5 Principles of Neuromuscular Therapy (NMT)

by Peter on March 26, 2015

What is Neuromuscular Therapy (St. John Method)?

I’m often asked what Neuromuscular Therapy (NMT) is, what it can do, and how will it help them. Having taught post graduates (Massage Therapist, Physical Therapists, Chiropractors and Dentists across North America, and parts of Europe and Africa) Neuromuscular Therapy for more than 10 years, it is the base of my treatments with patients. The principles of NMT are the same whether I’m using hands on techniques, or other modalities such as Light Therapy.
Neuromuscular Therapy is a comprehensive program of soft tissue manipulation techniques that balance the central nervous system (brain, spinal column and nerves) with the structure and form of the musculoskeletal system. NMT is based on neurological laws that explain how the central nervous system maintains homeostatic balance. These same laws dictate how the central nervous system initiates pain response.

There are five principles to Neuromuscular Therapy:
1. Postural Distortion

2. Biomechanical Dysfunctions

3. Trigger Points

4. Nerve Compression/Entrapment

5. Ischemia

 

Ischemia is a lack of blood supply to the soft tissues, which causes them to be very sensitive touch.

Trigger Points occur when nerves fire impulses at a rapid speed into an area of the body other than that which has been traumatized. Because of trigger points, the cause of serious pain may often be far from the actual site of the pain. This, in turn, inhibits proper blood flow, which causes ischemia an often leads to more pain and discomfort.

Nerve Compression and Entrapment is pressure on a nerve by bone, cartilage or soft tissue. The role of the soft tissues in nerve compression is vital. Failure to treat the associated soft tissue often treats the symptom without eliminating the cause of the pain. Nerve entrapment is the most common type of pain and always causes ischemia. Ignored, it can produce associated trigger points.

Postural Distortion or muscular contraction occurs when there is an imbalance of the musculoskeletal system resulting from movement of the body off the coronal, midsagital or horizontal planes. When the body tries to compensate in an effort maintain structural balance, muscle contraction, body distortion, and pain result. For example, lower limb-length inequality can cause a tilted pelvis, which usually results in a compensatory scoliosis that is maintained by sustained muscular effort.

Biomechanical Dysfunction is an imbalance of the musculoskeletal system resulting in faulty movement patterns. Repetitive strain of certain soft tissue result in adapted movement patterns that become muscular “habits” and must be reeducated.


How was St. John Therapy Developed?

Paul St. John developed an intense interest in studying and researching soft tissue pain and musculoskeletal dysfunction because of serious injuries he sustained throughout his life. He broke his back in three places in a high school football game, he was shot out of a helicopter as a Green Beret medic in Vietnam, and he was in a head-on automobile collision. For four years he awakened to HEADACHES and unceasing pain. Thousands of dollars in medical expenses left him without relief.

After years of chiropractic, neurology, osteopathy, and even psychiatry, he had found no permanent relief from his pain. This led him to medical libraries where he began to investigate the root causes of pain in the body. He studied pain mechanisms, researched the functioning of the nervous system, and the neurological laws that govern the WORKINGS of the body. Through this research he found that most pain conditions stem from the problems in the muscular system.

Armed with this information, he began to study his own body and the pain patterns which had developed from his injuries. During his research, he became familiar with a technique called receptor tonus technique, developed by Dr. Raymond Nimmo, D.C. He found that by pressing on the tissues of his neck, back and shoulders, he was able to get temporary relief. He then began perfecting the receptor tonus technique and, at the same time, began teaching others to treat his tissues. For the first time in four years, he was pain free.

Paul St. John went on to integrate the teachings of many other pioneers in the field of musculoskeletal pain and dysfunction including Marianno Racabado, P.T.; Janet Travell, M.D.; John Barnes, P.T.; Dr. John Christopher; Dr. Bernard Jensen, and other orthodox and non-conventional teachers. The result has been the development of the St. John Method of Neuromuscular Therapy.

If you have any questions regarding this technique or any other concerns or inquires you may have feel free to contact me.
In Health,

Peter Roach, RMT, CNMT, Laser Therapist

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Brenda has recently completed an advanced training with certification in the Dr. Vodder method of Manual Lymph Drainage (MLD) and Combined Decongestive Therapy (CDT), offered by the internationally recognized Dr. Vodder School.  The program that Brenda completed included pathology instruction and examination with the medical director of the School.

Completion of this 160-hour intensive training program makes Brenda one of approximately 1000 certified therapists in North America, currently certified to practice this specialized technique.

