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Neuromuscular Technique Certification

Approved for 8 Online Continuing Education Units/Credits (CEU's) for Pennsylvania Licensed Massage Therapists

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Approved for 8 Online CEU's for Pennsylvania Licensed Massage Therapists. Cost $100.00 / Certificates Awarded Upon Completion.



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Introduction
History
Summary

Neuromuscular therapy (NMT) offers a series of regional treatment protocols that are built on a foundational platform based in science and guided by clinical evidence. It uses time-tested, hands-on protocols that integrate well into any practice setting. With the increased emergence of complementary and alternative medicine,1 NMT is now often included in mainstream medicine and multidisciplinary clinics worldwide.

Simply defined, NMT is a precise, thorough examination and treatment of the body’s soft tissues using step-by-step regionally oriented protocols, with consideration of several perpetuating factors that may be associated with the current condition. For example, when a client has shoulder pain, the upper extremity protocol will be used for primary examination. In addition to assessing the muscles directly crossing the shoulder joint, the shoulder protocol would include examination of the muscles of the arm, forearm, and hand as well as the muscles that attach the shoulder girdle to the torso. The neck will also be assessed, since innervation to the shoulder must pass through the cervical region, and compression or entrapment of the nerves may be associated with the current problem. Perpetuating factors might include posture, habits of use, shoulder joint abnormalities, nutritional components, and other core elements that can mask as myofascial dysfunction.

Clients generally have chronic pain, a condition for which NMT is highly effective. Although some of the techniques also can be applied to acute injuries and in postsurgical care, all of them can be employed for preventive purposes. Whether NMT is used to manage a chronic condition, to treat acute injury, or to improve performance in sports or dance, it is always important for the practitioner to take a health history, perform an evaluation of the presenting condition, and remain mindful of other health conditions or medications that may produce some of the complaints.

NMT is sometimes inaccurately labeled as “deep tissue massage.” It is important to clarify that, although NMT is sometimes used on deeper tissues of the body, the superficial and intermediate tissues must also be assessed in an attempt to ascertain precisely where the problem lies. For instance, lower back pain often stems from the psoas muscle, which lies on the anterior surface of the spinal column, undoubtedly “deeply placed.” However, a myofascial trigger point in the rectus abdominis, the most 179superficial muscle of the anterior abdomen, has a target zone of referral into the lower back. Active myofascial trigger points in the rectus abdominis can result in lower back pain that may be confused with that produced by the psoas. Additionally, NMT protocols suggest that the rectus abdominis should be treated before the psoas muscle as a preparatory step to allow more comfortable penetration into the deep abdomen.

NMT assessments and examinations usually consider ischemia (tight tissue with reduced blood flow), myofascial trigger points (MTrPs) (hypersensitive points within muscles that give rise to referred phenomena, including pain),2 neural entrapment (pressure on nerves by muscles and other soft tissues), and nerve compression (pressure on nerves by osseous and other bonelike tissues, such as cartilage or discs). Also of primary consideration are the elements uncovered in a postural assessment (assessment of the position of the body as a whole) and the implications of dysfunctional gait patterns (manner of movement when walking) as well as other perpetuating factors, such as nutrition, breathing patterns, and psychologic stress.35

NMT emerged on two continents almost simultaneously well over a half century ago.5,6 The European term neuromuscular technique evolved from techniques developed in the early twentieth century, stemming primarily from the work of Stanley Lief and Boris Chaitow, and significantly further defined and expanded by Leon Chaitow. North American neuromuscular therapy also derived from a variety of sources, including massage, chiropractic, and myofascial trigger point therapy. European and American NMT methods are philosophically similar and differ primarily in hands-on application, which is discussed later in this chapter. European NMT uses a slow-paced, thumb-drag method, whereas NMT American version uses a medium-paced thumb- or finger-glide method. There is also a slightly different emphasis in the manner of application of ischemic compression (pressure applied to force blood from tissues and to enhance fluid exchange) for deactivation of MTrPs, a common source of referred pain.Additionally, American NMT offers a precisely directed, systematic method of examination and treatment of each individual muscle. European methods also use structured protocols, although they differ from the American routines. In European NMT, all muscles may be examined; however, less detail is involved when individual muscles are palpated and significant focus is placed on tissue textures, including cutaneous (skin) characteristics.24 Either method can be used independently, both are highly successful, and the two can be easily integrated together for enhanced outcome.

Both European and American methods of NMT emphasize the value of self-care applied at home and the client’s participation in the recovery process, which might include lifestyle changes that help to eliminate perpetuating factors which may be contributing to the condition. Both versions support the use of hydrotherapies, movement, and self-applied therapies. Education may also be offered to train clients to make healthy nutritional choices, to avoid exposure to neuroexcitants and neurotoxins, and to increase awareness of habits of use in work and recreational settings.

Over the last 70 to 80 years, NMT techniques have emerged throughout the world with unifying theoretic foundations and subtle differences in palpation methods.7 NMT has bridged multiple professions to be integrated into a variety of settings, including massage therapy, chiropractic, osteopathy, sports medicine, occupational therapy, physical therapy, nursing, health spas, professional sports, and conventional medicine. NMT has served as a powerful tool in the treatment of injury, in client care before and after surgery, and in treatment of repetitive trauma, and has also been applied as a preventive procedure for assessing and removing the potential sources of myofascial dysfunction before they become a problem. It has gained in popularity in the last two decades as complementary medicine has emerged within mainstream health care.

