C1-2 Manipulation for treatment of extremity neural tension

Many patients suffer from neural tension, and with so many potential causes it may become frustrating for the patient and the practitioner to get a handle on. It is important to remember that the nervous system is a continuous system meaning limitations anywhere along the system can have a negative influence or create pain in another area. I like to consider it like a guitar string which can be wound up from one end but fray and tear from the other end. So where we feel the tension may not be where the entrapment it. The spine is a common source of where the nervous system in wound up but many patients complain of pain in the extremities i.e. sciatica. 

To make this practical I will share a patient example. I had a patient present with right sided sciatica, naturally I address the lower back, piriformis, and remainder of the lower extremity to free up the sciatic nerve. SLR improved by 20% post treatment for low back, hip, and LE. Given the poor results I began to look elsewhere for possible entrapment of the nervous system versus limiting myself to the sciatic nerve only.

The first place I commonly look is the upper cervical spine. The reason for this is easily explained when looking at the picture below. As you can see there is a myodural bridge (MDB as noted in the picture). This bridge connects the muscles of the upper cervical spine to the dura along the spinal cord. Consider that stiffness in this area can create tension that will limit the way the spinal cord glides along the vertebral canal and since its continuous will influence the sciatic nerve as well.

Keep in mind this influence varies greatly from one person to another but it does impact everyone so it is worth checking for every patient. After assessing C1-2 stiffness it was apparent that it was limited and has recently been a source of headaches for the patient which is common with low back pain. After performing the manipulation for C1-2 pt stated 80% decrease in headache and stiffness in cervical spine and SLR improved 60%.  

In conclusion always consider the nervous system as a continuous with some of the greatest entrapment sites being in the spine. Having the ability to quickly assess and perform spinal manipulation is invaluable in patient care almost every musculoskeletal disorder. 

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