CDT enables Brenda to manage patients with lymphedema and venous insufficiency edema, using a combination of Manual Lymph Drainage, Exercise Therapy, Compression Bandaging and Skin Care.  This allows advanced care of patients with lymphedema, whether from surgery, radiation or congenital malformation.  Suitable venous oedemas may also be managed successfully with these techniques.

MLD can also be used in the care of patients with conditions such as venous stasis ulceration, wounds, scar tissue, burns, traumatic edema, dermatological indications such as rosacea, orthopaedic indications such as adhesive capsulitis, arthritic conditions, acute whiplash, Menieres Syndrome, migraines, etc.

Apart from increasing lymph flow, MLD also has a pain relieving effect and can be used with recent trauma, such as sport injuries.  Patients find the techniques soothing and relaxing with no side effects.  It is a gentle, rhythmic massage-like movement, performed with a great deal of precision and requires a well-trained therapist to obtain good results.

For more information, please contact Brenda at Brenda@bayswater.ca or call the clinic at 604-732-4665.

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This is the second article in a series looking at the 6 principles of Neuromuscular Therapy, and how they are applied in my treatment programs. Last week I talked about Posture, the first component that I look at when you come for treatment. The 6 principles I will be covering are:

  • Correcting postural distortions
  • Correcting dysfunctional biomechanics
  • Manually working on areas of ischemia
  • Releasing trigger points
  • Releasing nerve entrapment
  • Rehabilitating with exercise

So let’s talk about biomechanics.

 Biomechanics

The next stage that works in tandem with postural assessment is to look at your movement and motor patterns. This, with posture, help determine how I will treat your pain and determine the exercises that will be appropriate for you at this point in time.

Biomechanics is a huge field and many books and studies have been written on the subject. For example, examination of the foot and it’s components as you strike the ground have been studied in depth, and progression of the body from there up can all be examined. However what I’m looking for when you first come in with a complaint is to get a sense of how you move generally.

Often I will have a patient go into the hallway and walk for me. As people say, it’s kind of weird to try to walk your normal way when someone is watching you. But it’s from this observation combined with your static posture that I can determine the best way to approach your pain.

A general observation of your movement is what I’m looking for. Of coarse it is sometimes the chicken and the egg thing, are you moving in a particular dysfunctional way because of your pain, or does your movement pattern contribute to your pain.

 

 This gait pattern obviously will have some consequenses

I will usually try to mimic your gait for you, or show you using video of yourself walking. In this way I can keep a record of your progression. At this time I usually will give a corrective movement pattern here, in the hall, to help restore proper movement.

The biggest component for re-education of movement patterns is repetitiveness. Movement has got to become a conscious act, especially at the beginning when re- grooving a new pattern. For example the most common movement pattern I see is patients walking with no movement of their arms, or an arm that swings across their body. If these destructive movement patterns continue then all the therapy in the world will be for not the moment you walk out of the therapy office and down the road with the same old pattern. An arm that swings across the body several thousand times throughout the day will eventual produce a rotatory component to your gait, and the same problem and pain will crop up once again. So don’t be fooled. If your gait hasn’t been looked at, your not getting the most out of your therapy.

 

Proper gait patterns

 

Corrective movement patterns need to be preformed with a conscious mind, repeated for several minutes at least, and repeated several times a day. Think of it this way. There is a field (your body) that has a path running through it (the nerve pathways). The more that people use the path, the more the path gets trampled down and grooved. It becomes the path of least resistance. The path becomes more established and the more that this path is used, the more it will be to the exclusion of others. Movement patterns are a series of nerves that fire in a particular order to produce the movement. In order to create a different movement we have to create a different pathway. As in the field, the more other pathways are created and used, the more the original pathway will overgrow and be lost. Reintroducing a new movement pattern has got to repeated often and with conciseness to produce a different pattern.

First observation when looking at your gait will be looking at such patterns as arm swings and movement of the shoulders and spine. How does your pelvis move, side to side in a fixed pattern or does it not move at all? How does your leg move through the flexion and extension phase, and how does that relate to your knee and the way your foot strikes the ground. All of this will effect the way treatment to resolve your pain will progress.

Reintroducing new movement patterns is fairly easy but as mention, need to be repeated often. Personally when I workout in my garage gym and on the treadmill, I find it a perfect time to check into my gait, and re-groove a movement pattern. Mindfulness is important in rehab, particularly in movement.

Using gait as an example, a decrease in hip internal rotation will not allow the pelvis to rotate over the stance limb, thereby limiting the coupling mechanics (a whole other discussion!!) of the sacrum and lumbar spine. Due to the lack of hip movement the lumbar vertebrae make up for the movement, thus rotating way to much for its true function. The lumbar vertebrae true function is to stabilize the thorax and the pelvis ( this will be discussed much more in-depth when we look at the Functional stability component of NMT. Additionally, muscles in the low back, like the multifidus, will not achieve their normal length-tension relationships due to excessive movement. Potentially, this can be the source of low back pain, the lack of pelvic movement. The lack of motion in the sacrum/ilium and the excessive movement of the low back may lead to degenerative changes and excessive compression of the facets. You can appreciate how complicated this can all get! However re-grooving the proper movement will help for the present pain and for the future.

