What is Neuromuscular Therapy (NMT)?

As described by the NMT Center “NMT is a thorough program of recovery from acute and chronic pain syndromes which utilizes specific massage therapy, flexibility stretching, and home care to eliminate the causes of most neuromuscular pain patterns. This specific and scientific approach to muscular pain relief will help to bring about balance between the musculoskeletal system and the nervous system. NMT enhances the function of joints, muscles and biomechanics (movement) and it releases endorphins, the body's own natural pain killers. It can be part of a comprehensive program, complementing all other health care modalities."

How is NMT applied?

Neuromuscular Therapy is a specialized form of manual therapy that applies massage techniques very specifically to the musculoskeletal system to address dysfunction. Along with the manual therapy, a NMT therapist addresses perpetuating factors that create and intensify pain patterns through the use of flexibility stretching and movement, home care as well as other health care professionals trained in other modalities.

During a typical session of neuromuscular therapy, a trained therapist will focus on areas that are tender to the touch and areas that feel  ‘tight’.  When muscles and other soft tissues such as fascias, tendons and ligaments are tender to the touch it indicates unhealthy tissues. This unhealthy state is usually a result of ischemia, inflammation, trigger points, unresolved injuries and degradation.  Healthy muscles, tendons, ligament and fascias can tolerate appropriately applied deep pressure and only sense the pressure without sensing pain. Healthy tissues will not have that tight and stiff feeling when they are relieved of a workload such as lying on a massage table. The muscles maintenance of tight and stiff muscles when they are supposedly ‘relaxed’ gives rise to suspicion for the trained NMT therapist that there is dysfunction occurring in those areas.

A trained NMT therapist, is aware of the tenderness when treating but the tenderness is also a symptom of the dysfunction. So the manual work of NMT can be uncomfortable during treatment but should not be significantly painful. The therapist should work with the patients tolerance levels and never work to the point that the patient cannot maintain a relaxed state. The patient should  be able to breathe comfortably through the session.

NMT works with soft tissues by gliding, using steady pressure techniques, frictioning across fibers, lifting and kneading primarily to accomplish several important things. The first goal is to release the soft tissues and restore their length and ability to respond appropriately to the nervous system.  The second although seemingly basic, but nevertheless critical, is to manually flush blood through these tissues. The increase blood flow brings much needed nutrition and oxygen restoring the tissues capability to function with more ease and bring about healing.  Often the patient can feel the tenderness ease during the session as the muscles relax and increase blood flow restores the muscles capabilities.

What is a tight muscle:

Tight’ muscles are usually the result of sustained muscle contraction (electrically active) or contractures (electrically silent) resulting in a hypertonic state. Electrically silent means there is no nerve impulse detected. This is strange when muscles usually need a nerve impulse to contract. It is as if the ‘muscle contracting machinery’ got jammed resulting in the feeling of a tight muscle.  In the case of contractions, there is a nerve impulse but this too can become dysfunctional.

A muscle in a hypertonic state means too much muscle tone and a hypotonic state is too little tone. Healthy functioning muscles are controlled by the nervous system including how much tone they sustain. The tone in a muscle varies by the demand placed on it and whether they are moving or holding you in a particular position. They do this by coordinating with other muscles that assist in either a similar function or the same job by doing it together or taking turns. A single muscle never contracts 100% under normal circumstances. It has a multiple parts called muscle bundles that contract with a different set of nerves assigned to each bundle.  Each bundle coordinates with other bundles forming a group. Each group take turns contracting to maintain a certain tone and they can increase tone by recruiting more groups to contract at once or when circumstances demand less groups work together lowering the tone.

Muscles increase their tone when they have to work harder.  They can work harder to produce more motion. Muscles generally take very well to this type of work. When muscles are producing movement they go through a contract and relax cycle –shortening and lengthening creating a very nice pumping of blood and lymph fluid through them.  As long as they can get enough nutrition and oxygen either through moderate movement, a variety of movements or rest breaks they handle this type of a work load very well and are less prone to dysfunction.

Another type of workload for muscles is to hold the body in a particular position for extended periods of time. Standing at a job or sitting at a desk or computer for long periods of time are examples. Jutting our head forward and rounding our shoulders is common example of posture that requires sustained muscle contraction/contracture to maintain this position. When muscle sustains a contraction without being able to go through a contract (shortening) and relax (lengthening) cycle they cannot pump blood through themselves at optimal levels. Even though muscle can sustain a contraction with little movement, extended periods of this, challenge the muscle and is prone to dysfunction. Long periods of sustained contraction can result in reduced blood flow decreasing the available nutrition and oxygen that the muscle requires in order to work optimally and maintain a healthy state. But, often we demand our muscle to keep working by maintaining our sustained postures.  So our muscles respond in a variety of ways. 

1. They can compensate by recruiting more muscle bundle groups to contract at once thereby increasing muscle tone and demand for more energy.  More muscles can get recruited to assist the original muscles spreading the hypertonicity to other muscles. The energy demand increase and becomes unsustainable for the muscle to continue working in such a hypertonic state without producing pain, stiffness and loss of range of motion.

2. They can compensate by remodeling themselves. They do this by adding a different type of tissue (fibrotic or scar tissue) to shore themselves up in an attempt to handle the demanding workload of a sustained contraction.  Fibrotic tissue is structurally strong, but, it is stiff and cannot produce movement, therefore, changing the range of motion of the muscle it is embedded in. This loss of range of motion impacts not only the muscle itself but the other muscles and soft tissues associated with it.

3. In other cases, a muscle may compensate by producing trigger points which will also stiffen a muscle. Trigger points change the ability of a muscle to work properly in its own job as well as impacting associated muscles.  Trigger points often produce pain and discomfort along with the stiffness.

Daily activities that include a lot of movement are generally healthier for muscles. If your daily activity requires a lot on inactivity then you have to add activity purposefully into your day.  Yes, you guessed it, I mean exercise. Generally daily activates and exercise should include 3 types:

1.     stretching or lengthening

2.     strengthening and conditioning

3.     aerobic exercise.

How can you respond to these types of compensations:

If your body has responded to your lifestyle with hypertonic muscles, stretching and strengthening (movement) can be very helpful. Alternating the length of the muscle assist in pumping more blood through the muscle bringing much needed nutrition and oxygen therefore restoring the muscles health.

If there is fibrotic tissue then exercise, although helpful and warranted, may be frustrating because of the stubborn nature of fibrotic tissue. If you can find a stretch for those stubborn muscles, it is possible to get them to remodel again but you have to apply the stretches 4-5 time a day for a minimum of 21 days or so to begin to see changes happening.  If can be very helpful to get NMT where the therapist will manually lengthen the muscle and work across the fibers to stimulate the desired changes.  Combining NMT with daily regiment of stretching can produce good results. 

If there are trigger points, exercise can also be frustrating. Trigger points alter the length of a muscle by holding it taut. They often neurologically weaken the muscle as well as cause pain upon movement. This means that  exercise can be counterproductive. NMT can manually release trigger points freeing up the muscle making exercise more comfortable. 

It is important to remember that manual therapies are passive in nature and can be very helpful and even at times critical in releasing soft tissues that allow for exercise with more ease. However, manual therapies are not a replacement for exercise which is active in nature. Exercise causes your system to pump more blood and lymph, activate the coordination of the nervous system as well as maintain soft tissue strength and integrity.  Exercise, appropriately done, is what keeps tissues in generally good health. Exercise is a major way out of chronic pain.

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Neuromuscular Massage Therapy