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 persons acute to chronic myofascial pain and
dysfunction. About the Author
WD Peter Lane, LMT, CNMT, is Director of the
NeuroMuscular Therapy Center of New Mexico located in Albuquerque, New Mexico. He is an
instructor of anatomy and physiology and maintains a private practice treating patients
who present with a variety of soft-tissue dysfunctions. He travels the United States
training and certifying healthcare practitioners in Integrative NeuroMuscular Therapy.
Case Histories
Mary Jane
Mary Jane entered my clinic in November 1997. She had been diagnosed by
her physician and dentist with temporomandibular joint dysfunction, accompanied by chronic
neck and back pain. After seven automobile accidents none of which had been her
fault her physician and dentist were at a loss to effectively treat and reduce her
pain, which was at a level 8 on a scale of 10.
When she arrived at the clinic, the first thing I did was to take a
photograph of her postural alignment. From this photograph, I determined that she had a
raised and anteriorly rotated left ilium, forward rotated right shoulder and cervical
spine, accompanied by a TMJ that tracked severely to the left with extreme discomfort in
the rotation and translation. Next followed an information gathering period in which it
was discovered that she drank very little water, took multivitamins sporadically, was on
prescription anti-inflammatory medication and Prozac. Due to her pain, she seldom
exercised.
Upon palpation using two ounces of pressure, my touch produced
significant pain to the point that she could not tolerate my therapy. With such an acute
pain pattern, some therapists might hesitate to treat the patient at all. Instead, the
first course of treatment for Mary Jane was RICE, or rest, ice, compression and elevation.
After 48 hours, I asked her to telephone me with the results.
Two days later, after the RICE treatment, Mary Jane called to say that
her pain level had decreased to a level 5. At this point, Mary Janes true healing
began.
The integrative NeuroMuscular Therapy techniques that were helpful in
treating Mary Jane were pelvic facilitation, intraoral gloved procedures and
anterior/posterior cervical spine restorative procedures. I also worked on her psoas,
erector spinae, quadratus lumborum/iliolumbar ligament, gluteals and deep six lateral
rotators. This treatment, in partnership with her dentist and doctor, significantly
improved Mary Janes condition over the next several months, to the point that she is
now on a bimonthly maintenance schedule. In addition, she enthusiastically altered her
lifestyle and attitudes, drinking more water and exercising regularly. She also changed
her diet to include more healthful, low-fat foods in smaller portions. Her improved
lifestyle has led to a happier outlook as well.
Gloria N.
Gloria N was referred to my clinic by her physician with the diagnosis
of carpal tunnel syndrome. A court stenographer, Gloria had progressively lost the use of
her hands in the courtroom and was perilously close to being put on permanent disability,
with a reduction in her retirement benefits as well. Gloria described a burning sensation
radiating down her arms bilaterally into her carpal-metacarpal joints that created a level
8 pain. The pain kept her awake most of the night.
She was referred to a surgeon who recommended immediate surgery, but
she balked. She asked her primary care physician for an alternative treatment instead. He
suggested NeuroMuscular Therapy. Through the application of integrative NeuroMuscular
Therapy techniques, she is now on a PRN (as needed) maintenance schedule and
has resumed a full work schedule without the need of surgery.
In Glorias situation the procedures that proved to be effective
were ones that dealt with soft-tissue entrapment of the brachial plexus which began
unilaterally and then became bilateral in its scope. Again, pelvic facilitation was used
to gain symmetry in her pelvis, the centre of gravity in the body, followed by assessment
and soft-tissue release superficial to deep of both the posterior and anterior cervical
musculature. The primary goal was to gain long-term relief from entrapment of the brachial
plexus, therefore helping to create balance in her cervical spine. This included the
release of the scalenes working through the platysma, sterno- cleidomastoid and the supra
and infrahyoids. From there, treatment of the posterior cervical, upper posterior thoracic
musculature, arms, forearms and hands (from a dorsal and palmar perspective), was
performed.
In the case of most repetitive motion conditions, the therapist should
always look outside of the immediate area for soft-tissue factors that contribute to a
patients pain. In Glorias case, the nature of her job led to a need to assess
the musculature of her shoulders and the ergonomics of her immediate work environment.
Upon further investigation, it was discovered that the trapezius, SITS (supraspinatus,
infraspinatus, teres minor and subscapularis), rhomboids and pectoralis major/minor and
even subclavius by way of its trigger point referral, had all contributed to her
condition.
In conjunction with NMT procedures, her stenographers station was
altered to cushion and raise the level of her arms and wrists while she worked, therefore
reducing strain on the muscles. Coupled with an increase in water consumption and vitamin
B-12, along with some cervical, shoulder, arm and back stretches that she could do at
work, Gloria has regained 90% of her strength in both arms and wrists with a 95% decrease
in pain. The Judge Advocate General of the U.S. Air Force is very happy to have her back
full-time in the courtroom where she has worked for the past 23 years. |
|
Patient Mary Jane undergoes pelvic facilitation |
Integrative NeuroMuscular Therapy
(NMT) is a compre- hensive 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 persons 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 bodys 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 patients 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 patients conditions and some of
which involve treatment.
The first step is to look at the perpetuating factors that are
creating or prolonging a patients pain. Age, stress, response to prior therapies,
pre-existing conditions, family history, nutrition, diet and exercise all play a role in
the patients 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 patients 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 patients primary care physician to construct a
therapy that complements the patients 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 doesnt 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 patients 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 patients 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 cant 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 cant 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 Pflugers 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 patients 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 ones 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 patients existing value structure but those of other
healthcare modalities as well.
When we have broken down the barriers and boundaries that exist
in current healthcare delivery models, and we have physicians, chiropractors, dentists,
osteopaths, psychiatrists, physical therapists, podiatrists and surgeons who understand
the three dimensionality of pain and the efficacy of this type of bodywork, then we will
have truly created integrative medicine.
Suggested Reading
Travell J.G. and Simons D.G. 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.
|