The nervous system is a continuous structure that runs throughout the body, like the extensive roots of a tree. It includes the brain, spinal cord and the nerves that connect almost every structure of the body to the spinal cord. It is a key information transmitting organ; transmitting instructions from the control centers or sensations from body structures towards the interpretative and integrative higher centers. It is commonly injured by compression, tension and friction or irritation as it is subjected to contact stresses outside or inside the body.

                                 

 As everything is all connected, tension or impingement on one part of the nerve affects everything else along its course.  Take for example the pictures shown below.

It is not uncommon for symptoms of nerve pain presenting at distal areas of the body such as the elbow or wrist and hand to have its primary from the neck, considering that as the nerves exit, they can be compressed by muscles of the neck.  What this means is that we should look at the whole body structure and not focus on the regional complaint.  Oftentimes, releasing the restrictions on the neck would have significant effects on the symptoms experienced down the arm.  That is usually my first course of treatment.

It is also possible for nerve structures to develop adhesions along their course and for that, they might need to be mobilized.  I prefer not to do the limb tension techniques as I prefer not to stretch and provoke an already irritable and painful nerve.  Also, according to the book Manual Therapy for Peripheral Nerves by Barral and Croibier:

"A nerve tension can prematurely stop intraneural circulation.  When this happens, nutrition is compromised, particularly if the nerve sheaths are broken open.  This decrease in nutrition occurs intraneurally as well as to the accompanying nerve vessels. Normally, the spiral or winding regional vessels can adjust very well to the changing

position of the nerves without becoming cracked or overstretched.  However, as soon as their adaptability thresholds are exceeded, their lumen narrows.  This causes the blood flow to slow or even cease.  Studies on living tissue shows that the first microcirculation changes occur at a length increase of 8%.  With a stretch of about 15%, the blood flow is interrupted but normalizes again after the release of the traction force.  Manual therapy can help to decrease the mechanical forces acting on the nerves to improve the microcirculation."

If and when I have to, I prefer instead to use the principles of Clinical Neurodynamics as they use neural sliders initially and progress to neural tensioners only when the patient's body has shown a capability to tolerate it.  Tensioners though are end stage progression of treatment and are not always necessary.

The sequence of movements applied in neurodynamics are very specific so the nerve slides along its course and are mobilized only where the therapist wants them to be moved and the entire course of the nerve is not subjected to traction force or stretch.

Exodus 31:2-4

New Century Version (NCV)

² "See, I have chosen Bezalel son of Uri from the tribe of Judah. (Uri was the son of Hur.)³ I have filled Bezalel with the Spirit of God and have given him the skill, ability, and knowledge to do all kinds of work.⁴ He is able to design pieces to be made from gold, silver, and bronze,

Skill, ability and knowledge come from the Lord!

Video Interview of my DNS Instructor

DYNAMIC NEUROMUSCULAR STABILIZATION

Dynamic Neuromuscular Stabilization  or DNS is a system of assessment, treatment and exercise that is integrative and holistic in its approach to address pain syndromes and movement dysfunctions.  Developed by Dr. Pavel Kolar from the Prague School of Rehabilitation and Manual Medicine, it is truly a groundbreaking neurodevelopmental approach and quite revolutionary in its use of reflexes inherent to the body.

I was blessed to have taken Course A of the DNS program back in 2010.  Two DNS certified instructors held a four-day seminar-workshop at the Gleneagles Hospital in Kuala Lumpur, Malaysia.  It was a convention of physical therapists, osteopaths and chiropractors brought together by a common desire to acquire an entirely new learning experience.  I was eventually able to pass the exam and become Course A certified.

The culturally and professsionally diverse class

Breathing is the single, most fundamental movement of the human body.  There is no movement pattern of the human body that does not involve breathing.  Can you persist in any functional activity without breathing? No.  This puts the diaphragm in the limelight as an essential muscular component of any movement pattern.

The DNS paradigm recognizes this and is actually the first school of thought that emphasized it and delved into it in such detail.  It goes so far as to say that no successful movement rehabilitation can be achieved if the proper breathing pattern is not reinforced.  To formulate a summation: breathing is the key to proper movement, core stabilization, and joint alignment.

Stomach in, chest out? That's wrong!!!

The DNS paradigm introduces exercises based on a neurodevelopmental approach.  That means they want you to learn movement and strengthen your muscles in the same manner and sequence that you learned them growing up from infancy.  This effectively engages the core muscles while integrating proper breathing techniques as you exercise.  Core stability is one of the goals of the DNS program.

Notice the similarities.

The most fascinating aspect of DNS though is their use of reflex zones located within the body that elicits an involuntary reflex movement pattern embedded within our central nervous system.  These patterns are normally evoked in infants as they go through a sequence of motor development as they growing up and learn to move.  Stimulating these points is like giving the body and the nervous system a review of proper movement coordination and modulation.  The result of this intervention is truly astounding!

Note: the movements of the patient in the are involuntary and are elicited by proper positioning and stimulation of the reflex zones.

The true beauty that I see in the DNS paradigm is that we are basically "restoring" the body's systems to what it should have been.  And no matter how astounding and revolutionary the methods may seem, we are just finding out and using what God had already put in place.

