Issue link: https://www.massageandbodyworkdigital.com/i/121374
Dermoneuromodulation Dermoneuromodulation (DNM) is a gentle method of interacting with clients to help them resolve pain, regain function, and feel better. It was developed by Diane Jacobs, a Canadian physiotherapist specializing in pain science and the treatment of painful conditions. During her 40 years of practice, Jacobs became interested in Ronald Melzack, who developed the original Gate Control theory of pain along with Patrick Wall, and who later developed the NeuroMatrix model of pain. In 2007, Jacobs conducted a cadaver study that demonstrated how peripheral cutaneous nerves divide into rami, which spread outward into the underside of skin. This inspired her to develop a new conceptual approach to manual therapy for clients in pain: dermo (skin); neuro (nervous system); modulation (change); which equals dermoneuromodulation, or touching the skin to interact with the nervous system and effect change. DNM is a pain-free technique that places little physical demand on the client or the therapist. In practice, it may be blended into relaxation massages and therapeutic sessions, or combined with specific modalities such as Active Isolated Stretching, myofascial release, orthopedic massage, strain-counterstrain technique, and others. The basic hands-on skills of DNM are similar to many forms of massage, but the underlying concepts are rooted in modern neuroscience. a shift in perspective For massage therapists, learning DNM is a paradigm change that emphasizes clinical reasoning based on neuroscience. It is important to understand that pain and tight muscles are not evils to be banished, but are instead protective responses produced by the nervous system. Of these protective responses, 90 massage & bodywork the motor aspects are flinching and muscle tightness ("bracing"), and the sensory experience is pain or other discomfort. These may persist long after any injury or danger has passed. If we make the nervous system happy, however, it may abandon these protective responses. Anatomically, the nervous system includes central components (brain, nerve roots, and spinal cord) and peripheral components (deep and cutaneous nerves). During embryological development, the pain can often more correctly be attributed to tunnel syndromes. Moving nerves (neurodynamics) helps restore nerve health and wellbeing. Since tunnel syndromes often involve cutaneous nerves (found throughout the skin and subcutis), it would seem that moving nerves attached to the skin could resolve most musculoskeletal pain, i.e., by moving skin into areas where the nerves are embedded. This is done without pressure sufficient to damage or deform the underlying muscle, fascia, or other soft tissues. DNM uses body positioning and/ or skin stretching to resolve discomfort from tunnel syndromes, and DNM practitioners may also use some form of athletic taping to assist clients between treatment sessions. It might be said that the skin is the exposed portion of the brain; if the brain is a computer, then the skin is a keyboard. brain, nerves, and skin all arise from the same ectodermic tissue. It might be said that the skin is the exposed portion of the brain; if the brain is a computer, then the skin is a keyboard. As nerves proceed from the spinal cord to the skin, they pass through many tissue layers. These layers move and shift, and may be negatively impacted by both internal and external stimuli. The nerves pass through small, contiguous gaps, or tunnels, through these tissue layers. The points where nerves pass from one layer into another are subject to shearing forces that may impinge nerves and cause localized ischemia and nociception, which may lead to pain, increased muscle tension, and other protective responses. When this occurs, it is referred to as nerve compression syndrome, or tunnel syndrome. Myofascial may/june 2013 How Does It Work? The skin is full of innervation, much of it right at the skin's surface. Hilton law states: "The nerve supplying a joint supplies also the muscles that move the joint and the skin covering the articular insertion of those muscles."1 Noting this, it would make sense then that whatever we do to skin affects motor output indirectly (reflexively). Mechanoreceptors adapt at different speeds and in different ways. Fast adaptors fire when they detect movement, then shut off until new movement stimulates them again, similar to a motion detector light. Slow adaptors remain turned on, transducing information and firing action potentials into the spinal cord the whole time a stimulus is operating, regardless of whether it moves or doesn't, like a bathroom scale.