Fifteen years on why chronic pain doesn't resolve where it hurts

The symptom is not the cause

Dr. Alex Atiakshev works with clinicians on chronic pain that doesn't resolve where it hurts.

His practice asks one question: what sensory input is driving the problem, and where to correct it at the source.

He trained directly under Dr. José Palomar, who developed P-DTR (Proprioceptive Deep Tendon Reflex) in the 1990s, and now co-teaches its Foundation course.

This site is an educational resource for clinicians. If you are a patient, it does not book sessions, but you can bring the language here to your own clinician, or look for a certified P-DTR practitioner near you.

Get the free checklist 5 questions for cases that don't resolve. 8-page PDF, no signup.
Dr. Alex Atiakshev · Manual Therapy & P-DTR · P-DTR teacher with P-DTR Global
Dr. Alex Atiakshev

A note from the practice

Dr. Alex Atiakshev is a clinician with fifteen years of practice in receptor-based diagnostics, founder of Pro Prio Lab, and a P‑DTR teacher with P‑DTR Global

For more than fifteen years his work has centered on a single clinical question: what is actually driving this symptom? Five thousand patients and two hundred trained clinicians later, one observation has held: the symptom site is rarely where the driver lives.

Years practicing
15+
Graduates
200+
Patents
3
View records

Four ideas the practice is built on

  1. The symptom is not the cause

    Pain and restriction rarely sit where the driver does. The clinician's job is to find the primary dysfunction, the input the body is defending against or compensating for, and to correct it there.

  2. Compensation carries a structural cost over time

    The body adapts, redistributing load year after year, until the adaptation itself becomes the generator of chronic pain, instability, and the injuries that keep coming back.

  3. Sensory input is the upstream control variable

    Vision, the vestibular system (inner-ear balance), proprioception (sense of joint position and movement), the skin: these afferent channels (signals traveling from sensors into the nervous system) write posture, load perception, and motor output. Adjusting the input shifts the downstream behavior.

  4. P-DTR is principled diagnostic reasoning

    Proprioceptive Deep Tendon Reflex (P-DTR) is a receptor-based clinical-reasoning and assessment method. It reads how receptors are firing (the sensors in joints, skin, muscle, eyes, and ears) to locate the sensory input driving a pattern, then works with that input at its source. It is grounded in physiology, and it is not a treatment for the symptom or any disease.

The driver is rarely where the patient feels the symptom. The receptor-based assessment is built to locate that upstream input.

Working frame · Pro Prio Lab
Diagram: a misreading sensory receptor drives a symptom felt elsewhere in the body
Diagram · the symptom is not the cause
Selected cases

Four patients. One diagnostic question

Four cases where the symptom site wasn't the source. In each, Dr. Atiakshev's receptor-based assessment looked upstream - to the input the body had been compensating around.

  1. 01

    Hidden vestibular dysfunction behind unexplained balance loss

    The patient reported intermittent balance loss, with symptoms emerging only under specific load conditions. Receptor-based assessment and stabilometry considered asymmetric vestibular afferent input as a possible contributing factor, reported as a single-case observation.

    Balance · Vestibular · Posture
  2. 02

    Persistent dizziness and receptor-based clinical reasoning

    The patient presented with episodic dizziness, light sensitivity, and sound intolerance - receptor-based assessment considered asymmetric afferent input with predominantly cervical and occipital findings as a possible contributing pattern.

    Vertigo · Sensory overload
  3. 03

    Chronic neck pain considered through visual input

    Prior local approaches had not produced stable change - receptor-based assessment considered visual afferent input as a possible contributor to a cervical compensation pattern.

    Neck · Visual · Chronic
  4. 04

    TMJ and knee symptoms considered through visual input

    A recent eye injury was followed by TMJ symptoms and knee discomfort - receptor-based assessment considered visual afferent input as a possible primary contributor to the postural compensation pattern through the jaw and knee.

    TMJ · Knee · Visual
Read all eleven cases
Working through receptor-based reasoning at a whiteboard

What hurts is the compensation. The driver lives upstream in the sensory map.

Teaching · receptor-based reasoning

Essays on physiology and clinical thinking

  1. Clinical reasoning

    The invisible nociceptor.

    A nerve fiber can fire for years without producing pain - and quietly drive tension, fatigue, sleep, and mood along the way. A clinical framework for complaints that won't localize on imaging.

  2. Neurophysiology

    Why the scar still matters.

    The dorsal-horn amplifier that lets a healed injury keep running the body for years. A field guide to WDR neurons, wind-up, and central sensitization.

  3. Postural system

    What the skin of the foot is actually doing.

    A physiology essay on the four cutaneous mechanoreceptors of the sole - and why the mechanics of the skin itself shape postural control as much as the nervous system does.

A receptor-based assessment room
Receptor-based practice · the working frame
Training for clinicians

The method, taught

Stop chasing symptoms and start finding drivers. A program in P-DTR, neurophysiology, and the postural system for clinicians who want to work from principle rather than protocol.

Clinicians studying receptor-based reasoning
Studying receptor-based reasoning
Base course 5 seminars · 3 days each · ~8 months

Five seminars. Thirteen modules. Built around receptor-based clinical reasoning

Theory paired with intensive hands-on practice, real patients in the room, maintained clinical manuals - and the method becomes usable in your own clinic after seminar one.

Introduction and principles · Tools and rules of P-DTR · Muscle-receptor algorithms · Nociceptor work and inhibition patterns · Ascending tracts · Golgi, Pacinian, Ruffini, Meissner, Golgi-Mazzoni, Krause · The neurology of gait · Pelvis, spine, and major joints · Cranial dysfunctions · Meridian work (segmental referred-pain mapping) · Visceral and autonomic applications · Emotional reflexes (limbic-autonomic responses affecting motor output) · Clinical reasoning.

Master-class 1 day

Introduction to P-DTR

A single day to leave with Pro-Prio tests as a fast-triage tool, the core rules of the method, and enough foundation to begin working with nociceptor-driven patterns within your existing scope of practice.

Taught in 2 countries

Germany

Seminars are currently taught in Germany. Certification is conferred directly by the founder of the P-DTR method, Dr. José Palomar, after completion of the full curriculum and the author-led examination.

For whom Clinicians

Clinicians and manual therapy professionals

For practitioners working in manual therapy, rehabilitation, movement, and sports medicine who want to understand receptor-based clinical reasoning within their existing scope of practice.

Dates by email

Apply to train with Dr. Atiakshev

For hands-on clinicians who work with muscle, movement, and pain - manual therapists, chiropractors, physical therapists, clinicians in movement and rehabilitation, sports medicine clinicians, osteopaths, massage therapists, and applied kinesiologists.

For training, teaching collaboration, or press

Email is the primary channel for training inquiries, teaching collaboration, and press. Instagram for short questions about the method.

Email · primary channel
alex@atiakshev.com

Training inquiries, teaching collaboration, and press. The direct professional channel.

Write an email
Instagram
@dr.alexatiakshev

Short questions about the method.

Open Instagram

The content on this site is for informational purposes and does not substitute for an in-person evaluation. Treatment decisions are made only after an individual clinical assessment.