We believe that some direct and indirect barriers to active and passive movement are related to and maintained by altered cranial nerve, cerebellar, autonomic and an unknown number of other higher brain functions. Building on these concepts, an integrated diagnostic, treatment, and exercise program has been designed for a subset of long term chronic pain patients . The strategy integrates myofascial release, functional, cranial, and muscle energy treatment methods with patient-generated release enhancing maneuvers . Based on functionally related kinesiologic and neurophysiologic principles, release enhancing maneuvers (requested voluntary movements) are empirically designed to modify pathophysiologic peripherally and centrally mediated myofascial, neural, neuroendocrine and joint-related activities [17, 18, 19, 27, 40, 56]. We speculate that positive, and occasional pain exacerbating, changes occur through
• Restoration of appropriate myofascial and joint-related proprioceptive/exteroceptive feedback among kinesiologically related muscle groups
• Palpation related antinociceptive afferent peripheral stimulation by way of skin. Other soft tissue stimulation also modulates central and peripheral nociceptive processing in such areas as the somatosensory cortex, periaqueductal gray, hypothalamus, limbic system, spinothalamic tracts, dorsal horn, and spinal cord intermediolateral columns [5, 11, 23, 25, 49]
• Patient distraction.
The purpose of this paper is to introduce a few clinical concepts for others to try and, perhaps, do research.