The mechanistic viewpoint and evidence-based medicine
With the invention of the x-ray, doctors were finally able to see physical dysfunctions such as bone breaks and nerve root compression without exploratory surgery. This idea of “proof” became not only the validation of the diagnosis of many doctors, but the source of it. Even in manual therapy the conclusion jumped to was that pressure on the nerve root was the problem. Disc herniations create structural impingements that cause the pain. This evidence based viewpoint dominated medicine is still the prevalent view influencing the course of musculoskeletal medicine. Now we know that people often live pain free with structural dysfunctions, nerve root impingements and herniations. Even the effected symptomatic pain sufferers are not in constant pain. The obvious question is why is there pain only in some of the cases with the same structural dysfunction present? Why is there only pain sometimes if the cause is purely mechanical?
How does bodywork treat pain?
Where there is pain, there are always structural and postural deviations. Muscles and joints do not move properly and posture is visibly uneven. There are rotations, shifts and bends visible throughout the body either in standing, supine or prone position. There is also a lack of balanced or functional range of motion. There is a direct correlation between postural dysfunction, imbalance and pain in the body. Manual bodywork can be helpful in managing pain. Many people get relief from therapies that treat posture, structural fixations and muscular fascial imbalances. Muscle tissues are tight or weak and fixed in an uneven holding pattern. I helped many people by treating visually and palpably dysfunctional tissues that were tight or over stretched and retrained them in functional movement patterns. But how does the stuff we treated come back? By observing and studying the recalcitrance of dysfunction and compensation patterns in the body, one can ultimately come to the conclusion that most postural presentations in the body are actually not the cause but the effect of dysfunction in the body and pain is merely the signal that something is “off”.
How Does NYOM Treat Pain?
If the body is in pain, it assumes a physically defensive posture so as to not stimulate the creation of that pain. The related physical posturing is compensation. If we manually override the physical compensation and successfully reduce the amount of symptoms, have we resolved the problem or increased the efficiency of the compensation? One of my favorite tools is strength testing. Manual muscle testing to see which muscles are working can give us a lot of information about how the body is or isn’t functioning properly. Most chronic muscle issues are related to neurogenic inhibition and hypertonicity. If muscle function isn’t assessed, valuable information is being ignored. The most recent and most world shattering conclusion I have come to after 16 yrs in the field is that invasive procedures such as chemical ingestion, injections, surgery and even manually treating pain and posture with bodywork can miss the root cause because it is focusing on symptomatic relief. It is almost sacrilegious for me as a bodyworker to say that we can’t heal the body so let me explain my stance. Once you improve neuromuscular communication, the effects of bodywork, tissue and joint manipulation last and the changes made hold.
Who’s in charge?
Our autonomic nervous system controls 80% of all body function without us being cognizant of what is happening. We created computers to process data just like the human brain. Just like computers, by continual usage makes our “software” slow down and get “buggy”. Before long, we don’t quite function as fast as we did “out of the box”. Improper signaling slows down processing speed. In the tech world, a firmware update or system reinstall gets things running again. In the human world, few of us treat “software” issues and processing errors within the nervous system. When you reset neurological function and use manual therapy together, you make lasting changes. Those changes remove dysfunction at the root and allow for balanced movement patterns to emerge. Manual therapy doesn’t remove the source of dysfunction. It down regulates the pain signals and shifts posture away from pain generating receptors.. Neurogenic dysfunction is created in and by the nervous system.
Pain in the Brain and Neurological Compensation
When we have physical or emotional pain, we have a flood of input to the nervous system. The brain seeks to down regulate high signaling signals and it creates compensation when it can’t. It ignores disruptive attention grabbing pain signals so as to free up some bandwidth for other neurological processes. The brain down regulates this dysfunction by fragmenting it to lessen its high signal. It spreads it throughout the nervous system via an associative neural map and neurological compensation is born. When constant nagging physical discomfort suddenly goes away for a while, the nervous system is compensating. The brain wants to make you happy and make the pain go away. The brain frees up the cluttered workspace so the nervous system can focus on our organs and glands imperative for life function. Nagging pain signals act like interference and rob focus and energy from the body.