Psalm 139:13-15

New International Version 1984 (NIV1984)

¹³ For you created my inmost being;
    you knit me together in my mother’s womb.
¹⁴ I praise you because I am fearfully and wonderfully made;
    your works are wonderful,
    I know that full well.
¹⁵ My frame was not hidden from you
    when I was made in the secret place.
When I was woven together in the depths of the earth,

DORN METHOD SPECIALIST

Dorn Method is one of the techniques I utilize and integrate into my practice.  Described as  "a holistic, gentle, effective, non-manipulative and safe way to correct misalignments of the spinal column and other joints", I'd classify it as a form of mobilization with movement technique.  There are a few of these techniques which serve to mobilize joint or soft tissue structures as the patient adds a component of active movement.

It is quite unique in its presentation of the micro-subluxation of the femoral head as a cause of leg length discrepancy and hip joint malalignments.  I have observed immediate improvements in back pain symptoms and leg length correction problems on numerous occasions after application of this technique.

On one occasion, a basketball player on our team came to me complaining of lumbar spasms which impaired his ability to play.  He presented with hypertonus of his right paralumbar muscles, quadratus lumborum, hip flexors and hamstrings.  His right pelvis was also in anterior rotation.  Upon examination using the dorn method of assessment, his right leg was found to be longer than the left.  I applied the femoral head "repositioning" technique which is central to the Dorn method of treatment.  After doing just that, the back pain and muscular spasms, the leg length discrepancy and anterior rotation of the right pelvis all disappeared!  I was quite surprised.  It was the first time I applied Dorn to one of my players and it worked absolutely well! Player with jersey number 28 was able to play on that day.

This method, though effective and useful, is not "the answer" to all back pain conditions.  Bear in mind that the etiology of back pain is diverse and multi-factorial.  Still, it is a very useful tool in the arsenal of a capable manual therapist.

NOTE:

Beware of practitioners who 'mystify' their practice and move into the realm of energy and spiritual healing.  That is NOT manual therapy.

Psalm 142:2-4

New International Version 1984 (NIV1984)

² I pour out my complaint before him;
    before him I tell my trouble.

³ When my spirit grows faint within me,
    it is you who know my way.
In the path where I walk
    men have hidden a snare for me.
⁴ Look to my right and see;
    no one is concerned for me.
I have no refuge;
    no one cares for my life.

Psalm 51:10

New International Version 1984 (NIV1984)

¹⁰ Create in me a pure heart, O God,
    and renew a steadfast spirit within me.

Isaiah 40:30-31

New International Version 1984 (NIV1984)

³⁰ Even youths grow tired and weary,
    and young men stumble and fall;
³¹ but those who hope in the Lord
    will renew their strength.
They will soar on wings like eagles;
    they will run and not grow weary,
    they will walk and not be faint.

 
 If you need strength and spiritual healing, come to God first and foremost.

Where the diverse road started for me: My jump off point in manual therapy

My journey into manual therapy started way back during my college days.  But the road of learning widened when I joined the certification course offered by UST.  The primary instructors were Sir Valentin Dones and Sir Leomil Adriano.  I am truly grateful to them for opening up this road for me.

Since then, this road has opened up many avenues for me.  There are many roads to take indeed, and the journey becomes even more colorful and interesting.  But all roads should lead to just one destination: the betterment of the patient's well-being.

Give value to what you do.  Then people will see the value in you.

 

Proverbs 22:29

New International Version 1984 (NIV1984)

 Do you see a man skilled in his work? 

 He will serve before kings;
 he will not serve before obscure men.

New Living Translation (NLT)

Do you see any truly competent workers?

They will serve kings
 rather than working for ordinary people.

Certified Manual Therapist

College of Rehabilitation Sciences,

University of Sto. Tomas

Course Content

Module 1 : Introduction to Manual Therapy

                TMJ Examination and Treatment

Module 2: Manual Therapy of the Cervical Spine

Module 3: Thoracic Region Manual Therapy and

                Evaluation Techniques

Module 4: Lumbo-Pelvic Complex Manual Therapy

               Examination and Treatment

Module 5: Upper Extremity Manual Therapy Examination and

                   Treatment

Module 6: Upper Extremity Manual Therapy Examination and

    Treatment

Module 7: Integrated Neuromuscular Taping Therapy

Module 8: Neural Therapy Manual Examination and Treatment                    

Module 9: Muscle Energy/Positional Release  

               Techniques/Mulligan Technique for the Cervical   

                Spine

Module 10: Mulligan Approach to the Thoracic and Lumbar

                 Regions

1st Post: WHY and WHAT FOR?

I created this profile to serve as an online reference to my professional credentials.


Admittedly, there is a lack of awareness and information regarding us healthcare professionals.  


Who do you go to for this case? For that case? 
Who is the best professional to go to for which condition?
How qualified is that professional to address my problem?
How do I know that I can trust his judgment, approaches, methods?


All of us are or have been healthcare consumers at some point in our lives.  And I believe the discerning consumers ask good questions.  The same questions.  The right questions.


I don't have all the answers.  But for those who ask the right questions, you might actually find someone who can give the right answer.  Or at least lead you to it.


This profile aims to answer those who ask about me and what I can do.  I'll also try to give you insight into my treatment perspectives and clinical reasoning.  That way, you can make an informed decision as a healthcare consumer, if I do in fact have the right answer.  Or maybe I can lead you to it.



PROVERBS 18:15 (New Living Translation)


Intelligent people are always open to new ideas. In fact, they look for them.