• Straight leg raise test
• hamstring muscles
• knee extension angle test
• mechanosensitivity
• range of motion articular
• structural differentiation

• lumbosacral
• musculoskeletal
• radiculopathy

• Humans
• Radiculopathy/diagnosis
• Radiculopathy/physiopathology
• Diagnosis, Differential
• Lumbosacral Region/physiopathology
• Musculoskeletal Diseases/physiopathology
• Musculoskeletal Diseases/diagnosis
• Electromyography
• Magnetic Resonance Imaging

• Cadaveric study
• Femoral nerve stretch test
• L4 nerve root
• Straight leg raising test

• Humans
• Spinal Nerve Roots
• Lumbar Vertebrae
• Cadaver
• Male
• Aged
• Femoral Nerve
• Female
• Range of Motion, Articular/physiology
• Middle Aged
• Radiculopathy/physiopathology
• Aged, 80 and over

• electromyography
• kinematic
• low back pain
• radiculopathy

• Intervertebral Space Height
• Nerve Root
• Posterior Lumbar Interbody Fusion
• Tension

• flexibility
• hamstrings
• neurodynamics
• stretching

• Carpal Tunnel Syndrome
• Diacutaneous Fibrolysis
• physical therapy modalities
• ultrasonography

• Adult
• Aged
• Carpal Tunnel Syndrome/therapy
• Humans
• Hypesthesia
• Median Nerve/diagnostic imaging
• Ultrasonography
• Wrist

Epidural fibrosis is a common cause of pain after lumbar surgeries. There are no previous reports documenting profound limb weakness associated with epidural fibrosis. A 43-year-old woman uneventfully underwent microscopic discectomy. However, six additional surgeries were needed due to recurrent pain and weakness episodes, several days after the surgery. Operative findings were severe epidural fibrosis around the thecal sac and nerve roots. Epidural fibrosis excision did not prevent recurrent fibrosis; therefore, we performed a lordotic fusion with posterior column shortening to reduce neural tension and nerve-root stretching. Eventually, she became free from recurrent episodes of deteriorations and repetitive surgeries.

• Arachnoiditis
• Nerve
• Radiculopathy
• Root
• Thrombosis
• Varices
• Vasa-nervorum
• Vein
• Vena cava
• Venous

• Tibial nerve
• leg dominance
• sensory response
• sex

• RealSpine
• discectomy
• learning curve
• nerve root manipulation
• surgical skills
• surgical training

• Biomechanics
• Diagnosis
• Hamstrings
• Tibial nerve

• Leg dominance
• Sensory response
• Sex
• Stretching

• Adult
• Cross-Sectional Studies
• Female
• Humans
• Male
• Neurologic Examination/methods
• Peroneal Nerve/physiology
• Range of Motion, Articular
• Reference Values
• Reproducibility of Results

• Calcium imaging
• Nerve damage
• Patch clamping
• Peripheral nerve
• Uniaxial strain

• Bowstring disease
• Disc degeneration
• Low back pain
• Nerve stretch
• Scoliosis

• Humans
• Intervertebral Disc Degeneration/etiology
• Intervertebral Disc Displacement/etiology
• Low Back Pain/etiology
• Lumbar Vertebrae/surgery
• Nerve Compression Syndromes/diagnosis
• Nerve Compression Syndromes/etiology
• Nerve Compression Syndromes/surgery
• Scoliosis/etiology
• Spinal Cord Compression/diagnosis
• Spinal Cord Compression/etiology
• Spinal Cord Compression/surgery
• Spinal Nerve Roots/physiopathology

• Disability
• Lumbar disc herniation
• Percutaneous laser disc decompression

• Anatomy
• Herniated disc
• Lasegue’s test
• Movement nerve roots
• Straight leg raising

• Carpal tunnel syndrome
• Compression
• Manual therapy
• Median nerve

• peripheral nerve
• peripheral nerve biomechanics
• sciatic nerve
• sciatic nerve displacement
• shear strain
• ultrasound elastography

• Adult
• Cross-Sectional Studies
• Elasticity Imaging Techniques/methods
• Feasibility Studies
• Female
• Humans
• Knee Joint/diagnostic imaging
• Knee Joint/physiology
• Male
• Muscle Contraction/physiology
• Range of Motion, Articular/physiology
• Reference Values
• Reproducibility of Results
• Sciatic Nerve/diagnostic imaging
• Sciatic Nerve/physiology
• Young Adult

• complications
• corticosteroid
• dexamethasone
• epidural
• safe use

• Hamstring stretching
• Nerve mobilization
• Radicular lower back pain

• Chronic pain
• DRG
• cylindrical lead
• delivery sheath
• implantation technique

• SLR; straight leg raise; nerve root; sciatica; radiculopathy; spinal cord
• diagnostic imaging
• muscle
• nerve
• novel and functional imaging

• gabapentin
• lumbar spinal stenosis
• nasal calcitonin
• outcome

• Adolescent
• Adult
• Aged
• Bandages
• Combined Modality Therapy
• Female
• Humans
• Intervertebral Disc Displacement/therapy
• Lumbar Vertebrae
• Magnetics/therapeutic use
• Male
• Middle Aged
• Phytotherapy

Normal displacement of the conus medullaris with unilateral and bilateral SLR has been quantified and the "principle of linear dependence" has been described.

