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1st Jun

2010

Orthopedic Manual Therapy for Chronic Pain: “Reset Faulty Neuromuscular Programming”

Chronic musculoskeletal pain is very common, which often lowers people’s quality of life, and can even be disabling. The causes can be many, but what sufferers have in common is continuous pain, even long after the initial event or injury occurred, and healed.

The Osteopathic literature describes how our bodies can become sensitized, or certain regions such as spinal segments can become facilitated, leading to increased pain perception and muscle contraction (which results from pain), which in turn becomes recognized by our brain as the “normal state”.

In other words, our nervous system, including the brain, has become programmed so that this altered painful state is the “default” setting. Treatments such as pain medications may dull our pain perception, but until the heightened neural activity can be “shut off”, and the brain/central nervous system can be reprogrammed to recognize such reduced neural discharge as normal, lasting improvement cannot be expected.

ORTHOPEDIC MANUAL THERAPY AFFECTS PAIN RECEPTORS

Orthopedic Manual Therapy can consist of a number of treatment methods, such as soft tissue mobilization/myofascial release, joint mobilization or manipulation, and specific exercise therapy to mobilize or stabilize a region of our body.

When performed correctly and specifically, such treatment can inhibit increased nerve activity which would result in pain perception and muscle tension, by affecting nerve receptors located in our joints and adjacent soft tissues. In this way, the manual therapy treatment inhibits nerve impulses from reaching our brain, and our muscles, resulting in less pain perception and muscle tension, and improved mobility.

NEUROMUSCULAR REPROGRAMMING REQUIRES REGULAR REPEATED TREATMENT

When a facilitated or sensitized state of nerve activity has become our “normal” mode, it is usually necessary to frequently bombard our nervous system with impulses in order to successfully reprogram it. The longer the pain has been present, the longer it typically takes to see results.

Besides regular treatments by a competent orthopedic manual therapist, the person can also be taught certain exercises to do regularly every day, such as small joint movements, muscle stretches, nerve gliding exercises, or specific joint decompression positions etc, and perhaps frequent short duration ice/cold applications to further inhibit pain perception and muscle tension. The better the home exercise and self-care compliance, typically the better the treatment results.

I should also mention that a person’s frame of mind and emotional state is closely linked to the pain perception mechanism as well. A heightened level of anxiety and stress, as well as a pessimistic outlook can amplify our pain perception, and reduce the effectiveness of orthopedic manual therapy.

With time, as the vicious cycle of pain and muscle tension starts to break, less frequent treatment and exercise to inhibit pain is required, but progressed exercise training often is necessary in order to sustain improvements long-term.

The orthopedic manual therapist can now help you restore qualities such as normal coordination with movements, posture, flexibility, endurance and strength in order to minimize strain or compromise of tissues, while allowing you to return to activities that were previously not possible due the pain.

Best wishes,

Gunnar

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