This article provides an in-depth description of the adaptive expert system known as Integrated Biomechanic Therapy (IBT), as described in the filing with the US Patent Office, establishing IBT as a unique and useful system for integrating the practice of Massage Therapy with Corrective Exercise and Instructed Self-Care, in order to relieve pain in clients.
Integrated Biomechanic Therapy (IBT) relates to the field of bodywork treatments for identifying and resolving the mechanical nociceptive pain and corresponding sclerotomic referral patterns as contributor to nonspecific, neuropathic pain.
IBT utilizes an expert system for:
Tracking and identifying proper tissue implication in experience of pain
Tracking and identifying postural distortions and their contribution to tissue deformation and subsequent pain
Comprehensive assessment to track and identify postural distortions
Correctly matching postural distortions and the associated hypertonic tissues with their corresponding orthopedic massage protocols to relieve nociceptive response
Correctly choosing corrective exercise and range of motion movement patterns to bring proper stimulation and relief to hypotonic tissues via the gate control theory
How to use exercise progression
How to formulate programs for individual clients, and
How to instruct client self-care.
IBT is also utilized to form five separate therapy programs named Levels 0-4. These programs are designed to address the individual needs of each client in 2, 4, 6, or (two differing) 8 weeks.
Statement of Problem
There continues to be an epidemic of pain in the United States and much of it is attributed to chronic, non-specific, diffuse pain that is without any known cause. No injury, chronic illness, or surgery to explain this pain and no diagnostic test to point to a cause leave many suffering without real answers and thus no long term solutions.
Clients will seek physician intervention, but without any clear cause or solution doctors are limited to few options. Prescription pain medicine, muscle relaxers, or corticosteroid offer short term pain relief, these only serve to mask symptoms, are not long term solutions.
Some doctors may refer to physical therapy or to an orthopedist for further treatment and evaluation. This proves to be ineffective long term in many cases because physical therapy is really intended to provide care for those who have suffered from injury, illness or surgery. Physical therapy was not designed to deal with the wear and tear of daily life and does not fill the need of those who are not yet presenting with a pathological condition, yet are experiencing real pain.
Doctors are then left without options other than to manage their patient's pain for quality of life purposes; meanwhile, the cause has not been identified and pain worsens to the point where the client eventually starts presenting with diagnosable, often irreversible pathologies. Patients are often turned away with painful, potentially reversible conditions still present until they worsen to something that is identifiable.
Clients with this nociceptive pain are told often that this pain is, "All in their head," until they start presenting with known conditions including cervical/lumbar degenerative disc disease, herniated discs, rotator cuff tears, thoracic outlet syndrome, just to name a few.
There are also exists a problem in the licensed massage therapy industry of inconsistency and delivery of modalities of therapy. This prevents the ability to specifically track therapy performed, outcomes, and subsequently prevents provability of science-based orthopedic massage.
Historical Treatment of Nociceptive Pain and Utilization of Gate Control Theory
Historically, others have identified nociceptors and the sclerotomal pain referral patterns and chose to focus on the site of pain.
George S. Hackett M.D. established the Hackett Referral Patterns and introduced prolotherapy as an option for pain experienced by ligament and tendon laxicity. Prolotherapy is an injection of an irritant into the joint space, ligament, or tendon to activate the body's natural inflammatory response. This inflammatory response from the injection is meant to "trick" the body into stimulating its natural healing process.
This process is meant to cause growth of the tissue fibers that are relaxed in order to tighten the weakened structure. While the success rate of this is up for debate, it does not address the cause of the weakness and it uses a theory that involves "tricking" the body into strengthening itself by irritating it further. It involves multiple painful injections in order to continue the irritation and subsequent buildup of tissues.
The gate control theory has been used as a modulator of pain in many ways, most notably by providing a distracting stimulation of vibration with the TENS unit. The mechanoreceptor nerves sensing this vibration, the Pacinian corpuscles, are stimulated, thus closing the gate of the nociceptor pain response. This treatment, also called into question for it's efficacy, still does not address the underlying cause of the pain, it only serves to bring about numbness and potentially more relaxation to tissues that are suffering from effects of hypotonicity.
Conventional Treatment Methodology Flaws
The conventional treatment methodology for nonspecific pain management is:
Recommendation of rest
Various methods of hot/cold/vibration therapy
Over the counter medication or prescription medication
Various painful injections
Alternative treatments such as conventional massage, chiropractic or acupuncture also only serve to help manage pain.
Currently, correlation of postural positioning of the affected tissues and sedentary lifestyle has not been adequately considered in their implication of nociceptive pain. By neglecting this perspective, the cause of pain through correlation of posture has prevented a real long-term solution from being discovered.
There remains a true need in change in perspective in order to identify true cause and solution for this pain closer to its onset. This will prevent the early onset from turning into long term, chronic pain requiring further invasive treatments, up to and including surgery.
Solution Explanation and Justification
This expert system is based on the full consideration of the implication of postural distortion as the source of nociceptive pain.
IBT overcomes the aforementioned problems by providing an expert system to simultaneously alleviate hypertonic tissues (thereby eliminating the pro-nociceptive transmitter activation via mechanical tension on the nociceptors), stimulate the analgesic effects of the gate control theory by stimulation of mechanoreceptors as well as providing new feedback for the proprioceptors, as well as naturally stimulate inflammatory responses to strengthen the tissues using muscle contraction via integrating orthopedic massage technique protocols as well as corrective exercise protocols.
This expert system will serve to identify the cause of and solution to nociceptive pain and provide a direction for both doctors and clients. For doctors, this would give an additional conservative, trackable approach to consider before having to resort to more invasive treatment options. It will also serve clients because it will give them an option of accessible care that can serve as preventative as well as an early intervention. The expert system provides the methods of prevention and early intervention that is the real key to avoidance of the debilitating effects of cumulative nociceptive pain.
IBT also includes the instruction and certification of other practitioners in utilization of expert system. Practitioners are instructed on: performance of comprehensive assessment protocol in order to determine if IBT is an appropriate intervention, assessment of pain protocols, awareness of necessity for physician approval/referral, association of postural distortions with their appropriate orthopedic massage protocols, implementation of appropriate massage protocols for specific postural dysfunctions, integration and implementation of appropriate corrective exercise protocols with correlating postural distortions, and how to utilize the system for tracking and reporting.
IBT was devised in a way to enable the practitioner to present the expert system in the form of five different levels, ranging in duration of 2, 4, 6, or (2 differing) 8 week programs. The practitioner is also capable of performing single session treatments as long as full assessment is accomplished.
It is through these two models that a client can either chose to participate in a customized program or may receive single session care. Through the program model, the practitioner simultaneously performs and instructs the client through the program in order to educate and prepare the client to continue with self-care in the future. This option provides the client with the option of autonomy and the avoidance of prohibitive therapy costs once a maintenance stage of posture has been reached.
Overall, the IBT system provides a mechanism for licensed massage therapists to accurately track and report all necessary information in order to prove efficacy of both orthopedic massage, corresponding corrective exercises as well as instructed self-care.