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Massage
By Ben
San Antonio, Texas
Presents: |
NeuroMuscular
Therapy –
History and Uses
by Peter Lane, LMT, CNMT
 Integrative NeuroMuscular Therapy (NMT) is a comprehensive system
of soft-tissue manipulation techniques that were developed in
the 1930s in England by Dr Stanley Lief. Lief trained in the United
States as a chiropractor and naturopathic physician. The integrative
discipline that he developed, with additional insights from bodywork
professionals Leon Chaitow, Raymond Nimmo, John Upledger, Janet
Travell and others, balances the central nervous system with the
structure and form of the musculoskeletal system.
NMT is based on neurological laws that explain how the central
nervous system maintains homoeostatic balance, and in many cases,
eliminates the cause of a person’s acute to chronic myofascial
pain and dysfunction. Through the application of modern-day integrative
NMT procedures, which include cranio-sacral therapy, myofascial
release, positional release and trigger point therapy, homoeostasis
is restored between the nervous and musculoskeletal systems. Integrative
NeuroMuscular Therapy enhances the function of joints, muscles,
and the biomechanics of the body, and speeds healing by facilitating
the release of the body’s natural pain killers, endorphins.
Applications of NMT
Patients who suffer from acute to chronic pain resulting from
occupational, sports and/or automobile injuries, benefit from
receiving integrative NeuroMuscular Therapy. Specific types of
dysfunctions and repetitive motion and accumulative traumas respond
well to this treatment, including sciatica, rotator cuff dysfunction,
carpal tunnel and thoracic outlet syndrome, temporomandibular
joint dysfunction and migraines. Integrative NeuroMuscular Therapy
is also utilised in certain types of physical and sexual abuse-related
traumas.
Integrative NeuroMuscular Therapy approaches healing from a holistic
perspective (mind/body) creating long-term results. One of the
premises governing NeuroMuscular Therapy is that the procedures
utilised should stimulate the body to heal on its own. Once this
healing has begun, NeuroMuscular Therapy can be used to stimulate
soft-tissue repair in specific areas, while simultaneously addressing
some of the perpetuating factors causing the patient’s pain.
In this manner, a whole body approach to healing is achieved.
Assessment
A NeuroMuscular Therapist utilises many tools to achieve this
holistic goal, some of which involve assessing a patient’s
conditions and some of which involve treatment.
The first step is to look at the perpetuating factors that are
creating or prolonging a patient’s pain. Age, stress, response
to prior therapies, pre-existing conditions, family history, nutrition,
diet and exercise all play a role in the patient’s ability
to work in partnership with the therapist. The therapist determines
which specific tool or tools will be utilised by assessing postural
distortion and biomechanical dysfunction, the presence of ischaemia
and trigger points, and by determining the presence of nerve compression
and or entrapment in the soft tissue(s).
Postural distortion can be recognised by a raised, and in many
cases, anteriorly rotated ilium, arm and hand, accentuated by
an anterior rotation of the shoulder, that creates an abduction
of the arm. (see photos 1-3 below). In this case, the cervical
spine rotates, thereby compensating for the rotation in the pelvis.
This can cause lower back and neck pain. The condition would be
treated by pelvic facilitation, which is a three-dimensional approach
to the release of soft-tissue constrictions.
The NeuroMuscular Therapist must always work within the limitations
of a patient’s health. For example, if a patient is a 75-year-old
female who has smoked for 35 years and has a calcium-poor diet
accompanied by chronic lower back and hip pain, the NeuroMuscular
Therapist must allow for the possibility of osteoporosis or a
recent hip fracture or replacement. In this circumstance, the
therapist must work with the patient’s primary care physician
to construct a therapy that complements the patient’s condition.
Pelvic facilitation, erector spinae, quadratus lumborum and passive
stretching procedures would be altered to fit her situation.
