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Purpose: Several outcome measures are available to assess the severity of fatigue in people with multiple sclerosis (MS). The aim of this study was to adapt the Italian version of the Fatigue Impact Scale (FIS-40) and its modified versions: a 21-item Modified scale (MFIS-21), its 5-item short version (MFIS-5), and an 8-item version for daily use (DFIS-8) and investigate their measurement properties through classical theory-test (CTT) and Rasch analysis (RA). Methods: 229 Italian-speaking adults with MS were included. Questionnaires were cross-culturally translated and subjected to CTT (i.e. internal consistency through Cronbach's alpha and unidimensionality through confirmatory factor analysis [CFA]) and RA. (i.e. internal construct validity, reliability, and targeting). Results: Internal consistency was high for all scales (>0.850). Final CFAs reported issues in the unidimensionality for all scales except for FIS-40. Baseline RA revealed a misfit for all scales. After adjusting for local dependency, FIS-40, MFIS-21, and MFIS-5 fitted the Rasch model (RM). MFIS-21 and D-FIS-8 required a structural modification, i.e. item deletions to satisfy the RM. Conclusion: The FIS-40, MFIS-21, MFIS-5, and DFIS-8 achieved the fit to the RM after statistical and structural modifications. The fit to the RM allowed for providing ordinal-to-interval measurement conversion tables for all the questionnaires. IMPLICATIONS FOR REHABILITATION: The Fatigue Impact Scale (FIS-40), the 21-item Modified scale (MFIS-21), its 5-item short version (MFIS-5) and the 8-item version for daily use (DFIS-8) have been successfully cross-culturally validated in Italian. The FIS-40 and its versions fit the Rasch Model with minimal changes, determining that the studied outcomes represent a unidimensional construct, i.e. fatigue in multiple sclerosis. The final Rasch Model enables the transformation of scores into interval-level measurements, allowing clinicians to gauge the distance between individuals' scores on the scale continuum. Interval-level transformation allows rehabilitation professionals to better interpret clinical changes and researchers to apply parametric statistics. [ABSTRACT FROM AUTHOR]

Background: Myofascial trigger points (TrP) are diagnosed upon the presence of clinical signs among which hypersensitivity is considered one of the most important. The detection of the pressure pain threshold (PPT) is used to quantify the degree of hypersensitivity. However, there is a lack of normative data about how hypersensitive a TrP is. Therefore, the objective was to quantify the PPT for myofascial TrP in the upper trapezius muscle and its modification after manual or instrumental physical therapy interventions. Methods: A systematic review and meta-analysis were conducted among three databases (MEDLINE, Cochrane Library, and PEDro). Two independent reviewers conducted the electronic search and assessed the methodological quality of the included studies. Results: Eleven studies with a high-risk bias indicated that the PPT at TrP sites was 105.11 kPa lower (95% CI: −148.93; −61.28) at active TrP sites (Chi-squared = 1.07, df = 1 (p = 0.30), I2 = 7%) compared to the PPT of the upper trapezius muscles of healthy subjects. In addition, the PPT of TrP was also lower than the reference values coming from the pain-free population. Moreover, the PPT increased after both manual and instrumental treatment by 28.36 kPa (95% CI: 10.75; 45.96) and 75.49 kPa (95% CI: 18.02; 132.95), respectively. Conclusions: The results of the present study show that TrP has a decreased PPT when compared to healthy muscles and that physical therapy may increase the PPT. However, the clinical relevance of this decreased PPT needs to be further elucidated. Further, the high risk of bias in all the retrieved studies undermines the validity of the results. [ABSTRACT FROM AUTHOR]

