Functional Neurological Disorders: A Medical Massage Perspective PART I

Introduction

Today's overview contains a heartbreaking case presentation, as well as an educational discussion about who we are as professionals and how we should view the healthcare field's introduction of new diagnostic terms.

A Brief History of the New Term: Functional Neurological Disorder

Approximately 100 years ago, Freud's theory of conversion proposed that unconscious psychological conflict could manifest as physical neurological symptoms. The term "conversion reaction" first appeared in (1952), evolved into "hysterical neurosis, conversion type" in (1968), and became "Conversion Disorder" in (1980).

The term conversion originated from psychoanalytic theory, which proposed that psychological conflict or emotional trauma could be "converted" into physical neurological symptoms. It is recognized that these symptoms are genuine and are associated with abnormal functioning of brain networks involved in movement, sensation, attention, emotion, symptomatically expressed as a brain fog, cognitive decline, sleep disorders, headaches, behavioral disorders, and other neurological manifestations, despite the absence of structural damage.

From the perspective of medical massage, nothing has changed. We have long recognized that chronic stress can trigger excessive secretion of stress hormones, neuroinflammation, and a cascade of multisystem disorders expressed as encephalopathy/brain dysfunction, including many of the symptoms mentioned above.

For reasons of their own, beginning around 2013 psychiatrists and neurologists gradually adopted the term Functional Neurological Disorder (FND).

Today, Functional Neurological Disorder is the preferred medical term and is recognized by both psychiatric and neurological organizations.

What does massage therapy have to do with the decisions made by psychiatric and neurological organizations? How does this new terminology change the way I practice medical massage?

In my opinion, this change in terminology has created an opportunity for some continuing education (CE) providers to “develop” and market "new" massage protocols based primarily on a new diagnostic label rather than on long-term clinical experience and reproducible therapeutic outcomes.

I have been in this profession for many years, and I have seen healthcare—especially the field of psychiatry—introduce new names and labels for disorders that, in my opinion, often describe clinical conditions that have long been recognized under different terminology.

However, I would like to emphasize what I believe is most important for massage therapists. We should not become distracted by new terminology or diagnostic labels when long-term clinical experience has consistently demonstrated reproducible therapeutic outcomes. While medical terminology may evolve, our primary responsibility is to understand the patient's pathophysiology and apply treatment protocols that have repeatedly proven effective in clinical practice.

I view massage science as originating from biomedical science while evolving into a distinct clinical discipline specifically designed for the practical application of therapeutic massage. Although it shares knowledge with psychiatry, neurology, and primary care medicine, the clinical reasoning and treatment approach used in medical massage are fundamentally different.

Regarding Functional Neurological Disorder (FND), my professional opinion is that it represents brain dysfunction resulting from various underlying causes rather than structural damage to the nervous system. Regardless of the terminology, my clinical focus remains on identifying the physiological dysfunction.

As I discussed in my recent article, Chronic Stress-Related Psychiatric Disorders vs. Primary Psychiatric Disorders, medical massage distinguishes between primary psychiatric disorders and brain dysfunction secondary to conditions such as traumatic brain injury, viral infections, chronic stress-related encephalopathy, and other neurological disorders. This distinction is important because it directly influences clinical reasoning and treatment planning.

Throughout my career, I have treated patients diagnosed with PTSD. Similar to patients with chronic stress-related disorders, individuals with PTSD commonly present with persistent muscle tension, particularly within the cervical musculature and the diaphragm, accompanied by dysregulation of the body's stress response.

Current research exactly as it was many years ago, indicates that chronic activation of the sympathetic nervous system and dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis may contribute to abnormal cortisol regulation, altered breathing patterns, muscle hypertonicity, chronic pain, brain fog, cognitive decline, sleep disturbances, and delayed physiological recovery.

In my opinion, patients with PTSD, chronic stress-related encephalopathy, post-concussion syndrome, and Functional Neurological Disorder should be viewed as complex clinical conditions that may share common physiological mechanisms while differing in severity and underlying cause. Understanding these similarities may help massage therapists develop more appropriate treatment strategies.

Successful treatment of these complex cases requires much more than performing massage techniques. It requires a thorough understanding of autonomic nervous system dysfunction, careful patient assessment, and specialized clinical training. Without this knowledge, massage therapy may aggravate symptoms rather than facilitate recovery.

Looking Ahead

In Part II, I will present a heartbreaking case shared by an experienced medical massage practitioner diagnosed with Functional Neurological Disorder.

Her experience provides important lessons regarding clinical reasoning, autonomic dysfunction, continuing education, and the responsibilities we have as healthcare professionals.