1. 김&장 척추 크리닉
김일환 MD DC

3.  Neurogenic pain:
pain that initiated or caused by a primary
lesion or dysfunction in the nerve and
surrounding structure

4. 3 Pathodynamics of neurogenic pain
1. Mechanical interface dysfunction
2. Neural structural dysfunction
3. Innervated tissue dysfunction

5. 1. Mechanical Interface Dysfunction
surrounding structures of nervous
system(joints, muscle,disc,ligaments,Etc)
produce abnormal forces(pressure) on the
neural structures

6. 1. Mechanical Interface Dysfunction
Closing dysfunction-hypermobility
Opening dysfuntion-hypomobility
Pathoanatomical Dysfunction-stenosis
Pathophysiological dysfunction-inflammation

7. 2. Neural structural Dysfunction
neural structure exhibit reduced excursion /
abnormal tension or abnormally sensitive to
normal excursion(sliding) / tension

8. 3. Innervated tissue dysfunction
muscle dysfunction(Motor control
dysfunction)
neurogenic inflammation(SP, CGRP)

9. Neuropathodynamics of neurogenic pain
pressure on nerve->reduced venous return-
>further increased pressure->hypoxia-
>increased mechanosensitivity of nerve
mechanical irritation of nerve->nociceptive
stimulation of nervo nevosum->perineuronal
inflammation->endoneuronal edema->reduced
venous return->hypoxia-> increased
mechanosensitivity of nerve

10.  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

12. ULTT 4 (ulnar nerve)
supine ,shoulder depression
wrist/finger extension forearm pronation
elbow flexion
glenohumeral external rotation
glenohumeral abduction

14. Indication
unilateral cervicoscapular pain
unilatral root pain with neurological change
post surgical symptoms

15. Mechanical interface dysfunction
Level 1
progression 1
supine
cervical flexion/contralateral side flexion and
slight contralateral rotation
progression 2
contralateral side flexion mobs

16.  Level 2
progression 1
supine
cervical flexion/ipsilateral flexon(mid-range)
and slight ipsilateral rotation
progression 2
ipsilateral side flexion(end-range) mobs

17.  Neural structure dysfunction
supine
ipsilateral arm ULTT 1 position
first
lateral glide to ipsilatreal direction with elbow
extension
second
lateral glide to contralateral direction with
elbow flexion

18.  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

19.  Progression 2
ipsilateral scapula upward mobs
contralateral arm ULTT 1 position
ipsilateral SLR

20.  Progression 3
ipsilateral ULTT 1 in small amount
(shoulder depression or shoulder abduction
or elbow extension..)

21.  Level 2
progression 1
supine
contralateral ULTT1
ipsilateral ULTT 1
progression 2
ipsilateral ULTT 1 without contralateral ULTT 1

22.  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
trapezius, levator scapula, scalene..)

23. 감사합니다