Neuromuscular therapy

Neuromuscular therapy (NMT) is a form of massage. It is distinguished from other types of massage in that a quasi-static pressure is applied to the skin with the aim of stimulating specific areas of skeletal muscle. Often these areas of muscle are myofascial trigger points.

The application of NMT is dependent on several key factors:

• The location of myofascial trigger points
• Force has to be applied perpendicular to the skin surface if muscle is to be stimulated.

History

During the last several decades, neuromuscular therapy (NMT) has emerged as a significant methodology for assessing, treating and preventing soft tissue injuries and chronic pain. NMT, a series of manual treatment protocols based on the practitioner’s skill, anatomy knowledge and precise palpatory application, has found its home, not only in the treatment rooms of massage therapy, but also in occupational and physical therapy, nursing, Naturopathic, chiropractic, osteopathic and physical medicine clinics worldwide, as well as in many forward-looking Primary Care practices.

Between the mid-1930s and early 1940’s, European-style neuromuscular techniques (as NMT is called in Europe) first emerged, was developed by Stanley Lief and Boris Chaitow. These cousins, trained in osteopathy and naturopathy, studied with teachers like Dewanchand Varma and Bernard Macfadden and integrated assessment and treatment steps for soft tissue dysfunction. Their practice of NMT was set in Lief’s health resort, Champneys, at Tring in Hertfordshire, England where they were presented with a wide variety of conditions on which to test their theories and methods. Many osteopaths and naturopaths, including Peter Lief, Brian Youngs, Terry Moule, Leon Chaitow and others, have taken part in the evolution and development of European neuromuscular techniques. NMT, now taught widely in osteopathic and sports massage settings in Britain, forms an elective module on the Bachelor of Science (BSc(Hons)) degree courses in Complementary Health Sciences at the University of Westminster, London, a program developed (in part) by Leon Chaitow, DO.

In 1996, a landmark event for American NMT occurred when NMT American version was overviewed in Leon Chaitow's Modern Neuromuscular Techniques, as contributed by Judith DeLany. This significant text was the first to offer both the European and American methods within the same volume. Chaitow and DeLany have since published three definitive texts integrating the American and European versions of NMT. Clinical Application of Neuromuscular Techniques, Vols. 1 & 2, with accompanying Case Study Exercises, which aims to standardize the training of NMT techniques.

Influences

Trigger Points: Welcome Home

European NMT has embraced the orphan tissue fascia and the epidemic that is known widely as trigger points. Janet Travell and David Simons are two physicians who, amongst others, have assisted in our understanding and treatment of trigger points. Simons (Lewit & Simons, 1984) has described the evolution of trigger points in the following way:

“In the core of the trigger lies a muscle spindle that is in trouble for some reason. Visualize a spindle like a strand of yarn in a knitted sweater….. a metabolic crisis takes place, which increases the temperature locally in the trigger point, shortens a minute part of the muscle (sarcomere) – like a snag in a sweater – and reduces the supply of oxygen and nutrients into the trigger point. During this disturbed episode an influx of calcium occurs and the muscle spindle does not have enough energy to pump the calcium outside the cell where it belongs. Thus a vicious cycle is maintained and the muscle spindle can’t seem to loosen up and the affected muscle can’t relax.”

Having tested his concept, Dr. Simons found that at the core of a trigger point there is an oxygen deficit compared with the muscle tissue, which surrounds it. Travell (Travell & Simons, 1992) has confirmed that the following factors can all help to maintain and enhance trigger point activity:

1. Nutritional deficiency, especially vitamin C, B-complex and iron;

2. Hormonal imbalances (low thyroid, menopausal or premenstrual situations, for example);

3. Infections (bacteria, viruses or yeast);

4. Allergies (wheat and dairy in particular);

5. Low oxygenation of tissues (aggravated by tension, stress, inactivity, poor respiration).

A primary focus of NMT is to understand the formation, etiology and treatment of myofascial trigger points (TrPs). In NMT a special effort is made to locate the source of referred pain including any perpetuating influences and eliminating them while paying attention to correct negative postural patterns.

People interested in learning more about European NMT should visit [www.ntc.ie]