By: Veronika Campbell, PT, MPT, CSCS, NSC, CNMP, CVTP
What do you do as an athlete when you hit a road block in physical therapy, and why does it happen?
When physical therapy has hit a roadblock, many patients are left asking themselves, What did I do wrong? Veronika Campbell—owner of IMPT, a manual physical therapist that specializes in Barral Neural Manipulation, with over 25 years of experience, longtime collaborator with Spooner, and speaker at this year’s Huddle—says this reaction is all too common.
“I hear it all the time,” she explains. “Athletes say, ‘I went to physical therapy, and it didn’t help like I expected” or “I had some changes, yet I still feel stuck.’”
But in Veronika’s experience, that’s rarely the full story. Often, the patient is doing their home exercise program, and the therapist is guiding them skillfully through recovery. Still, progress can stall sometimes. Why? Because sometimes the body holds onto pain. It protects and guards something deeper that’s not immediately obvious. It’s not about anyone doing something wrong; it’s about the body being stubborn in ways that take time and curiosity to uncover.
The result? Frustration, shame, and a growing sense of doubt.
But what patients will feel empowered to know, is that there are more options for another layer of added help. Manual neural therapy is just one of those powerful ways to help.
The Body’s Built-In Healing Power
Veronika follows the osteopathic belief that the body has an incredible, built-in ability to heal itself, and her role is to help identify what might be getting in the way. “The ultimate goal is creating an environment so the body can heal itself,” she says. That might mean helping tissues move correctly or improving alignment, especially when repetitive strain or previous injury is causing compensation elsewhere in the body. Especially with athletes, the demands on the body are high: collisions, repetition, and explosive movement all take a toll. “If they have a restriction in their body, their body has to adapt and compensate,” she explains. That’s where her race car analogy comes in. “If you have a car with a flat tire, but you only drive it to the grocery store once a week, you’re not going to notice it right away. But if that was on a race car, you’d notice it immediately.” Athletes are like race cars, they need a team keeping close watch, because even the smallest imbalance can lead to breakdown. “I tell my athletes every millimeter matters,” Veronika says. “Even a joint being slightly off-axis matters because it can throw off a golfer’s swing path-just a few degrees off at impact can mean yards off target down the fairway.”
What Nerves and Baby Hummingbirds Have in Common
This is where the extra layer of adding more manual therapy can be a game changer for patients. Whether administered by a physical therapist in clinic, or a specialty manual physical therapist like Veronika at her practice. Manual therapy has long been used to address muscles and joints—and Veronika encourages patients and practitioners to look deeper. “When you’re pushing on a muscle, what’s inside there?” she asks. “There’s a nerve.” That knot you feel might not be in the muscle itself—it could be tangled fascia wrapped around a nerve. She compares it to a bunch of necklaces all twisted together. Before you can untangle them, the tissue has to be guided into ease, not forced. This approach is incredibly gentle and specific, designed to guide the body back into better movement without causing irritation.
“It’s like walking a dog that’s resisting you. You don’t drag it, you nudge it. That’s what we’re doing with the nervous system.” She even describes how an old scar, like one from an appendix surgery, can tighten fascia throughout the body and restrict shoulder movement. “You might think it’s a shoulder issue,” she says, “but we have to look upstream and see what’s really holding things back.” And when it comes to nerves, Veronika reminds patients to think of them less like muscles and more like something delicate. “A muscle is like your big Rottweiler. You can roughhouse a bit. But a nerve is like a baby hummingbird. It needs a much lighter touch.”
Athletes Aren’t Broken—They’re Compensating
Athletes are often the best compensators. They’ll find a way to keep going, even if it means pushing through pain or working around a limitation. “They have an incredible intrinsic motivation,” Veronika says. “Their livelihood may depend on it.” But that drive can lead to patterns of overuse and injury, especially when the body is trying to protect something deeper. She gives an example: if someone had COVID or bronchitis and their lungs stopped moving well, their thorax may lose its ability to rotate. “So every time they go to pitch, they can’t rotate,” she explains. “They over-rotate with the shoulder, then the elbow, and eventually strain the ulnar collateral ligament.” It’s a mechanical chain reaction, one that leads to serious injury like a torn UCL requiring Tommy John surgery. The key is to look upstream. “We’re so often treating the area that’s screaming,” she says, “but we’re not asking what’s causing all the tension in the first place.” Whether it’s an appendix scar, a restriction in the diaphragm, or another hidden factor, your medical team (physical therapists, and manual physical therapists) goal is to figure out what the body is protecting, and when that’s addressed, everything else begins to move more freely.
