Therapeutic heat and cold around the elbow on the response of median neurodynamic test 1

Objective: To compare the effects of the application of therapeutic heat and cold on the mechanical response of the median nerve neurodynamic testing.

Design: Single-blinded randomized crossover trial.

Methodology: 56 asymptomatic university students (mean age = 21.82 ± 1.64 years) of either gender with a limited elbow extension range of motion during a Median Neurodynamic Test 1 were recruited. Each subject was administered 3 testing conditions on separate days with a 24-hr washout period. The interventions included 1) therapeutic moist heat around the elbow, 2) therapeutic cold around the elbow and 3) no thermal agent as a controlled condition. Outcome measure of elbow extension range of motion at the onset of pain and submaximal pain were recorded before the intervention, immediately after the removal of the thermal agents (20^th min) and at 2 subsequent readings of 30 min and 1 hour after the removal of the thermal agent.

Results: There was a significant effect of using a thermal agent with time on the elbow range of motion at the onset of pain [F(2,165) = 3.622, p = 0.029] and submaximal pain[F(2,165) = 3.841, p = 0.023] at the 20th min. A posthoc comparison indicated that at the 20th min the mean elbow range at the onset of pain and submaximal pain for the therapeutic heat condition (mean = 33.5, S.D = 13.37 and mean = 16.80, S.D = 12.99 respectively) was significantly different than the no thermal agent condition (mean = 40.17, S.D = 12.34 and mean = 23.4, S.D = 13.82 respectively). However, therapeutic cold condition did not significantly differ from both the other conditions.

Conclusion: Therapeutic heat causes an immediate increase in elbow extension range of motion during a Median Neurodynamic Test1 and testing post the application of thermal agents can alter the test response.