• Les symptômes de neuropathie ont une forte prévalence dans notre cohorte de patients atteints de fibromyalgie. • Peu d'examens diagnostiques visant à confirmer une atteinte des petites fibres ont été rapportés. • La détection de symptômes de neuropathie pourrait faciliter la prise en charge thérapeutique pour les cliniciens. Selon des études récentes, environ 50 % des patients atteints de fibromyalgie (FM) présentent une neuropathie des petites et/ou des grosses fibres qui pourrait expliquer en partie les symptômes déroutants de la fibromyalgie. Notre objectif était d'estimer la prévalence des douleurs neuropathiques et des symptômes de neuropathie des petites fibres (SNPF) rapportés par les patients fibromyalgiques, indiquant la présence d'une pathologie des petites fibres. Un échantillon de patients a été recruté à l'échelle nationale pour participer à une enquête en ligne. Deux groupes ont été constitués pour l'analyse post hoc : les patients positifs selon les critères FRC (Fibromyalgia Research Criteria) (FM+) et ceux présentant des symptômes caractéristiques de fibromyalgie mais ne remplissant pas les critères FRC (FM−). Nous avons collecté les données de 854 patients (749 FM+ et 105 FM−). Parmi eux, 57,3 % (62,4 % dans le groupe FM+ et 21,0 % dans le groupe FM−) avaient un score ≥ 50/100 au questionnaire NPSI (Neuropathic Pain Symptoms Inventory), témoignant de douleurs neuropathiques sévères. Environ 46 % des patients présentaient au moins trois SNPF pouvant indiquer une pathologie des petites fibres, les plus fréquents étant une sécheresse oculaire/buccale, une allodynie et une dyshidrose. Le score NPSI a été associé de façon modérée ou forte avec le handicap (ρ de Spearman = 0,61), la douleur (ρ = 0,66), le degré de raideur (ρ = 0,46), le nombre de sites douloureux (ρ = 0,40) et les SNPF (ρ = 0,44). Malgré la prévalence élevée des douleurs neuropathiques et d'autres symptômes suggérant une pathologie des petites et/ou des grosses fibres, des examens neurophysiologiques n'ont été réalisés que dans 43,6 % des cas et une biopsie cutanée à l'emporte-pièce uniquement chez 1,9 % des patients inclus. La prise d'antidouleurs neuropathiques était également limitée (13,2 %). Nos observations montrent une forte prévalence estimée des douleurs neuropathiques et des SNPF chez les patients atteints de FM. [ABSTRACT FROM AUTHOR]

The assessment of the individual ability of modulating and coordinating the right and left bite force is poorly investigated. The present study describes a methodology for the assessment of the bilateral control of the biting force and evaluates the test-retest reliability in a sample of 13 healthy subjects. By modulating the intensity and the left/right balance of the biting force, the subject was able to drive a cursor on the screen to "reach and hold" targets, randomly generated within the physiological "range of force" of the subject. The average motor performance was evaluated by the mean cursor-target distance = 13 ± 5%, the Offset Error = 9 ± 5% and the standard deviation of the force vector = 17.7 ± 6.1% (expressed as % of the target). Mean distance and standard deviation indices had acceptable reliability. This technique improves the characterization of the mandibular motor function and it may have a relevant role for the assessment and rehabilitation of the neuromusculoskeletal disorders affecting the orofacial system. [ABSTRACT FROM AUTHOR]

