Changes in Nerve Excitability Depending on Intensity of Neural Stretching

신경 신장 적용 강도에 따른 신경흥분성 변화

  • Kim, Jong-Soon (Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan)
  • 김종순 (부산가톨릭대학교 보건과학대학 물리치료학과)
  • Received : 2021.06.15
  • Accepted : 2021.07.21
  • Published : 2021.08.31


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.



  1. Aminoff MJ. Electromyography in clinical practice: clinical and electrodiagnostic aspects of neuromuscular disease, 3rd ed. New York. Churchill Livingstone. 1998.
  2. Ballestero-Perez R, Plaza-Manzano G, Urraca-Gesto A, et al. Effectiveness of nerve gliding exercises on carpal tunnel syndrome: a systematic review. Journal of Manipulative & Physiological Therapeutics. 2017;40(1):50-59.
  3. Butler D, Gifford L. The concept of adverse mechanical tension in the nervous system. Journal of Physiotherapy. 1989;75(11):622-629.
  4. Butler D. Mobilisation of the nervous system. Melbourne. Churchill Livingstonem. 1991.
  5. Butler D. The sensitive nervous system. Adelaide. Noigroup Publications. 2000.
  6. Butler D. The neurodynamic techniques: a definitive guide from the Noigroup team. Adelaide. Noigroup Publication. 2008.
  7. Devor M, Seltzer Z. Pathophysiology of damaged nerves in relation to chronic pain. In: Wall PD, Melzack R. Textbook of pain, 4th ed. Edinburgh. Churchill Livingstone. 1999.
  8. Dilley A, Lynn B, Greening J, et al. Quantitative in vivo studies of median nerve sliding in response to wrist, elbow, shoulder and neck movements. Clinical Biomechanics (Bristol, Avon). 2003;18(10):899-907.
  9. Eom JR. Changes in nerve excitability by nerve stretch and nerve glide. Catholic University of Pusan. Dissertation of Master's Degree. 2016.
  10. Horng YS, Hsieh SF, Tu YK, et al. The comparative effectiveness of tendon and nerve gliding exercises in patients with carpal tunnel syndrome: a randomized trial. American Journal of Physical Medicine. 2011;90(6):435-442.
  11. Kimura J. Electrodiagnosis in diseases of nerve and muscle: principle and practice, 4th ed. New York. Oxford University Press. 2013.
  12. Kobayashi S, Shizu N, Suzuki Y, et al. Changes in nerve root motion and intra radicular blood flow during an intraoperative straight-leg-raising test. Spine. 2003;28(13):1427-1434.
  13. Kobayashi S, Takeno K, Yayama T, et al. Pathomechanisms of sciatica in lumbar disc herniation: effect of periradicular adhesive tissue on electrophysiological values by an intraoperative straight leg raising test. Spine. 2010;35(22):2004-2014.
  14. Kornberg C, McCarthy T. The effect of neural stretching technique on sympathetic outflow to the lower limbs. Journal of Orthopedic & Sports Physical Therapy. 1992;16(6):269-274.
  15. Lang E, Claus D, Neundorfer B, et al. Parameters of thick and thin nerve-fiber functions as predictors of pain in carpal tunnel syndrome. The Journal of Pain. 1995;60(3):295-302.
  16. Lewis J, Ramot R, Green A. Changes in mechanical tension in the median nerve: possible implications for the upper limb tension test. Journal of Physiotherapy. 1998;84(6):254-261.
  17. Lee DR, Rhee MH, Eom JR, et al. Changes in nerve excitability during neural stretching. PNF and Movement. 2018;16(2):287-294.
  18. Lundborg C, Nilsson Y, Skoglund R. Obervations on the mechanical sensitivity of sympathetic and other types of small-diameter nerve fibers. Brain Research. 1973;49(2):432-435.
  19. Magee D. Orthopedic physical assessment, 4th ed. Toronto. Saunders. 2002.
  20. Millesi H, Zoch G, Rath T. The gliding apparatus of peripheral nerve and its clinical significance. Annales de Chirurgie de la Main et Du Membre Superieur (Paris). 1990;9(2):87-97.
  21. Nee RJ, Butler D. Management of peripheral neuropathic pain: integrating neurobiology, neurodynamics, and clinical evidence. Physical Therapy in Sport. 2006;7(1):36-49.
  22. Ogata K, Naito M. Blood flow of peripheral nerve effects of dissection, stretching and compression. Journal of Hand Surgery British. 1986;11(1):10-14.
  23. Preston DC, Shapiro BE. Electromyography and neuromuscular disorders. Boston. Butterworth-Heinemann. 1997.
  24. Rickett T, Connell S, Bastijanic J, et al. Functional and mechanical evaluation of nerve stretch injury. Journal of Medical Systems. 2011;35(5):787-793.
  25. Shacklock M. Neurodynamics. Journal of Physiotherapy. 1995;81(1):9-16.
  26. Shacklock M. Clinical neurodynamics: a new system of musculoskeletal treatment. Edinburgh. Elsevier Health Sciences. 2005.
  27. Silver JR, Weiner MF. Nerve-stretching in the 19th century. Journal of Medical Biography. 2016;24(4):537-545.
  28. Sim SE, Gunasagaran J, Goh KJ, et al. Short-term clinical outcome of orthosis alone vs combination of orthosis, nerve, and tendon gliding exercises and ultrasound therapy for treatment of carpal tunnel syndrome. Journal of Hand Therapy. 2019;32(4):411-416.
  29. Stalioraitis V, Robinson K, Hall T. Side-to-side range of movement variability in variants of the median and radial neurodynamic test sequences in asymptomatic people. Manual Therapy. 2014;19(4):338-342.
  30. Sunderland S. Nerves and nerve injuries, 3rd ed. Melbourne. Churchill Livingstone. 1978.
  31. Tanoue M, Yamaga M, Ide J, et al. Acute stretching of peripheral nerves inhibits retrograde axonal transport. Journal of Hand Surgery (British Volume). 1996;21(3):358-363.
  32. Tubbs RS, Rizk E, Shoja MM, et al. Nerve and nerve injuries. Amsterdam. Elsevier. 2015.
  33. Vanti C, Bonfiglioli R, Calabrese M, et al. Upper limb neurodynamic test 1 and symptoms reproduction in carpal tunnel syndrome. A validity study. Manual Therapy. 2011;16(3):258-263.
  34. Walsh MT. Upper limb neural tension testing and mobilization. Fact, fiction, and a practical approach. Journal of Hand Therapy. 2005;18(2):241-258.
  35. Watanabe M, Yamaga M, Kato T, et al. The implication of repeated versus continuous strain on nerve function in a rat forelimb model. Journal of Hand Surgery American. 2001;26(4):663-669.
  36. Wilgis EF, Murphy R. The significance of longitudinal excursion in peripheral nerves. Hand Clinics. 1986;2(4):761-766.
  37. Yayama T, Kobayashi S, Nakanishi Y, et al. Effects of graded mechanical compression of rabbit sciatic nerve on nerve blood flow and electrophysiological properties. Journal of Clinical Neuroscience. 2010;17(4):501-505.
  38. Yoshii Y, Nishiura Y, Terui N, et al. The effects of repetitive compression on nerve conduction and blood flow in the rabbit sciatic nerve. Journal of Hand Surgery (European Volume). 2010;35(4):269-278.