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

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.