Effect of Neurodynamic Mobilisation Plus Core Stability on Pain and Motor Nerve Conduction Velocity in Athletes with Lumbar Radiculopathy

Introduction. Lumbar radiculopathy (LR) is a common debilitating disorder of neuromuscular origin that affects athletes. Material and Methods. This study was a parallel group design and a total of 24 clinically diagnosed athletes with LR were recruited for the study and randomly assigned to one of the two groups, i.e. neurodynamic mobilisation plus core stability group (NDS plus CS) and core stability group only (CS). NDS plus CS underwent neural mobilisation of the tibial nerve and core stability exercises, while CS group performed core stability for a total of 14 sessions on alternate days. The outcome measures of motor nerve conduction velocity (m NCV) of the tibial nerve and pain intensity were recorded before the start of the intervention, at midpoint (7th session) and at the end of the intervention (14th session). Results. Baseline scores of pain and m NCV (NDS plus CS: 6.75 ± 0.62, 38.10 ± 7.21 and CS: 6.58 ± 0.79, 38.92 ± 6.37) were non-significant. The outcome measures improved significantly during treatment in NDS plus CS group (baseline to 7th session, 7th to 14th session and overall mean change for pain and m NCV was found to be 4.74 ± 0.37 and -6.43 ± 3.08, respectively. Non-significant improvement was reported for CS group. Two-way repeated measures (2 x 3) ANOVA was used to analyse the change in the outcome measures and revealed that NDS plus CS group showed statistically significant main effects for group on pain level (F (2, 5.34) = 0.89, p < 0.001 and m NCV (F (2, 5.21) = 0.40, p < 0.03. Significant time and group x time interaction effects were also found. Conclusions. The findings of the study revealed that neurodynamic mobilisation plus core stability were found effective in improving pain level and motor nerve conduction velocity of the tibial nerve in athletes with lumbar radiculopathy.

Muscle energy technique versus active release technique on motor functions in patients with carpal tunnel syndrome

Introduction Carpal tunnel syndrome is the most common median nerve neuropathy, accounting for 90% of all neuropathies, with prevalence in the general UK adult population ranging from 7–16% and bilateral symptoms reported in more than 50% of all cases. The pathophysiological mechanisms involved in the median nerve compression and traction are thought to be complex. This study compared the effectiveness of muscle energy technique and active release technique in patients with carpal tunnel syndrome. Methods This study involved a total of 30 male and female patients with carpal tunnel syndrome, aged between 30 and 50 years. The patients were randomly assigned to two equal groups, group A and group B. Group A received muscle energy technique, and group B received active release technique. Results Independent one-tailed t-tests revealed that the intragroup comparisons showed statistically significant increases in pinch grip strength and motor nerve conduction velocity of the median nerve post-treatment in group A (P=0.001 and 0.0001 respectively), while in group B, there were statistically significant increases in pinch grip strength and motor nerve conduction velocity post-treatment (P=0.037 and 0.043 respectively). The intergroup comparisons showed statistically significant differences in favour of group A. Conclusions Because there was little significant difference between the two groups, this study concluded that both treatment techniques were effective in increasing median motor nerve conduction and hand grip strength. However, muscle energy technique increased motor nerve conduction velocity and pinch grip muscle strength more than active release technique.

Triphala Churna—A Traditional Formulation in Ayurveda Mitigates Diabetic Neuropathy in Rats

