Hilton’s Law in Massage Therapy

by Peter on June 16, 2011

Have you ever wondered why things work? Why does Massage feel good? Why does it make my muscles and joints feel looser? Why does using Laser on an area help? Why does that K-Tape help? These are all questions that I heard this week from my patients. And I love when my patients are curious, as I then can launch into the excitement of the  physiology of why I do what I do. Sometimes the experts are not exactly sure of how or why the body works the way it does, and people react differently to different treatment methods, but lots of research goes into theories. One of my favorites theories and a recognized Law of Physiology,  and one I keep coming back to in my answer to these questions, is a Law that was given in a series of lectures in 1860.

Hilton’s Law espoused by John Hilton in a series of medical lectures given in 1860-1862, is the observation that in the study of anatomy, one often finds that a nerve that innervates a joint also tends to innervate the muscles that move the joint and the skin that covers the distal attachments of those muscles. Wikipedia

For example, the musculocutaneous nerve supplies the elbow joint of humans with pain and proprioception fibres. It also supplies biceps brachii, brachialis, and the forearm skin close to the insertion of each of those muscles.

Hilton’s law arises as a result of the embryological development of humans (or indeed other animals). Hilton based his law upon his extensive anatomical knowledge and clinical experiences. As with most British surgeons of his day he intensely studied anatomy.

About Dr. John Hilton

John Hilton FRCS, FRS, FZS (1804 – September 14, 1878), British surgeon, was born at Castle Hedingham, in Essex.

He entered Guy’s Hospital in 1824. He was appointed demonstrator of anatomy in 1828, assistant-surgeon in 1845 and surgeon in 1849. In 1859 he was appointed professor of human anatomy and surgery at the Royal College of Surgeons College. As Arris and Gale professor from 1859 to 1862 he delivered a course of lectures on “Rest and Pain,” which have become classics. He was also surgeon-extraordinary to Queen Victoria. In 1867 he was elected president of the Royal College of Surgeons, of which he been made a member in 1827 and a fellow in 1843. He also delivered the Hunterian oration in 1867

Hilton was the greatest anatomist of his time, and was nicknamed “Anatomical John.” It was he who, with Joseph Towne the artist, enriched Guy’s Hospital with its unique collection of models. In his grasp of the structure and functions of the brain and spinal cord he was far in advance of his contemporaries.

As an operator he was more cautious than brilliant. This was doubtless due partly to his living in the pre-anaesthetics period, and partly to his own consummate anatomical knowledge, as is indicated by the method for opening deep abscesses which is known by his name. But he could be bold when necessary; he was the first to reduce a case of obturator hernia by abdominal section, and one of the first to practice lumbar colostomy. He died at Clapham on September 14, 1878.

So what does this mean to you?

There is a mechanism or link between the joints, muscles and skin. Nerves that feed the joint also feed the muscles crossing that joint and the skin covering the muscle. This means that any disruption to any of these structures affect the whole system. Grazes and cuts to the skin, for example, can create weakness and inhibition to the muscles and joints below just as an injury to the joint can affect the muscles and skin. It’s a loop where each part is capable of affecting the whole… in both directions. Deep to superficial, superficial to deep.

From a Neuromuscular Therapy (NMT) treatment perspective we affect and change physiology at a deeper level even if we are working more superficially. However, when this is combined with Joint Play (decompression of a joint) and Muscle Energy Techniques we also affect deep to superficially.

The very best results may come from treating both superficially and deep, thus showing the strength and power of the nervous system.

An example of this was with a patient on Wednesday. He describe a tingling, almost numbness along the front of his thigh, and a pain like symptom in hip buttock, and then went on to describe a almost “catching” in his hip, “way down deep”. Hilton’s Law in effect? After some investigation he had a hip stuck in flexion, very tight piriformis, psoas and adductors (possible a Hunter’s Canal entrapment). With some simple pelvic stabilization techniques and some NMT to the muscles, all seemed good. In fact today I just spoke to him and he feels fantastic. Hilton’s Law in effect? Maybe, but keeping this law in mind certainly helped throughout the treatment.

I also use Low Intensity Laser Therapy (LILT) to support Hilton’s Law. Basically, Laser light has a highly beneficial effect on nerve cells which blocks pain transmitted by these cells to the brain.  LILT increases the potential difference across the cell membrane moving the resting potential further from the firing threshold, thus decreasing nerve sensitivity.  A less understood pain blocking mechanism involves the product of high levels of painkilling chemicals such as endorphins and enkephalins from the brain, adrenal gland and other areas, as a result of stimulation by laser light.


Gate Control Theroy

I finished off with some K-Taping. What will this do? In this case using tape on the skin direct affects mechanoreceptors in the skin. Decrease the pressure in nerve endings leads to decrease in muscle contraction which leads to decreased pressure in the joint. This is all based on Hilton’s Law as well as other principles such as the Gate Control Theory (I will look at this theory at a later time).

Also using the K-Tape will cause changes in muscle tension, again using Hilton’s Law to bring about pain reduction. The K-Tape, in this case, was also used to help stabilize and support joint function. The result, as of today, NO PAIN!

Having therapists conscious of the Laws of Nature will be to your advantage to having successful treatments. Don’t be afraid to question your Health Care Provider to understand the why’s and what for’s of the treatment you receive. Just be prepared, if you ask me, to have an enthusiastic response. I love this stuff!

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


In Health,


Peter Roach, RMT, CNMT, Laser Therapist

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