Treatment
Specific tools that a NeuroMuscular Therapist uses are the thumbs,
fingers, elbows and pressure bars. Pressure bars are effective
instruments for the release of deeper constrictions along the
erector spinae musculature and at tendonous attachment sites throughout
the body. NeuroMuscular Therapy addresses the release of tissues
in layers, superficial to deep, and is performed at a moderate
speed with light lubrication. Treating origins and insertions,
as well as the belly of a muscle is also of critical importance.
It doesn’t require a great deal of pressure to be effective,
which is a benefit to the patient. In the proper application of
NMT, a “dig it out” mentality is never appropriate.
The ability to palpate and effectively treat trigger points is
an additional tool that is effective in treating myofascial pain
and dysfunction. A trigger point is an area of elevated neurological
activity located in fascia and the bellies of muscles that may
refer pain in a localised or peripheral manner. When a trigger
point is active, it can cause a substantial increase in a patient’s
myofascial pain locally or, in what seems to be a totally unrelated
area of the body. If left untreated, a trigger point can prevent
muscles from fully healing and ultimately have adverse long-term
effects on other systems.
The proper and judicious use of pressure, which includes the ability
to feel constrictions and trigger points and know at what angle
your thumb, finger or pressure bar might be best used, is critical
in the effectiveness of the therapy. When NeuroMuscular Therapy
is applied in this manner, it is very effective in releasing trigger
points and tracking down the cause of a patient’s pain.
In my NeuroMuscular Therapy training workshops, I tell my students
that in order to become superb NeuroMuscular Therapists, they
must also become excellent “muscle detectives” and
to be able to “dance with the muscles.”
Another means of increasing the effectiveness of NeuroMuscular
Therapy is through the use of empowerment, in other words, getting
the patient involved in his or her own wellness. In America, and
particularly in the Southwestern United States, we say that “you
can lead a horse to water, but you can’t make it drink.”
So it is with people who are in pain. A therapist can suggest
ways to help a person heal, using a number of tools, but if the
patient refuses to actually use the tools, the therapist can’t
force the patient to feel better. Consistent consumption of water,
multivitamins, B-12, B-6, stretching and a balanced diet, combined
with effective hands-on therapy, will greatly enhance healing
and reduce the amount of time the patient needs to undergo actual
therapy. When the patient feels that he or she is truly in control
of wellness and understands the mechanisms of their condition,
long-term healing can occur.
Laws of NeuroMuscular Therapy
The NeuroMuscular Therapist also operates under a system of laws
known as Pfluger’s Laws, which illustrate acute to chronic
pain patterns and how pain is distributed throughout the body.
The nervous system is designed to produce normal muscle tonus
at 30 stimuli per second. If, due to trauma, the nervous system
is suddenly innervating the damaged tissues at perhaps 75 stimuli
per second, it must respond in a more creative homoeostatic way
to distribute the pain.
The first step, according to the Law of Unilaterality, states
that “if a mild irritation is applied to one or more sensory
nerves, the movement will take place usually on one side only
and that side which is irritated.” As an illustration, if
I were involved in a motor vehicle accident, injure my left shoulder
and decline treatment of any kind, then my left shoulder would
probably be very tender within a matter of minutes. Assuming that
I continue without treatment and to ease the pain, drink substantial
amounts of alcohol and take a very hot shower, the next day not
only would the initial injury site be in pain, but so would the
equal and opposite side. This illustrates the second law, the
Law of Symmetry that says, “if the stimulation is sufficiently
increased the motor reaction is manifested not only to the irritated
side but also in similar muscles on the opposite side of the body.”
From a practical perspective if I can treat the unaffected side,
the injured, painful area can be addressed without initial direct
application of NMT.
Still by way of illustration, the following day, if I continue
to resist proper treatment of my condition, the pain would now
have travelled back and intensified at the original injury site
with a lesser pain still present on the opposite shoulder. This
describes the third law, the Law of Intensity that states “reflex
movements are usually more intense on the side of irritation and
at times the movements of the opposite side equal them in intensity
but they are usually less pronounced.”
