In recent years, there has been an increased interest in Pain Neuroscience Education (PNE) inphysical therapy. There is growing evidence for the efficacy of PNE to decrease pain, disability, fear-avoidance, pain catastrophization, limited movement, and health care utilization in people struggling with pain.
PNE teaches people in pain more about the biology and physiology of their pain experience including processes such as central sensitization, peripheral sensitization, allodynia, inhibition, facilitation, neuroplasticity and more.
PNE’s neurobiological model often finds itself at odds with traditional biomedical models used in physical therapy. Traditional biomedical models, focusing on anatomy, pathoanatomy, and biomechanics have been shown to have limited efficacy in helping people understand their pain, especially chronic pain, and may in fact even increase a person’s pain experience by increasing fear-avoidance and pain catastrophization. An area of physical therapy where the biomedical model is used a lot is manual therapy.
This contrast between PNE and manual therapy has seemingly polarized followers from each approach to see PNE as a ‘hands-off’ approach even having clinicians categorize patients as either in need of receiving PNE (with no hands-on), or hands-on with no PNE. Patients typically need both!
PNE and manual therapy should co-exist: they complement each other!.
PNE research has shown to have immediate effects of various clinical signs and symptoms associated with central sensitization. Using a model of sensitization (innocuous, noxious, and allodynia), we argue that PNE can be used in a manual therapy model, especially treating someone where the nervous system has become increasingly hypervigilant.
PNE should not be just a hands-off approach!
PNE has focussed on creating a Therapeutic Alliance (TA) between patient and provider. TA is a complex blend of therapist technical skill, verbal and non-verbal communication, sense of warmth, trust, and collaboration. We know that most patients attending Physical Therapy value physical tests and treatments as a high priority. It can be argued that human touch (manual therapy) and fulfilling a patient’s expectations can enhance TA, thus, positively influencing the treatment outcome.
The BPS Model
In recent years, there has been a huge shift in physical therapy toward a biopsychosocial approach. With the integration of the biopsychosocial approach into our profession, a lot of emphasis has been placed on the various psychosocial aspects of pain, which sometimes results in leaving behind the ‘bio’ of the biopsychosocial model. By incorporating a PNE-based explanation for our manual therapy techniques we see better results and we can integrate all 3 areas of the BPS model for the best outcomes.
Manual Therapy can relieve pain
Manual joint mobilization has been shown to generate (short-term) activation of brain-orchestrated endogenous analgesia. We use Manual Therapy to jump start this process as a preparation to a more active part of the treatment, which we know can further reduce pain.