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Summary This paper challenges current clinical models and systems for assessing and managing on-going pain states to incorporate a broader biological and therapeutic framework. Included is an acceptance of the current criticisms made towards a purely tissue based/modality based paradigm for pain treatment. The mature organism model proposed is presented as a workable conceptual starting block for incorporating mechanisms of pain into the broad science of stress biology and the biopsychosocial model of pain.

Summary Key features identifying typical signs, symptoms and history of disorders demonstrating adverse mechanical tension of the nervous system are addressed. An approach to “musculoskeletal pain” embracing a broader outlook to all possible sources of presenting symptoms is highlighted as the “component concept”. The treatment principles of presentations showing signs of adverse mechanical tension of the nervous system are outlined, and clarified by many clinical examples.

Summary 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.