Com par ison of m ean st andard deviat ion of pre and post int ervent ion for GRADE.

DISCUSSION

The result obt ained t hrough our result reveals t hat neural mobilizat ion can significant ly affect myofascial chain flexibilit y. In our st udy slump st ret ching is used for neural mobilizat ion as an i nt er ven t i on and pr e & p ost m o bi l izat io n measurement s are recorded. When comparing t he values, show ing pre and post mobilizat ion FFD1, t he mean FFD1 w as found t o be in low er values aft er m obilizat ion t hus show ing t hat incr eased t en sion has im pr oved f lexibil it y t hereby reducing t he dist ance.

In case of FFD2, t he cervical spine was kept bent w hich furt her increased t he neural t ension and im proved flexibilit y, hence show ing reduced values aft er mobilizat ion. Int erpret at ion of t he finger floor dist ance w as done using a grade syst em , w hich dem onst r at ed incr em ent in gr ades aft er m obilizat ion, t hereby show ing improvement in t he flexibilit y.

The st at ist ic m odif icat ions of FFD1 & FFD2 present ed in t his st udy aft er neurodynamic self mobilizat ion suggest t hat t here is a conversely proport ional relat ion bet w een neural t ension and posterior myofascial chain flexibilit y. The result s are also consist ent w it h t he assert at ions of But ler w ho see neur al m obilizat ion as a t herapeut ic t echnique f or t he t reat m ent of n er v o u s sy st em d y sf u n ct i o n s as w el l as dysfunct ions in t he t issues innervat ed by it [2].

The only variable w hich show ed no significant difference was TTA, t he mean has found t o be stat ic, pre & post mobilization, which show s t hat t here w as no significant change in angle. Thus t hr ough ou r r esult w e can say t hat slum p st retching has no significant effect on TTA.

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St ut i Sharma et al. EFFECTS OF NEURAL M OBILIZATION IN POSTERIOR M YOFASCIAL CHAIN FLEXIBILITY IN NORM AL SUBJECTS.

w it h ot her convent ional or new approaches.

Limitation of study: Single t ime int ervent ion and no comparison w ith other t echnique are the limitat ions of t he st udy.

CONCLUSION

Ther e w er e si gn i f i can t ch anges i n all t h e

variables post mobilizat ion show ing improved

flexibilit y. Therefore neural mobilizat ion is an

im port ant t echnique t o effect ively elongat e myofascial st ruct ures.

Clinical im plicat ion: Neur al m obilizat ion is found t o be effect ive in improving myofascial

flexibilit y. So t his technique should be used t o

opt imize flexibilit y and act ivit ies of daily living.

Conflicts of interest: None

REFERENCES

Acknow ledgement

We are very t hankful t o our deput y dean Dr. Anuradha Kusum and HOD of Physiot herapy Dept . Dr. Raj esh M ah eshw ar i for valuab le guidance, w e are also t hankful t o t he et hical commit t ee for approval of our research. Last but not least , w e are also deeply t hankful t o our all subject s w ho part icipated in t his st udy.

[4] . Kornberg C, Lew P. The effect of st ret ching neural st r u ct ur es o n gr ad e on e ham st r in g in ju r i es. J Ort hop Sport s Phys Ther. 1989;10(12):481-7. [ 5] . Sh ack l o ck M . Ad v an ce s i n d i agn o si s w i t h

neurodynam ic (neural t ension t est s), ISBN 0 7506 5456 2 Ort ho Div Neur obiologia. 2005;34-40. [6] . Kendall et al. M uscles, t est ing and funct ion, w it h

post ure and pain, Philadelphia, 2005

[7] . Vleem ing et al, The post erior layer of t he t hor aco lum bar fascia, it s funct ion in load t ransfer fr om spine t o legs,1995;20(7):753-758.

[8] . Jerem y Walsh et al. Slum p t est : Sensory responses in asym pt om at ic subject s. 2007;15 (4):231-238. [9]. Cleland, Joshua A., John D. Childs, Jessica A. Palm er,

an d Sar ah Eb er h ar t . Sl u m p st r et ch i n g i n t h e m anagement of non-radicular low back pain: a pilot clinical t rial. M anual t herapy 2006;11(4):279-286. [10]. Geoffrey D. M ait land, Slum p Test : Exam inat ion and t reat m ent, The Aust ralian journal of physiot herapy, 1986;31(6):215.

[11]. M assey A. The slum p t est : an invest igat ion of t he m o vem ent of p ai n sen si t i ve st r u ct ur es in t he ver t ebr al canal in subject s w it h low back pain. Dissert at ion present ed in part ial f ulfillm ent of t he Gr ad uat e Di pl o m a i n Advanced M ani p ul at ive Therapy, Sout h Aust ralian Inst it ut e of Technology 1982.

[12]. Sacco, I. C. N., S. Alibert , B. W. C. Queiroz, D. Pripas, I. Kieling, A. A. Kim ura, A. E. Sellm er, R. A. M alvest io, and M . T. Sera. Reliabilit y of phot ogram m et ry in r elat ion t o goniom et ry f or post ur al low er lim b assessm ent . Brazilian Journal of Physical Ther apy 2007;11(5): 411-417.

[13]. Kippers, Vaughan, and Anthony W. Parker. Toe-touch t est a m easure of it s validit y. Physical Therapy. 1987;67(11):1680-1684.

[14]. Sullivan M S. The relat ionship of lum bar flexion t o disabilit y in pat ient s w it h low back pain, Physical t herapy, 2000;80:240-250.

[15]. Ekedahl H. Finger t o floor t est and St raight leg raise t est , Validit y responsiveness and predict ive value pat i en t s w it h acu t e/ su bacu t e lo w back p ai n, 2012;93(12):2210-2215.

[1] . Diniz KT, M ironda RM , Ribeiro CD, Vasconcelos DA, FilhoJEC . Neural m obilizat ion Effect s in post er ior m yofascial chain flexibilit y and in head post ur e. Neurobiologia 2010; 73(3): 53-57.

[2] . But ler DS. The Sensit ive nervous syst em , ISBN 0-646-40251-X Aust r alia: Noi group of publicat ions, 2000

[3] . Carolyn Kisner and Colby. 5t h_{edit ion St retching for}

im paired m obi lit y, 2007;66-67.

How to cite this article

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St ut i Sharma, Shiv Kumar Verma, Vaibhav Agarwal. EFFECTS OF NEURAL