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Short-term changes in median nerve neural tension after a suboccipital muscle inhibition technique in subjects with cervical whiplash: a randomised controlled trial
Antolinos-Campillo PJ, Oliva-Pascual-Vaca A, Rodriguez-Blanco C, Heredia-Rizo AM, Espi-Lopez GV, Ricard F
Physiotherapy 2014 Sep;100(3):249-255
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVES: To assess the immediate effect of a suboccipital muscle inhibition (SMI) technique on: (a) neck pain, (b) elbow extension range of motion during the upper limb neurodynamic test of the median nerve (ULNT-1), and (c) grip strength in subjects with cervical whiplash; and determine the relationships between key variables. DESIGN: Randomised, single-blind, controlled clinical trial. SETTING: Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Spain. PARTICIPANTS: Forty subjects (mean age 34 years (standard deviation (SD) 3.6)) with grade I or II cervical whiplash and a positive response to the ULNT-1 were recruited and distributed into two study groups: intervention group (IG) (n = 20) and control group (CG) (n = 20). INTERVENTIONS: The IG underwent the SMI technique for 4 minutes and the CG received a sham (placebo) intervention. Measures were collected immediately after the intervention. MAIN OUTCOME MEASURES: The primary outcome was elbow range of motion during the ULNT-1, measured with a goniometer. The secondary outcomes were self-perceived neck pain (visual analogue scale) and free-pain grip strength, measured with a digital dynamometer. RESULTS: The mean baseline elbow range of motion was 116.0 degrees (SD 10.2) for the CG and 130.1 degrees (SD 7.8) for the IG. The within-group comparison found a significant difference in elbow range of motion for the IG (mean difference -15.4 degrees, 95% confidence interval (CI) -20.1 to -10.6; p = 0.01), but not for the CG (mean difference -4.9 degrees, 95% CI -11.8 to 2.0; p = 0.15). In the between-group comparison, the difference in elbow range of motion was significant (mean difference -10.5 degrees, 95% CI -18.6 to -2.3; p = 0.013), but the differences in grip strength (p = 0.06) and neck pain (p = 0.38) were not significant. CONCLUSION: The SMI technique has an immediate positive effect on elbow extension in the ULNT-1. No immediate effects on self-perceived cervical pain or grip strength were observed.

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