So up to this point I will have looked at your posture and how that posture translates into your movement. At this point I will have discussed what I see and how we proceed from here.  Usually I then can progress into the next three principles of NMT, that is

 

  • Correcting postural distortions
  • Correcting dysfunctional biomechanics
  • Manually working on areas of ischemia
  • Releasing trigger points
  • Releasing nerve entrapment
  • Rehabilitating with exercise

 

Next week I will discuss the next three components. Until then if you have any questions, comments or concerns please do not hesitate to contact me.

In Health,

Peter Roach, RMT, CNMT

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6 Steps in the Evolution of Therapy

by Peter on May 3, 2012

Over the many years I have been a Massage Therapist I have seen new treatment protocols come and go, new types of treatment modalities used and discarded, and standard rehab exercises evolve. And in all honesty, I’m what is known as an early adopter, one that looks at the latest research and findings, new tools, and new exercises, and incorporates relevant protocols into my therapy. Many rehab exercises that we were taught in the 80’s and 90’s are now considered dangerous to our spinal health. Also simple issues such as when to use heat and when to ice has change as more is discovered into the cell response. My own exercise program has changed over the years as well, as many of the exercises I did then do not work the area the way they were thought to. Yet still today I see many therapists and trainers using some of the same old techniques. And this means you as the patient may not be getting optimal care and advice.

There is so much research out there, and sifting through all of it is a process. Recently while on Spring Break Vacation I found myself reading scores of journals and research papers (thank goodness for the iPad) on manual therapy and rehab exercises. I find these type of readings so interesting and applicable, both for my patients and my own personal health and exercise programs.

Writing these articles provides a way for me to share with you what I find, and particularly why I do the treatments I do. It also helps me to physically note my thoughts and organize my treatment plans. Many of you know that the basis of my treatment is Neuromuscular Therapy (NMT). I taught this throughout Canada and the US, and also had the opportunity to teach in the Czech Republic and Germany, and shared some techniques when traveling in Africa. But as more research is conducted much of what I taught then has changed.

Over the next few articles I will reexamine the principles of Neuromuscular Therapy and how I apply it to my therapy. With this I will visit the ever expanding modalities that have been incorporated into my treatment plans as well as the theory. I hope you will find some of this as interesting as I do. If you have any questions, concerns or comments please do not hesitate to contact me.

Neuromuscular Therapy has 6 principles that I follow to assist us in bringing your body back to homeostasis. They are

Some or all of these can be done in a single treatment session.

Posture

The first thing you will notice when you come in for treatment is that I will always first look at your posture, that is, where you are in space. This I believe is probably the most important area to start with. Your center of gravity is situated at approximately the lower end of your spine, in the sacrum at S2. It is from this point our bodies move. If the center is not position on the proper planes of gravity, then when we move we will have a wobble pattern, or something similar. And this can have devastating effects in our body. Some people have postural distortions and experience no pain whatsoever yet others can have mild distortions and experience much pain. But postural deviations eventually will have an effect on our body. The constant and cumulative stresses on our joints and the muscles that help support our posture begin to break down and pain and discomfort can be as debilitating as the sudden incident of injury.

Understanding that when looking at your posture, it is only a snapshot in time. Our posture changes throughout the day, however in my experience we tend to adopt an average posture, and with constant monitoring of the posture do we get to know where your body tends to sit. Over a period of time we can tell how your posture is progressing.

Postural distortion is as mentioned the first component that I, an NMT therapist will look at. Why? The skeleton is actually just a bunch of joints stacked upon each other. And these joints have been designed in such away that it’s optimal function occurs when it is in its correct location in space. And each joint thereby has a specific function, both unto itself singularly and also in coordination with other joints. When these conditions are not met then a predictable level of dysfunction occurs at some point.

We’ve all experienced a degree of postural imbalances at some point during our lives. Being a bit bent over after gardening, or working at the computer all day only to find our shoulders have rounded and a forward head posture exists. However our bodies have an amazing capacity to adapt to changes, whether for the better or the worse. This ability to adapt is know as General Adaptation Syndrome (Seyle, 1958). Our bodies will adapt to loads and stresses placed upon it. In the case of our posture, if we continue to have a forward head posture or slumped shoulders and back, the bones will actually begin to remodel and change their form to adapt and support the less than functional posture. Of coarse the same is true in reverse, we can improve our posture by repeatedly promoting correct alignment.  We all have seen someone with a dowager’s hump, that big bump at the base of the neck. The predominant causative factor of this is usually poor posture. Do they have a forward head posture?