Explore whether previously recorded movements of conus medullaris with SLRs are i) primarily due to transmission of tensile forces transmitted through the neural tissues during SLR or ii) the result of reciprocal movements between vertebrae and nerves.

Controlled radiologic study.

Ten asymptomatic volunteers were scanned with a 1.5T magnetic resonance (MR) scanner using T2 weighted spc 3D scanning sequences and a device that permits greater ranges of SLR. Displacement of the conus medullaris during the unilateral and sham SLR was quantified reliably with a randomized procedure. Conus displacement in response to unilateral and sham SLRs was quantified and the results compared.

The conus displaced caudally in the spinal canal by 3.54±0.87 mm (mean±SD) with unilateral (p≤.001) and proximally by 0.32±1.6 mm with sham SLR (p≤.542). Pearson correlations were higher than 0.99 for both intra- and inter-observer reliability and the observed power was 1 for unilateral SLRs and 0.054 and 0.149 for left and right sham SLR respectively.

Four relevant points emerge from the presented data: i) reciprocal movements between the spinal cord and the surrounding vertebrae are likely to occur during SLR in asymptomatic subjects, ii) conus medullaris displacement in the vertebral canal with SLR is primarily due to transmission of tensile forces through the neural tissues, iii) when tensile forces are transmitted through the neural system as in the clinical SLR, the magnitude of conus medullaris displacement prevails over the amount of bone adjustment.

• Adult
• Female
• Hip/diagnostic imaging
• Hip/physiopathology
• Humans
• Knee/diagnostic imaging
• Knee/physiopathology
• Leg/diagnostic imaging
• Leg/physiopathology
• Lumbar Vertebrae/diagnostic imaging
• Lumbar Vertebrae/physiopathology
• Magnetic Resonance Imaging
• Male
• Movement/physiology
• Pelvis/diagnostic imaging
• Pelvis/physiopathology
• Spinal Cord/diagnostic imaging
• Spinal Cord/physiopathology
• Spinal Cord Diseases/diagnostic imaging
• Spinal Cord Diseases/physiopathology
• Spinal Nerves/diagnostic imaging
• Spinal Nerves/physiopathology
• Thoracic Vertebrae/diagnostic imaging
• Thoracic Vertebrae/physiopathology

• Wellcome Trust
• Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding (project 5960441, Kuopio, Finland).

Research has established that the amount of inherent tension a peripheral nerve tract is exposed to influences nerve excursion and joint range of movement (ROM). The effect that spinal posture has on sciatic nerve excursion during neural mobilisation exercises has yet to be determined. The purpose of this research was to examine the influence of different sitting positions (slump-sitting versus upright-sitting) on the amount of longitudinal sciatic nerve movement during different neural mobilisation exercises commonly used in clinical practice.

High-resolution ultrasound imaging followed by frame-by-frame cross-correlation analysis was used to assess sciatic nerve excursion. Thirty-four healthy participants each performed three different neural mobilisation exercises in slump-sitting and upright-sitting. Means comparisons were used to examine the influence of sitting position on sciatic nerve excursion for the three mobilisation exercises. Linear regression analysis was used to determine whether any of the demographic data represented predictive variables for longitudinal sciatic nerve excursion.

There was no significant difference in sciatic nerve excursion (across all neural mobilisation exercises) observed between upright-sitting and slump-sitting positions (P = 0.26). Although greater body mass index, greater knee ROM and younger age were associated with higher levels of sciatic nerve excursion, this model of variables offered weak predictability (R² = 0.22).

Following this study, there is no evidence that, in healthy people, longitudinal sciatic nerve excursion differs significantly with regards to the spinal posture (slump-sitting and upright-sitting). Furthermore, although some demographic variables are weak predictors, the high variance suggests that there are other unknown variables that may predict sciatic nerve excursion. It can be inferred from this research that clinicians can individualise the design of seated neural mobilisation exercises, using different seated positions, based upon patient comfort and minimisation of neural mechanosensitivity with the knowledge that sciatic nerve excursion will not be significantly influenced.

