경추의 진단과 치료

김 & 장 척추 크리닉김일환 MD DC

Neural Tension Technique

Concept

Neurogenic pain:

pain that initiated or caused by a primary le-sion or dysfunction in the nerve and sur-rounding structure

Conept

3 Pathodynamics of neurogenic pain

1. Mechanical interface dysfunction

2. Neural structural dysfunction

3. Innervated tissue dysfunction

Concept

1. Mechanical Interface Dysfunction surrounding structures of nervous

system(joints, muscle,disc,ligaments,Etc) produce abnormal forces(pressure) on the neural structures

Concept

1. Mechanical Interface Dysfunction Closing dysfunction-hypermobility Opening dysfuntion-hypomobility Pathoanatomical Dysfunction-stenosis Pathophysiological dysfunction-inflammation

Concept

2. Neural structural Dysfunction neural structure exhibit reduced excursion /

abnormal tension or abnormally sensitive to normal excursion(sliding) / tension

Concept

3. Innervated tissue dysfunction muscle dysfunction(Motor control dysfunc-

tion) neurogenic inflammation(SP, CGRP)

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

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

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

Cervical Neural Tension Technique

Indication unilateral cervicoscapular pain unilatral root pain with neurological change post surgical symptoms

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

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

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

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

Cervical spine Neural Tension Technique

Progression 2 ipsilateral scapula upward mobs contralateral arm ULTT 1 position ipsilateral SLR

Cervical spine Neural Tension Technique

Progression 3 ipsilateral ULTT 1 in small amount (shoulder depression or shoulder abduction

or elbow extension..)

Cervical spine Neural Tension Technique

Level 2 progression 1 supine contralateral ULTT1 ipsilateral ULTT 1 progression 2 ipsilateral ULTT 1 without contralateral ULTT 1

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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