Thursday Thoughts: Reset or Modulation? | Modern Manual Therapy Blog

Thursday Thoughts: Reset or Modulation?


This edition of Thursday Thoughts was inspired by my good friend and colleague Chris Nentarz. I was talking about teaching patients self assessments and resets and he said he prefers the term "modulation."

What are we doing with our manual therapies, repeated motions, and corrective exercises? I have definitely taken a liking to the term reset, but is that accurate? Are we turning off an alarm in the CNS that is lowering pain and movement thresholds?

I do use the term "modulation" in my courses for Manual techniques. When a patient cannot move properly without pain, paraesthesia, or perception of stretch, and a manual technique is performed, we are really modulating that perception. When that is no longer perceived and motion rapidly improves quality and quantity, we know the changes have to be neurophysiologic and not mechanical. Or, if you would like to think in mechanistic terms, there really is no separation between mechanical and neurological.

It's really splitting hairs, but I think having an understanding of what we think is happening is important. This is based on what we know is NOT happening, which is changes in

  • fascia
  • capsule
  • joint/bone position
Since those are not happening, we may conclude the changes are neurophysiologic. At this point, it is the most logical conclusion, even if it is somewhat more difficult to explain to patients. Now get out there and start modulating some stretch perception and sculpt some brains!

Keeping it Eclectic...

2 comments:

  1. http://www.npr.org/blogs/health/2015/02/18/387211563/pain-really-is-all-in-your-head-emotion-controls-intensity



    So the idea is at least getting somewhat mainstream now. Hopefully this will help with patients.

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  2. Thanks for sharing Bill, I'll give it a read later and share it on my social media and perhaps Physio Answers. The trick with getting the public (and may clinicians) educated on Pain Science is to word it so patients do not get offended at it being an output vs "all in my head."

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