The Preventive Effects of Neurodynamic Mobilisation

The Preventive Effects of Neurodynamic Mobilization on Delayed Onset Muscle Soreness: A Randomized, Placebo Controlled Trial

The aim of this study was to investigate the effects of neurodynamic mobilization (NM) technique on muscle damage and inflammation biomarkers, and pain, pressure pain threshold, range of motion (ROM), muscle strength, and functional status in delayed onset muscle soreness (DOMS). In the study, 32 healthy sedentary male volunteers were randomly divided into two groups as NM (n = 16) and placebo-NM (n = 16). After the initial evaluation of the individuals, femoral nerve NM and placebo NM techniques were administered three sets a day with ten repetitions for three days a week for three weeks. Three days after the end of the applications, the second evaluations were made and the DOMS creation protocol for the quadriceps femoris (QF) muscle was initiated. In order to trigger DOMS in individuals, 30 sets and 10 repetitions of eccentric knee extension (35°-95° flexion angles, 30°/sec speed) were performed on the dominant lower extremity with an isokinetic dynamometer. Baseline evaluations were repeated immediately after the DOMS protocol, and at hours 24, 48, and 72. During evaluations, muscle damage (serum creatine kinase (CK), lactate dehydrogenase (LDH), myoglobin, aspartate aminotransferase (AST), and alanine aminotransferase) and inflammation (interleukin-6 (IL-6), interleukin-10, interleukin-1 beta, tumor necrosis factor-alpha, and C reactive protein) biomarkers, pain (activity), pressure pain threshold, ROM, muscle strength (QF, hamstring eccentric/concentric) and performance (one-leg jump, vertical jump) parameters were measured.

The aim of this study was to investigate the effects of neurodynamic mobilization (NM) technique on muscle damage and inflammation biomarkers, and pain, pressure pain threshold, range of motion (ROM), muscle strength, and functional status in delayed onset muscle soreness (DOMS). In the study, 32 healthy sedentary male volunteers were randomly divided into two groups as NM (n = 16) and placebo-NM (n = 16). After the initial evaluation of the individuals, femoral nerve NM and placebo NM techniques were administered three sets a day with ten repetitions for three days a week for three weeks. Three days after the end of the applications, the second evaluations were made and the DOMS creation protocol for the quadriceps femoris (QF) muscle was initiated. In order to trigger DOMS in individuals, 30 sets and 10 repetitions of eccentric knee extension (35°-95° flexion angles, 30°/sec speed) were performed on the dominant lower extremity with an isokinetic dynamometer. Baseline evaluations were repeated immediately after the DOMS protocol, and at hours 24, 48, and 72. During evaluations, muscle damage (serum creatine kinase (CK), lactate dehydrogenase (LDH), myoglobin, aspartate aminotransferase (AST), and alanine aminotransferase) and inflammation (interleukin-6 (IL-6), interleukin-10, interleukin-1 beta, tumor necrosis factor-alpha, biomarkers, pain (activity), pressure pain threshold, ROM, muscle strength (QF, hamstring eccentric/concentric) and performance (one-leg jump, vertical jump) parameters were measured.

Femoral nerve neurodynamic mobilization group T1: Baseline measurements were made and blood samples were taken for biochemical analysis. NM and placebo NM techniques were applied for three weeks, three times a week, and totaling nine visits. At the end of the third week, it was waited 3 days to eliminate the acute effect of NM. T2: Baseline measurements and blood samples were repeated a second time. The protocol for establishing the DOMS was applied on the same day. T3: Following the protocol for inducing the DOMS, the baseline measurements were repeated for the third time without any interruption, and the blood sample was taken. T4-T5-T6: The first measurements and blood sample collections were repeated for the fourth, fifth and sixth times, respectively, 24h, 48h, 72h after the DOMS protocol.

Femoral nerve placebo neurodynamic mobilization group T1: Baseline measurements were made and blood samples were taken for biochemical analysis. NM and placebo NM techniques were applied for three weeks, three times a week, and totaling nine visits. At the end of the third week, it was waited 3 days to eliminate the acute effect of NM. T2: Baseline measurements and blood samples were repeated a second time. The protocol for establishing the DOMS was applied on the same day. T3: Following the protocol for inducing the DOMS, the baseline measurements were repeated for the third time without any interruption, and the blood sample was taken. T4-T5-T6: The first measurements and blood sample collections were repeated for the fourth, fifth and sixth times, respectively, 24h, 48h, 72h after the DOMS protocol.