Between the mid-1930s and early 1940s, European-style NMT first appeared through the work of Stanley Lief and Boris Chaitow. These cousins, trained in chiropractic and naturopathy, practiced in Lief’s world-famous health resort Champneys at Tring in Hertfordshire, England.7 They developed and refined “neuromuscular technique,” which was their means of assessing and treating soft tissue dysfunction found in the patrons of the healing center. Many osteopaths and naturopaths have since contributed to the evolution of the European NMT techniques, including Peter Lief, Brian Youngs, Terry Moule, Leon Chaitow, and others.6 Leon Chaitow has made a significant contribution as the author of dozens of books and textbooks that feature detailed application of NMT and as the developer of the first university program featuring NMT. John Sharkey has recently created the first master’s degree program in Dublin, Ireland, based on combined use of European and American NMT.

Following the development of European NMT, a step-by-step system began to emerge in America, stemming not only from European roots but also from modalities within chiropractic, traditional massage, and classic medicine. In the Receptor Tonus Techniques newsletter, Raymond Nimmo and James Vannerson wrote of their experiences with what they termed “noxious nodules.”8,9 They called their modality Receptor-Tonus Technique, although it is commonly referred to today as the Nimmo method. Although Nimmo continued to research, write about, and train practitioners to treat the noxious points that had come to be known as trigger points, his students began teaching 180their own treatment protocols, which were closely similar to his. Today, Nimmo’s original method is commonly incorporated in chiropractic settings and remains the basis for a number of traditional protocols in American NMT methods.

Nimmo’s and Vannerson’s struggle to support their theoretic platform was eased by the writings and research of Janet Travell and David Simons, two pioneers in the field of myofascial trigger point therapy. Travell and Simons’ work with MTrPs2,10 was rich in documentation, research, and references, and provided a new field of medical study, the basis of which is presented in Chapter 22 of this text. As clinicians gained access to Travell and Simons’ documentation and published work, MTrPs soon became a central focus of both European and American neuromuscular techniques.

Paul St. John, a massage therapist who was one of Nimmo’s students, developed his own NMT method in the late 1970s.7 St. John added detailed palpation to Nimmo’s basic routines and developed new techniques for the treatment of a number of muscles not included in Nimmo’s training. In the mid-1980s, Judith DeLany (then Judith Walker) became St. John’s first approved additional instructor of his method of NMT and assisted him in the development of course manuals used to teach NMT techniques and protocols to massage therapists from 1984 to 1989. As they blended Nimmo’s protocols with Travell and Simons’ insights, they also added emphasis on applied manual pressure as Prudden discussed.11 (See also Chapter 22 of this text.) In 1989, the two separated the work into two styles—the NMT St. John Method and the NMT American version.7 These two prominent NMT methods retained a strong focus on Nimmo’s original protocols. Although both systems featured considerable focus on MTrPs, each developer significantly infused his or her own particular style with unique insights and new techniques. A number of other teachers throughout the world have also developed their own systems of NMT based primarily on the work of Chaitow, DeLany, and/or St. John. In 2005, St. John developed neurosomatic therapy, which retained strong threads of his former NMT work. He passed the NMT St. John Method on to a new owner, who no longer teaches the method.

The differences between European and American styles of NMT were first compared in a text titled Modern Neuromuscular Techniques.12 In 2000, Chaitow and DeLany published the first volume of a set of comprehensive, anatomy-based, strongly referenced textbooks that blend the European regional examinations with the American step-by-step NMT protocols. Clinical Application of Neuromuscular Techniques, volume 1, The Upper Body3,5 and its companion volume 2 for the lower body4 also incorporate osteopathic and massage principles and integrate examination and assessment routines with treatment protocols. They also include positional release, muscle energy techniques, regional anatomy, common pathologic conditions, and substantial discussions on the physiology of the development of dysfunction in soft tissues. A practitioner may prefer one method over another; however, such preferences are likely purely personal. When practiced, either method works equally well to locate and release somatic dysfunctions, and each can be seamlessly integrated with the other to the benefit of both client and practitioner.

A solid foundation of palpable anatomy instruction, understanding of myofascial physiology, and development of skills in locating MTrPs form the foundation of NMT (Figure 10-12). Additionally, an emphasis on contraindications and precautions is crucial in any course that teaches NMT techniques. Although many of the protocols may be practiced without supervision, when the student is learning certain techniques (such as anterior cervical work), tableside assistance by qualified instructors is imperative. Some aspects of NMT can be covered in an online course, but it is strongly suggested that direct supervision by a qualified instructor be provided for some of the techniques, such as those that are deeply placed, those that lie near endangerment sites, and those that work with delicate areas, such as intraoral techniques.

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Approved for 8 Online CEU's for Pennsylvania Licensed Massage Therapists. Cost $100.00 / Certificates Awarded Upon Completion.



Please allow time for your purchase to process. We will contact you via email with instructions to access the online course as soon as your payment is complete. Please make sure your email address is correct. Thank you for your patience.