In the world of traditional manual therapy, we were taught to view the body as a machine. We learned the exact position of each vertebra, the direction of muscle fibers, and how to execute a precise manipulation. But every clinician with experience knows those moments when mechanics simply aren't enough. These are the moments when a patient "jumps" from a gentle touch, when tears well up during deep fascial release, or when pain persists despite clinical tests showing the tissue has fully healed.

 

The truth is, on the treatment table lies not just a "back" or a "neck"—there lies an entire nervous system carrying a history of experiences, injuries, and stresses. At Manual IL, we believe an expert manual therapist must be Trauma-Informed. In this article, we explore how trauma affects soft tissues and pain perception, and how to integrate HVLA and STB techniques within a therapeutic container that provides maximum safety for the nervous system.

 

Chapter 1: The Physiology of Trauma – Polyvagal Theory

To understand trauma in the treatment room, we must look to the work of Dr. Stephen Porges. He taught us that the Autonomic Nervous System (ANS) is not just a binary "Fight or Flight" (Sympathetic) versus "Rest and Digest" (Parasympathetic).

There are three primary states a patient may experience on the table:

1. Social Engagement: The ideal state. The patient feels safe, breathing is relaxed, and they can communicate effectively. The body is open to touch and change.
2. Sympathetic Mobilization (Fight or Flight): The patient perceives a threat (conscious or not). Muscles are guarded, heart rate increases, and the body is primed for defense. Strong touch here may be perceived as an assault.
3. Freeze/Dissociation (Dorsal Vagal Shutdown): The deepest trauma response. The patient appears very still or "disconnected." Tissues feel lifeless or intensely rigid in a way that doesn't respond to standard touch.

A therapist unaware of these states might perform an HVLA manipulation on a patient in "freeze" mode, leading to a severe post-treatment reaction or an exacerbation of chronic pain.

 

Chapter 2: Somatization – How the Fascia "Remembers"

Giveon Peled, through the STB method, emphasizes that the fascia is the body's largest sensory organ. It is rich in nerve endings and receptors that sense not just pressure, but emotional tension. When a person experiences trauma, the nervous system generates an immediate physical contraction. If not processed, the fascia may thicken and shorten around specific areas to "protect" them—a phenomenon known as "Armoring."

 

For example, a whiplash victim may heal mechanically, but their system remains in hyper-vigilance. Any rapid touch to the neck might trigger a cellular memory of the accident, causing immediate muscle guarding. STB allows us to "dialogue" with the tissue, gradually lowering the threat level before any deeper manual intervention.

 

Chapter 3: Principles of Trauma-Informed Care in the Manual Clinic

Eyal Feigin notes that being trauma-informed doesn't mean becoming a psychologist; it means adapting our manual techniques to the state of the nervous system.

1. Choice and Control: In trauma-informed care, the patient is an active partner. Before any manipulation, we ask for explicit permission: "I’m going to apply pressure here, is that okay with you?" Knowing they can say "stop" at any time lowers the brain's stress response significantly.

2. Transparency and Predictability: Surprise is the enemy of a post-traumatic nervous system. HVLA techniques must be coordinated. We explain exactly what will happen and the sound ("click") it might make. No "surprising" the joints.

3. Therapist Self-Regulation: Nervous systems communicate (Co-regulation). If the therapist is rushed or "aggressive" in their touch, the patient will sense it. We use "Listening Touch" instead of "invasive touch."

 

Chapter 4: Integrating HVLA and STB for Sensitive Patients

Can you perform a manipulation on a patient with PTSD? Yes, but timing is everything.

• Preparation with STB: We begin with fascial calming techniques to move the patient from a sympathetic state into "Social Engagement" and safety.
• Monitoring Reactions: If a patient stops talking, their breathing becomes shallow, or they begin to tremble—these are signs of neurological discharge or flooding. We immediately stop mechanical work and focus on Grounding.
• Manipulation as Release: Occasionally, a precise, gentle manipulation can act as a "vent" for years of stored tension, but only when 100% trust is established.

 

Chapter 5: Emotional Red Flags

Just as there are physical red flags, there are emotional red flags indicating a need for additional professional support (Psychotherapy, SE, etc.):

• Constant dissociation during touch.
• Recurrent panic attacks on the table.
• Pain that migrates throughout the body without mechanical explanation, clearly linked to emotional stress.

 

Summary: The Healing Touch in the Modern Era

Manual therapy is not just about bones and muscles; it is the art of communication between two human beings. By understanding the language of trauma, we transform from technical practitioners into holistic therapists in the deepest sense.

 

The combination of Eyal Feigin’s anatomical precision and Giveon Peled’s ability to listen to the tissue through STB creates a safe space where the body can finally let go.

 

Interested in learning how to work with complex cases of pain and trauma? Want practical tools for nervous system regulation through touch? Join our "Trauma-Informed Manual Therapy" course at Manual IL.