• Pagnez MAM
• Corrêa LA
• Almeida RS
• Meziat-Filho NA
• Mathieson S
• Ricard F
• Nogueira LAC

• Affiliation / Augusto Motta University Centre. Rehabilitation Science Postgraduate Program. Physiotherapy Department
• Affiliation / Federal Institute of Rio de Janeiro. Physiotherapy Department
• Affiliation / Madrid School of Osteopathy. Academic Department
• Affiliation / Serra dos Órgãos University Centre. Physiotherapy Department
• Affiliation / University of Sydney. School of Public Health. Musculoskeletal Health Sydney
• Affiliation(G) / Australia / New South Wales / Sydney
• Affiliation(G) / Brazil / Rio de Janeiro / Rio de Janeiro
• Affiliation(G) / Brazil / Rio de Janeiro / Teresópolis
• Cox Technique
• Manipulation, Spinal
• Sciatic Nerve / anatomy and histology
• Sciatic Nerve / physiology
• Ultrasonography

OBJECTIVE: The purpose of this study was to compare the cross-sectional area of the sciatic nerve in different positions of spinal manipulation using flexion-distraction technique.

METHODS: Thirty healthy participants were assessed in 6 different flexion-distraction technique positions of varying lumbar, knee, and ankle positions. Participants stood in the following 3 positions with the lumbar in the neutral position: (A) with knee extended, (B) with knee flexed, and (C) with the knee extended and ankle dorsiflexion. Participants then stood in the following 3 positions with the lumbar flexed: (D) with the knee extended, (E) with the knee flexed, and (F) with knee extended and ankle dorsiflexion. The cross-sectional area (CSA) of the sciatic nerve was measured with ultrasound imaging in transverse sections in the posterior medial region of the left thigh. The CSA values measured at each position were compared.

RESULTS: We analyzed 180 ultrasound images. The cross-sectional area of the sciatic nerve (in mm²) in position B (mean; standard deviation) (59.71-17.41) presented a higher mean cross-sectional area value compared with position D (51.18-13.81; P =.005), position F (48.71-15.16; P = .004), and position C (48.37-16.35; P = .009).

CONCLUSION: The combination of knee extension and ankle dorsiflexion reduced the CSA of the sciatic nerve, and flexing the knee and keeping the ankle in the neutral position increased it.

Author keywords: Ultrasonography, Lumbosacral Plexus, Physical Therapy Modalities, Manipulation, Osteopathic

Author affiliations: MAMP: Physiotherapy Department, Rehabilitation Science Postgraduate Program, Augusto Motta University Centre, Rio de Janeiro, Brazil; Academic Department, Madrid School of Osteopathy, Rio de Janeiro, Brazil; LAC, NAMF, RSA: Physiotherapy Department, Rehabilitation Science Postgraduate Program, Augusto Motta University Centre, Rio de Janeiro, Brazil; RSA: Physiotherapy Department, Serra dos Órgãos University Centre, Teresópolis, Brazil; SM: Musculoskeletal Health Sydney, School of Public Health, The University of Sydney New South Wales, Australia; FR: Academic Department, Madrid School of Osteopathy, Rio de Janeiro, Brazil; LACN: Physiotherapy Department, Rehabilitation Science Postgraduate Program, Augusto Motta University Centre, Rio de Janeiro, Brazil; Physiotherapy Department, Federal Institute of Rio de Janeiro, Rio de Janeiro, Brazil

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