Neuromuscular Therapy

What is Neuromuscular Therapy?

The human body maintains life and health in an amazing way. Each individual cell performs an activity that contributes to the body’s overall function. Nerve impulses transmit information to maintain a balanced internal environment called homeostasis. Every day, life situations threaten to disrupt that balance. Physical traumas, strains and emotional stress undermine homeostasis. This imbalance leads to aches and pains which left untreated may result in physiological dysfunction.

There are ways to get at the roots of these imbalances and alleviate much of the pain and dysfunction. The St. John Method of Neuromuscular Therapy (NMT), developed by Paul St. John in response to his own constant, debilitating pain, is one such method. It is based on research that identifies the fundamental causes of pain.

The St. John Method of NMT is a comprehensive program of soft tissue manipulation techniques that balance the central nervous system (brain, spinal cord and nerves) with the structure and form of the musculoskeletal system (skeleton and muscles of the body). The St. John Method of NMT is based on neurological laws that explain how the central nervous system maintains homeostatic balance. Accordingly, these same laws dictate how the central nervous system initiates pain responses.

One law that applies, Arndt’s Law, represents how pain originates in the body. Simply stated, it says that different levels of stimuli to the nerves affect physiological activity. At homeostasis (balance) nerves transmit impulses very slowly. Injury, trauma, postural distortion, or stress cause nerves to speed up their transmissions, inhibiting equilibrium and making the body vulnerable to pain and dysfunction. It is necessary to stabilize low levels of neurological activity to maintain homeostasis and thus overall health.

The St. John Method of Neuromuscular Therapy considers five principles that cause pain. They are:

1. Ischemia
2. Trigger points
3. Nerve compression or entrapment
4. Postural distortion
5. Biomechanical dysfunction

Ischemia

Ischemia is a lack of blood supply to the soft tissues, which causes them to be very sensitive to touch. Typically, if less than 5 to 10 pounds of pressure causes tenderness, the tissues are in an ischemic state. This is one of the first conditions a neuromuscular therapist analyzes.

Trigger points

Trigger points occur when nerves fire impulses at a rapid speed into an area of the body other than that which has been traumatized. Because of trigger points, the cause of serious pain may often be far removed from the actual site of the pain. This, in turn, inhibits proper blood flow, which causes ischemia and often leads to more pain and discomfort.

Nerve compression or entrapment

Nerve compression or entrapment is pressure on a nerve by bone, cartilage or soft tissue. The role of the soft tissues in nerve compression is vital. Realigning vertebrae without treating associated soft tissue frequently treats the symptom and not the cause. Spinal nerves are subject to intrusion when any of the vertebrae are dislocated or spinal disks herniated. Treating the surrounding soft tissues that cause or maintain the dislocation greatly enhances rehabilitation and alleviation of pain.

Whiplash often causes nerve entrapment by the soft tissues. The nervous system initiates tightening of the muscles to stop bleeding in the tissues caused by violent snapping of the neck backward and forward. This tightening results in muscular spasm. After bleeding stops, the spastic response, initially a curative one, will continue if intervention is not made. This muscular spasm causes pressure on nerves and creates its own painful condition.

Nerve entrapment is the most common type of pain and always causes Ischemia. Ignored, it can produce associated trigger points.

Postural distortion

Postural distortion is an imbalance of the muscular system resulting from movement of the body off the coronal, midsagittal and horizontal planes. Gravitational force (33.5 lb per square inch) is constantly pulling the body toward Earth. If there is an imbalance in the structural system, gravity causes the body to compensate in an effort to retain balance. Trauma, gravitational pressure or psychological patterning causes the soft tissues to assume a weight-bearing function and thus become thicker, denser and harder. Muscle contraction, body distortion and pain are the results of compensations the body makes in order to maintain structural homeostasis. By determining why the compensations have occurred, the distorted patterns can be eliminated, proper posture restored, and associated pain diminished or eliminated in most cases.

Other body distortions are caused by muscles contracting and shortening while others lengthen in an effort to hold the body upright as a result of “righting reflexes”. These reflexes respond to messages from the inner ear, eyes, muscles or skin to bring the body into equilibrium.

Biomechanical dysfunction

Biomechanical dysfunction is an imbalance of the musculoskeletal system resulting in faulty movement patterns. Repetitive strain of certain soft tissues results in adapted movement patterns that become muscular “habits” and must be re-educated.

How Does Neuromuscular Therapy Help You?

