• PNF and Movement
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• v.16 no.2
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• pp.287-294
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• 2018

Purpose: The neurodynamic test used to implicate symptoms arising from the nerve is proposed to selectively increase the strain of the nerve without increasing the strain of adjacent tissue, although this has not yet been established in the time of nerve tension application. This study aimed to investigate the acute effects of nerve stretching time on nerve excitability using compound nerve action potential (CNAP) analysis. Methods: Thirty healthy young adults (mean age=23.10 years) with no medical history of neurological or musculoskeletal disorder voluntarily participated in this study. Nerve excitability was assessed using the median nerve conduction velocity test. The amplitude of the CNAP was measured under three conditions: resting phase (supra-maximal stimulus, without nerve stretching), baseline phase (two-thirds of the supra-maximal stimulus, without nerve stretching), and stretch phase (two-thirds of the supra-maximal stimulus, with 1-5 minutes nerve stretching). One-way repeated measures ANOVA was conducted to compare the latency and amplitude of CNAP. A post-hoc test was analyzed using the contrast test. Results: The latency was significantly delayed after 1 min. of nerve stretching in comparison with the baseline test. However, no significant difference was found during the nerve stretching (1-5 min.). The amplitude was significantly increased by nerve stretching. Conclusion: Nerve stretching can induce nerve excitability without any nerve injury. Based on the results, more than 1 min. of nerve stretching as a neurodynamic test can be a useful method in the clinical setting.

• PNF and Movement
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• v.19 no.2
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• pp.195-203
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• 2021

Purpose: Neurodynamic tests are used to examine neural tissue in patients with neuro-musculoskeletal disorders, although this has not yet been established in the intensity of nerve tension application. This study aimed to investigate the acute effects of neural stretching intensity on nerve excitability using the latency and amplitude of nerve conduction velocity test (NCV) analysis. Methods: Thirty young, healthy male and female subjects (mean age = 21.30 years) voluntarily participated in this study. Nerve excitability was assessed using the median sensory NCV test. The latency and amplitude of the NCV test were measured under four different conditions: reference phase (supra-maximal stimulus, without neural stretching), baseline phase (2/3 of the supra-maximal stimulus, without neural stretching), weak stretch phase (2/3 of the supra-maximal stimulus, with weak neural stretching), and strong stretch phase (2/3 of the supra-maximal stimulus, with strong neural stretching). Results: The NCV latency was significantly delayed after one minute of neural stretching at the baseline, weak phase, and strong phase in comparison with the reference phase. The NCV latency was significantly delayed by increasing the strength of neural stretching. Furthermore, the NCV amplitude was significantly increased at the weak and strong phases, which were under neural stretching, in comparison with the baseline phase. The NCV amplitude was significantly increased by increasing the strength of the neural stretching. Conclusion: Transient neural stretching as a neurodynamic test can increase the sensitivity of the nerve without negatively affecting the nervous system. However, based on the results of this study, strong neural stretching in the neurodynamic test may delay the transmission of nerve impulses and hypersensitivity.

• Physical Therapy Korea
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• v.17 no.2
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• pp.67-74
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• 2010

The purpose of this study was to examine the acute effects of nerve mobilization, static stretching, and hold-relax on the flexibility of hamstring muscles and their surface electromyographic (EMG) responses to passive stretches in poststroke hemiparesis. This study was a randomized cross-over trial. Fourteen subjects received three treatment sessions in random order with each consisting of ten repetitions. The treatment sessions included nerve mobilization, static stretching, and hold-relax. The treatment sessions were held at least 24 hours apart to minimize any carryover effect. The outcome was measured by the distance between the greater trochanter and lateral malleolus and hamstring EMG activity during passive knee extension stretching. Repeated-measures analysis of variance showed significant changes in hamstring flexibility and EMG activity in main effect of time pre, post and followup (p<.05). However, no significant differences occurred among the three stretching techniques. No technique was consistently found to be superior. The three stretching techniques in this study make it difficult to determine the most effective technique. Therefore, clinicians use nerve mobilization of effective stretching techniques with other stretching techniques.

