1. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 1 Introduction to Neuromuscular Therapy

2. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter Objectives How Neuromuscular Therapy (NMT) works Components of NMT techniques History Goals and therapeutic intent Knowledge and tools required Relating to a client Precautions

3. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins NMT Applications Used to treat acute or chronic pain in: Sport injuries (strains and sprains) Automobile injuries (whiplash) Repetitive strain injuries (carpal tunnel syndrome) Accumulative trauma injuries (TMJD) Skeletal disorders (herniated discs)

4. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Contraindications Large bruises Phlebitis Varicose veins Open wounds Skin infections

5. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins How NMT works 1. Assess soft tissue Use effleurage, petrissage and friction Locate chronically shortened muscles Deactivate trigger points

6. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins How NMT works cont’d 2. Use lengthening techniques Myofascial release Deep effleurage Muscle stripping Passive stretching

7. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins How it works cont’d Even horses have trigger points Horse receiving NMT

8. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of NMT History taking and evaluation Soft tissue assessment and treatment Lengthening techniques Trigger point therapy

9. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Pressure to a Trigger Point

10. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of NMT cont’d Stretches (passive, active and MET) Postural stress analysis Reducing perpetuating factors Client management and follow up

11. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins History Europe (1930s-1940s) Stanley Lief Boris Chaitow Brian Youngs Leon Chaitow All were trained in osteopathy and naturopathy

12. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins History cont’d America Raymond Nimmo Janet Travell Paul St. John Judith Walker Delany

13. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins History cont’d European and American similarities: Importance of understanding etiology Treatment of trigger points Client home care program European and American difference is hands-on approach

14. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Goals and Therapeutic Intent Identify and isolate tissue irregularities Reduce ischemia Reduce hypertonicity Reduce soft tissue pain

15. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Goals and Therapeutic Intent cont’d Normalize reflex activity Eliminate trigger points Restore normal ROM Release adhesions and fascial binding Eliminate perpetuating factors

16. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Knowledge Required A precise grasp of musculoskeletal anatomy An understanding structural kinesiology Orientation of trigger points/referral patterns Postural stress analysis Assessment skills to examine client’s dysfunction

17. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Tools required Effective amount of lubricant “Thummby” for deep effleurage/possibly for trigger points Pressure bars (T-Bar)

18. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Tools required cont’d T-Bar Pressure Bar

19. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Relating to the Client Avoid fostering dependency Dependent clients expect to be fixed Do not feel responsible for their own health Promote client participation Encourage client participation Provide support

20. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Relating to the Client cont’d Client-therapist communication is vital Ask client the following three questions: –Where is it tender or sensitive to my touch? –Do you feel sensations in any other part of the body? –Do you feel a decrease in discomfort as I press on this area?

21. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Precautions Do not treat clients with the following: Unstable heart condition Untreated high blood pressure Diabetes Inflammation Sunburn

22. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Precautions cont’d The therapist should also consider: Client’s fear of being injured Restricted ROM Very recent surgery Upcoming sporting event Pregnancy

23. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Precautions cont’d The following requires the therapist to refer client to a medical professional: Inflammation Discoloration Neurological symptoms

24. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Review What is necessary to apply neuromuscular therapy effectively and with confidence? A. Palpatory artistry and good luck B. Precise and thorough knowledge of anatomy C. A medical degree D. Really strong hands

25. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Precise and thorough knowledge of anatomy