{"id":1622,"date":"2019-05-01T09:18:01","date_gmt":"2019-04-30T23:18:01","guid":{"rendered":"http:\/\/blog.amt.org.au\/?p=1622"},"modified":"2019-05-01T09:18:10","modified_gmt":"2019-04-30T23:18:10","slug":"lets-have-a-dnm","status":"publish","type":"post","link":"https:\/\/blog.amt.org.au\/index.php\/2019\/05\/01\/lets-have-a-dnm\/","title":{"rendered":"Let’s Have a DNM"},"content":{"rendered":"\n

By Leah Dwyer<\/h2>\n\n\n\n
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As a new graduate, I had many questions regarding manual therapy and what I may or may not be doing with my hands. As a long standing recipient of massage due to a complex neuromuscular condition called Dystonia<\/a>, and as a busy remedial massage therapist, I knew that massage felt good and could make people feel better temporarily but I had \u00a0questions regarding some claims being made. When I discovered the biopsychosocial model<\/a> and Explain Pain<\/a> duo, Lorimer Moseley and David Butler, things began to make more sense to me. DNM fits nicely into the current understanding of pain and the role of the nervous system. This intrigued me even more.<\/p>\n\n\n\n

I recently had the pleasure of attending Diane Jacobs<\/a>\u2019 three day DNM workshop in Melbourne along with other massage therapists, osteopaths, myotherapists and a physiotherapist. I became intrigued by Diane Jacobs\u2019 work after reading her posts and comments on social media, so this was an exciting opportunity.<\/p>\n\n\n\n

\u201cAny lasting change that occurs within the patient and their body is the result of a patient\u2019s brain having decided to change its own output, not because a manual therapist has any special, expensively obtained manual skill set, or magical power in their hands<\/em>\u201d.<\/p>diane jacobs<\/cite><\/blockquote><\/figure>\n\n\n\n

In the Beginning<\/strong><\/h4>\n\n\n\n

Jacobs developed DNM after hearing David Butler speak in Canada during the late 90s about nerves, the nervous system and pain. Jacobs began to question the role of cutaneous nerves<\/a> and embarked on a journey to increase her nerve knowledge then researched cutaneous nerves. Out of this Jacobs developed DNM, which she has been teaching since 2007.<\/p>\n\n\n\n

Embrace The Nerves<\/strong><\/h4>\n\n\n\n

I have been fascinated by the human nervous system for years because of my Dystonia and because I\u2019m a neuroscience nerd. DNM brings together everything I\u2019ve learned about neuroscience, neurodynamics and current pain science.<\/p>\n\n\n\n

DNM is a scientific explanation for slow, attentive manual therapy rather than a treatment model and the overall goal of DNM is to reduce pain via the nervous system and nerves.<\/p>\n\n\n\n

A therapist with a good grounding in pain science and kind, minimally invasive, hands could, according to the premises of DNM, be a catalyst for change. Over the three days, we learnt manual techniques that gave me a better understanding of the directions that the cutaneous nerves run in the body and how to manually influence them.<\/p>\n\n\n\n

Many manual therapy treatment models still target muscles that lie deep under the skin. However, if we accept the principles of DNM and current pain science, pain is a nervous system phenomenon and manual therapists cannot touch anything except skin.<\/p>\n\n\n\n

Slow Down<\/strong><\/h4>\n\n\n\n

DNM is a slow, gentle manual therapy much like lymphatic drainage. DNM discourages causing nociception and instead encourages less invasive manual therapy that does not add to the nociceptive load that a client may already be carrying. Persistent pain is likely due to an overly sensitive nervous system and brain, therefore we as therapists should not add to a positive feedback loop by further sensitising the client\u2019s nervous system.<\/p>\n\n\n\n

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Diane Jacobs demonstrating DNM
Photo: Leah Dwyer<\/figcaption><\/figure><\/div>\n\n\n\n

In DNM, special attention is given to the cutaneous nerves, which have been overlooked in most manual therapy techniques. In our workshop, we learnt that sore spots on the surface correspond to grommet holes or exit points for cutaneous nerves.<\/p>\n\n\n\n

Once a tender spot is found, the irritable spot is unloaded by gently dragging the skin away from the spot and not compressing it further. Holding the skin in a stretched position away from the tender spot for a period of time allows the client\u2019s nervous system to process the new information.<\/p>\n\n\n\n

This gentle stretching of the skin away from sore spots then allows the backed up nerve to move more freely. Palpating for tender spots then unloading the spot by stretching the skin gently away rather than compressing the spot facilitates a reduction in tenderness and the nerves can move more freely within their compartment tunnels.<\/p>\n\n\n\n

Most of the DNM techniques require the client to be in a side-lying position because it puts the body in the least amount of neural tension; our peripheral nervous system evolved while we were quadrupeds. Palpation skills are important in this treatment model. I thought of it as a bit like reading Braille. Gentle palpation and constant communication with my massage partner yielded the best results. If tenderness or secondary hyperalgesia<\/a> did not accompany what I felt then I moved on to another area.<\/p>\n\n\n\n

I learnt that not every lump and bump means something.<\/p>\n\n\n\n

\u201cWe know that descending modulation exists, and that brains will exploit opportunities to re-modulate stalled movement that does not serve them well.<\/em>\u201d<\/p>diane jacobs<\/cite><\/blockquote><\/figure>\n\n\n\n

The Takeaway<\/strong><\/h4>\n\n\n\n

The brain and the nervous system are the big Kahuna and pain is a nervous system phenomenon. It makes perfect sense to me therefore to be mindful of the nervous system in our treatments. DNM taught me to:<\/p>\n\n\n\n