Neuromuscular Therapy

2/27/23

NMT [1930s]: Developed in Europe by Stanley Leif

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

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

• Performing NMT

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

- amount of pressure varies

- use pain scale of 1-10

- muscle response is best at level 5-6 (hold static pressure for 8-12 sec)

- tissue releases after this amount of time (20 sec at the longest)

- if it does not release, return to it later

- without stretching, trigger points will return

- after stretching the area, you may begin Trigger point therapy

• Types of NMT

- Trigger Point Therapy

- Myofascial Release

- Strain-Counterstrain

- Facilitated Positional Release

Trigger Point Therapy was developed by Nimmo who insisted that TPs had a neurological origin, meaning that TPs were connected to nerves.

- Objective: identify and palpate; apply techniques to relieve pain from muscle

- enhances function of joints, muscle 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

- prepares for exercise

- increases range of motion

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

fasciculation - a brief, spontaneous contraction affecting a small number of muscle fibers

• Types of Trigger Points

- active trigger point: client can feel and describe its location

- latent trigger point: client is not aware of it until therapist palpates the area

- satellite trigger point - lie within the pain referral zones; activates trigger points

central trigger point - in the center of the muscle fiber; overuse or strain releases calcium

- responds well to heat/ cold contrast

attachment trigger point - form at junctions of myofascial and tendinous tissues/ inflammation

- responds well to ice and effleurage (elongated tissue)

Myofascial Release

Developed by Andrew Still

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

- can decrease pain and increase ROM, bringing the body into balance by allowing tissue to realign

fascia - a thin 3D-web casing of connective tissue that surrounds and holds every organ, blood vessel, bone, nerve fiber and muscle in place

• Indications of restricted fascia

- injury

- stress

- postural distortion

- biomechanical dysfunction

• Technique

- direct

- indirect

- Bindegewbs massage

- Structural Integration (Rolfing)

Strain-Counterstrain - [1950s] Developed by Lawrence Jones

- alleviates somatic dysfunction by resetting the muscle spindle fibers and golgi tendons

somatic dysfunction - describes all lesions of the musculoskeletal system: an impairment related to the somatic system/ body framework; primary cause of pain

pain - usually indicates poor blood circulation, acid build-up, overuse of body, restricted joints

- placing the joint in a position of comfort, holding that position then very slowly returning it to normal position

• Indications

- tight/ sore muscles

- muscle strains

- muscle spasms

• Technique

- Locate painful area and use a pain scale of 1-10

- Position client comfortably so the muscle is shortened and relaxed for 90sec while client remains passive (discomfort level should only be 1-2)

- Therapist should then return the muscle to its anatomical position

- 75-90% pain relief should be experienced

3/7/23

Musculoskeletal System

3/14/23

Movements

Flexion - The angle of the joint diminishes; forward

Extension - The return movement from flexion

Abduction - Sideward movement from abduction or toward the midline

Adduction - Return movement from abduction or toward the midline

Lateral flexion - Side bending of the head or trunk

Muscle Energy Technique (MET) - Developed by Fred Mitchell

- A therapeutic procedure that is used to improve the functional mobility of the joints

- The two basic reflexes produced during MET manipulations are post-isometric relaxation and reciprocal inhibition

- Involves active participation by the client

Variations of MET

- Contract-relax or agonist-contract

- Antagonist-contract

- Contract-relax contract the opposite

- Conditions that respond to MET: Tense, shortened muscles

- Various outcomes of MET: Relaxing and lengthening hypertonic muscles, stimulating and strengthening weakened muscles, lengthening chronically shortened fibrotic muscles.

The Bodywork Systems that Incorporate Passive Positioning Techniques:

Passive Positioning Techniques: The gentlest of soft tissue manipulations when addressing mobility restrictions from pain and soft tissue dysfunction

- Strain-Counterstrain

- Ortho-Bionomy: A method of structural integration that was developed in the 1970s by a British osteopath and bodyworker, Arthur Pauls, with the goal of restoring structural alignment and balance through gentle movement and postural adjustment, which release tension and holding patterns.

- Structural Muscular Balancing

Positional Release

- The body is moved passively toward the body's preference and away from the pain, seeking the tissue's preferred position. Movements are toward ease and away from bind, away from any restrictive barrier and toward comfort. Positioning is done slowly so we don't cause and more increased pain

- After the position is released the body part is passively and slowly returned to its position

Important Terms:

Positional Release - Passively moving the body away from the pain. Movements are towards ease and away from bind, away from any restrictive barrier and toward comfort

Musculotendinous junction - the area of the muscle where the muscle fibers become tendons Myofascial Trigger Point - Hyperirritable nodule associated with dysfunctional contractile tissue that creates a pain response when digital pressure is applied

Myotherapy: Bonnie Prudden - 1980s - To relieve pain in muscles by releasing TPs using ischemic compression and corrective exercises

Ortho-Bionomy - a healing system developed by Pauls, based on the body's self-correcting reflexes

Pain scale - an assessment tool allowing the client to rate his or her level of pain or discomfort on a scale of 1-10 or 1-5

Physiopathology Reflex - Self-perpetuating dysfunctional neurologic circuit

Pincer Palpation - Employed in areas where the muscle tissue can be picked up between the thumb and fingers of the same hand in which the belly of the muscle is rolled between thumb and fingers to identify dysfunctional tissue

Preferred Position - placing a body part in the most comfortable position where it wants to be

PRICE - Protect, rest, ice, compression, elevate

Reciprocal Inhibition - When a muscle that is acting on a joint contracts and the opposing muscle is reflexively inhibited

Rolfing - aligns the major body segments through manipulation of the fascia or the connective tissues

Satellite Trigger Point - A hypersensitive spot that forms because of the dysfunction of the primary myofascial trigger point

Splinting - the tendency of muscle tissue situated ear an injury to tighten and to protect the inured tissue

Still Point - Designates a quieting of the cranial rhythm when applying craniosacral therapy (hold for 20s)

Strain-Counterstrain - a therapeutic technique developed by Lawrence Jones that incorporates position release

Stretching - Passive and active stretching of the muscle and connective tissue to achieve normal resting length

Trigger Point - Hyperirritable nodule associated with dysfunctional contractile tissue that elicits a pain response when digital pressure is applied

Planes of the Body

- Sagittal (medial) plane - Vertical plane that divides the body into right and left halves

- Coronal (frontal) plane - Vertical plane that divides the body into ant/ posterior halves

- Transverse (horizontal) plane - Divides the body into upper and lower halves

Axes of the Body

- Frontal (horizontal/ lateral) axis - passes horizontally from side to side

- Sagittal (horizontal) axis - passes horizontally from front to back

- Vertical Axis - passes perpendicularly to the ground

Movements in Sagittal plane

- Flexion - the angle of the joint diminishes

- Extension - The return movement from flexion

Movements in the Frontal Plane

- Abduction

- Adduction

- Lateral Flexion

Movements in the Transverse Plane

- Rotation left and right - twisting such that the anterior aspect turns left or right

- Lateral Rotation - outward rotation

- Medial rotation - inward rotation

Counterstrain

- Passive

- Indirect

- Tender points (no radiation)

Technique

- Find the tender point

- Palpate

- Position of ease

- 70-100% decrease in pain

- Hold a passive position for 90 sec

- Passively return the client to a neutral position