6 Steps in the Evolution of Therapy – by Peter Roach

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.


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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