Functional Neurological Disorders: A Medical Massage Perspective Part II

Link to Functional:” Neurological Disorders: A Medical Massage Perspective PART I”

https://www.medicalmassage-edu.com/blog/functional-neurological-disorders-medical-massage-perspective-part-1.htm

From the Author: Case Presentation

After publishing my article, "Chronic Stress-Related Psychiatric Disorders vs. Primary Psychiatric Disorders," https://www.medicalmassage-edu.com/blog/chronic-stress-related-psychiatric-disorders-vs-primary-psychiatric-disorders.htm  a medical massage practitioner shared a heartbreaking personal story in my Facebook group. The complete presentation is quite lengthy, so I have included only selected excerpts here. Readers who are interested in reading the entire presentation are welcome to visit my Facebook group: https://www.facebook.com/groups/medicalmassage

The case began as follows:

Hello Boris Prilutsky,

I have been practicing Medical Massage Therapy for 20 years. I have not given up on my career, but I have been fighting to return to practice for the past three years.

In the fall of 2023, I was diagnosed with a rare and very complex form of PTSD with a comorbidity known as Functional Neurological Disorder (FND). This condition affects how the brain and body send and receive signals. According to the University of Alabama at Birmingham (UAB), it affects more than 300,000 Americans and was previously diagnosed as Conversion Disorder.

Conversion Disorder, now more commonly referred to as Functional Neurological Disorder (FND), is a condition in which a person experiences genuine neurological symptoms—such as weakness, paralysis, tremors, abnormal gait, numbness, or non-epileptic seizures—without evidence of structural damage to the nervous system. The symptoms result from impaired functioning of neural networks rather than disease or injury to the brain or peripheral nerves. Psychological stress, trauma, or PTSD may trigger or worsen symptoms in some individuals, although not all cases are associated with psychological factors.

My MRI, CT scans, and laboratory tests all came back essentially normal. However, I feel that the evaluation focused primarily on my brain and basic laboratory markers rather than assessing my entire body or performing comprehensive postural and functional evaluations.

My Initial Reply

A normal MRI, CT scan, and routine laboratory findings are common components of the standard diagnostic work-up. It is reassuring that no structural abnormalities or other significant pathology were identified.

As I mentioned in the introduction, I have treated patients with PTSD throughout my career. When I first began working with these patients, PTSD was not as widely recognized as it is today. Since the COVID-19 pandemic, chronic stress-related disorders have become much more prevalent and now affect millions of people.

From my clinical perspective, PTSD represents one of the most severe forms of chronic stress-related dysfunction.

A hallmark of PTSD is persistent autonomic nervous system dysregulation, characterized by increased muscle tension, particularly within the cervical musculature and the respiratory muscles, including the diaphragm. Chronic activation of the sympathetic nervous system together with dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis may contribute to abnormal cortisol regulation, sustained muscle hypertonicity, dysfunctional breathing patterns, chronic pain, sleep disturbances, brain fog, impaired concentration, short-term memory difficulties, and delayed physiological recovery.

Rather than repeating concepts I have discussed elsewhere, I encourage readers to watch my short educational video presentations, where I explain these physiological mechanisms and the clinical reasoning behind my treatment approach in greater detail.

https://www.youtube.com/watch?v=Xwe8T0uj_gg

Clinical Discussion: Functional Neurological Disorder from a Medical Massage Perspective

Although the types of brain dysfunction I have described were not as common decades ago as they are today in the post-COVID era, they certainly existed. At that time, they were not referred to as Functional Neurological Disorders (FND).

From my perspective as a medical massage clinician, the terminology is less important than understanding the patient's underlying physiological dysfunction. Regardless of the diagnostic label, my clinical focus remains on identifying autonomic nervous system dysregulation, abnormal muscle tone, impaired respiratory mechanics, altered circulation, and other functional disturbances that may be addressed through appropriately applied medical massage.

In my opinion, therapists should avoid becoming distracted by evolving terminology. New diagnostic classifications may help physicians communicate within their specialties, but massage therapists must continue to base their clinical decisions on sound physiology, careful assessment, and reproducible therapeutic outcomes.

To better understand my clinical reasoning, I recommend reading my article:

"A Translational Model Across PTSD, Chronic Stress Disorders, Long COVID, and Traumatic Brain Injury."

https://www.medicalmassage-edu.com/blog/neuroinflammation-stress-tbi-long-covid.htm

In that article, I describe the physiological similarities that, in my opinion, connect these conditions despite their different medical diagnoses.

One particularly important aspect of this case is that the practitioner reported receiving massage therapy from several therapists without improvement. In fact, according to her own description, her condition became progressively worse.