• Neural mobilisation
• Neurodynamics
• Peripheral nervous system
• Physical therapy
• Physiotherapy
• Sciatic nerve
• Ultrasonography
• Ultrasound imaging

Previous studies in humans have reported that the dimensions of the intervertebral foramina change significantly with movement of the spine. Cervical spondylomyelopathy (CSM) in dogs is characterized by dynamic and static compressions of the neural components, leading to variable degrees of neurologic deficits and neck pain. Studies suggest that intervertebral foraminal stenosis has implications in the pathogenesis of CSM. The dimensions of the cervical intervertebral foramina may significantly change during neck movements. This could have implication in the pathogenesis of CSM and other diseases associated with radiculopathy such as intervertebral disc disease. The purpose of this study was to quantify the morphological changes in the intervertebral foramina of dogs during flexion, extension, traction, and compression of the canine cervical vertebral column. All vertebral columns were examined with magnetic resonance imaging prior to biomechanic testing. Eight normal vertebral columns were placed in Group 1 and eight vertebral columns with intervertebral disc degeneration or/and protrusion were assigned to Group 2. Molds of the left and right intervertebral foramina from C4-5, C5-6 and C6-7 were taken during all positions and loading modes. Molds were frozen and vertical (height) and horizontal (width) dimensions of the foramina were measured. Comparisons were made between neutral to flexion and extension, flexion to extension, and traction to compression in neutral position.

Extension decreased all the foraminal dimensions significantly, whereas flexion increased all the foraminal dimensions significantly. Compression decreased all the foraminal dimensions significantly, and traction increased the foraminal height, but did not significantly change the foraminal width. No differences in measurements were seen between groups.

Our results show movement-related changes in the dimensions of the intervertebral foramina, with significant foraminal narrowing in extension and compression.

The dorsal root ganglion (DRG) is a key structure in the mechanism of symptomatic radicular pain, weakness and change in sensation. DRG localization can assist in the decision making process of which areas require decompression, and type of procedure that should be performed to treat radicular symptoms. In this study we determine dimensions of lumbar foramina, DRG and its relationship to the neuroforamina through anatomic and magnetic resonance imaging (MRI) evaluation Agreement between MRI and anatomic assessment of DRG location will be determined.

Sixteen embalmed cadavers, 10 females and 6 males, aged 68 to 106 years had an MRI of the thoracolumbar spine followed by dissection. Measurements made included foraminal height and width, DRG size and nerve root take off angle. The center of the DRG and its relationship to the foramina were measured and the probability of agreement between anatomic and MRI assessment were made.

The greatest width of the DRG was 6.5mm bilaterally at L5 (range 3.2-6.5mm). The nerve root take off angle was largest at L5 on the left (range 50.5o-58.8o) and L4 on the right (range 50.5o-57.2o). The center of the DRG was found bilaterally in the medial zone of the foramen of L1-4 and lateral zone at L5. Foramina size increased from L1 to L5 in the ventral to dorsal and cephalad to caudal direction. Pedicle width increased from L1 to L5. The estimated overall probability of agreement between anatomic and MRI DRG location was 86.3% (95% confidence interval = 77.5% − 92.0%).

The percentage of agreement between MRI and anatomic evaluation of lumbar DRG location significantly exceeded our pre-defined threshold of 70% (p = 0.0013).

Our results aid in surgical decision-making as true anatomic position can be directly correlated to what's seen on MRI.

• MRI
• cadaver
• dorsal root ganglia
• lumbar foramina
• lumbar spine

Following peripheral nerve compression, peripheral nerve microcirculation plays important roles in regulating the nerve microenvironment and neurotrophic substances, supplying blood and oxygen and maintaining neural conduction and axonal transport. This paper has retrospectively analyzed the articles published in the past 10 years that addressed the relationship between peripheral nerve compression and changes in intraneural microcirculation. In addition, we describe changes in different peripheral nerves, with the aim of providing help for further studies in peripheral nerve microcirculation and understanding its protective mechanism, and exploring new clinical methods for treating peripheral nerve compression from the perspective of neural microcirculation.