• Journal of International Academy of Physical Therapy Research
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• v.3 no.2
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• pp.422-428
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• 2012

The present study purposed to examine the effects of transcutaneous electrical nerve stimulation, self-stretching and functional massage on the recovery of muscle contraction force for muscle fatigue caused by sustained isotonic contraction. The subjects of this study were 45 healthy students. They were divided into transcutaneous electrical nerve stimulation group(n=15), self-stretching group(n=15) and functional massage group(n=15), and using Primus RS. We observed the pattern of changes in maximal voluntary isometric contraction force(MVIC) after causing muscle fatigue in quadriceps femoris muscle through sustained isotonic contraction. Maximal voluntary isometric contraction force(MVIC) were greatly increased after transcutaneous electrical nerve stimulation, self-stretching and functional massage. In the comparison of recovery rate of muscle contraction force for muscle fatigue caused by sustained isotonic contraction among the treatment groups, it did not show any significant differences. However, it showed that each treatment may be effective in recovery of muscle fatigue caused by sustained isotonic contraction.

• Physical Therapy Korea
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• v.22 no.4
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• pp.8-16
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• 2015

The purpose of this study was to evaluate the effects of mobilization of the sciatic nerve on hamstring flexibility, lower limb strength, and gait performance in patients with chronic stroke. This study was a randomized clinical trial with a crossover design. Sixteen subjects were recruited for this study. The subjects were randomly divided into two intervention groups and underwent either of the following two interventions: sciatic nerve mobilization or static stretching of the hamstring. We assessed hamstring flexibility, lower limb strength, and gait performance using a digital inclinometer, a hand-held dynamometer, and the 10-meter walk test, respectively. Subjects had a 24-hour rest period between each session in order to minimize carryover effects. Measurements for each test were assessed prior to and immediately after the intervention sessions. Using a two-way analysis of variance test with repeated measures, data from the two trials were analyzed by comparing the differences between both techniques. The level of statistical significance was set at .05. Sciatic nerve mobilization resulted in significantly better knee extensor strength (p=.023, from $15.32{\pm}5.98$ to $18.16{\pm}6.95kg$) and knee flexor strength (p=.011, from $7.80{\pm}4.80$ to $8.15{\pm}4.24kg$) in the experimental group than in the control group. However, no significant effects of static stretching of the hamstring were observed on hamstring flexibility from the ankle plantar flexion (p=.966) and ankle neutral positions (p=.210) and on gait performance (p=.396). This study indicated that the sciatic nerve mobilization technique may be more effective in muscle activation of the knee extensor muscle and knee flexor muscle than hamstring static stretching technique in patients with chronic stroke.

• Journal of Korean Neurosurgical Society
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• v.49 no.3
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• pp.167-170
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• 2011

Isolated hypoglossal nerve paresis due to mechanical compression from a vascular lesion is very rare. We present a case of a 32-year-old man who presented with spontaneous abrupt-onset dysarthria, swallowing difficulty and left-sided tongue atrophy. Brain computed tomographic angiography and magnetic resonance imaging of the brainstem demonstrated an abnormal course of the left vertebral artery compressing the medulla oblongata at the exit zone of the hypoglossal rootlets that was relieved by microvascular decompression of the offending intracranial vertebral artery. This case supports the hypothesis that hypoglossal nerve palsy can be due to nerve stretching and compression by a pulsating normal vertebral artery. Microvascular decompression of the intracranial nerve and careful evaluation of the imaging studies can resolve unexpected isolated hypoglossal nerve palsy.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.2
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• pp.173-178
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• 2021

