Neuromuscular Therapy

4 Types of NMT

- Myofascial release - Strain-counterstrain - Facilitated positional release - Trigger point therapy

Mid 1930s: Neuromuscular Therapy was evolved in Europe by Stanley Leif.

NMT - the manual application of specialized pressure and strokes applied by finger or thumb contact. It encourages restoration of function normality by focusing on myofascial trigger points.

- enhances functions of joints, muscles and biomechanics of the body

- speeds up healing by facilitating the release of endorphins

- restores homeostasis between the nervous and musculoskeletal system

- treats trigger points and prepares for exercise

Andrew Still helped develop modern Myofascial Release

MFR - reduces fascial tension using long-lasting, light sustained pressure along the skin

fascia - a 3D web of connective tissue that wraps every tissue of the body (organs, muscles, blood vessels, and bone). Necessary in helping hold organs in place and aid in movement.

Indications include: injury, stress, postural distortion, or biomechanical dysfunction

4 Techniques for postural distortion and biomechanical dysfunction

- Direct

- Indirect

- Bindegewbs Massage (1940s: Elizabeth Dickey)

- Rolfing/ Structural Integration (1940s: Ida Rolf)

- light to moderate traction and twisting also helps achieve biomechanical and reflex change

- can decrease pain and increase ROM, allowing tissue to realign

1950s: Lawrence Jones developed Strain-Counterstrain

SCS - a manual therapy technique that uses passive body positioning of hypertonic (spasmed) muscles and dysfunctional joints toward positions of comfort or tissue ease that compress or shorten the offending muscle

Note:

-the purpose of shortening is to relax abnormal reflexes that produce the muscle spasm, forcing immediate reduction of muscle tone to normal levels

- alleviates somatic dysfunction by resetting the muscle spindles and golgi tendons

Indications include: tight/ sore muscles, muscle strains, muscle spasms

SCS Techniques

- Locate painful area and communicate using the pain scale of 1-10 - Position client comfortably so muscle is shortened and relaxed for 90 sec while client remains passive - Discomfort level should only be pain level of 1-2

- Therapist brings the muscle back into neutral anatomical position (remind the client that they must not help you move their limbs)

1942: Trigger Point Therapy - Janet Travell and David Simons were both medical doctors who originated injecting various substances into trigger points (corticosteroids, analgesics, saline, etc.)

TPT - Soft-tissue treatment that helps release tense, painful knots in muscles and fascia. Helps speed up healing process and improves range of motion.

trigger point - Tense, contracted, bunched fatigued tissue. Localized areas of soft tissue dysfunction that negatively influence distant target areas. Includes localized areas of deep tenderness and increased resistance and often produces fasciculation/ twitching.

3 main types of trigger points

Active - client can fell it and describe its location

Latent - Client is not aware it exists until the therapist palpates the area

Satellite - Lie within the pain referral zones. Activates trigger points.

Central and Attachment Trigger Points

Central TP - in the center of the muscle fiber, caused by overuse or strain which releases calcium (responds well to heat/ cold contrast)

Attachment TP - form at junctions of myofascial and tendinous tissues/ inflammation (responds well to ice, effleurage and elongated tissue)

pincer palpation - palpation technique used in areas where muscle can be picked up between the thumb and fingers of the same hand

Note:

- physical/ emotional stressors alter neuromuscular structures which causes more stress in a joint, restriction, discomfort and fatigue, lack of oxygen, and retention of waste + inflammation

- pain is usually caused by poor blood circulation, acid build up, overuse of body, restricted joints

- Without the step of stretching, trigger points will return

- After stretching the area you may begin TPT

NMT Routine

Prone/ Supine

1. Effleurage

2. Stretching

3. Hold TP 7-12 sec

4. Effleurage

Performing NMT

- NMT is not about how much pressure a client can take

- Amount of pressure varies

- Use pain scale of 1 to 10 (communicate with client)

- Muscle responds best at pain level 5-6

- Hold static pressure for 7-12 sec (20 sec max)

- Tissue usually releases around this time frame

- If it does not release come back to it later

S.T.A.R.

Sensitivity

Tissue texture

Asymmetry

Range of motion

T.A.R.T.

Tenderness

Assymetry

Range of motion

Tissue texture