Sciatic Nerve Stiffness Using Two-Sequences of Lower Limb Neurodynamic Testing: A Shear Wave Elastography Study

NCT ID: NCT07136441

Last Updated: 2025-09-11

Basic Information

• Recruitment Status: RECRUITING
• Total Enrollment: 60 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2025-08-15
• Study Completion Date: 2026-02-28

Brief Summary

The purposes of the study are:

1. To measure differences in Sciatic nerve (SN) stiffness using shear-wave elastography (SWE) during two movement sequences of the lower limb neurodynamic test (LLNT) in low back pain with sciatica.

2. To measure differences in Sciatic nerve stiffness using shear-wave elastography during two movement sequences of the lower limb neurodynamic test in control group.

3. To compare difference in Sciatic nerve stiffness using shear-wave elastography during two movement sequences of the lower limb neurodynamic test between low back pain patients with sciatica and control group.

Detailed Description

As peripheral nerves can exhibit regional variations in their anatomy and mechanical properties, investigating the response of different nerve segments to different loading patterns based on the order of joint movement will provide a better understanding of nerve biomechanics during neurodynamic testing.

This may help optimize the lower limb neurodynamic test (LLNT) application for different pathological situations and potentially increase its diagnostic capacity to detect localized alterations in a specific nerve segment such as sciatica.

Ultrasonography does not have the sensitivity required to detect all forms of peripheral nerve disorders and fails to provide information about nerve mechanical properties such as stiffness.

By using neurodynamic sequencing, clinicians may direct neural stress toward targeted areas suspected of involvement and, at the same time, perform the test with reduced load on more remote nerve segments. The ability to modify neural load distribution during the LLNT could play an interesting role in differential diagnosis, when symptoms present similar characteristics but have different regional origin.

There is a gap in the literature concerning the measurement of (SWV) of sciatic nerve during LLNT proximal (LLNT-PROX) to distal and from distal (LLNT_DIST) to proximal sequences of LLNT.

Conditions

Sciatic Nerve

Study Design

• Observational Model Type: CASE_CONTROL
• Study Time Perspective: CROSS_SECTIONAL

Study Groups

Group A (Low Back Pain with Sciatica)

Thirty patients with low back pain with sciatica aged 25-40 years with unilateral leg pain for 3-12 months, lumbar disc herniation (L4-5) confirmed by MRI, and positive straight leg raising test. Participants will receive sciatic nerve tension tests using both proximal-to-distal and distal-to-proximal sequences with shear wave elastography assessment.

Lower Limb Neurodynamic Test (LLNT) with Shear Wave Elastography

Intervention Type: DIAGNOSTIC_TEST

Participants underwent sciatic nerve stiffness assessment using shear wave elastography during two distinct sequences of the lower limb neurodynamic test. Each participant received:

Proximal-to-distal sequence: Starting with hip flexion, followed by knee extension, then ankle dorsiflexion with toe extension.

Distal-to-proximal sequence: Starting with ankle dorsiflexion and toe extension, followed by knee extension, then hip flexion.

Group B (Control Group)

Thirty healthy control participants aged 25-40 years, free from symptoms of nerve irritation or compression, with normal neurological examination findings including normal reflexes, sensation, negative straight leg raising test, and normal motor strength. Participants will receive the same sciatic nerve tension tests in both sequences.

Lower Limb Neurodynamic Test (LLNT) with Shear Wave Elastography

Intervention Type: DIAGNOSTIC_TEST

Participants underwent sciatic nerve stiffness assessment using shear wave elastography during two distinct sequences of the lower limb neurodynamic test. Each participant received:

Proximal-to-distal sequence: Starting with hip flexion, followed by knee extension, then ankle dorsiflexion with toe extension.

Distal-to-proximal sequence: Starting with ankle dorsiflexion and toe extension, followed by knee extension, then hip flexion.

Interventions

Lower Limb Neurodynamic Test (LLNT) with Shear Wave Elastography

Participants underwent sciatic nerve stiffness assessment using shear wave elastography during two distinct sequences of the lower limb neurodynamic test. Each participant received:

Proximal-to-distal sequence: Starting with hip flexion, followed by knee extension, then ankle dorsiflexion with toe extension.

Distal-to-proximal sequence: Starting with ankle dorsiflexion and toe extension, followed by knee extension, then hip flexion.

Intervention Type: DIAGNOSTIC_TEST

Other Intervention Names

Two-Sequence Neurodynamic Testing

Eligibility Criteria

Inclusion Criteria

• Thirty participants ranging in age from 25 to 40 years from both genders with a diagnosis of low back pain with radiating leg pain and thirty control group.
• The main symptoms are low back pain with unilateral leg pain(sciatica) for 3-12 months for group A.
• Patients with lumbar disc herniation (L4-5) with diagnostic imaging as MRI for group A.
• Positive straight leg raising are considered for inclusion in the study for group A.
• Control group must be free from any symptoms of nerve irritation or compression, with normal neurological examination findings, including reflexes, sensation, negative straight leg raising and motor strength.

Exclusion Criteria

• Diabetes mellitus.
• Any type of polyneuropathy
• Trauma of lumbar spine
• Previous history of back surgery
• Piriformis syndrome.
• Participants with conditions that reduce image quality on US imaging (thick gluteal subcutaneous fat tissue.
• Hip joint prosthesis.
• Professional athletes (Neto et al., 2024).
• Skin infection

• Minimum Eligible Age: 25 Years
• Maximum Eligible Age: 40 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Cairo University

OTHER

Sponsor Role: lead

Responsible Party

Manar Fawzy Mohamed

Principal Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Eman Ahmed Abd Elmoez, PhD

Role: STUDY_CHAIR

Professor, Cairo university

Najlaa Fathi Ewais, PhD

Role: STUDY_DIRECTOR

Assistant Professor, Cairo university

Ebtisam Abdelkareem Ali, PhD

Role: STUDY_DIRECTOR

Lecturer, Cairo university

Hatem Mohamed El-Azizi, PhD

Role: STUDY_DIRECTOR

Professor, Cairo university

Locations

Cairo University

Giza, , Egypt

Site Status: RECRUITING

Countries

Egypt

Central Contacts

Manar Fawzy Mohammed Hussein, M.Sc

Role: CONTACT

manar.fawzy@the.suezuni.edu.eg

+20 120 140 8924

Ebtisam Abdelkareem Ali, PhD

Role: CONTACT

Facility Contacts

Manar Fawzy Mohammed Hussein, M.Sc

Role: primary

manar.fawzy@the.suezuni.edu.eg

+20 120 140 8924

Other Identifiers

P.T.REC/012/005897

Identifier Type: -

Identifier Source: org_study_id