Dentro de unos meses tendremos por España, en Madrid para ser concretos, a Diane Jacobs.
Hablará de dermoneuromodulación, y como aquí un servidor es algo impaciente,… vamos que todo lo que suena a zérapi y a nervios me entusiasma, no he podido esperar tanto y he decidido hacerle una pequeña entrevista, para ver de qué va todo esto.
Agradeciendo a Diane su aportación, aquí os dejo el texto.
Several Spanish physiotherapists, among whom I include myself, are excited about the course of DNM in September.
Maybe now is a good moment to know the meaning of the term “dermoneuromodulation”.
The term originated with a little bit of help from SomaSimple friends in the mid-2000’s as I struggled, as we all struggled, to become more conscious and articulate about manual therapy in general, and discuss problems inherent within it.
David Butler’s neuromobilization workshop in the late 90’s, and discovering Melzack’s neuromatrix model of pain in 2003, plunged me into cognitive dissonance from which I have yet to emerge. In 2006 a colleague at the U. of Saskatchewan, and I, began a case series study (scheduled for write-up/ publication this year). Results indicated “weak but statistically significant” results, about what one would expect from a case series on any kind of manual treatment.
The word “dermoneuromodulation” simply means skin/nervous system/change. It does not imply that the practitioner is the one “doing” something called “change” “to” something anatomical in another person. It does not exclude the nervous system of the patient as change agent under its own auspices, thus DNM is as close to being an interactive model of manual care as opposed to an operator model as any kind of manual therapy approach can be, while still handling bodies of other (live, conscious) people.
Other than “skin”, the surface all of us touch regardless of whatever else we might conjecture about what we are doing/affecting/handling, sensory endings, and cutaneous nerves, there is no mention of “tissue”.
Which patients can benefit from the application of the concept of DNM?
All patients who one would normally expect to benefit from any sort of manual therapy will be suitable for DNM, i.e., people with persisting pain that is:
1. mostly confined to a particular region
2. changes with position or rest
3. goes away when the person lays down
That sort of pain problem, which is usually mechanical in nature, is easily treated with DNM.
And, something important nowadays , What about evidence and DNM?
We conducted a case series, unpublished, which showed “weak but statistically significant” support for the intervention. I think that’s the usual story for manual therapy interventions.
A woman who teaches PT in Portugal has shown interest in DNM, and has contacted the researchers who did the case series for details. She has indicated that she wants her class of Masters level students to research the method.
Less important than direct evidence, in my opinion, is to have a good science-based explanatory model for proceeding, clinically, and a good science-based rationale to provide to the patient, woven into sound pain education.
Do you think that DNM integrates easily with current paradigms of manual therapy?
What I have found is that practitioners learn a method physically, first, and often never bother to unpack the explanatory model that was taught with it.
The explanatory model that accompanies DNM won’t replace other explanatory models, unless the practitioner wishes it to. It can peacefully coexist with them all, until such time as the practitioner allows his or her mind to cultivate more reading and thinking. Then he or she will see for themselves where there might exist discrepancies or ideas that are mutually exclusive, and will choose as individuals which set of ideas make the most sense to them.
I can’t declare my explanatory model is completely correct. All I can say, is that after 40 years of examining explanatory models of all kinds, this one I offer is (in my own opinion) “less wrong.”
In your opinion, What’s the main contribution from DNM to manual therapy?
Research in manual therapy tells us that there is little or no interrater reliability for palpation or application, little or no agreement on what constitutes the overall best approach, and that success in terms of favourable outcomes depends a lot on context and treatment relationship.
Applications differ widely in amount, intention, length, depth, angle, and zone of contact. I am of the opinion that manual therapy is optional, yet often may be optimal, to acheiving successful outcome in terms of pain reduction and movement improvement. The real trick in treatment is to leave the locus of control with the patient while still providing them with professional physical contact as required, by them, as individuals, in the moment, and within the context of a therapeutic relationship.
I do not know what should be ruled out in order to show the world that manual therapy is useful; I only think that these items I’ve discussed should be left ruled in.
Thank you very much, Diane
See you in September!