Neuromuscular Therapy: Your Questions, Answered

Neuromuscular Massage Therapy (NMT) is a significant methodology for assessing, treating and preventing soft tissue injuries and chronic pain. It is a specific, therapeutic, goal-oriented approach to resolving pain, restrictions and referred pain caused by myofascial Trigger Points. Trigger points (TP’s) are defined as hyperirritable spots in skeletal muscle which give rise to referred pain and sensations. Often times, this pain is experienced distant from the location of the actual TP responsible for the pain clients may present with. For this reason, among others, client’s find this pain to be frustratingly elusive.

Basic Principles of NMT

• Ischemia- Lack of blood, oxygen & nutrients

• Trigger Point- Area of localized tenderness, that when stimulated/stressed produce referred pain

• Neural Implications- Compression or Entrapment of nerves or nerve structures

• Postural Distortions- Imbalances in the musculoskeletal system which result in movement of bony landmarks off the body’s natural planes. Created by person’s muscle memory pattern, injury, or structural anomaly through adaptive changes in length of muscle tissue

• Dysfunctional Biomechanics- Prolonged shortening or imbalances in muscular tonus, resulting in faulty movement patterns; secondary to structural imbalance

According to a study conducted by the Journal of Musculoskeletal Pain, 90% of the population likely has experienced, or currently is experiencing musculoskeletal pain. Wow! Sounds crazy, but I see it every day. Even clients that I’ve had for years will sometimes fail to mention a soft tissue issue, because they were so used to living with it, they thought that it was normal. Or, they simply did not realize that it was their muscles that were contributing to their problem. UGH! We demand so much of our muscles every single day, that we just take it for granted until we are in pain. Unless it was a specific injury or direct trauma, soft tissue pain usually develops as a result of repetitive overuse, improper posture, faulty movement patterns and/or poor ergonomics. Pain is simply our body’s way of communicating to us that something is not right. It is no wonder that muscular pain is so prevalent in society today.

Family doctors and physicians in general, aren’t equipped for troubleshooting chronic myofascial pain. It simply is not usually in their “wheelhouse” of diagnoses. And, let’s face it, currently there is no medical doctor for the muscular system. We’ve got neurologists, cardiologists, podiatrists, dermatologists, urologists…you get the idea. However, there are no doctors for strictly the muscles! So, what happens when we go to the doctor for that neck or low back pain, and nobody can give you a clear answer or diagnosis as to what is going on, after all tests and exams are exhausted? Unfortunately, it often goes undiagnosed or misdiagnosed. Or, even more frequently, gets medicated (which is usually just a band-aid)! Sometimes, physical therapy is recommended. Sometimes this is successful, sometimes not, sometimes it can even make a condition worse. In the cases it is not as successful for muscular-related problems, let’s take a look at why that might be. Below is the recommended order in which to follow for the most optimal rehabilitative outcome.

Proper Stages of Rehabilitation:

1. Therapy: Eliminate spasms & hyper-contractions in the tissues

2. Movement: Restore proper biomechanics

3. Stretching: Restore flexibility to the tissues

4. Exercise: Rebuild strength of the injured tissues

5. Conditioning: Build endurance

Notice that the very first step in proper rehabilitation is to release the soft tissue…MASSAGE! More often than not, this step is not addressed first, or second, or third. Many of the clients that end up on my table state that they have been everywhere and tried everything, to no avail. Because, the muscles and associated myofascial trigger points were never released and/or addressed. When these stages of rehabilitation are followed out of order, setbacks may be experienced and exacerbation of symptoms are often experienced.

"You cannot strengthen a muscle that has a trigger point, because the muscle is already physiologically contracted. Too many physical therapists see a weakened muscle and immediately attempt to strengthen it without testing for the presence of trigger points. Attempts at strengthening a muscle with trigger points will only cause the trigger points to worsen..." — Devin Starlanyl, MD author of Fibromyalgia and Chronic Myofascial Pain Syndrome: A Survivor's Manual

Please, don’t get me wrong; physical therapy is wonderful. I’ve had huge success with PT, post-op. However, there is a time for it (and any modality, for that matter) that is more advantageous to clients and these stages of rehabilitation, when followed, speed up recovery.

How can NMT help?

NMT addresses tight, painful muscles that are usually deprived of blood flow (ischemia). Blood flow brings oxygen and nutrients to muscle tissue, as well as carries out toxins and metabolic waste. During a treatment, the manual manipulation of the muscles and soft tissue create lengthening, relaxing any contractions, encouraging blood flow. When addressing TP’s, specific static compression is applied to the area for 8-12 seconds. If the client feels the pressure reproducing pain or sensations into the vicinity of their pain pattern/complaint, you can be sure that the true source of the pain has been located. Remember, TP’s typically produce referred pain AWAY from the actual location of the TP responsible for their pain. This is why an experienced NMT practitioner may be working in an area completely remote of your area of complaint. For example, if you present with temporal headaches, I might treat your upper trapezius, suboccipitals or sternocleidomastoid. These muscles all contain TP’s that produce headaches in the temple. By applying pressure to the trigger point, in effect, I am interrupting that pathophysiological neural pathway. In essence, we’re “quieting down” the nervous system, which “quiets down” the muscular system. To summarize, if you have been to massage therapists who are working locally where you are experiencing your pain, but not getting adequate relief, chances are, they are just chasing the pain instead of treating the area responsible for it.

What has NMT successfully treated?

Here are a few:

• Frozen shoulder

• Headaches

• Low Back Pain

• Bursitis

• Tennis Elbow

• Whiplash

• Restricted range of motion

• Sciatica

• Tendonitis

• Neck Pain

Does NMT hurt/is it painful?

Pain does not exist in healthy tissues. Treatment is usually addressing existing pain. Therefore, it is likely that one will experience mild to moderate discomfort. However, it will be the goal of your therapist to work within your pain threshold. Ultimately, you are in control of the amount of pressure administered.

How many treatments are necessary?

This is very individualistic. The entire duration of treatment is determined by factors such as how long the condition has existed, how well one responds to treatment, the overall state of health, age and what lifestyle activities contribute to the condition.

“RULE OF THUMB”

Generally, I tell clients it takes 1-2 treatments for

Every month that the condition has existed.

Deborah Moody has been a licensed, practicing massage therapist, specializing in NMT for 27 years. She has taught in the field of massage for over 15 years and continues to provide continuing education for massage therapists throughout the country. Deborah currently has a private practice in the heart of historic San Marco, just outside of downtown Jacksonville, FL. Find out more at www.advancedbodyworksolution.com