Central Health are pleased to announce that Max Zusman has kindly agreed to present two hot off the press evening lectures on consecutive evenings in June. A lecture titled ‘Neurological mechanisms of manual therapy’ on the evening of June 1st Will be swiftly followed by ‘An Enduring Mechanical Mechanism for Passive Movement’ on the evening of June 2nd. Anyone who has heard Max lecture previously will know we are in for a thought provoking, potentially challenging treat!
The lectures will run from 6-9pm in an as yet to be confirmed Central London location. Attendance will cost £40 for an individaul lecture, or £70 for the pair. Please call reception on 020 7404 6343 to reserve a place. More info as we get it.
Neurological Mechanism of Manual Therapy
There now exists sufficient evidence to cast serious doubt on the long-standing implication that the efficacy of passive oscillatory or thrust manoeuvres is causally related to their presumed ability to create sustained ‘changes’ in ranges of passive movement. Indeed, the (contrary) evidence is now so ‘specific’ that even seemingly supportive evidence, should this emerge, would require a significant ‘shift in philosophical goal-posts’. Nevertheless, though often modest, positive clinical consequences can be observed with (passive) movement-based therapy. This raises the question as to the mechanisms by which they occur. In this regard, another similarly long-standing but only relatively recently considered possibility is that the movement-based therapies – passive in particular, but also active – are capable of pain inhibition. Where this occurs, such a positive therapeutic experience encourages the logical ‘progression’ to increasingly intense and/or functional therapeutic movement, and subsequent recovery (graduated exposure). Mechanisms (contributing to informed clinical reasoning) underlying cognitive behavioural and mechanical stimulus sources of pain inhibition proposed to be available with this ‘neurological’ model of manual therapy are discussed. These include the clinically validated entities distraction and its antithesis ‘mindfulness’, habituation, extinction of pain memory and extrinsic stimulation. The last features the (‘new’ for mechanical stimuli) model of synaptic inhibition known as long-term depression (LTD).
An Enduring Mechanical Mechanism for Passive Movement
The physiotherapy profession has long struggled to propose and demonstrate plausible, therapeutically worthwhile ‘mechanical’ effects for manually applied passive movement. The present proposal is based on the capacity for non-excitable connective tissue cells to ‘sense’ externally applied mechanical stimuli and convert mechanical into internal chemical ‘signalling’, leading to gene transcription. In the presence of tissue damage, gene activation results in the production and secretion of the (mainly collagen) components of extracellular matrix. This takes the form of granulation tissue required for tissue repair and remodelling. The dependence of these (restorative) events on the presence of anatomically specific extracellular mechanical ‘force’ suggests a structurally enduring role for manually applied passive movement in the facilitation of optimal repair and restoration of function.
