Physical therapy treatment can be broken into 3 primary categories and they are all tied to the nervous system. These groups are: manual therapy, balance therapy and strengthening. Proper treatment addresses the nervous system through these treatment categories to effect change. This is because muscles, joints, organs(including the inner ear) all send information into the nervous system, in the form of electrical impulses, and they are affected by the electrical impulses returning from the nervous system. The nervous system determines the tension in the muscles and the blood flow to muscles and organs. Effective treatment will change those signals INTO the nervous system to improve what comes OUT of the nervous system to change how you feel.

Trigger Point Dry Needling (TDN): A procedure for myofascial pain where a monofilament needle(acupuncture needle) is inserted into the muscle to target and release tight, tender bands of muscle(called myofascial trigger points). Trigger points are like tiny ‘Charlie Horses’ within 1 or more muscles that can produce pain locally or elsewhere. These can remain in the muscle long after an acute or overuse injury because the nervous system has adapted to the injury by tightening the muscle to protect itself. Those muscle fibers that are now prevented from relaxing normally send in messages that the nervous system identifies as irritating and it sends messages to tighten up. So this is a cycle that doesn’t turn off. Dry needling could be pictured as a power surge that trips a circuit breaker to shut off the power(breaking the cycle)

Counterstrain: An osteopathic technique that relaxes muscle guarding and pain. Tender points are found within muscles but rather than forcing the muscle to stretch, the opposite approach is used. The muscle is shortened and by taking tension out of the muscle, the tight and irritated muscle sends fewer complaints into the nervous system.  By cutting off nerve impulses from the irritated muscle for a few minutes, the nervous system often returns to normal. This is an indirect way to alter the nervous system’s demands on the body.

Reflex Techniques: Reflexes will drive a quick contraction of a muscle and a relaxation of the muscles that pull against that muscle. An example would be the doctor tapping a tendon in the knee to see if you kick. We see that the quad contracts quickly but on the other side of the leg, the hamstring relaxed. Using a stretch reflex in the muscle//tendon or the joint(joint manipulation) will cause the nervous system to relax muscles. This is like a volume control.

Soft Tissue Mobilization: This is the physical manipulation of muscles, tendons, ligaments, and fascia(connective tissue wrapping the muscles and connecting them to other muscles). Myofascial release engages restriction between muscles and fascia for long holds. Fascial manipulations involves focus on ‘densifications” within muscles that disrupt the muscle function. Deep tissue massage focuses on the muscle directly and it’s circulation and lymphatic drainage. 

Visceral Mobilization: When organs refer pain or other sensations to the external body, we call the symptoms viscerosomatic(organ/body). The most familiar viscerosomatic referral is from the heart when acute pain in the left shoulder and neck arises like chest wall pain during a cardiac event. Other viscerosomatic symptoms are less recognizable to the public but cause plenty of other pains in back, hip etc just as muscles do. Many organs(viscera) are basically muscular tubes. Like muscles, they are also affected by the blood supply in and lymphatic drainage out. This osteopathic technique involves gentle pressure(a message into the nervous system) to increase the blood supply and lymphatic drainage. A good balance of oxygen rich blood in and metabolite rich lymph out balances the pH(acidity). Low pH looks like an injury to the nervous system and this technique, like the others, affects it.

Therapeutic Exercise: The examples above describe how the nervous system will cause muscles to tighten(guard) and how we get stuck in these cycles. The flip side to this is that the nervous system also inhibits muscles from working normally. These muscles(generally working in groups) must be returned to normal function. After breaking up the guarding patterns with manual techniques, strengthening weakened groups comes next for recovery.

Vestibular Retraining: The vestibular system is a sensory system in the inner ear that helps maintain balance and spatial orientation. It works together with your vision and postural muscles to function. Retraining involves all of these and can overlap with the previously mentioned techniques.