I am not claiming that massage therapy caused her deterioration. I do not have sufficient chronological clinical information to reach that conclusion. However, based on my own clinical experience, I believe that conventional massage approaches may aggravate symptoms in patients with significant autonomic nervous system dysregulation if the therapist does not recognize the underlying physiological dysfunction.

5 years ago, I encountered similar situations in my own practice. Several patients consistently experienced negative responses following treatment. Initially, I was confused by these reactions and made the difficult decision to stop treating such patients until I could better understand the physiological mechanisms involved. Only after further clinical observation, study, and reflection did I modify my treatment approach.

I described that experience in detail in one of my previous articles and strongly recommend that readers review it before attempting to treat patients with complex neurological or stress-related disorders.

https://www.medicalmassage-edu.com/blog/massage-therapy-demand-vs-client-retention.htm

When the practitioner described receiving massage treatments and also referenced continuing education courses that teach massage for Functional Neurological Disorder, I shared the following response:

"I understand that you became desperate to get better and believed massage therapy could help you. Unfortunately, our profession—including parts of the continuing education community—is not free from misinformation or inadequate clinical preparation. In my opinion, therapists should not attempt to treat complex neurological conditions unless they fully understand the underlying physiology, possess appropriate clinical training, and have substantial practical experience. Otherwise, treatment may fail to help the patient and, in some cases, may aggravate existing symptoms."

Briefly, I explained that I was originally trained to apply a medical massage protocol for the management of concussion symptoms and the prevention of post-concussion encephalopathy. After introducing that protocol into clinical practice, I repeatedly observed positive outcomes. Only after reproducing those results in many patients and documenting my clinical observations did I publish my findings. Within a short period of time after I published my work, some continuing education providers slightly adjusted the concepts I had presented in my original article and, in my opinion, acted irresponsibly by beginning to teach post-concussion rehabilitation protocols without sufficient clinical experience or understanding.

I discuss this issue in greater detail in the article below.

For curious minds, please follow the link below. I am aware that nowadays people prefer to read short texts. However, dear friends, let's agree that educational presentations—especially those related to continuing education and opportunities to learn—sometimes require more time and careful reading.

I encourage you to click on all of the links included in this article. They provide important background information.

https://www.medicalmassage-edu.com/blog/responsible-vs-irresponsible.htm

For that reason, I encourage massage therapists to critically evaluate continuing education programs. Before adopting new treatment methods, clinicians should carefully examine the instructor's clinical experience, the physiological rationale behind the protocol, and whether the reported outcomes have been consistently reproduced in practice.

As healthcare continues to introduce new diagnostic terminology, massage therapists should remain committed to scientific reasoning, clinical observation, and patient safety. Diagnostic labels may evolve, but responsible clinical decision-making should always remain grounded in physiology, careful assessment, and reproducible therapeutic outcomes.

Summary and Recommendations to the Profession

This case should serve as an educational reminder that complex neurological and stress-related disorders require thoughtful clinical reasoning rather than a routine application of massage techniques.

From my perspective as a medical massage practitioner and educator, as I mentioned previously, patients diagnosed with PTSD, Functional Neurological Disorder (FND), post-concussion syndrome, chronic stress-related encephalopathy, and, in many cases, Long COVID may present with different medical diagnoses while sharing important physiological characteristics. One of the most significant of these is autonomic nervous system dysregulation.

For massage therapists, this distinction is critically important. Our responsibility is not to establish a medical diagnosis but to recognize when autonomic dysfunction, altered breathing mechanics, muscular hypertonicity, and impaired physiological recovery may influence the patient's response to massage therapy.

For this reason, I encourage every massage therapist to critically evaluate continuing education courses before adopting new treatment methods. We should ask important questions:

• Is the protocol supported by sound physiology?
• Has the instructor demonstrated consistent clinical outcomes over many years?
• Has the treatment approach been refined through extensive patient care rather than theoretical discussion alone?
• Does the instructor clearly explain patient selection, contraindications, treatment progression, and possible adverse reactions?

Massage therapists should remain focused on what matters most: carefully evaluating each patient, and applying treatment only when they possess the necessary knowledge, clinical skills, and experience.

Our profession has a responsibility not only to help patients but also to protect them. When treating individuals with complex neurological disorders, good intentions alone are not enough. Clinical competence, humility, and sound judgment are essential.

I hope this discussion encourages thoughtful professional dialogue and inspires massage therapists to continue advancing their education while maintaining the highest standards of clinical responsibility and patient safety.

Ultimately, our goal should never be to follow terminology or trends. Our goal should be to understand the patient, understand the physiology, and provide the safest and most effective care possible.

Best wishes, 

Boris Prilutsky