Hi again,
Here are Chris Maher's comments in reply to some of the points raised:
1. What is one dose of ANT mobilisation?
The ANT treatment 'dose' is the treatment protocol we followed in our
study. This is on page 2648 of the paper. There are other treatment
protocols (doses of ANT) possible. Our conclusions confine to the dose
we tested.
2. Would you recommend ANT mobilisation if clinical findings consistent
with adverse neural tension were discovered?
No because we our study showed that the dose we applied did not work and
other doses are of unknown value. In contrast we have 5 RCTs showing
that a graded physical activity program is effective. I would always
prefer to use a treatment of known value. Saves me wasting my patient's
time and money.
3. The "flaw" in Scrimshaw & Maher's study is that they applied neural
mobilisation (NM) indiscriminately.
The underlying premise of this criticism is that there is some
identifiable sub-group of patients who would respond differently.
However no-one has articulated that sub-group let alone provided data to
support the validity of the sub-grouping so the criticism is
unjustified.
Chris
-----Original Message-----
From: - for physiotherapists in education and practice
[mailto:[log in to unmask]] On Behalf Of David Felhendler
Sent: Tuesday, 10 December 2002 4:47 AM
To: [log in to unmask]
Subject: Re: Evidence base for post op spinal surgery
Hi,
I agree with Frank that they applied neural mobilisation (NM)
indiscriminately. Another thing that might be a worth a second thought
is how far one should take the movement one is using for the neural
mobilisation.
If memory serves me correctly (I don't have the article at hand for the
moment) they performed the movement until the onset of pain (P1). I
think that that might be taking it a bit too far and would suggest to
stop the movement at first onset of muscle activity (M1). This muscle
activity is suggested to be elicited as a protective reflex when the
intraneural bloodflow is decreased from the elongation of the nerve
(1-4).
Regards,
David Felhendler, PT
Norrkoping, Sweden
1. Lundborg, G., Rydevik, B., Effects of stretching the tibial nerve of
the rabbit. A preliminary study of the intraneural circulation and the
barrier function of the perineum, J. Bone Joint Surg., 55B (1973)
390-401
2. Ogata, K., Naito, M., Blood flow of peripheral nerve: effects of
dissection, stretching and compression, J. Hand Surg., 11B (1986) 10-14
3. Clark, W.L., Trumble, T.E., Swiontowski, M.F., Tencer, A.F., Nerve
tension and blood flow in a rat model of immediate and delayed repairs,
J. Hand Surg., 17A (1992) 677-687
4. Hall, T., Zusman, M., Elvey, R.L., Adverse mechanical tension in the
nervous system? Analysis of the straight leg raise, Manual Ther., 3
(1998) 140-146
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