As soon as we face the facts and accept that the only means of action that exists for the manual therapist, in the application of the technique itself, constitutes the stimulation of the receptors of the somesthesia, and that no matter what his desire or expectations are, the result will be the sole fact of the CNS, a whole world opens up to us:
• It becomes possible to see the possibility of truly learning neurophysiology and applying it in manual therapy.
• We realise that regardless of the name of the therapy, we all do the same thing: stimulate the receptors of the somesthesia. It's inevitable.
• No more feeling that you are missing the boat if you do not look into what other therapeutic systems are doing. If a technique contains a stretch of the skin, it is of little use to know if it is osteopathy, reflexology, craniosacral, etc. However, it is very important to know that this stretch is the necessary stimulus for the Ruffini corpuscle to transform this mechanical energy into an action potential, and to know everything that happens in the CNS following this stimulation.
• Without denying it or putting it aside, we no longer feel obliged to defend at all costs the colours of the therapeutic system to which we first adhered. Each therapeutic system is good, none is totally complete. It is worth learning a few of them (or as many as we want, since each of them will bring us something new) and practising them with neurophysio always in mind.
• We come to understand that the therapist cannot "adjust" the patient, but that he can communicate with his CNS and hopefully modify his interpretation of the situation.
• We become free.
The nervous system will always have the last word; it is up to us to provide information from which it will benefit. Our responsibility: to study and be open to the great discoveries made in recent years in the fields of neurophysiology and neuroscience.
This freedom can only be obtained through a serious study of neurophysiology and neuroscience.
So, for now, we've all learned several techniques, we've all gone to several schools. How do we choose, amongst the techniques we have already learned, those that would be most beneficial for our patients?
What I suggest is this (my point of view):
1- Manual therapy should be gentle and pleasant
In recent years, several studies have been done on C fibres that are sensitive to pleasant touch. It seems that these fibres are of paramount importance for the regulation of homoeostasis. We all do it unconsciously: to touch, being touched, feels good. All animals do, take the time to read again the page on social grooming.
2- Manual therapy should be slow and punctuated by therapeutic pauses
"Autonomic changes happen slowly, over a long period of time." (Craig, A.D. 2015)
Looking for a lasting improvement for our patient, means that we also want a profound modification of the CNS. Changes in the autonomic nervous system (sympathetic and parasympathetic) take place over a long period of time. These changes cannot occur in milliseconds, but in minutes or even hours. To avoid inhibiting our stimuli as we apply them, I recommend waiting up to two minutes between applications. It would take too long here to do all the neurophysiology, but if you read A.D. Craig's book, which would probably take several months, many dictionaries and other reference books, you will understand. (I also introduce several elements of neurophysiology in my class and we will discuss it in the blog.)
In addition, some fibres that are sensitive to stretch or contraction may take up to 15 seconds to activate after the end of the contraction and their action potential may last up to one minute. If that were the only reason to make a therapeutic pause, it would already be a very good reason.
3- Manual therapy should never cause pain
Pain is counterproductive in manual therapy. When nociceptive C fibres are activated during a manual therapy session, they provoke, at best, a withdrawal reflex and, at worst, a sympathetic "fight or flight" reaction. Since your patient will neither fight with you nor will he run away, his cortisol level and other stress hormones are likely to rise. This is certainly not the ideal situation for him. Note that even if the patient « accepts » this pain, this reflex still occurs, because it is totally generated by the spinal cord.
If your techniques already meet these three criteria, you already have in your hands techniques that will be very beneficial to your patients.