Download - Cervical spine neural tension technique
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경추의 진단과 치료
김 & 장 척추 크리닉김일환 MD DC
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Neural Tension Technique
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Concept
Neurogenic pain:
pain that initiated or caused by a primary le-sion or dysfunction in the nerve and sur-rounding structure
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Conept
3 Pathodynamics of neurogenic pain
1. Mechanical interface dysfunction
2. Neural structural dysfunction
3. Innervated tissue dysfunction
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Concept
1. Mechanical Interface Dysfunction surrounding structures of nervous
system(joints, muscle,disc,ligaments,Etc) produce abnormal forces(pressure) on the neural structures
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Concept
1. Mechanical Interface Dysfunction Closing dysfunction-hypermobility Opening dysfuntion-hypomobility Pathoanatomical Dysfunction-stenosis Pathophysiological dysfunction-inflammation
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Concept
2. Neural structural Dysfunction neural structure exhibit reduced excursion /
abnormal tension or abnormally sensitive to normal excursion(sliding) / tension
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Concept
3. Innervated tissue dysfunction muscle dysfunction(Motor control dysfunc-
tion) neurogenic inflammation(SP, CGRP)
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Concept
Neuropathodynamics of neurogenic pain pressure on nerve->reduced venous return->fur-
ther increased pressure->hypoxia->increased mechanosensitivity of nerve
mechanical irritation of nerve->nociceptive stimu-lation of nervo nevosum->perineuronal inflam-mation->endoneuronal edema->reduced venous return->hypoxia-> increased mechanosensitivity of nerve
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Upper Limb Neural Tension Tech-nique(ULTT)
ULTT 1(Median nerve) Supine, no pillow, contralateral neck flexion shoulder depression
glenohumeral abduction 90-110 degree glenohumeral external rotation forearm supination/wrist,finger extension elbow extension
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Upper Limb Neural Tension Tech-nique(ULTT)
ULTT 4 (ulnar nerve) supine ,shoulder depression wrist/finger extension forearm pronation elbow flexion glenohumeral external rotation glenohumeral abduction
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Cervical Neural Tension Technique
Indication unilateral cervicoscapular pain unilatral root pain with neurological change post surgical symptoms
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Cervical spine Neural Tension Technique
Mechanical interface dysfunction Level 1 progression 1 supine cervical flexion/contralateral side flexion and
slight contralateral rotation progression 2 contralateral side flexion mobs
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Cervical spine Neural Tension Technique
Level 2 progression 1 supine cervical flexion/ipsilateral flexon(mid-range) and
slight ipsilateral rotation progression 2 ipsilateral side flexion(end-range) mobs
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Cervical spine Neural Tension Technique
Neural structure dysfunction supine ipsilateral arm ULTT 1 position first lateral glide to ipsilatreal direction with elbow exten-
sion second lateral glide to contralateral direction with elbow flex-
ion
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Cervical spine Neural Tension Technique
Tension dysfunction level 1 progression 1 general off-loading position supine shoulder elevation arm by side slight cervical flexion/ipsilateral flexion/ipsilateral
rotation elbow flexion/forearm pronaton/wrist&finger flexion
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Cervical spine Neural Tension Technique
Progression 2 ipsilateral scapula upward mobs contralateral arm ULTT 1 position ipsilateral SLR
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Cervical spine Neural Tension Technique
Progression 3 ipsilateral ULTT 1 in small amount (shoulder depression or shoulder abduction
or elbow extension..)
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Cervical spine Neural Tension Technique
Level 2 progression 1 supine contralateral ULTT1 ipsilateral ULTT 1 progression 2 ipsilateral ULTT 1 without contralateral ULTT 1
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Cervical spine Neural Tension Technique
Level 3
ipsilateral ULTT 1 with contralateral cervical flexion
ipsilateral ULTT 1 with contralateral cervical flexion mobs ipsilateral ULTT 1 with ipsilateral myofascial release (upper trapez-
ius, levator scapula, scalene..)
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감사합니다