Neuromuscular therapy (NMT) is a form of medical massage. It is distinguished from other types of massage in that a quasi-static pressure is applied to the skin with the aim of stimulating specific areas of skeletal muscle. Often these areas of muscle are myofascial trigger points.
Neuromuscular Therapy (NMT) History
During the last several decades, neuromuscular therapy (NMT) has emerged as a significant methodology for assessing, treating and preventing soft tissue injuries and chronic pain. NMT, a series of manual treatment protocols based on the practitioner’s skill, anatomy knowledge and precise palpatory application, has found its home, not only in the treatment rooms of massage therapy, but also in occupational and physical therapy, nursing, naprapathic, chiropractic, osteopathic and physical medicine clinics worldwide.
With a foothold planted in both holistic and traditional medicine, NMT emerged in both Europe and North America almost simultaneously over the last half-century. It is interesting to note that the early developers knew little, if anything, about each other, yet the theoretical basis of all the modern protocols are similar since they are each rooted soundly in physiological principles.
Between the mid-1930s and early 1940’s, European-style neuromuscular techniques (as NMT is called in Europe) first emerged, was developed by Stanley Lief and Boris Chaitow.
A few years after neuromuscular techniques emerged in Europe, Raymond Nimmo, DC and James Vannerson, DC first published their newsletter, Receptor Tonus Techniques in America, where they wrote of their experiences with what they termed ‘noxious nodules’. Over the next several decades, a step-by-step system began to emerge, supported by the writings of Janet G. Travell and David Simons. Travell and Simons’ two volume set of textbooks, Myofascial Pain and Dysfunction: The Trigger Point Manual provided the medical, dental, massage and other therapeutic communities with documentation, research and references for myofascial trigger points.
Travell and David Simons have assisted in our understanding and treatment of trigger points. Simons (Lewit & Simons, 1984) has described the evolution of trigger points in the following way: “In the core of the trigger lies a muscle spindle that is in trouble for some reason. Visualize a spindle like a strand of yarn in a knitted sweater….. a metabolic crisis takes place, which increases the temperature locally in the trigger point, shortens a minute part of the muscle (sarcomere) – like a snag in a sweater – and reduces the supply of oxygen and nutrients into the trigger point. During this disturbed episode an influx of calcium occurs and the muscle spindle does not have enough energy to pump the calcium outside the cell where it belongs. Thus a vicious cycle is maintained and the muscle spindle can’t seem to loosen up and the affected muscle can’t relax.”
Having tested his concept, Dr. Simons found that at the core of a trigger point there is an oxygen deficit compared with the muscle tissue, which surrounds it. Travell (Travell & Simons, 1992) has confirmed that the following factors can all help to maintain and enhance trigger point activity:
1. Nutritional deficiency, especially vitamin C, B-complex and iron;
2. Hormonal imbalances (low thyroid, menopausal or premenstrual situations, for example);
3. Infections (bacteria, viruses or yeast);
4. Allergies (wheat and dairy in particular);
5. Low oxygenation of tissues (aggravated by tension, stress, inactivity, poor respiration).
In 1996, a landmark event for American NMT occurred when NMT American version was overviewed in Leon Chaitow's Modern Neuromuscular Techniques, as contributed by Judith DeLany. This significant text was the first to offer both the European and American methods within the same volume. Chaitow and DeLany have since published three definitive texts integrating the American and European versions of NMT. Clinical Application of Neuromuscular Techniques, Vols. 1 & 2, with accompanying Case Study Exercises, which aims to standardize the training of NMT techniques.
Neuromuscular Therapy And The Acupuncture Connection
Acupuncture needling is the use of a solid needle for therapy. This contrasts with the use of a hollow hypodermic needle to inject substances such as saline solution to the same point. Such use of a solid needle has been found to be as effective as injection of substances in such cases as relief of pain in muscles and connective tissue. Analgesia produced by needling a pain spot has been called the needle effect.
In the treatment of trigger points for persons with myofascial pain syndrome, the acupuncture needle is inserted into the skin; fascia and oftentimes the muscle directly at the site of the myofascial trigger point. Proper dry needling of a myofascial trigger point will elicit a local twitch response (LTR), which is an involuntary spinal cord reflex in which the muscle fibers in the taut band of muscle contract. The LTR indicates the proper placement of the needle in a trigger point. Research has indicated that dry needling that elicits LTRs improves treatment outcomes. When combined with neuromuscular therapy we have a winning combination which is effective in treating a wide variety of conditions including:
- Back Pain
- Brachial Plexus Entrapment
- Carpal Tunnel Syndrome
- Chronic Pain
- Dental Occlusion Problems
- Joint Immobility
- Muscle cramping
- Neck Pain
- Postural Distortions
- Repetitive Strain Injuries
- Skeletal Problems
- Spinal Disc Herniation
- Sports Injuries
- TMJ Dysfunction
How is Treatment Applied?
NMT and acupuncture are either applied on alternating treatment days, and occasionally on the same treatment. Of course depending upon the circumstances each treatment can be applied without the other. We have found through observation that these techniques work best when they applied on alternating treatments since applying them together if often too powerful for the patient. Our practice philosophy is always “less is more” when it comes to treatment. NMT is also frequently combined with biopuncture techniques in the event that a patient does not respond adequately to acupuncture and NMT either alone or in combination. Dr. Denny holds the highest level of certification in these practice specialties including a Diplomate in Pain Management, Acupuncture and Neuromuscular Therapy, and biopuncture techniques.