To investigate the beliefs, knowledge, attitudes, behavior, and the clinical management procedures of the Italian physical therapists specialized in orthopedic manipulative physical therapy (OMPT) toward running and its correlation with low back pain (LBP). Design: A cross-sectional online survey was conducted in 2019, according to the Checklist for Reporting Results of Internet E‐Surveys (CHERRIES) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Setting: Italy. Participants: One thousand two hundred and eighteen Italian OMPTs. Survey Monkey software was used to administer the survey. The questionnaire was self-reported and included 26 questions. Descriptive statistics were used and related to the effective respondents for each question. One thousand two hundred and eighteen questionnaires (60.9%) were included in the analysis. A considerable cohort of OMPTs working in private practice clinical settings (n = 845; 69.4%; 95% CI 66.7–71.9) has indicated running not to be a relevant risk factor for the onset of LBP (n = 806; 66.2%; 95% CI 63.4–68.8). Moreover, most of the participants (n = 679; 55.7%; 95% CI 52.9–58.5) adopted a combination of manual therapy techniques and therapeutic exercise for the management of runners with LBP. Widespread knowledge of clinical and theoretical management of LBP in runners-patients has emerged among Italian OMPTs. The OMPTs' academic background agrees with the recent literature and therefore highlights the paucity of studies related to LBP as running-related injuries. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the knowledge of orthopedic manual therapists (OMTs) regarding context factors (CFs) capable of triggering nocebo effects during the treatment and how this knowledge is related to their socio-demographic features. Design: A cross-sectional online survey. Setting: National. Main Outcome Measures: A 20 items questionnaire composed by open-ended and closed single-choice questions was administered to explore: (a) socio-demographic variables (10 questions); (b) the relation between different CFs and nocebo-related effects (2 questions); and (c) the knowledge of participants about nocebo-related effects and how they managed them in the clinical practice (8 questions). Participants: 1288 OMTs were recruited from the database of the Master in Rehabilitation of Musculoskeletal Disorders (MRDM) of the University of Genova from March to May 2019. Inclusion criteria were: (a) to possess a valid email account; (b) to understand and use as a native language the Italian; (c) to be graduated as OMTs; and (d) to be employed as physiotherapists specialized-OMTs during the survey. Results: 791 responses were received (61.4%); 473 of them were male (59.8%), with an average age of 31.0 ± 7.1 years. OMTs defined nocebo-related effects as the psychosocial context effects around therapy and patient with specific biological bases (72.2%). OMTs know that their clinical practice is pervaded by nocebo-related effects (42.5%), triggered by CFs. Participants communicated nocebo-related effects balancing the positive features of the therapy with the negative ones (50.9%), during the decision of the therapeutic plan (42.7%). They reported associative learning as the main mechanism involved in nocebo-related effects (28.8%). OMTs taught and trained patient's strategies to manage nocebo-related effects (39.6%) through an evaluation and correction of patient's anxieties, doubts and expectations (37.7%). OMTs most frequently considered themselves to have a "medium" education about nocebo-related effects (48.2%) and that their management should be taught during bachelor (78.6%). Conclusion: OMTs believed that nocebo-related effects were present in their clinical practice and that they can be triggered by CFs. [ABSTRACT FROM AUTHOR]

Backgrounds: Contextual factors (CFs) have been recently proposed as triggers of placebo and nocebo effects in musculoskeletal pain. CFs encompass the features of the clinician (e.g. uniform), patient (e.g. expectations), patient–clinician relationship (e.g. verbal communication), treatment (e.g. overt therapy), and healthcare setting (e.g. design). To date, the researchers' understanding of Italian patients' knowledge about the role of CFs in musculoskeletal pain is lacking. Objectives: The aim of this study was to investigate attitudes and beliefs of Italian patients with musculoskeletal pain about the use of CFs in clinical practice. Methods: A national sample of Italian patients with musculoskeletal pain was recruited from 12 outpatient private clinics in Italy. An invitation to participate in an online survey was sent to patients: a) exhibiting musculoskeletal pain; b) aged 18–75; c) with a valid e-mail account; and d) understanding Italian language. Survey Monkey software was used to deliver the survey. The questionnaire was self-reported and included 17 questions and 2 clinical vignettes on the patients' behavior, beliefs, and attitudes towards the adoption of CFs in clinical practice. Descriptive statistics and frequencies described the actual number of respondents to each question. Results: One thousand one hundred twelve patients participated in the survey. Five hundred seventy-four participants were female (52%). The average age of patients was 41.7 ± 15.2 years. Patients defined CFs as an intervention with an unspecific effect (64.3%), but they believed in their clinical effectiveness. They identified several therapeutic effects of CFs for different health problems. Their use was considered ethically acceptable when it exerts beneficial psychological effects (60.4%), but it was banned if considered deceptive (51.1%). During clinical practice, patients wanted to be informed about the use of CFs (46.0%) that are accepted as an addition to other interventions to optimize clinical responses (39.3%). Moreover, patients explained the power of CFs through body–mind connections (37.1%). Conclusion: Patients with musculoskeletal pain had positive attitudes towards the use and effectiveness of CFs when associated with evidence-based therapy. They mostly perceived the adoption of CFs in clinical practice as ethical. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe contextual factors (CFs) used by nurses to increase placebo and to prevent nocebo effects. Background: Placebo effects have been studied in the nursing discipline, but nocebo effects still remain unexplored. Recently, a set of CFs functioning as triggers of placebo/nocebo effects has been described; however, its use in daily care has never been documented to date. Design: A national cross‐sectional survey, according to the Checklist for Reporting Results of Internet E‐Surveys guidelines and STrengthening the Reporting of OBservational Studies in Epidemiology (STROBE), was performed in 2016. Methods: A wide sample of Italian nurses belonging to four national associations was involved. A questionnaire based on CFs literature was developed and administered through the SurveyMonkey Software® exploring: (a) CFs definition, (b) beliefs, (c) case‐by‐case frequency of use, (d) circumstances of application, (e) clinical conditions where participants perceived their potential beneficial effects, (f) ethical implications and (g) communication issues with the patient. Results: Out of 1,411 eligible nurses, 455 answered (32.2%) and 425 questionnaires (30.1%) were valid for the analysis. A total of 211 nurses (49.6%) defined the CFs as an intervention with a possible aspecific effect; participants believed in the CFs (2.91; 95%CI 2.88–2.94), using them >2 times/month, mainly in addition to a nursing intervention to optimise clinical outcomes (n = 79; 18.6%). Psychological and physiological therapeutic effects have been perceived mainly in chronic pain (n = 259; 60.9%) and insomnia (n = 243; 57.2%). According to participants, CFs have been reported as ethically acceptable when exerting beneficial psychological effects (n = 148; 34.8%); however, 103 (24.2%) of nurses did not communicate to the patient when CFs were used. Conclusions: Nurses are aware of CFs as elements to increase the placebo and prevent the nocebo effects in concomitance with evidence‐based nursing interventions. Relevance to clinical practice: The CFs valued by nurses and experienced as effective are mainly based upon the internal quality of the nurse and the quality of the relationship between the nurse and the patient. These qualities require a large personal investment; therefore, nurses should be supported in developing these qualities since their nursing graduation. [ABSTRACT FROM AUTHOR]