• grants-supported paper
• microcirculation
• nerve blood flow
• nerve compression
• neural regeneration
• neuroregeneration
• peripheral nerve
• peripheral nerve injury
• sciatic nerve

• Disc
• Foraminal
• Herniation
• Lateral
• Medial
• Outcome
• Prognosis
• Radiculopathy
• Sciatica
• Surgery

• Adolescent
• Adult
• Biomechanical Phenomena
• Case-Control Studies
• Child
• Extremities/physiopathology
• Fatigue Syndrome, Chronic/physiopathology
• Female
• Humans
• Male
• Range of Motion, Articular/physiology
• Spine/physiopathology
• Surveys and Questionnaires
• United States
• Young Adult

• Blood flow
• Cauda equine
• Lumbar canal stenosis
• Nerve root
• Prostaglandin E1

• Ulnar nerve
• blood flow
• cubital tunnel syndrome
• laser Doppler flowmeter
• nerve transposition

• Aged
• Aged, 80 and over
• Collateral Circulation/physiology
• Cubital Tunnel Syndrome/physiopathology
• Cubital Tunnel Syndrome/surgery
• Elbow Joint/blood supply
• Equipment Design
• Female
• Follow-Up Studies
• Hand Strength/physiology
• Humans
• Laser-Doppler Flowmetry/instrumentation
• Male
• Microsurgery/methods
• Middle Aged
• Nerve Transfer/methods
• Range of Motion, Articular/physiology
• Regional Blood Flow/physiology
• Surgical Flaps/blood supply
• Surgical Flaps/innervation
• Ulnar Nerve/blood supply
• Ulnar Nerve/surgery

Individuals with chronic fatigue syndrome (CFS) have heightened sensitivity and increased symptoms following various physiologic challenges, such as orthostatic stress, physical exercise, and cognitive challenges. Similar heightened sensitivity to the same stressors in fibromyalgia (FM) has led investigators to propose that these findings reflect a state of central sensitivity. A large body of evidence supports the concept of central sensitivity in FM. A more modest literature provides partial support for this model in CFS, particularly with regard to pain. Nonetheless, fatigue and cognitive dysfunction have not been explained by the central sensitivity data thus far. Peripheral factors have attracted attention recently as contributors to central sensitivity. Work by Brieg, Sunderland, and others has emphasized the ability of the nervous system to undergo accommodative changes in length in response to the range of limb and trunk movements carried out during daily activity. If that ability to elongate is impaired—due to movement restrictions in tissues adjacent to nerves, or due to swelling or adhesions within the nerve itself—the result is an increase in mechanical tension within the nerve. This adverse neural tension, also termed neurodynamic dysfunction, is thought to contribute to pain and other symptoms through a variety of mechanisms. These include mechanical sensitization and altered nociceptive signaling, altered proprioception, adverse patterns of muscle recruitment and force of muscle contraction, reduced intra-neural blood flow, and release of inflammatory neuropeptides. Because it is not possible to differentiate completely between adverse neural tension and strain in muscles, fascia, and other soft tissues, we use the more general term “neuromuscular strain.” In our clinical work, we have found that neuromuscular restrictions are common in CFS, and that many symptoms of CFS can be reproduced by selectively adding neuromuscular strain during the examination. In this paper we submit that neuromuscular strain is a previously unappreciated peripheral source of sensitizing input to the nervous system, and that it contributes to the pathogenesis of CFS symptoms, including cognitive dysfunction.

• adverse neural tension
• central sensitivity
• chronic fatigue syndrome
• manual therapy
• neurodynamics
• orthostatic intolerance

Back-related leg pain (BRLP) is a common variation of low back pain (LBP), with lifetime prevalence estimates as high as 40%. Often disabling, BRLP accounts for greater work loss, recurrences, and higher costs than uncomplicated LBP and more often leads to surgery with a lifetime incidence of 10% for those with severe BRLP, compared to 1-2% for those with LBP.

In the US, half of those with back-related conditions seek CAM treatments, the most common of which is chiropractic care. While there is preliminary evidence suggesting chiropractic spinal manipulative therapy is beneficial for patients with BRLP, there is insufficient evidence currently available to assess the effectiveness of this care.

This study is a two-site, prospective, parallel group, observer-blinded randomized clinical trial (RCT). A total of 192 study patients will be recruited from the Twin Cities, MN (n = 122) and Quad Cities area in Iowa and Illinois (n = 70) to the research clinics at WHCCS and PCCR, respectively.

It compares two interventions: chiropractic spinal manipulative therapy (SMT) plus home exercise program (HEP) to HEP alone (minimal intervention comparison) for patients with subacute or chronic back-related leg pain.

Back-related leg pain (BRLP) is a costly and often disabling variation of the ubiquitous back pain conditions. As health care costs continue to climb, the search for effective treatments with few side-effects is critical. While SMT is the most commonly sought CAM treatment for LBP sufferers, there is only a small, albeit promising, body of research to support its use for patients with BRLP.

This study seeks to fill a critical gap in the LBP literature by performing the first full scale RCT assessing chiropractic SMT for patients with sub-acute or chronic BRLP using important patient-oriented and objective biomechanical outcome measures.

ClinicalTrials.gov NCT00494065