iSAW 01.10 More Research Needed

Manual Therapy for intransigent pain

We get sent (without solicitation) a steady flow of Worker’s Compensation cases. The people presenting invariably describe complex, severe, unremitting pain that has failed to respond to conventional therapy. It’s up to 360 NMT to try something different. We sample from the following sequences, often interchangeably.

Manual Therapy 1 – Getting under the radar
First-strike pain weaponry for severe pain often includes the use of car buffers, Chinese soup spoons, hedgehogs, implements from spiky life, alternate heat/cool, and old fashioned jostling and vibration. The sensations from these mostly cutaneous distractions swiftly travel up to the brain via the medial lemniscus, as opposed to pain slowly creeping up the spinothalamic tract. Could this be an example of speed kills? More research needed.

Manual Therapy 2 – Following the barrier
Pressure-release manual therapy has been popularized by David Simons MD and Leon Chaitow DO. We apply either direct or shear pressure to ascertain barriers of tissue resistance (induration). Softening of this resistance is the goal. Some say this takes seconds (Prudden), some say 2-5 minutes (Stecco), or something in-between. More research needed.

Manual Therapy 3 – Getting the motor running
The preferred technique of Myopain Seminars (also popular in Europe) involves an active contraction of the target muscle along with manual compression (CoCo – get it?). CoCo forces a sideways squashing, or broadening of aberrant muscle tissue. Well, something changes. More research needed.

Manual Therapy 4 – Here, there, then back to here
I’ve recently returned to the old Nimmo receptor tonus technique that I first learned in the mid-nineties. In this method the muscle is pre-warmed with effleurage and then placed on slack. Pressure is applied in repeated doses for just 5-7 seconds. One then moves to another area, often the antagonist muscle, before returning to re-treat the original. The tissue changes may be likened to meat tenderizing after you take it out the oven.