NMT can help individuals experiencing structural distortion, biomechanical dysfunction and the accompanying pain that is often a symptom of the underlying problem. It is used to locate and release spasms and hypercontraction in the tissues: eliminate trigger points that cause referred pain; restore postural alignment, proper biomechanics and flexibility to the tissues; rebuild the strength of injured tissues and assist venous and lymphatic flow. NMT is an effective and economically feasible method of treatment.

I have unquestionably noticed improvement in areas of increased range of motion, postural symmetry, postural stability, oral motor control, regulating muscle tonus and isolating muscle movement by incorporating NMT techniques with my standard treatment.
Susan Cujas, OTR/L

How Neuromuscular Therapy Performed?

The client is actively involved in the process of healing by helping the neuromuscular therapist understand his or her particular condition. At the initial visit, the therapist evaluates for:

1. Postural distortions.
2. Biomechanical dysfunction.
3. Soft tissue causes of these patterns and presenting pain conditions.

The NMT therapist develops a treatment plan by screening gait patterns and measuring the positioning of the body on the coronal, midsagittal and horizontal planes. These measurements provide reference points from which to determine distortion patterns. An exacting analysis of proper posture and biomechanics explains the cause and effect relationship to pain.

The therapist then palpates the soft tissues to determine if there are ischemic, trigger point, nerve compression and/or entrapment possibilities. When the body is aligned on the midsagittal, coronal and horizontal planes, the tone of both somatic (body covering) and visceral (internal organ) tissues improves. As tone is normalized, the nervous system is balanced.

The appropriate pressure to use during a neuromuscular therapy treatment varies depending upon age, fitness, nutritional health, postural pattern of the patient, as well as the extent of trauma and toxicity level of the tissues. The proper level of pressure elicits a moderate state of discomfort. If pressure is too light, it does not produce the necessary stimulation of nerve receptors to produce the desired therapeutic response. When adhesions are found in the tissues, deeper pressure may be used by working across muscle fibers.

In using the St. John Method, the therapist applies pressure for 8-12 seconds to each area being treated, prompting a therapeutic response in the tissues. Pressing longer may cause the body to treat the pressure as an intrusion, particularly if there is inflammation in the tissues. Optimal success is achieved by applying pressure to trigger points or ischemic areas 3-4 times for 8-12 seconds rather than a longer duration. This is because the therapist’s goal is to interrupt the physio-pathological reflex circuits.

How Did Neuromuscular Therapy Begin?

Paul St. John had a vested interest in studying and researching soft tissue pain and musculoskeletal dysfunction. He was seriously injured three times in his life: he broke his back in three places in a high school football game, was injured in Vietnam, and was in a head-on auto accident. For nearly four years, he awakened to headaches and unceasing pain. Thousands of dollars in medical expenses left him without relief. He found that by pressing on the tissues of his neck, back and shoulders, he was able to get temporary relief. Frustration and fear led him to medical libraries where he began his investigation of pain. He discovered a great deal of literature on soft tissues and the interrelationship between muscles, tendons, ligaments and fasciae, and the role they play in causing pain. From his research, he became familiar with a technique called the receptor tonus technique, which prompted him to attend a course with Dr. Nimmo. He began performing the receptor tonus technique and incorporating his knowledge of the body into his work, training other individuals in his method so they could treat him. For the first time in four years, he was pain free. He then attended massage therapy school while expanding on his own treatment technique. In 1978, he developed the St. John Method of Neuromuscular Therapy and began teaching seminars while maintaining a clinical practice to further his research.

Neuromuscular Therapy has been presented to healthcare professionals at such institutions as Johns Hopkins University, the University of North Carolina, and to The Kentucky Dental Society and the Atlanta CranioMandibular Society. NMT has also been presented before the Physical Medicine Research Foundation; the American College for Advancement in Medicine; the American Academy of Head, Neck and Facial Pain; at American Massage Therapy Association conventions; and at the Institute for TemporoMandibular Regulation in Germany.

I have studied the work of Racabado, Travell’s spray and stretch, CranioSacral Therapy, Myofascial Release, electrical stimulation and many other modalities. All of these modalities have made me successful when treating patients, but the St. John Method of Neuromuscular Therapy was the missing piece to the puzzle. St John NMT is the best modality that I studied in the past five years for treating soft tissue pain. All healthcare professionals that are working with people in pain should have the caliber of training that the St. John NMT Seminars provide.
Dr. Gerald Murphy, DDS, American Academy of Head, Neck and Facial Pain