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1st May

2015

Nervous System often the “Magic” behind Manual Therapy

In health care today, the term Evidence Based Medicine, is being used frequently, and demanded by the industry and insurance companies, to justify our use of treatment methods.  In the field of orthopedic physical therapy, there is now a growing and substantial body of evidence that shows positive outcome following treatment with orthopedic manual therapy, including therapeutic exercise therapy, for a variety of conditions, including even degenerative conditions such as osteoarthritis.

But what is the mechanism behind this “magic”, since surely such treatment cannot change or reverse the arthritic condition or degenerative disc?  Unfortunately, there is a great number of practitioners who claim that the reduced symptoms are due to some miraculous healing power of the treatment, or because the treatment corrected joint subluxations or “joints being out”.  Although joint “locking” occasionally occurs, the truth typically is far from the above.

I have in past newsletters discussed the biomechanical effects of orthopedic manual therapy, which is important in order to restore normal mobility.  However, the neurophysiological effects of treatment may be of even greater importance.

When a person is in pain, there is increased discharge of nerve impulses from nerve fibers capable of causing pain, from certain tissues in the body.  This in turn causes specific deep muscles to contract, or “guard”, limiting motion, and compromising oxygen delivery and circulation, further adding to our pain perception. When we experience pain, there is also activation of the sympathetic nervous system, or the fight and flight system, specifically targeting the involved area, and neurologically related areas farther away.  This in turn may make our sensory organs more sensitive, including the pain nerve fibers, and less stimulation of these fibers is necessary to make them fire.  For people who develop more pronounced sensitization, often in chronic pain conditions, this mechanism is particularly pronounced.

There is a constant interaction between nerve pathways that inhibit perception of pain, and facilitate perception of pain.  When the latter dominate, and reach a certain pain threshold, we perceive pain, but only when the threshold has been reached.  We can think of this as a glass filled with water.  Under normal circumstances, stimulation of various sensory nerves imbedded in joint capsules, including some of the pain nerve fibers, only partially fill up the glass, and we do not experience pain.  However, often times a region or spinal segment becomes “facilitated” or sensitized, markedly amplifying these nerve impulses, and the water fills up the glass, and spills over, resulting in pain perception.  Once this has occurred, the pain-muscle guarding cycle can be self perpetuating.  The longer this process remains, the more the nervous system can get sensitized.

What we can accomplish with skilled manual therapy, is inhibit some of the nerve pathways that facilitate our perception of pain, including the sympathetic nerve fibers, to reduce the neural facilitation and raise the threshold at which pain fibers fire.  Techniques such as soft tissue mobilization, and in particular joint mobilization or manipulation, and manual traction may all be effective in accomplishing this, while also increasing mobility and reducing protective muscle guarding.  Stress, anxiety or other emotional issues can also add to the facilitation or sensitization process, and therefore empathy and a caring attitude shown by the treating physical therapist will help to “empty the glass” of nerve receptor discharge, and lower the pain perceived.

In order to have long lasting improvement, we also need to apply exercise physiology, to restore normal active movement and tissue tolerance to strain with daily activities.  This entails a specifically targeted and progressed exercise rehabilitation program.

So the magic here lies within ourselves and especially in the nervous system, and the manual physical therapist simply applies tools to activate or deactivate neurophysiological mechanisms to a more normal state, necessary for healing and recovery of normal movement.

Although this letter describes this topic in a simplified fashion, I hope you find it of interest, so please feel free to share it with others.  Additional details were provided in the December, 2014 newsletter.   To read past newsletters, and to see our free consultation offer, please visit www.mossbergpt.com.

With best wishes for good health,

Gunnar

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