ADDENDUM: DTM was previously known as YAP. So all reference to YAP in the video is referring to DTM. Same thing…different name.
Here we answer some common questions for beginning DTM-ers. These questions relate to the intensity of the application, the duration and the frequency of the application. KEY TAKE HOME MESSAGE: THE BENEFIT YOU GET WILL BE TRANSIENT INITIALLY BUT WITH REPETITIONS, THE RESULTS WILL BE CUMULATIVE!
Admittedly, it takes me forever to answer a question. 🙂 Now you know my wife’s pain! For those that don’t want to listen to all of the details, here are the short answers to the above questions.
How hard to tug? Gentle in assessment, more vigorous in application, careful on elderly skin.
How long to spend on each point? 10-30 seconds. Remember to move while you’re tugging.
How often do you apply DTM? Similar to using McKenzie methods, frequently to begin with, decreased frequency later. The benefits appear to be cumulative. Let your patients know this or they’ll come back and say the results are nice but then the pain comes back. Explain that the regular application of the process is necessary to change the mechanical interface dysfunction for good, to restore the “flow” in the nerve and for those membrane channels to extinguish. Keep the “flow” by keeping active and maybe sub DTM for painful rolling of historical “crunchy bits” with foam rollers and lacrosse balls. Our experience suggests that it’s quicker to get the job done in warm ups and not as painful. More on that later.
References:
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Quintner JL, Cohen ML. Referred pain of peripheral nerve origin: analternative to the "myofascial pain" construct. Clin J Pain. 1994Sep;10(3):243-51. Review. PubMed PMID: 7833584.
Quintner JL, Bove GM, Cohen ML. A critical evaluation of the trigger pointphenomenon. Rheumatology (Oxford). 2015 Mar;54(3):392-9. doi:10.1093/rheumatology/keu471. Review. PubMed PMID: 25477053.
Dilley A, Bove GM. Disruption of axoplasmic transport induces mechanicalsensitivity in intact rat C-fibre nociceptor axons. J Physiol. 2008 Jan15;586(2):593-604. PubMed PMID: 18006580; PubMed Central PMCID: PMC2375581.
Dilley A, Richards N, Pulman KG, Bove GM. Disruption of fast axonal transportin the rat induces behavioral changes consistent with neuropathic pain. J Pain.2013 Nov;14(11):1437-49. doi: 10.1016/j.jpain.2013.07.005. PubMed PMID: 24035352.