The Concept of Adverse Mechanical Tension in the Nervous System Part 1: Testing for “Dural tension”

Abstract

The concept of using tests such as the straight leg raise and prone knee bend to stress “dura” or what Maitland (1978) has termed “pain sensitive structures within the vertebral canal” is believed to be an oversimplification of the true anatomical and biomechanical facts. This paper expands this concept to embrace the nervous system as a whole. It introduces the term adverse mechanical tension of the nervous system to explain how pathology affects the normal movement and biomechanics of the nervous system and its surrounding tissues. Mechanisms of sign and symptom production based on current literature are also put forward. The standard or “base” tension tests and relevant biomechanics are reviewed and some new variations/combinations described. The key feature of this approach is to understand basic principles of tension testing and to be able to apply them to a wide variety of clinical presentations. The concept of using tests such as the straight leg raise and prone knee bend to stress “dura” or what Maitland (1978) has termed “pain sensitive structures within the vertebral canal” is believed to be an oversimplification of the true anatomical and biomechanical facts. This paper expands this concept to embrace the nervous system as a whole. It introduces the term adverse mechanical tension of the nervous system to explain how pathology affects the normal movement and biomechanics of the nervous system and its surrounding tissues. Mechanisms of sign and symptom production based on current literature are also put forward. The standard or “base” tension tests and relevant biomechanics are reviewed and some new variations/combinations described. The key feature of this approach is to understand basic principles of tension testing and to be able to apply them to a wide variety of clinical presentations. Biography: David Butler graduated from the University of Queensland with a Bachelor of Physiotherapy in 1978. He then worked in private practice in Brisbane and in 1985 completed the Graduate Diploma in Advanced Manipulative Therapy in Adelaide, South Australia. He is currently a senior physiotherapist at the West Hill Hospital, Dartford, Kent and involved in teaching clinical applications of altered nervous system mechanics. Louis Gifford trained at Sheffield City Polytechnic where his interest in manipulative therapy was first fostered. After working in Walton Hospital, Liverpool, and St Stephen's Hospital, Chelsea, he went on to complete the one-year postgraduate Diploma in Advanced Manipulative Therapy in Adelaide, South Australia, in 1985. He then spent two years working and teaching in Adelaide before returning in 1988 to private practice in Falmouth. His interest in manual treatment of mechanical disorders of the nervous system has been the result of a close friendship and working relationship with Mr David Butler.