Neuromuscular Techniques (NMTs) is an umbrella term including a variety of interventions affecting the nervous and muscular systems simultaneously. Trigger Point Therapy is perhaps the most common. Myofascial release and Positional Release are other examples.
Applying static pressure to by compressing can profoundly affect the underlying tissues. Such techniques are an integral part of deep tissue massage, acupressure, and shiatsu. These techniques are reasonably simple and very effective. They can promote the flow of energy within the body, calm the mind, normalise muscle tone, and improve muscle function. Additionally, they are effective for reducing tightness as well as alleviating local and referred pain.
NMTs originated thousands of years ago and exist in one form or another in most Easter and Western bodywork modalities. They were more formally researched and introduced in recent times by Stanley Lief and Leon Chaitow in the 1930s. The term ‘trigger point’ (TrP) was first used in 1942 by Janet Travell and defined as: “a highly irritable localised spot of exquisite tenderness in a palpable taut band of skeletal muscle.”
As the name suggests, NMTs affect the interaction between the nervous and the muscular system. Excessive tension can accumulate in a small area of a muscle. This can make the muscle tight, weak, restrict its range of motion and even cause local or referred pain. It is essential to engage the nervous system as it is the one governing muscle tone.
Effects of NMTs
Common causes of TrPs
More about TrPs
There are about 620 referenced TrPs spread throughout the body. Each one has a specific recognisable pain or dysfunction and may have an associated referral pattern. Some TrPs, however, may be latent, i.e. not causing spontaneous pain but causing a dysfunction. It is observed that older people tend to have more latent TrPs while younger people more active.
TrPs can develop in any muscle as well as in scar tissue, ligaments, tendons, joint capsules, and skin. The ones found in the myofascial network are most mapped and recognised. There may be multiple TrPs in a single muscle. The primary or central one is always in the muscle belly, while the secondary or satellite ones can be spread throughout. It is essential to always treat the primary first as the secondary ones may dissipate spontaneously, while the reverse is rarely the case.
TrPs can be as small as a pinhead all the way to the size of a pea. What they all have in common though is that they are all tender to pressure. The pain they cause is usually described as deep and dull.
How TrPs appear
At present, there is no definitive agreement about how TrPs develop. Here are some suggested explanations:
How NMTs work
Nerve endings fire excessively in TrPs. One theory suggests that the application of pressure further aggravates and therefore overload and fatigues the nerve. It is very likely, though that there are additional factors at play in this overly simplistic explanation.
It is likely that the application of deep sustained pressure is also effective because it creates an ischemic compression of the underlying tissue. A build-up of pressure is created behind the area of compression by deliberately inhibiting local circulation. Upon release, fresh blood surges through the muscle. By alternating deep sustained pressure with effleurage, a pumping effect is created. Each time the fresh blood enters the area it promotes and accelerates the removal of waste products.
It is more plausible that these two factors coupled with the interruption and resetting of the neural messages to the muscle produce the effects of NMTs. They alter the reflex pattern which holds the muscle in its hypertonic state. In a clinical environment, the client is encouraged to relax as the painful stimulus is gradually increased through pressure. This response as opposed withdrawal helps to restore the normal resting length of the muscle and eliminate the TrP.
NMTs also can reset reflex patterns. Injured or inflamed areas cause pain when stretched or even at their normal resting length. The central nervous system signals the muscle to contract and shorten to alleviate the discomfort. The problem is that this new contracted, hypertonic position becomes the new ‘normal’ state.
An effective NMT uses a painful TrP as a way of engaging and adjusting the neuromuscular reflex. With client communication and skilful application, the natural response of contracting and tensing further during compression pain is replaced with gradual relaxation and letting go.
Ultimately, NMTs aim to achieve the following:
Treating TrPs with NMTs
Let’s suppose that a client presents themselves with ‘tension’ headaches, neck pain, and pain behind the eye. This common upper trapezius TrPs referral pattern is confirmed when palpating the muscle.
There are two possible approaches for addressing the issue:
The most effective way of treating and alleviating TrPs would include a combination of techniques from the list above and the client’s preference. An approach focusing on NMTs may look like this but is by no means the only approach:
Some technical considerations when applying the described NMT include:
As previously stated, including additional techniques will make the release of TrPs more effective.
In conclusion, be mindful, notice the build-up of tension before it develops into a TrPs. If you get one or a few, don’t worry. A capable soft tissue therapist would be able to help you resolve them.
Martin Stefanov Petkov