Clinical Presentation
A 28-year-old female presented with persistent right-sided pain extending from the cervical region to the calf, associated with headaches, nausea, and constant musculoskeletal tension. Symptoms were unilateral, fluctuated with stress, and accompanied by intermittent tremors. Neurological examination and cranial imaging were unremarkable. Conventional physiotherapy and massage provided only transient relief.
The patient’s narrative:
“I have always struggled with upper body and shoulder tension, but this has become a daily issue. I am in pain most days. No one seems to pinpoint the problem, and although physiotherapy and massage help briefly, the pain soon returns.”
This clinical picture is consistent with Functional Neurological Disorder (FND), characterized by disabling symptoms without identifiable structural pathology, often with an excessive stress-related component (Stone et al., 2020).
Response to Manual Therapy
Following a single session of manual therapy, the patient reported:
“Since seeing you, I’ve felt so much lighter and more at ease in my body. I haven’t had a single headache or any pain. It’s such a relief to wake up without symptoms. That one session has had such a positive impact, I cannot quite believe it.”
This rapid improvement raises the question: How can manual therapy influence symptoms of FND?
Pathophysiological Considerations
FND is increasingly understood as a disorder of abnormal brain–body communication, involving:
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Heightened autonomic arousal: disproportionate sympathetic activation relative to current stressors (Pick et al., 2020).
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Emotionally encoded body responses: traumatic or overwhelming memories may remain “somatically imprinted,” with the autonomic nervous system (ANS) reactivating past states when triggered (Edwards et al., 2012).
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Somatic hypervigilance: increased awareness and amplification of bodily sensations, leading to symptom persistence (Brown et al., 2020).
In this context, manual therapy does not “treat” FND directly, but provides a physiological entry point to modulate autonomic tone, reducing sympathetic dominance and permitting parasympathetic rebalancing.
Mechanism of Change: Autonomic Modulation via the Dive Reflex
The mammalian dive reflex is a conserved neurophysiological response to facial immersion in cold water, triggering bradycardia, peripheral vasoconstriction, and enhanced parasympathetic activity (Panneton, 2013). It represents one of the strongest natural mechanisms to override sympathetic arousal.
Manual therapy can utilize principles of this reflex by:
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Inducing parasympathetic dominance through controlled application of water- or copper-based conductive materials, exploiting their biophysical properties to enhance vagal tone.
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Facilitating tissue release: when a patient evokes a stressful memory, sympathetic tension is palpable in soft tissues (particularly fascia and smooth muscle). Parasympathetic induction via the dive reflex creates the neurophysiological “space” for tissues to relax.
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Interrupting memory–body coupling: once tissue tension collapses, the previously “charged” memory no longer evokes the same somatic sympathetic response.
Clinical Process
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Patient role: Identify and focus on a personally significant overwhelming memory (often early-life or highly emotionally charged).
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Practitioner role: Apply gentle craniosacral techniques to regions of tension while pads (water/copper interface) are positioned over autonomic outflows (typically cranial and sacral regions).
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Critical factor: The patient must consent to reducing the emotional intensity of the memory. Ambivalence may prevent release.
In this case, the pivotal memory was the traumatic suicide of the patient’s best friend at age 18. When evoked during treatment, the associated tissue tension collapsed under parasympathetic induction, and subsequent recall did not re-trigger sympathetic overdrive.
Clinical Considerations and Cautions
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Emotional memories, particularly from early childhood (<7 years), often carry disproportionate autonomic weight (van der Kolk, 2014).
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The subjective insignificance of a memory to the adult does not negate its physiological imprint on the body.
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Practitioner assumption or premature intervention is inappropriate; the patient must be ready and willing to disengage from the autonomic control exerted by the memory.
Conclusion
This case highlights how manual therapy, when combined with autonomic modulation strategies such as the dive reflex, may provide significant symptom relief in FND. The therapeutic effect appears to occur not through structural correction, but through neurophysiological rebalancing of the autonomic nervous system and decoupling of maladaptive memory–body associations.
References
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Brown, R. J., Reuber, M., & Carson, A. (2020). Psychological and psychiatric aspects of functional neurological disorders (FND). Handbook of Clinical Neurology, 139, 197–212.
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Edwards, M. J., Adams, R. A., Brown, H., Pareés, I., & Friston, K. J. (2012). A Bayesian account of “hysteria.” Brain, 135(11), 3495–3512.
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Panneton, W. M. (2013). The mammalian diving response: An enigmatic reflex to preserve life? Physiology, 28(5), 284–297.
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Pick, S., Howlett, S., Cohen, K., & Stone, J. (2020). Functional neurological disorder: Mechanisms and treatment. Journal of Neurology, 267(6), 1970–1981.
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Stone, J., Carson, A., & Hallett, M. (2020). Functional neurologic disorder: Diagnosis and treatment. Continuum: Lifelong Learning in Neurology, 26(1), 153–177.
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van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking.
