Neuromuscular Therapy

[Karen L]

Hello, I wanted to decontaminate my mind. I am getting taught this in school and I find it so very difficult to reconcile this with what I have learned about the nervous system. This Wiki entry sounds like an advertisement for Neuromuscular Therapy.

Blickenstaff's Law of Inverse Coercion, which states that the more force involved in a treatment the fewer people it can be used on, and vise versa.

Pernkopf

[nari]

Karen, this is going to be rather hard for you to disassociate the two rationales for pain management. I guess it will be a matter of learning both the rationales (in order to pass exams, etc) and apply the more accurate of the two once you are through school.
A bothersome case of cognitive dissonance for you - good luck with it.
Unless you feel brave enough to challenge the tutors and that would be a Sisyphean challenge and a half.

Nari

[Diane]

It is another one of those mesodermal treatment constructs.
Why on earth should every treatment pathway be through muscle? Or joint? Or disc? I don't get why these constructs are still around, needing major deconstruction.

[marcel]

Originally Posted by Diane

It is another one of those mesodermal treatment constructs.
Why on earth should every treatment pathway be through muscle? Or joint? Or disc? I don't get why these constructs are still around, needing major deconstruction.

Hy,

The description of neuromuscular ther. method came to me as old school massage techniques.

Question : a treatment pathway through joint or disc seems not logical as I read Diane's reply.

I can follow that to a degree, but let's say a disc protrusion causes noxious substances irritating a nearby radix wich can lead to inflammation of that nerve-root then ther is the causing factor of a possible pain state ; look at : (inflammation induces ectopic mechanical sensitivity,...... "Bove ,Ransil et al")
Just an example.

To see the disc problem above as a point of treatment alone is narrow-vision (treat only the disc) to neglect it as a cause is narrow-vision too.

I think (am convinced) we need to look at patients problems multi dimensionaly.
Yes there is one director the nervous system, it can be "kicked" by it's fellow organs (tisues).


just my toughts

[Karen L]

Hello Marcel,

Thank you for posting a reply. I agree that a patient needs to be viewed as a whole.The techniques I am being taught are rough and inelegant with no regard for the delicate cutaneous nerve structures below. I may not consent tomorrow when I have to exchange treatment of the upper trapezius with another student. The most glaring omission to the explanation of Neuromuscular Therapy was the neural component of pain. We were told that the muscles had the pain. Trigger points and taut bands cause muscles to shorten and we must lengthen them with coercion to break the pain tension cycle.

Today was my first day treating the public. I had two nice patients and did two nice relaxation massages. I can handle that, people who are asymptomatic for pain and just want a therapeutic touch.

I am obsessive right now about Simple Contact and DNM, I can understand there are limitations in their applications. In the example of a disc protrusion from what I have learned so far, would be that the brain will not allow movement until the perceive threat is no longer perceived. So stimuli must be non threatening and the muscles will move to the point where there is tolerance. Movement to perfuse and flush the nerves is very important. Movement as analgesia. Movement will help reduce ischemia.

By treating the origin of this pain you would necessarily be treating the disc, the joint capsule, the nerve root, the spinal cord segment. Manual massage therapy support would be very limited around the injured structure especially in the acute stage. Very few of these techniques would apply because they do not satisfy the needs of deformed nerves; an intervention which allows a movement to be performed in a non-threatening context and a treatment that satisfies the need action sequence. And thus moving the patient into the resolution stage and comfort. I hope I have this right. I'm using my notes from Barrett's class.

I will be useful to a patient in pain one day.

best regards,
Karen

[nari]

Karen,

You certainly

will be useful to a patient in pain one day.

Keep hanging around Somasimple, that will help you. All of us here started working with patients without the real benefit of what we now understand about pain, with the exception of Barrett. He was light years ahead of almost all of us.

Nari

[Diane]

Karen,

[gilbert]

Originally Posted by marcelk

Hy,


To see the disc problem above as a point of treatment alone is narrow-vision (treat only the disc) to neglect it as a cause is narrow-vision too.

I think (am convinced) we need to look at patients problems multi dimensionaly.
Yes there is one director the nervous system, it can be "kicked" by it's fellow organs (tisues).

Marcel

YES

That is my point of view exactly. Problems are multi-dimensional/multi-factorial and we need to have a broad enough vision. I will say that I've often found the Nervous System involved in conditions where it wasn't traditionally considered.
Example: years back treating a child with longstanding Congenital Muscular Torticollis, a supposed "muscle tightness" problem, I was surprised at the large increases in range I could get with reflex inhibition using spray & stretch, an obvious neural mechanism.
-Gilbert

[nari]

Marcel

I agree wholeheartedly.

The main concern I have with modern physiotherapy is the priority given to muscle, joint and any subsequent dysfunction, without at least equal attention to the nervous system's part in the picture. The disc prolapse can be one part of the story of pain, or may have little or nothing to do with the pain.
The same goes for ACL damage; too often the pain presentation is observed as something that can be resolved with strengthening of muscles. The method works (sometimes) but the reasoning is lost in the inherent belief that instability/weakness always = pain.