The mobilization was carried out with the patient lying on the non-dominant side in a total flexion position, and the therapist performed the hip extension movement with the knee joint kept in flexion till the patient felt soreness or pain. This position was held for three seconds and then released. This tensioning maneuver was repeated in three sets of ten repetitions at each session and an interval of 2 min between series were performed. A total of nine sessions were performed within three weeks.

The individual was asked to lie on his non-dominant side and keep his head in the midline. In this position, while the pelvis was stabilized, the upper leg, which was in full knee extension, was grasped and the hip was abducted for 3 seconds. This maneuver was repeated in three sets of ten repetitions at each session and an interval of 2 min between series were performed. A total of nine sessions were performed within three weeks.

Muscle soreness was assessed using a 100 mm visual analog scale (0 = no soreness, 10 = excruciatingly painful). Each subject walked down 10 steps of stairs and asked to indicate the soreness level on the line. The marked point was measured with a ruler and recorded in millimeters.

Creatine kinase (U/L) was assessed using an enzyme-linked immunoassay as per the manufacturer's protocol (Beckman Coulter, Inc., CA, U.S.A.).

Lactate dehydrogenase (U/L) was assessed using an enzyme-linked immunoassay as per the manufacturer's protocol (Beckman Coulter, Inc., CA, U.S.A.).

Aspartate aminotransferase (U/L) was assessed using an enzyme-linked immunoassay as per the manufacturer's protocol (Beckman Coulter, Inc., CA, U.S.A.).

Alanine transaminase (U/L) were assessed using an enzyme-linked immunoassay as per the manufacturer's protocol (Beckman Coulter, Inc., CA, U.S.A.).

Myoglobin was assessed using an enzyme-linked immunoassay test (minimum detectable concentration: 21ng/ml; Detection range: 21-3.000 ng/ml) following the manufacturer's recommendations (Cobas, 6000, Roche, Germany).

Tumor necrosis factor-alfa (pg/ml), was assessed using a sandwich enzyme linked immunoassay test as per the manufacturer's protocol.

Human interleukin-6 ((pg/ml)), was assessed using a sandwich enzyme linked immunoassay test as per the manufacturer's protocol.

Human interleukin-10 (IL-10) was assessed using a sandwich enzyme linked immunoassay test as per the manufacturer's protocol.

Human interleukin-1β (pg/ml) was assessed using a sandwich enzyme linked immunoassay test as per the manufacturer's protocol.

The pressure pain threshold ((N/cm2) ) was measured using a digital pressure algometer (JTECH Medical Industries, Salt Lake City, US) at the midpoint of quadriceps femoris muscle and the other at 5 cm above the superior pole of the patella (representing the musculotendinous junction). The average value of three trials was used in the analysis. PPT measurements were found to have acceptable intra and inter-observer reliability (ICC 0.7).

The active knee flexion range of motion (°) was measured using a digital goniometer (Baseline number: 12-1057). To measure the knee ROM, the axis of the digital goniometer was attached to the lateral joint space of the knee; the fixed arm was placed in the middle of the femur, between the greater trochanter and the lateral joint space of the knee; and the moving arm was lined up with the lateral malleolus of the fibula. After the measurement, the angle of goniometer was reset to zero and the trial was repeated two times. This method for assessing ROM has been validated previously (ICC: 0.98).

Quadriceps femoris muscle strength (Nm) was measured in the eccentric phase with an isokinetic dynamometer (Cybex Humac Norm Testing and Rehabilitation System, CSMI, USA) (ICC: 0,90). During the measurement, the patient's chest, abdomen, thigh, and ankles were fixed with a strap, and the dynamometer rotation axis was aligned with the knee joint axis. Peak torque values were adjusted to create flexion and extension movements between 35-95° and angular velocities of 30°/sec. Then, in order to warm up the individuals and ensure their adaptation to the test, 3 trials were made at the same speed and angle before the test, and after a 30-second rest period, the test was started. Individuals were asked to perform five maximum repetitions at an angular velocity of 30°/sec, and the highest values were recorded as the peak torque value by the dynamometer.

In the one leg hop test (cm), participants required to stand on one leg to be tested, to jump off and to land on that leg without losing balance. Three hops (with 60 sec rest between hops) were performed and the distance hopped was measured with a standard tape measure. Mean value of distance was recorded as centimeter.

Inclusion Criteria: Being in the age range of 20-32 years. Being male (Because gender difference in the magnitude of eccentric exercise-induced muscle damage might exist as shown in previous studies, only men were recruited in the present study.) Being inactive according to activity guidelines published by the American College of Sports Medicine (less than 30 minutes of moderate physical activity as five times a week). Exclusion Criteria: Absence of DOMS symptoms, History of vascular disease, Recent injury or surgery to their lower extremity, Neurological impairments and regular use of pain and inflammation medications.