Background: Contextual factors (CFs) represent a potential therapeutic tool to boost physiotherapy outcomes, triggering placebo effects. Nevertheless, no evidence about the use of CFs among physical therapists is currently available. Objective: To investigate the use of CFs and the opinion of Italian physical therapists specialized in Orthopaedic Manual Therapy (OMTs) on their therapeutic benefits. Design: An exploratory cross-sectional online survey. Methods: A 17-item questionnaire and 2 clinical vignettes assessed the perspective of OMTs on the adoption of CFs in daily clinical practice. The target population was composed of 906 OMTs. An online survey was performed in 2016 using SurveyMonkey Software. Data were analyzed by descriptive and inferential statistics. Results: A total of 558 volunteers (61.6% of the target OMT population) participated in the study. Half of the participants (52.0%) claimed to use CFs frequently in their practice. More of 50% of OMTs valued the therapeutic significance of CFs for different health problems as determined by a combined psychological and physiological effect. OMTs considered the use of CFs ethically acceptable when they exert beneficial therapeutic effects and their effectiveness has emerged in previous clinical experiences (30.6%). They disagreed on the adoption of CFs when they are deceptive (14.1%). Moreover, OMTs did not communicate the adoption of CFs to patients (38.2%), and CFs were usually used in addition to other interventions to optimize clinical responses (19.9%). Psychological mechanisms, patient’s expectation and conditioning were believed to be the main components behind CFs (7.9%). Limitations: Considering that the data collected were self-reported and retrospective, recall and response biases may limit the internal and external validity of the findings. Conclusions: OMTs used CFs in their clinical practice and believed in their therapeutic effect. The knowledge of CFs, placebo and nocebo mechanisms and their clinical effects should be included in physical therapists’ university studies. [ABSTRACT FROM AUTHOR]

