cervical spine neural tension technique
TRANSCRIPT
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..)
감사합니다