[Segmental and somatic dysfunction : How does manual medicine work?]

Manual medicine is based on neurophysiologic and biomechanical principles. Impaired senso-motor regulation causes segmental and somatic dysfunction. Via segmental mapping, somato-sensory and vegetative dysfunction arises. Local pain, referred pain, and vague symptoms can occur in the thoracic and abdominal regions. Myofascial structures can transfer these dysfunctions to other body areas, where segmental neuronal connections lead to further dysfunction. Manual medicine addresses these aspects.

Manual interventions work by influencing the proprioceptive system, improving senso-motor regulation. Furthermore, proprioceptive stimulation inhibits pain mechanisms in the CNS (spinal and cerebral). Manual techniques may focus on joints, myofascial, or visceral structures. The main common target is to induct proprioceptive stimulus into related spinal segments.

Knowledge of these neurophysiologic and biomechanical aspects can be a powerful tool in differential diagnostics, particularly in cases of apparently inconsistent clinical findings. Additionally, structural pathology can lead to reflex-mediated dysfunction. To determine whether structural pathology or functional derangement is accountable for symptomatology, a manual approach on a trial basis can be very helpful. Lege artis indicated and performed, manual medicine offers an excellent risk-benefit ratio.