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Tunnel Syndrome

"A tunnel syndrome is basically a cranky nerve whose tunnel has become a compressive or tensional threat to the neurons inside it; nociceptive neurons embedded within the nerve walls that confine them signal "danger". Causes can be medical or metabolic or hormonal (e.g., pregnancy, diabetes, myzodema), or non-medical. Non-medical tunnel syndromes may arise because of too much movement of a repetitive kind, or simply not enough movement of any kind. Nociceptive neurons within a nerve, complaining, activate others nearby, to create a so-called sterile inflammation, or peripheral sensitization, inside the nerve itself. "Neuritis" is currently classiried by IASP as a special category of neuropathic pain. This is a kind of persisting pain that manual therapy can be very useful for treating." Diane Jacobs

The DNM is particularly directed towards the treatment of cutaneous nerves. These nerves carry all the body surface information, which is transmitted to the CNS. Information from the mechanoreceptors, of course, but also from all those fibres that will measure our external environment, temperature, skin chemistry, nutrition, pH, etc. And they have almost always been forgotten, or worse, neglected. I think this is because we don't see them: they don't seem as important as muscles, fascias, or other structures even sometimes imaginary. The human is thus made, he must see to believe.

Two important books confirm that tunnel syndromes are not reserved for "large" peripheral nerves, but that small nerves could also be affected. These books are: Nerve Injury and Repair by Göran Lundbord and Tunnel Syndromes by Marko M. Pećina.

In my classes, you are going to learn them, to draw them and to relieve them from a possible compression.


"An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." -

"The word "potential" in this definition suggests to us that pain is not irrevocably correlated to tissue damage, rather to "danger", and to the brain's own opinion about the state of its body. When we experience pain, it is we for whom the experience is unpleasant, sensory, and emotional. Our predictive brains do not particularly care what "we" experience, which might be "pain"; they just do their own work, filtering input, in the moment, from a large number of sources, including whatever experiences we have had through a lifetime, the current context they are in, and ongoing sensory input, to decide what current reality is. Our spinal cords simply do not care; their job is to reflexively protect and guard." Diane Jacobs

DNM mainly treats neuropathic pain. It is not involved in pain whose causes are medical, such as injuries like cuts or fractures, deep somatic pain, visceral pain, and suspicious pain of unknown origin.

Descending Modulation

"Upon receipt in the dorsal horn of the spinal cord, nociceptive (pain-signalling) information from the viscera, skin and other organs is subject to extensive processing by a diversity of mechanisms, certain of which enhance, and certain of which inhibit, its transfer to higher centres. In this regard, a network of descending pathways projecting from cerebral structures to the dorsal horn plays a complex and crucial role. Specific centrifugal pathways either suppress (descending inhibition) or potentiate (descending facilitation) passage of nociceptive messages to the brain."

Progress in Neurobiology 66 (2002) 355–474, Descending control of pain, Mark J. Millan

"Manual therapy has long been a component of physical rehabilitation programs, especially to treat those in pain. The mechanisms of manual therapy, however, are not fully understood, and it has been suggested that its pain modulatory effects are of neurophysiological origin and may be mediated by the descending modulatory circuit. Therefore, the purpose of this review is to examine the neurophysiological response to different types of manual therapy, in order to better understand the neurophysiological mechanisms behind each therapy’s analgesic effects. It is concluded that different forms of manual therapy elicit analgesic effects via different mechanisms, and nearly all therapies appear to be at least partially mediated by descending modulation. Additionally, future avenues of mechanistic research pertaining to manual therapy are discussed."

The Role of Descending Modulation in Manual Therapy and Its Analgesic Implications: A Narrative Review

Andrew D. Vigotsky1 and Ryan P. Bruhns2

Hindawi Publishing Corporation
Pain Research and Treatment
Volume 2015, Article ID 292805, 11 pages

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