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.
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.
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);
Crossover
Combination of Movement Representation Techniques with neural mobilization exercises
Other interventionThe 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 exercises
Other interventionThe control intervention will consist in three series of active neural mobilization exercises
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.
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.
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.
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