CENTERED BODYWORK- STRUCTURAL INTEGRATION, CRANIOSACRAL AND ORTHOPEDIC MASSAGE
What is Neuromuscular Therapy?
I have not yet seen a commonly accepted, standard definition for neuromuscular therapy or neuromuscular massage. At it's core, I believe it's a variety of techniques that specifically work with the nervous system to help relieve muscular or structural issues. All massage inadvertently works with muscles nerves and the nervous system as a whole, so defining what is and what isn't neuromuscular therapy is a bit tricky. This concept is very popular for selling massage therapists classes, though not very well known by massage clients. Even many massage therapists seem to not know what it is or when it might be applied. Let me shed some light while acknowledging we are in ambiguous territory.
Neuromuscular therapy techniques are great when other standard techniques don't work. I may do a deep tissue or myofascial release session and find one of the following:
One of the more challenging scenarios is when fascial restrictions of a significant magnitude are causing trigger points. Often clients say, "Just massage here!" This is because NMT has worked, albeit temporarily, in the past. In many of these cases, posture or adhesions due to injury will continue to cause trigger points if not dealt with. That is why NMT is not my go to technique. However, it is very helpful when other techniques fail. For example, I try releasing a shoulder and it just wont let go due to a trigger point in the trapezius or levator scapula muscle. Or I try a shoulder range of motion test and I sense an early holding that doesn't permit the full range or mobility.
NMT techniques can gently or not so gently release an area by tricking the nervous system. One trick is strain, counter strain, also known as positional release. In this case, we hold the tender point to encourage a rush of blood flow with chemicals that help a muscle let go. Then we place the muscle it's located on into a position of ease. This tricks the brain into believing it's already done it's job. Another trick is CRAC stretching: Contract-Release-Antagonist-Contract. You isometrically contract the problem muscle(s), then release, next isometrically contract in the opposite direction and finally stretch passively or actively. Then repeat. This tricks the nervous system by principles know as post-isometric relaxation phase and reciprocal inhibition - meaning the muscle can't resist due to it or it's opposing muscle being activated.
The next level of this work gets much more complicated. Techniques like NKT and PDTR work on specific, dysfuctional muscle activation patterns. This type of work is helpful when nothing else works. It requires much more assessment to get the right results and usually many years of training to appropriately apply. I am trained in basic NKT, and will refer out of state usually if I can not resolve the issue and believe it is a neurological programming problem. But those are the few strangely persistent cases.
NMT can be very helpful as well to set in the results you have achieved through other techniques. It can help the nervous system acknowledge and remember your new range of motion and proprioception. I don't know what I'd do without it. I also don't use it as a primary treatment, because often restrictions in various types of tissues appear to be the primary cause. And while releasing those areas, the nerves are already receiving some treatment. Once adhesions are released, often muscle balance corrects on its own because muscles that could not move well now can. The motor center of the brain starts to recognize the new capacity and reprograms the muscle activation sequences for different movements. Occasionally, the change doesn't register and NMT and NKT are very helpful.
There is still much debate and a lot research to be done before we know why a technique works on a condition for certain. But we do know anecdotally that sometimes this technique works when this problem occurs. And fortunately, that's a pretty good place to start,
I have not yet seen a commonly accepted, standard definition for neuromuscular therapy or neuromuscular massage. At it's core, I believe it's a variety of techniques that specifically work with the nervous system to help relieve muscular or structural issues. All massage inadvertently works with muscles nerves and the nervous system as a whole, so defining what is and what isn't neuromuscular therapy is a bit tricky. This concept is very popular for selling massage therapists classes, though not very well known by massage clients. Even many massage therapists seem to not know what it is or when it might be applied. Let me shed some light while acknowledging we are in ambiguous territory.
Neuromuscular therapy techniques are great when other standard techniques don't work. I may do a deep tissue or myofascial release session and find one of the following:
- that my work is not releasing as much as I'd like
- that the condition of the tissue doesn't match it range of motion
- that there is an early soft end feel or stopping point in a range of motion test, which is not a true end
- there is a sense of emotional or neurological bracing
- there is a specific "knot" in the tissue known as a trigger point, not a tight length of muscle or length of fascial restriction
- there is a referral pain pattern or chain of pain from a specific point that is causing issues down the line
- the area is too tender for deeper work or there has been a significant injury or surgery
One of the more challenging scenarios is when fascial restrictions of a significant magnitude are causing trigger points. Often clients say, "Just massage here!" This is because NMT has worked, albeit temporarily, in the past. In many of these cases, posture or adhesions due to injury will continue to cause trigger points if not dealt with. That is why NMT is not my go to technique. However, it is very helpful when other techniques fail. For example, I try releasing a shoulder and it just wont let go due to a trigger point in the trapezius or levator scapula muscle. Or I try a shoulder range of motion test and I sense an early holding that doesn't permit the full range or mobility.
NMT techniques can gently or not so gently release an area by tricking the nervous system. One trick is strain, counter strain, also known as positional release. In this case, we hold the tender point to encourage a rush of blood flow with chemicals that help a muscle let go. Then we place the muscle it's located on into a position of ease. This tricks the brain into believing it's already done it's job. Another trick is CRAC stretching: Contract-Release-Antagonist-Contract. You isometrically contract the problem muscle(s), then release, next isometrically contract in the opposite direction and finally stretch passively or actively. Then repeat. This tricks the nervous system by principles know as post-isometric relaxation phase and reciprocal inhibition - meaning the muscle can't resist due to it or it's opposing muscle being activated.
The next level of this work gets much more complicated. Techniques like NKT and PDTR work on specific, dysfuctional muscle activation patterns. This type of work is helpful when nothing else works. It requires much more assessment to get the right results and usually many years of training to appropriately apply. I am trained in basic NKT, and will refer out of state usually if I can not resolve the issue and believe it is a neurological programming problem. But those are the few strangely persistent cases.
NMT can be very helpful as well to set in the results you have achieved through other techniques. It can help the nervous system acknowledge and remember your new range of motion and proprioception. I don't know what I'd do without it. I also don't use it as a primary treatment, because often restrictions in various types of tissues appear to be the primary cause. And while releasing those areas, the nerves are already receiving some treatment. Once adhesions are released, often muscle balance corrects on its own because muscles that could not move well now can. The motor center of the brain starts to recognize the new capacity and reprograms the muscle activation sequences for different movements. Occasionally, the change doesn't register and NMT and NKT are very helpful.
There is still much debate and a lot research to be done before we know why a technique works on a condition for certain. But we do know anecdotally that sometimes this technique works when this problem occurs. And fortunately, that's a pretty good place to start,
Centered Bodywork
6637 SE Milwaukie Ave, Suite 202, Portland, OR 97202
415-410-4622
6637 SE Milwaukie Ave, Suite 202, Portland, OR 97202
415-410-4622
