Neural Mobilisation Effect on Calf Muscle

The Effect of Neural Mobilization on Calf Muscle Length and Strength in Ballet Dancers: a Randomized Controlled Trial

The purpose of this study was to investigate Neural mobilisation effects on calf muscles length and strength is crucial to optimize ballet performance and prevent injuries.

Study Overview

• Status: Completed
• Conditions: Calf Muscle Tightness
• Intervention / Treatment: Other: Neural mobilisation; Other: Gastrocnemius stretching

Detailed Description

A randomized controlled trial is conducted with a total of 54 non-professional ballet dancers recruited from ballet studios across the Klang Valley following inclusion and exclusion criteria. Baseline measurement of calf muscle performance was conducted before randomization using knee-to-wall (KtW) test, handheld dynamometer (HHD) and Y-balance (YBT). Participants were allocated to experimental (NM and self-stretching) or control (self stretching) .

• Study Type: Interventional
• Enrollment (Actual): 54
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Malaysia
  • Negeri Sembilan
    • Seremban, Negeri Sembilan, Malaysia, 71800
      • Inti International University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Classical ballet trained female or male .
• Subjects who are trained in classical ballet syllabus such as Royal Academy of Dance (RAD) Syllabus, The Classical Ballet Syllabus by Commonwealth Society of Teachers of Dancing (CSTD), Vaganova Syllabus and more.
• Aged 13-23 years old
• Dancers who took class/practice ballet for at least 3 times per week
• Participated in ballet competition in recent 6 months

Exclusion Criteria:

• Professional full time ballet dancers
• Non-ballet dancers
• Self-reported lower extremity injuries in the past 6 months prior to date of data collection
• Subjects with existing musculoskeletal injuries might affect calf muscle performance
• Involvement in other sports or physical training

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Neural mobilisation group; neural mobilisation of tibial nerve and gastrocnemius stretching	Other: Neural mobilisation; the neural mobilisation was done with placement of participant's leg in hip flexion, knee extension, ankle dorsiflexion and eversion to load the nerve. Then leg is placed back to neutral position, with ankle naturally plantarflexed to unload the nerve. NM of tibial nerve was done in a total of 10 seconds each repetition, with 5 seconds each for loading and unloading of nerve. Then 12 repetition was done in one set, which amount to a total of 120seconds or 2 minute per set. A total of 3 sets was done on each leg, with a 1-minute resting interval after each set. NM was administered to participants in experimental group before their ballet class for 3 times a week lasting for 4 weeks.; Other Names: nerve gliding; nerve tensioning; Other: Gastrocnemius stretching; Participants was instructed to perform the classic wall stretch for gastrocnemius as self-stretching for a duration of 30 seconds each leg. It was done facing the wall and one leg had knee flexed in front while the other leg had knee extended behind. A 30 second hold was maintained at maximum stretched position by leaning forward while both soles of feet remain contact on the ground. Self-stretch was performed throughout the 4-week study duration before every ballet training or class.; Other Names: calf self stretching
Active Comparator: Gastrocnemius stretching group; Participants was instructed to perform the classic wall stretch for gastrocnemius as self-stretching for a duration of 30 seconds each leg. It was done facing the wall and one leg had knee flexed in front while the other leg had knee extended behind. A 30 second hold was maintained at maximum tretched position by leaning forward while both soles of feet remain contact on the round. Self-stretch was performed throughout the 4-week study duration before every ballet training or class.	Other: Gastrocnemius stretching; Participants was instructed to perform the classic wall stretch for gastrocnemius as self-stretching for a duration of 30 seconds each leg. It was done facing the wall and one leg had knee flexed in front while the other leg had knee extended behind. A 30 second hold was maintained at maximum stretched position by leaning forward while both soles of feet remain contact on the ground. Self-stretch was performed throughout the 4-week study duration before every ballet training or class.; Other Names: calf self stretching

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
knee to wall test	The participants placed the testing foot onto the measuring tape with foot perpendicular to the wall while lunging or bending the knee to touch the wall. Then participants slide their foot further away from the wall as much as ossible while maintaining contact of knee to the wall as well as heel of foot on the floor. The calf muscle flexibility is evaluated with the measurement of distance from the great toe to the wall will be the maximum possible ankle dorsiflexion for the individual.	From enrollment to the end of treatment at 4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Calf muscle strength	Calf muscle strength was measured using handheld dynamometer (HHD).The device was placed at the plantar aspect of metatarsophalangeal joint height and the body of HHD should be maintained perpendicular to the plane of ankle plantarflexion movement. Isometric contraction of ankle plantarflexor was done in maximum possible force for 5 seconds. Participant performed one trial to familiarize with the test, followed by 3 repetitions alternated on each leg with 1-minute resting interval.	From enrollment to the end of treatment at 4 weeks
Dynamic balance using Modified Star Excursion Balance Test (mSEBT)	Participants maintained their hands on the hip and reached tip of hallux to the maximal distance. The reaching foot were to avoid touching the ground and the heel of standing foot should remain on the ground. One trial on each direction was performed to familiarize with the test, followed by three trials with 1 minute resting interval. Normalize reach distance to lower limb length and normalized composite score were calculated to ultimately evaluate dynamic balance of an individual.	From enrollment to the end of treatment at 4 weeks

Collaborators and Investigators

• Sponsor: INTI International University
• Investigators: Principal Investigator: NITHIYAH MARUTHEY, Inti International University

Publications and helpful links

General Publications

• Cho SY, Myong Y, Park S, Cho M, Kim S. A portable articulated dynamometer for ankle dorsiflexion and plantar flexion strength measurement: a design, validation, and user experience study. Sci Rep. 2023 Dec 14;13(1):22221. doi: 10.1038/s41598-023-49263-2.
• Avila-Carvalho L, Conceicao F, Escobar-Alvarez JA, Gondra B, Leite I, Rama L. The Effect of 16 Weeks of Lower-Limb Strength Training in Jumping Performance of Ballet Dancers. Front Physiol. 2022 Jan 12;12:774327. doi: 10.3389/fphys.2021.774327. eCollection 2021.
• Alimoradi M, Sahebozamani M, Hosseini E, Konrad A, Noorian S. The Effect on Flexibility and a Variety of Performance Tests of the Addition of 4 Weeks of Soleus Stretching to a Regular Dynamic Stretching Routine in Amateur Female Soccer Players. Sports (Basel). 2023 Jul 19;11(7):138. doi: 10.3390/sports11070138.

Study record dates

Study Major Dates

• Study Start (Actual): August 20, 2024
• Primary Completion (Actual): January 15, 2026
• Study Completion (Actual): January 15, 2026

Study Registration Dates

• First Submitted: May 6, 2026
• First Submitted That Met QC Criteria: May 6, 2026
• First Posted (Actual): May 13, 2026

Study Record Updates

• Last Update Posted (Actual): May 14, 2026
• Last Update Submitted That Met QC Criteria: May 12, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: neural mobilisation; calf muscle length; calf muscle strength
• Other Study ID Numbers: INTI-IU/FHLS-RC/BPTHI/1NY12024

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: Upon careful consideration it will be decided to protect participants privacy

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No