Scroll of Truth with Diane Jacobs
I don't know who made this cartoon but whoever it is, THANK YOU!
So true. So very true.
Haha at all the spinal HVLA manipulators out there.
The majority of patients having manual therapy for back or neck pain report adverse events.
Meanwhile, this might be what manual therapy is REALLY all about.
The interoceptive turn. "The science of how we sense ourselves from within, including our bodily states, is creating a radical picture of selfhood."
Is it ever.
This new paper by Eggart et al. (reference at the bottom of this blog), proposes that the effects of massage on depression may be all about helping this inner sense of self to change. I would argue this is not limited to only massage but pertains to all slow, kind, interactive, intelligent manual therapy.
Dermoneuromodulating (DNM) is a method for handling the human body and, most of all, its nervous system, in order to facilitate change, particularly in terms of its pain and motor outputs. DNM will not replace everything therapists have already learned, but it may provide a new conceptual container for it. At the very least it provides the participant with a novel approach to handling that is patient‑ and nervous system‑friendly.
Light and interactive, DNM ignores musculoskeletal structure and instead targets pain directly, by focusing on the nervous system, continuous from skin cell to sense of self, directly. The only “structures” considered in any depth will be skin and the cutaneous nerve, long ignored in manual therapy ‑ participants will be exposed, perhaps for the first time , to the extensive branched system that innervates skin.
DNM will provide participants with an expanded frame through which they can set up the all-important treatment relationship, assess patients and their pain problems from the brain’s perspective, teach the patient about pain production without faulting them, recruit their cooperation for manual handling, and put them in charge of their own recovery. DNM is based on Melzack’s Neuromatrix framework of pain as output, the most clinically useful pain model in existence from an interactive manual therapy standpoint. Persisting pain is the reason most patients come to see a manual therapist.
DNM is a fully interactive treatment model: unlike a strictly operative model, in which, for example, biomechanical “faults” must be found, then “corrected”, DNM considers biomechanical expression as defense, not defect. We put “pain” first; i.e., we put the nervous system of the patient (not their anatomy), and their own subjective complaint, their own interoceptive reality, front and center in the treatment encounter; we add a bit of strategic novel stimuli, then we wait a few minutes, and allow the nervous system to self‑regulate. Subsequent improvement in motor output is assessed and regarded as a sign that the nervous system now works with less intrinsic stress.
Reference:
Michael Eggart, Silvia Queri, Bruno Müller-Oerlinghausen, 2019, Are the antidepressive effects of massage therapy mediated by restoration of impaired interoceptive functioning? A novel hypothetical mechanism. Medical Hypotheses Volume 128, July 2019, Pages 28-32
Diane Jacobs, PT
Diane Jacobs graduated from U. Sask with a physiotherapy diploma in 1971, started using manual therapy in1983, and went solo in 1994. She has been interested in pain science and working cutaneous nerves into the manual therapy story since 1998; she calls this dermoneuromodulating. She helped to found the Canadian Physiotherapy Association Pain Science Division in 2009 and served on it until 2014. In 2016 she published a book, DermoNeuroModulating. Her time is spent treating, writing, teaching internationally, and presenting.