There is a persistent assumption in manual therapy that the intensity of treatment reflects its effectiveness. If it does not hurt, it cannot be doing much. If the practitioner is working hard, the treatment must be working. This logic is understandable but clinically wrong, and for people with chronic pain it can lead to choices that worsen rather than resolve their condition.

The Nervous System’s Response to Force

The body responds to significant mechanical input as a potential threat. This is a fundamental aspect of nervous system function. When a strong force is applied to the tissues, the nervous system evaluates it and, if it interprets the input as threatening, responds by increasing muscle tone, activating defensive reflexes, and, in sensitised individuals, amplifying pain signals.

For someone with acute pain and a nervous system that is not sensitised, forceful treatment may be well tolerated and highly effective. The tissue needs intervention and the system can absorb the input without significant defensive escalation.

For someone with chronic pain, the situation is different. The nervous system is already operating with lowered thresholds and heightened reactivity. Strong mechanical input, even when clinically well-intentioned, can trigger a significant pain flare that sets recovery back rather than advancing it. This is not a rare outcome. It is a common experience for people with fibromyalgia, central sensitisation, and long-standing musculoskeletal pain who have undergone aggressive manual therapy.

Why Gentle Approaches Can Achieve More

A gentle approach works with the nervous system’s regulatory capacity rather than against its defensive response. When the input is light enough not to trigger a threat response, the nervous system can receive and respond to it constructively. Holding patterns can release. Muscle tone can reduce. The system begins to recalibrate.

This is the clinical logic behind Body Stress Release. The input Peter van Minnen applies is intentionally minimal, guided by the body’s own responses. The nervous system is not overridden. It is invited to release, and because it is not simultaneously defending against a perceived threat, the release is more complete.

Matching the Approach to the Presentation

The choice between gentle and more forceful approaches should be determined by the clinical picture, not by assumptions about what effective treatment looks like. Acute presentations in robust individuals with clear structural dysfunction often respond best to direct, confident intervention. Chronic presentations, sensitised nervous systems, and cases where previous forceful treatment has caused flares call for a fundamentally different strategy.

Understanding which situation you are in is the starting point. For those whose pain has a significant neurological component and whose system has been aggravated by previous treatment, BSR’s gentle approach is not a compromise. It is the clinically appropriate choice.

The neurological basis of chronic pain and why forceful approaches can worsen it is explored in detail in our article on chronic pain and the nervous system.

If previous treatment has made your pain worse, contact us to speak with Peter van Minnen at Hever Health about a gentler approach to resolution.