Open Access Research article

Effect of glenohumeral forward flexion on upper limb myoelectric activity during simulated mills manipulation; relations to peripheral nerve biomechanics

Marinko Rade12*, Michael Shacklock3, Saara M Rissanen4, Stanislav Peharec5, Petar Bačić5, Corrado Candian6, Markku Kankaanpää7 and Olavi Airaksinen1

Author Affiliations

1 Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, P.O. Box 1607, 70211 Kuopio, Finland

2 “Prim. dr.Martin Horvat” Orthopaedic and Rehabilitation Hospital, Luigi Monti street n.2, 52210 Rovinj, Croatia

3 Neurodynamic Solutions, Adelaide, Australia

4 Department of Applied Physics, University of Eastern Finland, Kuopio, Finland

5 Polyclinic for Physical and Rehabilitation Medicine Peharec, Pula, Croatia

6 Regional Institute for the Studies on Social Services (I.R.S.Se.S), Trieste, Italy

7 Department of Physical and Rehabilitation Medicine, Tampere University Hospital, Tampere, Finland

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BMC Musculoskeletal Disorders 2014, 15:288  doi:10.1186/1471-2474-15-288

Published: 2 September 2014



It is generally accepted that muscles may activate via the common nociceptive flexion reflex (NFR) in response to painful stimuli associated with tensile or compressive forces on peripheral nerves. Following the basic assumption that the radial nerve may be stressed around the elbow during the execution of the Mills manipulation, two positions considered to have different mechanical effects on the radial nerve and the brachial plexus were tested in order to i) explore whether muscles are activated in certain patterns with concomitant changes in nerve tension, ii) establish whether muscle responses can be modified with mechanical unloading of the brachial plexus.


Muscle responses were quantified bilaterally in eight subjects (N = 16) during Mills Manipulation (MM) pre-manipulative positioning and a Varied position that putatively produces less mechanical tension in the brachial plexus. End range pre-manipulative stretch was used in order to simulate the effects of Mills manipulation. Electromyographic signals were recorded with a 16 channel portable EMG unit and correlated with kinematic data from three charge-coupled device adjustable cameras which allowed for precise movement tracking.


Compared with the Standard Mills manipulation position, the Varied position produced significantly reduced myoelectric activity (P .001) in all test muscles. Additional subjective data support the notion that certain muscle activity patterns were protective.


It seems that protective muscles are selectively activated in a specific pattern in order to protect the radial nerve from mechanical tension by shortening its pathway, suggesting integration of muscle and neural mechanisms. Furthermore, the significantly decreased myoelectric activity with reduced mechanical tension in the brachial plexus may help controlling collateral effects of the Mills manipulation itself, making it potentially safer and more specific.

Tennis elbow; Radial nerve; Mills manipulation; Nociceptive flexion reflex; Neurodynamics