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The tarsal tunnel is a fibrous osseous conduit for the tibial nerve and associated tendons. It is mechanically dynamic, and foot and ankle movements appear to move and change tunnel shape. However, the effect of foot and ankle movements is not clear. The aim of this study was to measure tarsal tunnel dimensions in anatomical position of the foot and ankle and quantify its changes at different positions in cadavers. A cross-sectional study with a total of 16 cryopreserved lower extremities from cadaveric specimens were used. The foot was cut using an anatomical saw at the level of the tarsal tunnel. Measurements of the cross-sectional area (CSA), transverse diameter (TD), longitudinal diameter (LD) were taken in anatomical position and during foot and ankle movements. All the tarsal tunnel measurements were significantly modified by ankle plantar flexion (p < .05). The CSA increased by 68.97 mm2 (p < .001), the TD increased by 1.40 mm (p < .002) and the LD increased by 2.55 mm (p < .007). The TD was also significantly modified by the inversion position of the ankle, showing an increase of 0.84 mm (p < .004). The rest of the ankle positions did not produce significant changes in tarsal tunnel measurements. Foot and ankle plantar flexion position produce and increase in the CSA and the TD of the tarsal tunnel at its distal end in cadavers. This could suggest a reduction in tarsal tunnel pressure during plantar flexion.

The tarsal tunnel is a clinically important fibrous osseous conduit for the tibial nerve and associated tendons. It is mechanically dynamic, and normal ankle movements appear to change the tunnel shape, potentially having an impact on the tibial nerve. The objective of this study was to measure changes in the tibial nerve and tarsal tunnel dimensions in plantarflexion and dorsiflexion of the ankle joint in healthy subjects. A cross-sectional study with 13 volunteer subjects and a total of 18 records was designed. The cross-sectional area, anterior-posterior distance, transverse distance, and flattening ratio of the tibial nerve were measured by using ultrasound in plantarflexion and dorsiflexion of the ankle joint. The anterior-posterior distance of the tarsal tunnel was also measured. The tunnel anterior-posterior distance significantly increased during plantarflexion (p.001) and decreased during dorsiflexion (p = .027) of the ankle. From plantarflexion to dorsiflexion of the ankle, the tibial nerve cross-sectional area significantly decreased (p = .035). The anterior-posterior distance also decreased significantly (p.001), whereas the transverse distance increased (p.001), thus decreasing the flattening ratio of the tibial nerve (p.001). Ankle joint position determined significant changes in the shape and dimensions of the tibial nerve at the tarsal tunnel.

In hamstrings injuries, sciatic nerve and muscle disorders can coexist. Therefore, differential diagnosis to include or exclude nerve involvement is an important aspect of evaluation. The objective of this paper is to investigate the mechanical behaviour of the sciatic nerve and biceps femoris muscle in the proximal thigh with the ankle dorsiflexion manoeuvre at different degrees of hip flexion during the straight leg raise in cadavers.A cross-sectional study was carried out. Linear displacement transducers were inserted into the sciatic nerve and the biceps femoris muscle of 11 lower extremities from 6 fresh cadavers to measure potential strain of both structures during ankle dorsiflexion at 0°, 30°, 60° and 90° of hip flexion during the straight leg raise. Excursion was also measured with a digital calliper.Ankle dorsiflexion resulted in significant strain and distal excursion of the sciatic nerve at all ranges of hip flexion during the straight leg raise (p 0.05). In contrast, the ankle movement did not affect the strain in biceps femoris at any position of the hip (p 0.05).Ankle dorsiflexion at different degrees of hip flexion during the straight leg raise produces changes in the strain and excursion of the sciatic nerve in the upper thigh. In contrast, the biceps femoris muscle at the same location was not affected by ankle movement. These findings show differential behaviour between the nerve and muscle with ankle dorsiflexion at this location that could be used as differential diagnosis in posterior hip pain.

Background Neurodynamic tests (NDTs) have shown to be useful in evaluating neural tissue involvement. Peroneal nerve reaches high importance in ankle injuries. However, up to date, no study has documented the normal responses for this nerve. Objectives The objective of this study was to document normal responses of the peroneal neurodynamic test (NDTPER) in asymptomatic subjects. Differences in sensory response depending on sex and leg dominance were also examined. Design A cross-sectional study was designed. Method Forty-four asymptomatic subjects with a total of 88 lower limbs were tested. The range of motion (ROM) at the point of first appearance of symptoms (S1) and the point of symptoms tolerance (S2), quality and distribution of sensory responses were recorded. Results Hip flexion was significantly higher at S2 than S1 (mean difference, 27.22°; 95% CI: 25.29°, 29.14°; p 0.05). The descriptor of the quality of sensory responses more often used by subjects was stretching (90.9%) in the external foot (74.6%). Conclusions This study provides the normal hip flexion angle and quality and distribution of sensory responses to the NDTPER in asymptomatic subjects. Responses were independent of the influence of sex or leg dominance.

