New Course Release: Dermoneuromodulating: Treating the Patient as if Their Nervous System Really Mattered
Most of our training as physiotherapists and healthcare professionals hardly includes the sensory nervous system. It may have been mentioned, but it was not investigated. It was not taught as part of a context for us being out in the world, treating patients.
But how else are we going to get information into another person's nervous system or new input into it unless we consider the sensory nervous system?
Our brains get information from the environment through the sensory nervous system - whether it be the eyes, the ears, etc. And then the brain will do all sorts of lovely predictive processing and the brain will decide to believe whatever it wants.
The brain wants to believe what it wants to believe. And that goes for absolutely everybody and absolutely every patient., So we have to deal with that factor, which is kind of a hurdle .
We're going to explore the sensory nervous system because that is our best option to help patients. When I learned about the nervous system in physical therapy school, it was all about the spindles. However, spindles don't register exteroceptive input. They register interoceptive input.
So where do we start and how can we affect the sensory nervous system?
The best place to start is with the skin.
We have cutaneous nerves all over the body. As soon as you're on skin, you're actually moving and touching cutaneous neural rami. When you move the skin around, you're moving these rami around and the rami are coming from a fascicle of a nerve. You can think of a fascicle like a fibre optic cable or a round noodle, of which we have 72km throughout our body. Within the noodle, we have smaller noodles which are fascicles, and they run longitudinally along the entire length of the nerve, all the way from your big toe to your spinal cord. Some of them end at the spinal cord and some of them go all the way up to the dorsal column nuclei in the hindbrain. So as soon as you're touching on skin, you're touching somebody's brain.
That's pretty cool, right?
You're automatically in the brain of the other person but through touch. And you can't not be on a nerve when touching skin because skin is loaded with receptors.
- Our nervous system is comprised of our brain + spinal cord, which is the central nervous system, and the 72 kilometers of peripheral nerves all through the body going to every single bit of tissue.
- It's composed of the most excitable cells in the body. So these are body cells, but they're long, skinny ones, and they're excitable. What does that mean? It means that it doesn't take much to get them to fire.
- Nerve cells are the only ones that can produce an action potential, which can travel. The rest of the body cells don't care whether you're touching them or not. They can't even feel you - they feel each other but not you.
- Even though it's this extensive and its cells are long and skinny, it's only 2% of the whole body; however, it runs 100% of your existence.
- Even when you're dead asleep at night the nervous system is alive and awake - keeping you alive, making you breathe, making your heartbeat, making sure that you roll over, etc.
- Physiologically it's running all of your physiology all the time.
- In order to do his job, it's using 25% of all your available glucose and oxygen at all times. So it's a big energy hog. If it doesn't get fueled, it gets cranky and it will let you know. It won't malfunction completely, but it will be grumpy and it'll let you know that it's not happy (ex: it might give you pain).
- In order to get glucose and oxygen, it has to have good blood flow. Wherever a nerve goes, there has to be an artery to supply it.
- There's not usually a problem getting blood into a nerve because you've got blood pressure behind it, pushing the blood through.
- However, if there is a lack of movement/exercise, there may not be good drainage of a particular nerve. That nerve may become entrapped because it's constipated - it may be thicker than it should be, it may have backed up blood inside of it, and it will be harder for it to slide through its tunnels.
Watch This Video To Learn More:
Dermoneuromodulating: Treating the Patient as if Their Nervous System Really Mattered
Dermo → Skin
Neuro → Nervous System
Modulation → Change
Dermoneuromodulating (DNM) is a method for handling the human body and, most of all, its nervous system, in order to facilitate change, particularly in terms of its pain and motor outputs. DNM will not replace everything therapists have already learned, but it may provide a new conceptual container for it. At the very least it provides the participant with a novel approach to handling that is patient‑ and nervous system‑friendly.
Light and interactive, DNM ignores musculoskeletal structure and instead targets pain directly, by focusing on the nervous system, continuous from skin cell to sense of self, directly. The only “structures” considered in any depth will be skin and the cutaneous nerve, long ignored in manual therapy ‑ participants will be exposed, perhaps for the first time, to the extensive branched system that innervates skin.
In This Online Course by Diane Jacobs You Will Learn:
- Increased awareness of the role the nervous system plays in pain production, and in response to manual therapy
- Better ways of accessing and communicating with the nervous system on every level
- Appreciation for the cutaneous nervous system
- A science-based method of manual therapy handling that takes into account what has been learned in neuroscience and pain science over the last couple decades
- Better palpation skill, and motivation to have manual therapy hands that are warm, slow, light, kind, effective, responsive and intelligent.
Anyone with a license to touch people who treats patients with pain.
About the Instructor
Diane Jacobs, PT
Diane Jacobs graduated from U. Sask with a physiotherapy diploma in 1971, started using manual therapy in1983, and went solo in 1994. She has been interested in pain science and working cutaneous nerves into the manual therapy story since 1998; she calls this dermoneuromodulating. She helped to found the Canadian Physiotherapy Association Pain Science Division in 2009 and served on it until 2014. In 2016 she published a book, DermoNeuroModulating. Her time is spent treating, writing, teaching internationally, and presenting.