Background: A variety of interventions has been proposed for symptomatology relief in primary headaches. Among these, manual trigger points (TrPs) treatment gains popularity, but its effects have not been investigated yet. Objective: The aim was to establish the effectiveness of manual TrP compared to minimal active or no active interventions in terms of frequency, intensity and duration of attacks in adult people with primary headaches. methods: We searched MEDLINE, COCHRANE, Web Of Science and PEDro databases up to November 2017 for randomized controlled trials (RCTs). Two independent reviewers appraised the risk-of-bias (RoB) and the grading of recommendations, assessment, development and evaluation (GRADE) to evaluate the overall quality of evidence. Results: Seven RCTs that compared manual treatment vs minimal active intervention were included: 5 focused on tension-type headache (TTH) and 2 on Migraine (MH); 3 out of 7 RCTs had high RoB. Combined TTH and MH results show statistically significant reduction for all outcomes after treatment compared to controls, but the level of evidence was very low. Subgroup analysis showed a statistically significant reduction in attack frequency (no. of attacks per month) after treatment in TTH (MD -3.50; 95% CI from -4.91 to -2.09; 4 RCTs) and in MH (MD -1.92; 95% CI from -3.03 to -0.80; 2 RCTs). Pain intensity (0-100 scale) was reduced in TTH (MD -12.83; 95% CI from -19.49 to -6.17; 4 RCTs) and in MH (MD -13.60; 95% CI from -19.54 to -7.66; 2RCTs). Duration of attacks (hours) was reduced in TTH (MD -0.51; 95% CI from -0.97 to -0.04; 2 RCTs) and in MH (MD -10.68; 95% CI from -14.41 to -6.95; 1 RCT). Conclusion: Manual TrPs treatment of head and neck muscles may reduce frequency, intensity, and duration of attacks in TTH and MH, but the quality of according ot GRADE approach was very low for the presence of few studies, hidh RoB and imprecision of results. [ABSTRACT FROM AUTHOR]

Aim: To assess whether patients with persistent neck pain display evidence of altered masticatory muscle behavior during a jaw-clenching task, despite the absence of orofacial pain or temporomandibular disorders. Methods: Ten subjects with persistent, nonspecific neck pain and 10 age- and sex-matched healthy controls participated. Maximal voluntary contractions (MVCs) of unilateral jaw clenching followed by 5-second submaximal contractions at 10%, 30%, 50%, and 70% MVC were recorded by two flexible force transducers positioned between the first molar teeth. Task performance was quantified by mean distance and offset error from the reference target force as error indices, and standard deviation of force was used as an index of force steadiness. Electromyographic (EMG) activity was recorded bilaterally from the masseter muscle with 13x5 grids of electrodes and from the anterior temporalis with bipolar electrodes. Normalized EMG root mean square (RMS) was computed for each location of the grid to form a map of the EMG amplitude distribution, and the average normalized RMS was determined forthe bipolar acquisition. Between-group differences were analyzed with the Kruskal Wallis analysis of variance. Results: Task performance was similar in patients and controls. However, patients displayed greater masseter EMG activity bilaterally at higher force levels (P < .05). Conclusion: This study has provided novel evidence of altered motor control of the jaw in people with neck pain despite the absence of orofacial pain or temporomandibular disorders. [ABSTRACT FROM AUTHOR]

Dear Editor, We read with interest the paper by Brindisino et al.,[1] performing the Italian cross-cultural validation of the Shoulder Pain and Disability Index (SPADI) in individuals with non-specific shoulder pain. The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. The domain reliability refers to three measurement properties: internal consistency, reliability (i.e., test-retest, inter/intra-rater), and measurement error. [Extracted from the article]

Background: Peripheral Neuropathic Pain (PNP) is a common clinical condition. Neurodynamic concepts are a useful tool to assess these pathologies, and neurodynamic testing is considered valid when assessing patients with PNP or other neurological condition. However, evidence regarding reliability of neurodynamic testing is still lacking. Objectives: To summarise and synthesise the evidence about the reliability of Upper Limb Neurodynamic Tests (ULNTs).Study design: Systematic review with meta-analysis. Methods: MEDLINE, PEDro, CINAHL, Scopus, and EMBASE were searched from inception to February 2012. All publications inherent the reliability of ULNTs in individuals with and without pathologies were included. The assessment of risk of bias was performed through the use of QAREL score. A meta-analysis was planned accordingly to group homogeneity found. Result: 14 studies were included in the qualitative synthesis. Regarding intra-rater reliability, their results suggest that parameters subject-related (Onset of Pain, OP;Submaximal Pain,SP) are more reliable than parameters rater-related (First Resistance, R1;Second Resistance, R2) even though the risk of bias has been evaluated as moderate-to-high. The result of the meta-analysis of the two studies with moderate risk of bias included in the quantitative synthesis show that ULNT1 has a moderate reliability (k = 0.69; 95% CI = 0.49 - 0.89). Conclusion: Although promising results regarding clinical performance of ULNT1 test, its reliability still needs to be confirmed in a clinical population with further studies of higher methodological quality. Moreover, a difference in Range of Motion (RoM) greater than 10° should be considered as clinically relevant when applying astructural differentiation manoeuvres, comparing the response with the contralateral arm, or detecting a treatment effect. However, further confirmation and validationis needed to test this hypothesis. [ABSTRACT FROM AUTHOR]