The fourth law, the Law of Radiation, states that “if the
excitation continues to increase it is propagated upwards and
reactions take place through centrifugal nerves coming from the
cord segments higher up.” In other words, the pain will
radiate upward from the site of the original injury toward the
brain and then, failing alleviation, will radiate outward, creating
a general contraction of all the muscles in the body.
This is a very profound and unsettling series of events. If left
untreated, I would, in all likelihood, awaken one morning unable
to move with intense headache pain, accompanied by a general contraction
of all the muscles from head to toe. Not only would the nervous
and musculoskeletal systems be adversely affected but so would
all of the other systems in the body, such as the respiratory,
cardiovascular, digestive and endocrine. This illustrates the
fifth law, the Law of Generalisation that states “if the
irritation becomes very intense it is propagated in the medulla
oblongata, which becomes the focus from which the stimuli radiate
to all parts of the cord causing a general contraction of all
the muscles of the body.”
Unfortunately, if a patient arrives at this stage, they are often
irritated by the seemingly do-nothing advice of the therapist.
At this point, the best advice is to seek evaluation and treatment
from a primary care physician and to RICE the body. Other integrative
treatments that prove effective are to increase water consumption
and to increase intake of vitamins, such as 1200 mcg of B-12 and
200 mg of B-6 per day in tablet form. NeuroMuscular Therapy, using
as little as 2 grams of pressure, would be enough to significantly
increase pain and further perpetuate muscle constrictions and
trigger point referrals. Generally, within 48 to 72 hours, the
patient’s condition will have improved enough for healing
body work to begin.
Once NeuroMuscular Therapy has begun, treatment can literally
“pull the plug” on pain by interrupting the source
of abnormal stimulation. This decreases the electrical innervation
to the muscles and viscera, therefore decreasing muscle spasms,
ischemia and metabolic waste build-ups throughout the body. This
has a cascading positive effect on the other systems in the body.
It is critical to maintain consistent consumption of water (6-8
glasses/day), a good multivitamin and vitamins B-6 and B-12.
Summary
Proper intent, desire and training are prerequisites to becoming
a qualified NeuroMuscular Therapist. Opening one’s heart
and mind to an endless realm of healing opportunities that ultimately
benefit the patient is what integrative NeuroMuscular Therapy
is about. It is my sincere desire that a more comprehensive, multidisciplinary
approach to pain erasure and management will be achieved in the
future. Not only must we deal with a patient’s existing
value structure but those of other healthcare modalities as well.
When we have broken down the barriers and boundaries that exist
in current healthcare delivery models, and we have physicians,
chiropractors, dentists, osteopaths, psychiatrists, physical therapists,
podiatrists and surgeons who understand the three dimensionality
of pain and the efficacy of this type of bodywork, then we will
have truly created integrative medicine.
Suggested Reading
Travell J.G. and Simons D.G. Myofascial Pain and Dysfunction:
The Trigger Point Manual. 2 Vols. Williams and Wilkins. Baltimore.
1983.
Chaitow Leon. Modern Neuromuscular Techniques. Churchill Livingstone
Publishers. New Jersey. 1996.
Caillet Rene. Low Back Pain Syndrome. FA Davis Company. Philadelphia.
1988.
Upledger JE. Craniosacral Therapy and Craniosacral Therapy II:
Beyond the Dura. Eastland Press. Chicago. 1987.
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| Case
Histories
Mary Jane
Mary Jane entered my clinic in November 1997. She had been diagnosed
by her physician and dentist with temporomandibular joint dysfunction,
accompanied by chronic neck and back pain. After seven automobile
accidents – none of which had been her fault – her
physician and dentist were at a loss to effectively treat and
reduce her pain, which was at a level 8 on a scale of 10.
When she arrived at the clinic, the first thing I did was to take
a photograph of her postural alignment. From this photograph,
I determined that she had a raised and anteriorly rotated left
ilium, forward rotated right shoulder and cervical spine, accompanied
by a TMJ that tracked severely to the left with extreme discomfort
in the rotation and translation. Next followed an information
gathering period in which it was discovered that she drank very
little water, took multivitamins sporadically, was on prescription
anti-inflammatory medication and Prozac. Due to her pain, she
seldom exercised.
