Efficacy of Combining Movement Representation Techniques to Active Neural Mobilization in the Mechanosensitivity of the Median Nerve in Asymptomatic Volunteers.

N/ANot Yet RecruitingNCT07154017

University of Gran Rosario10 enrolled

Overview

The objective of this study will be to determine whether the combination of movement imaging techniques with neural mobilization (NM) exercises works to modify median nerve sensitivity to mechanical stimuli. Movement Representation Techniques (MRTs) are defined as therapeutic or training systems that neurophysiologically evoke a perceptual-cognitive representation of movement. They can be combined with the execution of actual movement or with afferent sensory stimulation (motor command). There is evidence demonstrating positive results in pain reduction and improved range of motion using MRTs alone. The study will be evaluated in 10 randomly selected asymptomatic volunteers, considering the following variables: pressure pain threshold, elbow extensor range of motion, and sensory responses before and after the intervention, in both the experimental and control groups. The period between interventions will be 72 hours.

The objective of this pilot study will be to determine the efficacy of combining movement representation techniques with neural mobilization (NM) exercises on median nerve mechanosensitivity. Movement representation techniques (MRTs) are defined as therapeutic or training systems that neurophysiologically evoke a perceptual-cognitive representation of movement through imagery or observation of motor actions. They can be combined with actual movement execution or with afferent sensory stimulation (motor command). There is evidence demonstrating positive results in pain reduction and range of motion gains using MRTs alone. The study will be designed as a randomized, single-blind, crossover pilot clinical trial. In this study, 10 asymptomatic volunteers will be randomly selected and measured in the following variables: pressure pain threshold (PPT), elbow extensor range of motion (EROM), and the spatiotemporal distribution of pre- and post-intervention sensory responses in both the experimental group (RMM + MN) and the control group (MN). The washout period between interventions will be 72 hours.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

OTHER

Masking

Interventions

Combination of Movement Representation Techniques with neural mobilization exercisesOTHER

The experimental intervention will be an exposition of movement representation techniques in an established sequential order, consisting of action observation, implicit/explicit motor imagery and visual feedback with a mirror in combination with neural mobilization exercises.

Neural mobilization exercisesOTHER

The control intervention will consist in three series of active neural mobilization exercises

Eligibility

Sex: ALLMin age: 18 YearsMax age: 45 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * asymptomatic volunteers of both sexes * aged 18 to 45 * with no symptoms or history of disease in the cervical region, shoulder girdle, or upper limb. Exclusion Criteria: * history of surgery or trauma to the cervical spine, shoulder girdle, or upper limb; * nonspecific shoulder pain; * presenting symptoms of chronic pain in any region of the body; * aphantasia (inability to create mental images); * hypermobility; * history of cancer or active disease; * current infection; * rheumatological disease; * neurological and/or psychiatric disorders; * altered sensation; * current pregnancy; * consumption of centrally acting medications; * undergoing physiotherapy treatment in the last month; * inability to understand the informed consent document; * previous experience with median nerve provocation testing.

Outcomes

Primary Outcomes

Elbow Extensor Range of Motion

The elbow extension movement will be measured during the median nerve provocation test, through digital inclinometry of both the dominant and non-dominant arm by an experienced Physiotherapist.

Time frame: Pre- and post-interventions with a 72-hour washout period, for both control and experimental.

Pressure Pain Threshold

Pressure pain thresholds (PPTs) will be performed at two sites, the dominant and non-dominant side, in asymptomatic participants: 1) the upper trapezius muscle, and 2) the proximal third of the forearm. A pressure algometer will be used. The device has a rod at one end with a 1 cm2 flat, circular rubber tip. Pressure will be applied progressively in a perpendicular direction at a rate of 0.5 kgf/cm2 per second to the assessment sites. Volunteers will be asked to verbally report the moment they feel the pressure exerted with the pressure algometer begin to change to a sensation of pain (first painful sensation). At that moment, the evaluator will stop applying pressure and a value will be obtained. Three measurements will be taken at each site, 30 seconds apart. The PPT will be determined as the arithmetic mean of the three measurements.

Time frame: Pre and post interventions, both control and experimentalPre- and post-interventions with a 72-hour washout period, for both control and experimental.

Spatiotemporal distribution of sensory responses

Humanoid software (University Center of Assistance, Teaching and Investigation, CUADI, Argentina) will be used to evaluate the spatiotemporal distribution of pain intensity and/or perceived sensations. To mark the sensations that subject feel during the arm stretch test. To do this, the subjects will mark the area on the touchscreen where they perceive tension or stretching. The sensations will be representated by different colours: yellow is used for mild sensations, orange for moderate sensations, and red for intense sensations.