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Myofascial trigger points (TP) constitute a conundrum in research and clinical practice as their etiopathogenesis is debated. Several studies investigating one or few muscles have shown that both active and latent TP causes an increased muscle activity, however the influence of TP on modular motor control during a reaching task is still unclear. Electromyographic signals, recorded from the muscles of the shoulder girdle and upper arm during a reaching task, were decomposed with Non-Negative Matrix Factorization algorithm. The extracted matrices of motor modules and activation signals were used to label the muscles condition as dominant or non-dominant. The presence of latent and active TP was detected in each muscle with manual examination. Despite a similar muscle activity was observed, we found that muscles with active TP had increased weighting coefficients when labeled in the dominant condition. No influences were found when muscles were in the non-dominant condition. These findings suggest that TP altered the motor control without co-contraction patterns. As a preliminary evidence, the present results suggest that the increased weighting coefficients in presence of TPs are associated with an alteration of the modular motor control without affecting the dimensionality of motor modules for each individual and reciprocal inhibition. [ABSTRACT FROM AUTHOR]

Recent studies suggest that transitory blood flow restriction (BFR) may improve the outcomes of training from anatomical (hypertrophy) and neural control perspectives. Whilst the chronic consequences of BFR on local metabolism and tissue adaptation have been extensively investigated, its acute effects on motor control are not yet fully understood. In this study, we compared the neuromechanical effects of continuous BFR against non-restricted circulation (atmospheric pressure-AP), during isometric elbow flexions. BFR was achieved applying external pressure either between systolic and diastolic (lower pressure-LP) or 1.3 times the systolic pressure (higher pressure-HP). Three levels of torque (15, 30, and 50% of the maximal voluntary contraction-MVC) were combined with the three levels of pressure for a total of 9 (randomized) test cases. Each condition was repeated 3 times. The protocol was administered to 12 healthy young adults. Neuromechanical measurements (torque and high-density electromyography-HDEMG) and reported discomfort were used to investigate the response of the central nervous system to BFR. The investigated variables were: root mean square (RMS), and area under the curve in the frequency domain-for the torque, and average RMS, median frequency and average muscle fibres conduction velocity-for the EMG. The discomfort caused by BFR was exacerbated by the level of torque and accumulated over time. The torque RMS value did not change across conditions and repetitions. Its spectral content, however, revealed a decrease in power at the tremor band (alpha-band, 5-15 Hz) which was enhanced by the level of pressure and the repetition number. The EMG amplitude showed no differences whilst the median frequency and the conduction velocity decreased over time and across trials, but only for the highest levels of torque and pressure. Taken together, our results show strong yet transitory effects of BFR that are compatible with a motor neuron pool inhibition caused by increased activity of type III and IV afferences, and a decreased activity of spindle afferents. We speculate that a compensation of the central drive may be necessary to maintain the mechanical output unchanged, despite disturbances in the afferent volley to the motor neuron pool., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Gizzi, Yavuz, Hillerkuss, Geri, Gneiting, Domeier, Schmitt and Röhrle.)

Background and Aim: In the acute phase of neuropathic pain due to nerve root disorders, the neurodynamic approach proposes the mobilization of the contralateral limb to decrease the pain and increase the range of motion in the affected limb. The aim of this study was to evaluate the effect of the contralateral knee mobilization on the ipsilateral knee extension range of motion in Slump position in healthy adult subjects., Methods: Thirty-eight healthy subjects underwent a placebo, control and experimental manoeuvres that included a passive contralateral knee mobilization into extension. The knee, hip and cervical angles and distance between glabella and femoral condyle achieved in Slump test position were measured with an optoelectronic motion analysis system before and after each manoeuvre., Results: Experimental manoeuvre produced a statistically significant increase of the knee extension ROM when compared to the control (p=.017) and placebo (p=.007) manoeuvres. A significant increase of the hip angle and distance between glabella and femoral condyle was detected after the experimental manoeuvres (p<.001), but not after the placebo and control manoeuvres., Conclusions: The contralateral mobilization in Slump position increases the ipsilateral knee extension ROM. Further research is required to confirm that the knee increment ROM was due to the neural component.