Upon palpation using two ounces of pressure, my touch produced
significant pain to the point that she could not tolerate my therapy.
With such an acute pain pattern, some therapists might hesitate
to treat the patient at all. Instead, the first course of treatment
for Mary Jane was RICE, or rest, ice, compression and elevation.
After 48 hours, I asked her to telephone me with the results.
Two days later, after the RICE treatment, Mary Jane called to
say that her pain level had decreased to a level 5. At this point,
Mary Jane’s true healing began.
The integrative NeuroMuscular Therapy techniques that were helpful
in treating Mary Jane were pelvic facilitation, intraoral gloved
procedures and anterior/posterior cervical spine restorative procedures.
I also worked on her psoas, erector spinae, quadratus lumborum/iliolumbar
ligament, gluteals and deep six lateral rotators. This treatment,
in partnership with her dentist and doctor, significantly improved
Mary Jane’s condition over the next several months, to the
point that she is now on a bimonthly maintenance schedule. In
addition, she enthusiastically altered her lifestyle and attitudes,
drinking more water and exercising regularly. She also changed
her diet to include more healthful, low-fat foods in smaller portions.
Her improved lifestyle has led to a happier outlook as well.
Gloria N.
Gloria N was referred to my clinic by her physician with the diagnosis
of carpal tunnel syndrome. A court stenographer, Gloria had progressively
lost the use of her hands in the courtroom and was perilously
close to being put on permanent disability, with a reduction in
her retirement benefits as well. Gloria described a burning sensation
radiating down her arms bilaterally into her carpal-metacarpal
joints that created a level 8 pain. The pain kept her awake most
of the night.
She was referred to a surgeon who recommended immediate surgery,
but she balked. She asked her primary care physician for an alternative
treatment instead. He suggested NeuroMuscular Therapy. Through
the application of integrative NeuroMuscular Therapy techniques,
she is now on a PRN (‘as needed’) maintenance schedule
and has resumed a full work schedule without the need of surgery.
In Gloria’s situation the procedures that proved to be effective
were ones that dealt with soft-tissue entrapment of the brachial
plexus which began unilaterally and then became bilateral in its
scope. Again, pelvic facilitation was used to gain symmetry in
her pelvis, the centre of gravity in the body, followed by assessment
and soft-tissue release superficial to deep of both the posterior
and anterior cervical musculature. The primary goal was to gain
long-term relief from entrapment of the brachial plexus, therefore
helping to create balance in her cervical spine. This included
the release of the scalenes working through the platysma, sterno-
cleidomastoid and the supra and infrahyoids. From there, treatment
of the posterior cervical, upper posterior thoracic musculature,
arms, forearms and hands (from a dorsal and palmar perspective),
was performed.
In the case of most repetitive motion conditions, the therapist
should always look outside of the immediate area for soft-tissue
factors that contribute to a patient’s pain. In Gloria’s
case, the nature of her job led to a need to assess the musculature
of her shoulders and the ergonomics of her immediate work environment.
Upon further investigation, it was discovered that the trapezius,
SITS (supraspinatus, infraspinatus, teres minor and subscapularis),
rhomboids and pectoralis major/minor and even subclavius by way
of its trigger point referral, had all contributed to her condition.
In conjunction with NMT procedures, her stenographer’s station
was altered to cushion and raise the level of her arms and wrists
while she worked, therefore reducing strain on the muscles. Coupled
with an increase in water consumption and vitamin B-12, along
with some cervical, shoulder, arm and back stretches that she
could do at work, Gloria has regained 90% of her strength in both
arms and wrists with a 95% decrease in pain. The Judge Advocate
General of the U.S. Air Force is very happy to have her back full-time
in the courtroom where she has worked for the past 23 years.
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