When I look at your posture, what I am seeing are the planes around which the body moves. These planes are

1. The sagittal plane which divides our body in left and right halves. In this plane I look to see how symmetrical your left side is to the right. Is your head in the middle or does it tilt to off to one side. Your nose and pubic bone should be aligned and fall equally between your feet.

2. The coronal plane divides our body in front and back halves. Here we should see that your ear, shoulder, hip, knee and ankle bone all fall in the same line. It is also in this view that I can get a sense of the spinal curves of your body. An increase or decrease of spinal angles will eventually come to haunt you.

3. The transverse plane divides the body into top and bottom halves. In this plane I look to see if shoulders are aligned, if your hips, knees and ankles are aligned. As mentioned earlier, your pelvis is the base for which your spine sits. Proper alignment here is a must if full recovery of any condition is to be met.

Poor posture causes constant spinal load. The result is an increase firing of nerves thereby causing erector spinae (back muscles) contraction resulting in back pain. There are several principles that I have adopted from a book entitled Muscle Balance and Testing. Evaluating and treating postural problems requires an understanding of the basic principles relating to alignment, joints and muscles

  • Faulty alignment results in undue stress and strain on bones, joints, ligaments and muscles.
  • Joint positions indicate which muscles appear to be elongated and which appear to be shortened
  • A relationship exists between alignment and muscle test findings if posture is habitual
  • Muscle shortness holds the origin and insertion of the muscle closer together
  • Adaptive shortening can develop in muscles that remain in a shortened condition
  • Muscle weakness allows separation of the origin and insertion of the muscle
  • Stretch weakness can occur in one-joint muscles that remain in an elongated condition

(Taken from Muscle Balance And Testing)

In most cases when a patient comes in and their center of gravity is off, a simple but effective maneuver is all that is needed to bring it back to center. Pelvic stabilization is a simple, none invasive and gentle technique that has the ability to move your pelvis back to a perfect place. Keeping it there is the hard part. That’s where the rest of the NMT principles come into affect.

So the ability to “see” the skeleton within is what all great NMT therapists do and is the first step to assessing further the inter relationship of the soft tissue with the skeletal system.

In the next issue we will look at biomechanics, that is, how you move.

As always if you have any questions, comments or concerns please do not hesitate to contact me.

In Health,

Peter Roach, RMT, CNMT

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Form Follows Function? Or does Function Follow Form?

November 24, 2011

An American architect Louis Sullivan, told us “Form follows Function”. In 1896, he wrote an article The Tall Office Building Artistically Considered. Here Sullivan actually said ‘form ever follows function’, but the simpler (and less emphatic) phrase is the one usually remembered. For Sullivan this was distilled wisdom, an aesthetic credo, the single “rule that […]

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Clinical man (Homo clinicus) – A satire by Clifton K. Meador, MD.

November 17, 2011

I read this wonderful article and wanted to share it with you. It is writen by Clifton K. Meador, MD. in the Autumn 2011 Journal of The Pharos of Alpha Omega Alpha Honor Medical Society. The author (A!A, Vanderbilt University, 1954) is clinical professor of Medicine at Vanderbilt University School of Medicine, clinical professor of […]

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K Taping for Kids – Patellofemoral Syndrome

November 3, 2011

Did you know that using K Tape is also great for kids! Take for example my daughter. Weeks ago she came back from playing a soccer tournament. Four games in 5 hours and lots of running around. The following day she was complaining of knee pain, somewhere around her kneecap. After an examination I believed […]

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The Journey of Massage Therapy

October 27, 2011

Definition: a. The act of traveling from one place to another; a trip. b. A distance to be traveled or the time required for a trip Have you ever thought of your massage therapy as a journey? Or for that matter have you ever thought of seeing any of your practitioners as a journey? I […]

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Saving Your Hands

October 6, 2011

Often I’m ask by therapists and patients alike how I care for my hands. After almost 28 years of massage, 4 days a week, and 8 hours a day, my hands take a beating. And all too often I see new therapists coming out of school and begin working so hard that after 4-6 months […]

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Kinesiology Taping at the Utopia Academy

September 29, 2011

Today I had the great pleasure of presenting an hour presentation to the introduction of Taping for Massage Therapists at the Utopia Academy of Massage Therapy. I felt a great sense of honor to be asked to present by a woman that has truly become a colleague that I look to for guidance, Annette Ruitenbeek, […]

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