Friday, November 21, 2008

NeuroMuscular Therapy


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.

Suggested Readings:

Travell JG and Simons DD. 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.
* Courtesy- Peter Lane. http://lifepositive.com

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