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Reid H.L.1, Nelson A.1, Hill N.1, Rubotham J.1
1University of Nottingham, Division of Physiotherapy and Rehabilitation Sciences, Nottingham, United Kingdom
Background: Hamstring strain represents 17% of all injuries. Managing the problem has shown to be a challenge, with one third of injuries likely to reoccur. There does not seem to be a consensus within both clinical practice and the evidence base on the most effective clinical management. One proposed cause of hamstring injury is increased sensitivity of neural tissue. Recent research has reported two interventions that have been shown to positively influence the sensitivity of nerves in the posterior chain. Szlezak et al. (2011) reported an immediate increase in straight leg raise (SLR) after unilateral postero anterior mobilisations (UPALM) when applied to the lumbar spine. Ganesh et al. (2015) reported these same effects lasted 24 hours post intervention. Castellote-Caballero et al. (2014) reported an immediate increase in SLR following a tibial neurodynamic sliding technique (TNDS).
Purpose: It is not yet known which intervention (UPALM and/or TNDS) is more effective and whether any carryover effect lasts longer than 24 hours post intervention.
Aim: To investigate whether grade III ipsilateral UPALM delivered at the rate of 1.5Hz , and/ or a TNDS produced an immediate and longer term increase in SLR measurement of the same participant's dominant leg .
Aim: To investigate whether grade III ipsilateral UPALM delivered at the rate of 1.5Hz , and/ or a TNDS produced an immediate and longer term increase in SLR measurement of the same participant's dominant leg .
Methods: This was a single blind randomised controlled pilot study with a crossover design. Healthy participants (n=15) aged 18-40 were randomly assigned to receive either a UPALM intervention, TNDS intervention, or both (UPALM+TNDS) interventions to their dominant side. SLR measurements were taken pre and post interventions. Following seven days, participants returned to have an alternative intervention and their SLR measurement was taken again for the results to be analysed and compared. This procedure was repeated until each participant had received all three interventions. Participants returned on a fourth occasion to have a final measure of SLR. Blinding of both the therapist (intervention) and researcher (measuring SLR) was maintained throughout.
Results: Using the paired T test, the results immediate post- intervention were significant in all conditions, the UPALM intervention (+4.54 degrees, p= 0.002) and TNDS intervention (+5.00 degrees, P=0.000) and UPALM+TNDS (+4.77 degrees p=0.001). However, there was no statistical significant difference (p=0.629) between the mean average change in SLR measurements following each intervention. In terms of carryover, a positive accumulation effect of the interventions was descriptively noted and baseline SLR continued to increase week by week. The average difference between week one and week four was +7.59°. A repeated measures ANOVA identified that there was no significant difference (p=0.59) in each weekly baseline SLR (pre intervention measure).
Conclusion(s): This study found a statistical difference (immediate increase) in SLR for all three conditions with no difference between groups. This suggests that one was no more effective than the other. The descriptive trend related to accumulative increase in SLR merits further investigation.
Implications: This was an unpowered pilot study therefore findings are not conclusive requiring further research in the area.
Funding acknowledgements: None
Topic: Musculoskeletal: lower limb
Ethics approval: This study was approved by the Medical School Ethics Committee, The University of Nottingham, UK
All authors, affiliations and abstracts have been published as submitted.
