Great Post! The Application of Working Memory and Treatment of Chronic Pain States | Modern Manual Therapy Blog

Great Post! The Application of Working Memory and Treatment of Chronic Pain States

Carolyn Berryman reviews the previous BIM post about Working Memory and Chronic Pain. She gives a good example about using mental imagery while performing a potential painful movement pattern like a heel strike. Have your patient imagine the movement, but concentrate on it's tactile feeling, and proprioception and how it should feel, as opposed to the nociceptive input the movement may perform. 

The more I read the BIM research, the more I am convinced that MDT and repeated motions, which you have the patient perform hourly as a self treatment mode works to decrease CNS sensitivity as much as it does mechanically. 


  1. When it comes to individuals with a primary complaint of pain, our manual therapy effects are most likely much more nervous system mediated than mechanically mediated. The force and duration of our treatments make permanent mechanical changes very unlikely. Movement and exercise performed for painful conditions are also likely causing neuro-physiologic effects resulting in decreased pain and increased mobility. In short, they are decreasing the perceived threat level and causing a decreased pain output. Someone who has low back pain and receives mobilization, manipulation, or soft tissue work, or any other kind of hands on treatment is experience decreased pain because of nervous system effects, NOT mechanical changes in their tissues. Take also an example of someone who has "tight" hamstrings and performs hamstring "stretching" is likely just increasing their nervous system's tolerance (both PNS and CNS) to stretch/ROM, NOT increasing the length of their hamstring tissue. Now, the result is that they are more "flexible" but those effects are likely nervous system mediated not mechanically/tissue mediated.

  2. Now, granted increased mobility, ROM, "Flexibility, or decreased tone/tightness may be observed, but these are not from true mechanical changes (i.e. lengthening of tissue). These are perceived mechanical changes that have been caused by the nervous system....