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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.

Verondersteld wordt, dat het concept om tests zoals het heffen van het gestrekte been en het buigen van de knie in buiklig toe te passen om de ‘dura’ ’ of wat Maitland(1978) als ‘pijngevoellige structuren binnen het wervelkanaal’ heeft aangeduid ’ onder spanning te brengen een te eenvoudige voorstelling is van de werkelijke anatomische en biomechanische feiten. In dit artikel wordt het concept behandeld via een benadering van het zenuwstelsel als geheel. De auteurs introduceren de term ‘provocerende mechanische spanning van het zenuwstelsel’ om te verklaren hoe een pathologische toestand de normale beweging en biomechanica van het zenuwstelsel en de omliggende weefsels beinvloedt. Tevens worden mechanismen beschreven met betrekking tot het optreden van verschijnselen en symptomen gebaseerd op de bestaande literatuur.

En los ultimos anos, la filosofia y el enfoque que la fisioterapia tradicional tenia del dolor se iban enfrentando a los desafiantes hallazgos y resultados de la investigacion moderna sobre el mismo. Como consecuencia, la profesion ha comenzado a abarcar modelos de dolor mas dinamicos y de mayor alcance y ha iniciado un cambio de pensamiento y practica. Un ejemplo de esto se encuentra en el modo en que la reciente integracion del modelo biopsicosocial esta comenzando a impactar sobre la forma en que los fisioterapeutas razonan y trabajan. Ademas, la investigacion sobre el dolor ha desafiado la interpretacion que se tenia de los mecanismos subyacentes del mismo, de sus causas y origenes, ademas de la eficacia y los mecanismos de las intervenciones empleadas.

In the past three decades, a scientific revolution has occurred in the understanding of the experience of pain. However, a clinical revolution based on the new science is yet to occur. Pain is a multidimensional experience with many con­ tributing and interacting biological/pathobiological mecha­ nisms. These mechanisms may be nociceptive, peripheral neu­ rogenic, central, affective/cognitive or relate to output systems such as the motor and autonomic nervous system. With a better understanding of pain-related neurobiology and some clinical decision making skills, reasoned attempts at a diagnosis of pain can be made. The essential question and first step related to clinical integration is to ask, "what is (are) the predominant mechanism(s) in a given patient's pain state?" This paper pro­ vides the underlying clinical biology of pain mechanisms and proposes pain patterns related to the mechanisms. J HAND THER 10:86-95, 1997.

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.