Neuropathy is a common complication of diabetes affecting a large number of people worldwide. Triphala churna is a formulation mentioned in Ayurveda-a traditional system of medicine. It is a simple powder formulation consisting of powders of three fruits, Emblica officinalis L., Terminalia bellirica (Gaertn.) Roxb. and Terminalia chebula Retz. Individual components of Triphala churna have anti-diabetic and antioxidant activities. Hence, this study was designed to evaluate the effect of Triphala churna on diabetic neuropathy. Diabetes was induced with streptozotocin (STZ, 55 mg/kg, i. p.) in rats. Animals were grouped and treated orally with Triphala churna at a dose of 250, 500, and 1,000 mg/kg after 6 weeks of diabetes induction for the next 4 weeks. At the end of study, parameters such as body weight, plasma glucose level, motor nerve conduction velocity were determined. The effect of Triphala churna on thermal hyperalgesia, mechanical hyperalgesia, and mechanical allodynia was also determined at the end of study. The plasma cytokine levels like TGF-β1, TNF-α, and IL-1β were determined by ELISA assay. Histopathology study of the sciatic nerve was studied. Western blotting was performed to study the expression of neuronal growth factor.Treatment with Triphala churna showed a significant reduction in plasma glucose and a significant rise in body weight. Triphala treatment significantly increased the motor nerve conduction velocity and decreased the thermal and mechanical hyperalgesia, as well as mechanical allodynia. The treatment significantly inhibited levels of circulatory cytokines like TGF-β1, TNF-α, and IL-1β. Histopathology study confirmed the neuroprotective effect of Triphala churna. The expression of NGF was significantly increased in sciatic nerves after treatment with Triphala churna. From the results, it can be concluded that Triphala churna delays the progression of neuropathy in diabetic rats.

Afterdischarges in Myasthenia Gravis

Introduction: This study aimed to analyze the clinical features of myasthenia gravis (MG) in combination with the afterdischarges and compare the characteristics of afterdischarges in MG with different serum antibodies.Methods: Ninety-two patients with MG were analyzed retrospectively. The afterdischarges were investigated using motor nerve conduction examination, F-wave examination, and repetitive nerve stimulation (RNS).Results: Afterdischarges were observed after the M wave in 14 of 92 patients. Three of these 14 patients tested positive for the muscle-specific tyrosine kinase antibody (MuSK-Ab), and 11 patients tested positive for the acetylcholine receptor antibody (AchR-Ab). The characteristics of the afterdischarges on RNS differed distinctly between the two antibody groups. The afterdischarges occurred on the first stimulation, but decreased on the second and subsequent stimulations in patients with MuSK-MG, while the afterdischarges continued to occur on each stimulation in patients with AchR-MG.Discussion: The characteristics of the afterdischarges on RNS enabled easy identification of their synaptic or neurogenic nature.

Case Report: Myopathy in Critically Ill COVID-19 Patients: A Consequence of Hyperinflammation?

Introduction: COVID-19-associated muscular complications may comprise myalgia, weakness, wasting, and rhabdomyolysis. Skeletal muscle damage in COVID-19 may be due to direct infection by the virus SARS-CoV-2 through interaction with the ACE2 receptor, systemic hyper-inflammatory state with cytokine release and homeostatic perturbation, an autoimmune process, or myotoxic drugs. Disclosing the cause of weakness in an individual patient is therefore difficult.Case Description: We report two patients, who survived typical COVID-19 pneumonia requiring intensive care treatment and who developed early on myalgia and severe proximal weakness in all four limbs. Laboratory exams revealed elevated serum creatine kinase and markedly increased C-reactive protein and interleukin 6, concurring with a systemic inflammatory response. On admission in neurorehabilitation (4 and 7 weeks after COVID-19 onset, respectively), the patients presented with proximal flaccid tetraparesis and limb-girdle muscle atrophy. Motor nerve conduction studies showed decreased amplitude and prolonged duration of compound muscle action potentials (CMAPs) with normal distal motor latencies and normal conduction velocities in median and ulnar nerves. Needle electromyography in proximal muscles revealed spontaneous activity in one and myopathic changes in both patients.Discussion: Clinical, laboratory, and electrodiagnostic findings in these patients were unequivocally consistent with myopathy. Interestingly, increased distal CMAP duration has been described in patients with critical illness myopathy (CIM) and reflects slow muscle fiber conduction velocity due to membrane hypo-excitability, possibly induced by inflammatory cytokines. By analogy with CIM, the pathogenesis of COVID-19-related myopathy might also depend on hyperinflammation and metabolic pathways that may affect muscles in a pathophysiological continuum from hypo-excitability to necrosis.