DNM
DermoNeuroModulation
DermoNeuroModulation is, first of all, the realisation that whatever we think we touch when we practise manual therapy, it is definitely the skin that we touch.
Then, through the study of skin neurophysiology, we see certain concepts that can only be part of our new vision of manual therapy:
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The cutaneous nerves are scattered throughout the skin, through its entire thickness.
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Cutaneous nerves are mixed nerves, which include sensory neurons (mechanoreceptor and C-fibres) and motor neurons (which serve for the autonomic innervation of the skin).
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As soon as we move the skin a little, the central nervous system is alerted. It will sense us, and it will be able to respond if we give it a chance.
Our conception of manual therapy is going to evolve in this new field as we become aware that most tunnel syndromes (compressions suffered by nerves) are due to soft tissue compressions.
A thorough study of cutaneous nerves will be part of the programme: their origin and location will help us determine a better treatment plan.
70 techniques are presented as a means of action. All of these techniques are painless and aim to suggest to the CNS an alternative to the pain the person is experiencing.
Knowing that manual therapy is only part of a good treatment, we will also have discussions about the bio-psycho-social aspect of manual therapy treatments.
References
What if manual therapy wasn't exactly what we think it is?
And what if, this time, we relied on what science, neuroscience, is telling us to understand what we are really doing?
"Small diameter sensory fibres provide the feedback from the body that is absolutely essential for the homeostatic control systems that maintain the physiological conditions of the body. They provide the vital signals that indicate that the body is alive. " (Craig, A.D. (2015) How do you feel? An Interoceptive Moment with your Neurobiological Self. Princeton, NJ: Princeton University Press, p. 110)
Why does the CNS need to know exactly what is happening in the body?
No muscle in the body contracts by itself. No bone, fascia or tissue has the will to change itself. All of them, without exception, only respond to motor outputs from the CNS. We cannot change them from the outside. The only way we can do this is to learn how to « talk to the body », dialogue with the CNS, and only the CNS can issue motor outputs to modify tissue tensions, muscle contractions and other homeostatic-type normalisations.
We are going to totally put aside the unverifiable theories and those of therapies whose "scientific evidence » are in fact only statistics. It is not a question of knowing that manual therapy is effective and that it brings comfort and well-being: this has been an established fact for millennia. It is now a question of how it can do so. Neuroscientists can help us understand.
Here are a few important books :
"When I wrote my dissertation, and above all when I rewrote it and made it into a book, I realised that what we called the sense of "touch" was much more than simple touch. It involved all the receptors of the skin, of course, but also all the receptors of the joints, the muscles, the musculo-tendinous junctions, the visceral mechanoreceptors, thermal receptors, C-tactile receptors and the nociceptors. All of these fibres carry information to the central nervous system, from its internal environment or external environment, and that is not visual, auditory, taste or olfactory information. We see then that what we called "touch" also implies movement and sensations. It is easy to understand that all manual therapies become somesthesia therapies. However, it is also necessary to include in this group all the movement therapies such as Tai Chi, Qigong, Yoga, and the various practices of meditation which involve breathing and which have a direct impact on visceral mechanoreceptors amongst others. A big project that describe everything that happens ... “
« It was during my first DNM class that I was convinced that my intuition was very close to reality. DNM was teaching me what I already thought, but also clarifying points that were still obscure for me. Shortly after this class I began to translate everything, to reread everything, to practise, and I had this strong impression of having found the missing link. We must face that fact that everything happens in the nervous system, we can’t model the body. Changes will occur ONLY if the nervous system decides. As therapists, the only thing we can do is to try to influence the CNS, to "speak" to it, to "propose" modifications to it, and if the CNS can benefit from it, no doubt it will change. Otherwise, it is not by pushing, cracking, modelling that we will get there.
You have to talk to the CNS: you have to learn its language and use the right channels of communication. You have to know the physiology of the human body, especially neurophysiology to be able to do a good job in manual therapy. »
Louise is the director of AIMTC (Académie Internationale des Méthodes Thérapeutiques Contemporaines) where she teaches DNM, Bowen and Niromathé.
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