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ginger -> Ballistic dural stretching (March 28, 2006 6:43:00 PM)
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Dural tightness is a common feature in presentaions where referred pain is evident. All peripheral nerves are sheathed in a complex tough fibrous network. This sheath can be affected by inflammatory events as with other structures with blood vessels. Tightness and poor extensibility can result, this then can be a lasting feature of an otherwise solveable referred pain event.
By stretching dura , many unresolved pain problems will be solved. Self stretch plays a usefull role, however , strong stretches that bring about quick resolution are of value.
The best of which in my view, are ballistic stretches of dura.
Muscle bellies can be seen to contract with a quick stretch, this leaves whatever is not muscle to stretch. ballistic stretches are done with a forcefull quick movement through the last part of range of a joint or combination of joints. The hold is momentary, repeated 6-8 times , with testing for length and sensitivity done frequently.
For instance , brachial dura can be stretched with patient supine, therapist at the shoulder facing patients head, patients hand held into wrist and finger extension ( full ) elbow extended and shoulder hanging off the edge of the bench into horizontal extension. By drawing the wrist and fingers downwards into further end range hor. ext. a sense of the limits of dural length can be gained. quite often there will be pain and/or a minor exacerbation of other altered upper limb altered sensation during this test.
Repeated forcefull wrist finger extension into end of range and beyond , with quick movements controlled by therapist, into a painfull range, will bring about rapid and lasting improvements to range and many referred events associated with brachial dura.
Other dural stretches will be described if asked.
Approaching dural stretches with prolonged gentle stretch will ultimately work , though much slower and less likely to provide the kind of immediate pain and symptom relief available with ballistic stretching.
These stretches are safe, when done with skill and good handling, provide permanent improvements to extensibility and often remarkable quick pain and symptom relief.
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