tag:blogger.com,1999:blog-3190056069771978380.post7432678975118599880..comments2022-04-20T02:32:52.220-07:00Comments on Neurotonics: a PT team blog: Microglia and Pain: A Manual Therapy Perspective IIIDiane Jacobshttp://www.blogger.com/profile/01356363026969420734noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-3190056069771978380.post-21059149362237351222009-02-16T08:13:00.000-08:002009-02-16T08:13:00.000-08:00Hello satyajit,"can you please simplify the entire...Hello satyajit,<BR/>"can you please simplify the entire thing for me in manual therapy prospective."<BR/><BR/>Really, I think it all boils down to the fact that on some levels a therapist's handling will be interpreted as an added threat by a patient's non-conscious brain, no matter how kind a person we happen to be. It's really important IMO to reduce the threat factor as much as possible, by controlling the context as best you can. <BR/><BR/>1. Reassure the patient that you will not intentionally cause them any increased discomfort, as that would be counter-productive for the purpose of pain downregulation.<BR/> <BR/>2. Recruit them to help you determine their own comfort level. Make it clear that it's you and them, teamed up to help a non-conscious part of their system learn to reduce the discomfort it has produced. Then you have to fulfill your end of the bargain:<BR/><BR/>a. Ask the patient to relax and breathe freely;<BR/>b. Do not provoke any more pain in your already pain-provoked patient, and;<BR/>c. Watch the patient's motor output like a hawk to ensure you do not provoke their pain further with your well-intended efforts. (Watch eyelids, facial muscles etc., tell the patient to let you know about any discomfort they may be experiencing from your grip, or handling.) <BR/><BR/>Pain is something that must be contained, meticulously and swiftly, by you on the outside, but <I>mostly</I> by the patient's awareness, on the inside, or it can become/remain widespread, severe, and persisting. <BR/><BR/>The patient's job (whether they realize it or not) is to learn to downregulate their own pain. To do that they have to learn how - this is something completely kinesthetic and non-verbal. You can't teach them exactly how - all you can do is explain to them that they have brain parts whose job is precisely to do that, and that they will need to help those parts do their job again, and that you'll try to help that happen or at least not interfere. <BR/><BR/>Our manual therapy benefits people more, I think, when we follow a few simple guidelines, such as these:<BR/> * Let the <I>patient's</I> brain lead the way during the actual contact, and learn to "feel" when improvements occur in non-conscious output, mostly autonomic<BR/> * Lighter is always better than harder<BR/> * Slower is better than faster<BR/> * Lingering longer is better than jumping around too abruptly <BR/> * More time between visits is better than less (optimal physiological changes take at least three days to complete, then it takes time for the system to settle into/"learn" or neuroplasticize a new "normal") <BR/> * The patient should report significant improvement each visit<BR/> * Most patients will be "better", as in ready to discontinue, within a span of 3 to 5 sessions, for most kinds of "pain," even pain that seems at first to be complex, mysterious (without clear mechanism) and widespread<BR/> * Be completely happy for them and let them go off to live their life as a normal person, not as a lifelong "pain patient."Diane Jacobshttps://www.blogger.com/profile/01356363026969420734noreply@blogger.comtag:blogger.com,1999:blog-3190056069771978380.post-69927918601371260922009-02-16T07:10:00.000-08:002009-02-16T07:10:00.000-08:00hi,all the parts are too terse for me to follow. c...hi,<BR/><BR/>all the parts are too terse for me to follow. can you please simplify the entire thing for me in manual therapy prospective. it would of great help for me a practicing physiotherapist. <BR/><BR/>satyajit<BR/>www.physioindia.blogspot.comsatyajit mohantyhttps://www.blogger.com/profile/10478820484216397642noreply@blogger.comtag:blogger.com,1999:blog-3190056069771978380.post-9884672418441441522008-08-09T05:15:00.000-07:002008-08-09T05:15:00.000-07:00Hi Eric, "I'd suggest (effect of manual therapy) m...Hi Eric, <BR/>"I'd suggest (effect of manual therapy) might be to reduce the afferent nociceptive barrage arriving at the cord. Would you agree?"<BR/><BR/>I would: certainly in a neurodynamic model the whole point of the intervention is to help the neurons access their own oxygenation. If they aren't distressed they won't "sweat" fractalkine (as per Watkins 2003), not so much anyway (fractalkine seems to be some sort of microglial attractant). <BR/><BR/>The part that cannot ever be ruled out (from a manual therapy perspective) (and I don't know why anyone would ever want to) is stimulation of descending modulation from the hind-brain. <BR/><BR/>Contact with skin will alert all parts of the nervous system at once, but I suspect responses in different regions differ. <BR/>1. The S1 cortex will accept the contact as non-threatening (of course context must be managed to make it so)<BR/>2. The hindbrain and assorted nuclei, alert centers such as locus ceruleus won't "know" who or what is touching their organism - they will simply sense and respond. If they do their "alerting" as usual but get absolutely no response from S1, because S1 is happily ignoring or else enjoying the contact, all the hindbrain will be able to arouse will be itself. Part of its arousal function is descending modulation of upcoming nociception - we want to stimulate that, and want it to continue, but we definitely don't want S1 to react, either to us or to the alerts from the hindbrain. <BR/><BR/>It's more complicated than that, of course, and there are lots of cortical regions/pathways that likely do get alerted/stimulated and somehow their reaction is curtailed - context again.<BR/><BR/>I think however that this is the beginning of a reasonable hypothesis for the descending analgesia/descending modulation part of getting those microglia back into their little cages, in the context of applying manual therapy. <BR/><BR/>For manual therapy to work on pain perception, the contact has to be non-nociceptive, and your handling/exteroceptive input has to be placed under veto control of the patient, and the patient has to be told that, explicitly. <BR/><BR/>The patient has to have a chance to learn how to handle "you" and that you will respond to any discomfort they might feel, either verbally or physically expressed. Once the patient feels in complete control, they can trust you and therefore the process, and allow it to occur. <BR/><BR/>Fortunately most people "get it" right away. Some take longer. That's life. :)Diane Jacobshttps://www.blogger.com/profile/01356363026969420734noreply@blogger.comtag:blogger.com,1999:blog-3190056069771978380.post-57185376232857528292008-08-08T21:25:00.000-07:002008-08-08T21:25:00.000-07:00Dermoneuromodulator,What effect do you think manua...Dermoneuromodulator,<BR/>What effect do you think manual therapy has on the microglia? Based on that wonderful diagram from the textbook of pain you used to illustrate the overlap of neurogenic and neuropathic pain, I'd suggest it might be to reduce the afferent nociceptive barrage arriving at the cord. Would you agree?Anonymousnoreply@blogger.com