Behavior, motor control and brain maps.
Here’s the rub; whether you feel pain or not, pain signals are still being sent in the nervous system “24/7-365” . All it takes is for symptoms to flare up is the correct pathway to be stimulated. Pain lies dormant in a stiff osteoarthritic toe until the necessary receptors are stimulated. Pain is the response. We learn to avoid the pain. The more time that passes, the more our brains record neuron maps of our daily activities. The more we do things, the easier they become. As people, we become experts at compensation to the point where we often don’t see what we have become. The brain and our DNA record and respond to electrochemical stimulation in the nervous system. The more compensation we have learned, the less we access new pathways in the body and brain. We become deeper set in our patterns due to neuroplasticity. Poorly compensated motor control becomes our new baseline and the brain only accesses inefficient pathways. We lose fine motor skills and the brain just rewrites the program like someone erasing your favorite show to record theirs.
Still chasing symptoms?
I spent years studying with top bodywork professionals. Venerable leaders in the manual bodywork field who spent 20 to 30 years building cutting edge practices. I learned from brilliant people and applied the work and I still had clients I couldn’t “figure out”. I tried everything I could. I pushed myself for answers daily. As a focused student and clinician I was missing something and I didn’t know what. It wasn’t until I witnessed the functional neurology of P-DTR that things began to click. I soon understood that the relationship of pain and causality in the body is set up by the mothership that is the central nervous system. For me, hot topic industry arguments for releasing in fascia vs joints and yoga over kettle bells or acupuncture vs massage instantly became moot. The new information was like a new magic lens to see through. It was illuminating. It was now as if I could see if the chicken or the egg came first.
NYOM = Comprehensive Bodywork
The system I use incorporates all the tools that I have learned or used in my practice in the past. The order and some application of techniques is more effective. The New York orthopedic massage approach has always been integrative. Now we are even more comprehensive, taking neurological as well as biomechanical causes into account. Now I comprehensively understand the regulation of the nervous system and its direct effect on musculoskeletal tissue, ligaments and joints. Reversing chronic dysfunction is more effective and lasting than ever. If your symptoms keep coming back maybe you should reevaluate your tactics. Book an appointment with New York Orthopedic Massage today and have your issues assessed and treated.
Brilliant! Reread it a couple times. Loved the idea of the brain freeing up workspace so that’s why even though the dysfunction is still there the pain may come and go.
Question-If someone has a software issue (torn labrum, torn ligament, etc.) and they feel pain if you address the hardware issues that might have lead to the software issues and help them correct dysfunctional patterns they will still feel pain until the actual software issue is healed right? You gave me a definition of pain during our last visit but can’t remember what you said.
Please keep writing! I find this articles really useful as I start to understand the magic of your work.
Hi Nicole! Thanks for the kind words. Hardware is arthritis, torn labrum, muscle strain… Software problems create the instability that causes hardware problems unless trauma is the inception of the dysfunction. Compensation from a hardware problem is neurological in nature. Even animals limp to avoid a painful foot. Adapted compensatory postures and repetitive motions create more hardware issues which create more software compensation. Software issues are usually not resolved with stretches or massage or joint manipulation but many symptoms can be addressed. Ultimately, as we get “old” we learn to move in ways that don’t stimulate high signaling dysfunction. Pain is a product of the insula and is projected into our body from the brain, so it isn’t always consistent depending on how much the brain is dealing with. If your nervous system isn’t efficient and you are in sympathetic overdrive, you have a higher likelihood of feeling pain. You have to address both the software and hardware problems but some surgeries are unnecessary and diagnosis is lazy at times. By the same token, when you need surgery, it is the best option. Some cases of arthritis will not be an issue if the muscle strain pattern is resolved and the joint becomes stable. The arthritis is there but isn’t stimulated any more. Each case must be assessed thoroughly and separately.