No Pain, No Gain Is NOT True!
Because nerves are so sensitive, neural manipulation is never about provoking pain. “You’re not trying to overpower or irritate the system, you’re trying to free it up,” Veronika explains. The goal is to find the specific point where the nerve is restricted, often identified through hands-on assessment and nerve tension tests. Once that tension point is located, techniques like Barral Neural Manipulation, fascial release, cupping, dry needling, or skin rolling can be used carefully to restore space and movement. But not all tools are appropriate, and athletes need to know that taking recovery into their own hands can make it worse, like overloading with a massage gun. “You don’t want to just slam the area with a Theragun,” she says. “That could irritate the nerve.” Instead, she prefers the Barral Neural Manipulation technique that is guided by the tension in the tissue and then manual techniques are applied to create slack, ease, slide, and glide in the nervous system. Many Spooner therapists, for example, are trained in functional mobilization. So with applying those techniques, the goal is to allow space for the nerves to glide and move can be helpful in the recovery process.
A Team Approach That Moves Patients Forward
Veronika’s approach is deeply collaborative, especially when working with Spooner physical therapists. “My sweet spot,” she explains, “is gently helping free up the system so someone can move better, and then referring them to a therapist who can help retrain those changes.” If she restores a shoulder’s external rotation from 45 to 90 degrees, that new range likely won’t have good control yet. “They haven’t used that motion in months, so it’s probably going to be sloppy,” she says. That’s where Spooner’s team steps in with movement re-education, postural alignment, and neuromuscular retraining. Or vice versa, if an athlete needs extra hands on manual neural manipulation, Spooner physical therapists will work collaboratively together with Veronika to get patients the best results. Whether it’s PNF, home programs, or posture work, she knows the therapists at Spooner have the tools to help patients use their new mobility safely and avoid future injury. “It’s like I reset the electronics in a car,” she adds. “But the patient still needs the tires, the alignment, the paint job—Spooner does all that.”
And For Female Athletes, It Can Be Even More Involved
Sometimes, even the most dedicated efforts to stretch, strengthen, and move well aren’t enough for female athletes, because the body is still protecting something deeper. Especially with the complexity of hormonal and menstrual changes each month that may not align with game days. Veronika shared the story of a yoga practitioner who had practiced regularly for over 30 years but could never open her hip on one side. She had tried everything. “It turned out she’d had ovarian cysts and tension through the fascia around her ovaries and psoas,” Veronika explained. “After a few visits treating the fascia and the nerves in that area, her hip just opened up.” For decades, her body had been guarding something important. “You can’t stretch through something your body is protecting,” she says. “Her body was saying, ‘You’re not going to injure or strain your ovary, it’s too important.’”
This protective mechanism is something Veronika sees often, especially in athletes. If young athletes can be treated early, their bodies often respond quickly. “They only need a couple visits sometimes,” she says. “They still need strengthening and neuro re-education, and that’s where Spooner’s programs come in, transitioning them into performance, not just pain relief.” With a strong support system, these athletes can enter the next level of their sport not just injury-free, but functionally sound. Maybe opening the door for a better and longer performance in their sports career.
Your Body’s Big Red Flags
If something is persistently short, tight, or weak, and nothing seems to help, it may not be about working harder. “The body is probably protecting something deeper,” she says. “It might be a nerve, an organ, or even an artery.” And for athletes in particular, the nervous system is often the key. PTs already have the tools—nerve glides, nerve tests, anatomical knowledge. The question is: can we identify where the nerve is restricted, treat that point, and then build a plan around the new motion?
The signs aren’t always dramatic. Numbness and tingling are obvious nerve symptoms, but so are stubborn tightness and unexplained weakness. That’s when it might be time to talk with your physical therapist at Spooner about other options. “If what you’re doing isn’t changing anything,” Veronika says, “that’s a good time to ask what the body might be protecting, and who can help you find it.”
To work with a Spooner physical therapist to feel and move better, schedule an appointment today!
To learn more about Veronika and how collaboration between neural manipulation and physical therapy can be helpful, visit Integrated Manual Physical Therapy