Background Neurodynamic tests (NDTs) consist of a combination of movements aimed to stress different parts of the nervous system and are considered to be able to detect increased nerve mechanosensitivity. Currently, there are no studies in healthy subjects that define the normal response to sural neurodynamic test (NDTSUR). Objectives The main aim of this study was to document normal responses of the NDTSUR in asymptomatic participants. The secondary aim was to investigate potential gender and leg dominance influences. Design A cross-sectional study was designed. Methods NDTSUR was performed on 44 asymptomatic participants with a total of 88 lower limbs. The range of motion at the point of first appearance of symptoms (S1) and the point of pain tolerance (S2), quality and distribution of sensory responses were recorded. Results Hip flexion was significantly greater (p 0.05). The descriptor of the quality of the sensory responses more often used by participants was stretching (87% and 76% for S1 and S2, respectively) in the posterior knee and lateral leg. Conclusions This study describes the sensory responses of asymptomatic participants resulting from the NDTSUR. The findings indicate that NDTSUR responses are independent of the influence of gender or leg dominance.

Background The mechanical effects of hip joint mobilization on hip capsular-ligament tissue have never been studied. Objective To evaluate the strain on the inferior ilio-femoral (IFF) ligament after 5 min of high-force long-axis distraction mobilization (LADM) and to analyse the immediate effects on hip range of motion (ROM). Design Cross-sectional laboratory cadaveric study. Methods Thirteen hips hip joints were mobilized from nine fresh-frozen cadavers (mean age, 75.6 ± 7.8 years). High-force LADM in open-packed position was maintained during 5 min. Strain on IFF ligament was measured with a microminiature differential variable reluctance transducer at the beginning and just before the end of high-force LADM. Hip flexion, extension, abduction and internal rotation ROM were assessed using a universal goniometer before and after joint mobilization. Results The strain on IIF ligament increased 20.2 ± 8.5% after 5 min of high-force LADM, showing a significant increase (p = 0.004). Hip ROM also increased significantly (p 0.8). Conclusion The strain on IIF ligament and hip ROM increased significantly after 5 min of high-force LADM. The improvements on hip ROM appear to be related to the changes in the strain on capsular-ligament tissue after high-force LADM.

Background: No study has evaluated the mechanical effect of different magnitudes of long axis-distraction mobilization (LADM) force on hip joint space width (JSW) or the association between the separation of joint surfaces and the strain on hip capsular ligaments. Objective: To compare the joint separation when applying three different magnitudes of LADM forces (low, medium and high) and to analyse the correlation between joint separation, strain on the inferior ilio-femoral ligament and magnitude of applied force. Design: Repeated measures controlled laboratory cadaveric study. Methods: Three magnitudes of force were applied to 11 cadaveric hip joints (mean age 73 years). Ultrasound images were used to measure joint separation, and strain gauges recorded inferior ilio-femoral ligament strain during each condition. Results: The magnitude of joint separation was significantly different between low (0.23 ± 0.19 mm), medium (0.72 ± 0.22 mm) and high (2.62 ± 0.43 mm) forces (p < 0.001). There were significant associations between magnitude of force, joint separation and the strain on the inferior ilio-femoral ligament during LADM (r > 0.723; p < 0.001). Conclusion: Hip joint separation and ligament strain during LADM are associated with the magnitude of the applied force.

Resumen Objetivo En nuestra practica clinica, el masaje funcional ofrece buenos resultados en el tratamiento de pacientes diagnosticados de sindrome subacromial y presencia de puntos gatillo en el musculo redondo mayor. Nuestro objetivo es comprobar los resultados del masaje funcional del musculo redondo mayor sobre el dolor, la funcion y la movilidad, en pacientes diagnosticados de sindrome subacromial. Material y metodos Estudio experimental de serie de casos, aleatorizado, simple ciego, multicentrico (dos centros), con 38 participantes distribuidos aleatoriamente en dos grupos. Un fisioterapeuta de cada centro proporciono a todos los participantes un tratamiento protocolizado en sesiones diarias durante tres semanas y, adicionalmente, los asignados al Grupo Masaje Funcional recibieron diariamente cinco minutos de masaje funcional del redondo mayor, y los asignados al Grupo Movilizacion Pasiva recibieron diariamente cinco minutos de movilizacion pasiva en direccion del estiramiento muscular. Resultados El Grupo Masaje Funcional consiguio una mejoria estadisticamente significativa en todas las variables de resultados. El Grupo Movilizacion Pasiva consiguio mejoria estadisticamente significativa en todas las variables a excepcion de los movimientos de extension y rotacion externa. En la comparacion entre grupos, la mayor mejoria del Grupo Masaje Funcional en extension alcanza significacion estadistica, y la mayor mejoria en abduccion, extension y rotacion externa alcanza significacion clinica de pequena a moderada. Los sujetos asignados al Grupo Masaje Funcional mostraban una mejor satisfaccion con los resultados. Conclusiones En este estudio, el masaje funcional de los puntos gatillo del musculo redondo mayor proporciona mejores resultados clinicos que la movilizacion pasiva en direccion del estiramiento muscular.