Inferior alveolar nerve (IAN) injury is usually caused by stretching or crushing of the neurovascular structures and postoperative intra-alveolar hematoma or edema after dental procedures. This results in paresthesia in the ipsilateral chin, lip (vermilion border, skin, and mucosa), and labial or buccal alveolar mucosa of the mandibular anterior teeth. However, there are no reports of sensory alterations in the teeth, especially tooth hypersensitivity, after IAN injury. I report a case in which paresthesia of the lower lip and hypersensitivity of the lower anterior teeth occurred simultaneously after the removal of the third molar that was located close to the IAN. In addition, I discuss the reasons for the different sensory changes between the tooth and chin (skin) after nerve injury from a neurophysiological point of view. Since the dental pulp and periodontal apparatus are highly innervated by the inferior alveolar sensory neurons, it seems necessary to pay attention to the changes in tooth sensitivity if IAN injury occurs during dental procedures.

• The Journal of Korean Physical Therapy
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• v.27 no.3
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• pp.164-168
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• 2015

Purpose: Flexibility has been considered one of the most important goals in rehabilitation. This study aimed to investigate the effect of transcutaneous electrical nerve stimulation (TENS) with the static stretching technique on the flexibility of hamstrings. Methods: Twenty-four subjects (15 men, 9 women) with limited hamstrings flexibility received three different intervention sessions in random order. The treatment sessions included static stretching (SS), static stretching with motor-level TENS (SS with motor TENS) and sensory-level TENS (SS with sensory TENS). All sessions of SS were performed in the straight-leg raise position for 30 seconds followed by rest for 15 seconds, in repetitions for 10 minutes using a belt. The TENS groups underwent TENS stimulation ($40{\mu}s$, 100 Hz) during the stretching for 10 minutes. Outcome measures were evaluated according to active knee extension (AKE) and recorded before the session and at 0, 3, 6, 9, and 15 minutes after the session. Results: There was significant improvement in hamstrings flexibility within all groups (p<0.05). SS with TENS (both sensory and motor) maintained significant increases in knee extension range of motion until 15 minutes post-treatment. In contrast, the SS-only group maintained significantly increased hamstrings flexibility only until 6 minutes post-treatment (p<0.05). Conclusion: Improvement in hamstrings flexibility with SS with TENS was maintained longer than with SS-only intervention. Electrical stimulation with stretching may be more effective than SS alone for increased duration of maintained hamstrings flexibility.

• Korean Journal of Head & Neck Oncology
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• v.36 no.1
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• pp.9-14
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• 2020

Visual identification of recurrent laryngeal nerve (RLN) is considered as a gold standard of RLN preservation during thyroid surgery. Intraoperative neuromonitoring (IONM) is classified into the intermittent type and continuous type and helps surgeons identify the functional integrity of RLN and predict the postoperative vocal cord function. RLN injury during thyroid surgery is associated with tumor factors and surgeon factors. Tumor factors mean such as direct tumor invasion, adhesion of RLN to the tumor, and compression by a large thyroid tumor. Surgeon factors include nerve transection, stretching, thermal injury, and ligation injury. A recent meta-analysis reported that the IONM could reduce the RLN injury. Considering various nerve injury mechanism, we suggest that using both I-ONM and C-IONM together is more effective method in preventing nerve damage than using I-IONM alone.

• Journal of Korean Neurosurgical Society
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• v.45 no.3
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• pp.185-187
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• 2009

Although most of sacral perineural cysts are asymptomatic, some may produce symptoms. Specific radicular pain may be due to distortion, compression, or stretching of nerve root by a space occupying cyst. We report a rare case of S1 radiculopathy caused by sacral perineural cyst accompanying disc herniation. The patient underwent a microscopic discectomy at L5-S1 level. However, the patient's symptoms did not improved. The hypesthesia persisted, as did the right leg pain. Cyst-subarachnoid shunt was set to decompress nerve root and to equalize the cerebrospinal fluid pressure between the cephalad thecal sac and cyst. Immediately after surgery, the patient had no leg pain. After 6 months, the patient still remained free of leg pain.