Nari

[pht3k]

I had a patient years ago with knee pain. after evaluation, i suspected a meniscal tear. so i referred him to an orthopaedist. the ortho thought the same. he went into a surgical intervention. to discover that he had a ruptured meniscus and a completly ruptured ACL. the particularity is that there were no acl fragments... the ortho said that it was because a) it were a very old injury with natural cleaning of the joint from macrophage etc or b) it were congenital. The ortho was favouring a) but in any case it was a not new and the guy never reported knee pain/instability prior to the meniscus tear. this guy was on the national elite alpine skiing team practicing mostly with the bumps (not sure what is the real english name; in french we say: il fait de la bosse...) !!!
the thing to remember: frank ligament instability without any pain. even with massive sollicitation...

[JasonE]

Originally Posted by Pernkopf

Hello Marcel,

Thank you for posting a reply. I agree that a patient needs to be viewed as a whole.The techniques I am being taught are rough and inelegant with no regard for the delicate cutaneous nerve structures below. I may not consent tomorrow when I have to exchange treatment of the upper trapezius with another student. The most glaring omission to the explanation of Neuromuscular Therapy was the neural component of pain. We were told that the muscles had the pain. Trigger points and taut bands cause muscles to shorten and we must lengthen them with coercion to break the pain tension cycle.

Today was my first day treating the public. I had two nice patients and did two nice relaxation massages. I can handle that, people who are asymptomatic for pain and just want a therapeutic touch.

I am obsessive right now about Simple Contact and DNM, I can understand there are limitations in their applications. In the example of a disc protrusion from what I have learned so far, would be that the brain will not allow movement until the perceive threat is no longer perceived. So stimuli must be non threatening and the muscles will move to the point where there is tolerance. Movement to perfuse and flush the nerves is very important. Movement as analgesia. Movement will help reduce ischemia.

By treating the origin of this pain you would necessarily be treating the disc, the joint capsule, the nerve root, the spinal cord segment. Manual massage therapy support would be very limited around the injured structure especially in the acute stage. Very few of these techniques would apply because they do not satisfy the needs of deformed nerves; an intervention which allows a movement to be performed in a non-threatening context and a treatment that satisfies the need action sequence. And thus moving the patient into the resolution stage and comfort. I hope I have this right. I'm using my notes from Barrett's class.

I will be useful to a patient in pain one day.

best regards,
Karen

Where are you receiving this training? My initial training fell short of covering the whole of NMT, but the instructors equipped us with the ability to work effectively without causing unnecessary discomfort. If your NMT technique is causing pain (intentionally)... well, something just doesn't sound right. Are you learning the full NMT system, or just the trigger point aspect?

Trigger point work does not necessarily = NMT

Good NMT (in my experience) utilizes the NEURO as well as the Muscular in its approach to Therapy.

Aside from that, I completely agree with using movement, stretching, etc to address the source of the problem rather than focusing on the symptoms. Bodywork should incorporate active components in addition to the passive.

[Karen L]

Hello,

Case in point. I was not looking forward to having muscle stripping, frictions and stretching done on my neck today. It is not that I don't trust the student I was paired with or my ability to say stop if it was painful. My problem is I know I get rebound pain when a treatment is too deep too quick and stretching that aggravates my already at risk neck. We are being taught NMT and TrPs at the same time for expediency and I understand they are seperate types of treatment. Sure enough the lack of motion in the class situation and the muscle work put me over the edge and into a nasty neck ache. Others in my class were also concerned with getting headaches and migraines from the treatment. No one is intentionally inflicting pain, but in the learning process it is inevitable.

Last day in our theory class that accompanied the practical, I suggested that posture was not linked to pain. A should have finished the statement with Pain is caused by lack of movement. Today in class the TA mocked me because I had spoken up, albeit incorrectly about posture and pain. He can mock away, because I watched him moving and changing position in response to the pathetic chairs we all are forced to use. And another student said she couldn't sit for any length of time in the instructor's recommended neutral desk posture. Some appreciate me sticking my neck out...

What is the point of being equipped with a technique that causes pain or discomfort as a means to relieve pain. It is the height of absurdity to me. I understand that in treating mobility there are times when a patient must work through a pain barrier to retrain the nervous system but to mash and stretch muscles doesn't make sense. (I used to massage out TrPs with some moderate ischemic compressions and slowly flushing the tissues. My friends were perfectly happy with my style and I'm wasn't busting my fingers but it was never a lasting effect). I have clear ideas what I want and how to practice when I'm done and lasting correction is my main concern.

The failing of this class is that it does not recognize the neurological as anything other than a reflexive effect. They have no neuro to offer in this class.

You are all kind and generous to share your thoughts and I appreciate it very much. I learn every day.

"Thought for the day" If a Trp Therapist uses Lidocaine for a block in a muscle, why does a Dentist inject Novocaine at a nerve instead of just shooting up masseter or pterygoids?
Makes you wonder.

Karen

[marcel]

Nari,

I agree with you too.

Originally Posted by Pernkopf

"Thought for the day" If a Trp Therapist uses Lidocaine for a block in a muscle, why does a Dentist inject Novocaine at a nerve instead of just shooting up masseter or pterygoids?
Makes you wonder.

Karen

The Trp therapist believes pain originates from a Trp; if he (or she) would block the innervating nerve to the muscle it would have same results. On the other hand Trp's are beleived to give reffered pain so what would happen if you block nerves to the reffered area of that Trp.
I am quite happy with my dentist blocking the nerve instead of my masseter.

About Trigger points : there's a nice art. in Diane's DNM manual about the Trp concept and it's misconceptions.

[Diane]

Marcel, here is the link to that article, here.