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Neuromuscular and Trigger Point Therapy:

What they are and How They Work:

Neuromuscular Therapy is a modality, which provides Body Therapists with a powerful set of tools to use with clients, who are in pain due to muscular, tendon or other soft tissue problems. The emphasis is on treating pain and dysfunction in the neck, shoulders and upper limbs and pain syndromes in the Low back and lower limbs.

Neuromuscular Therapy focuses on the reflexes in the sensory-motor system which registers and respond to noxious stimuli, eventually creating the chronic pain cycle. Persistent irritation for e g., can gradually become amplified causing muscle tension, local ischemia, accumulation of toxic metabolites, and result in even more irritation. As this cycle continues, the neural pathways become facilitated - the message becomes ingrained. Muscle tissue again responds with increased tension and trigger points may develop referring the pain elsewhere. This is the chain of pain and dysfunction that Neuromuscular Therapy and Trigger-point Release is designed to break.

Neuromuscular Therapy works by improving circulation to ischemic tissue; releasing hypertonic muscles, tendons and fascia; finding and deprogramming the referral patterns of trigger points, and addressing soft tissue involvement in nerve compression and entrapment. It also looks at the bigger picture of posture and biomechanics as well as the role of personal behavior in perpetuating pain and facilitating healing.

Nerve compression or entrapment - pressure on nerve tissue from bone, cartilage, or soft tissue. Nerve entrapment is the most common type of pain and always causes ischemia

Trigger Points

Treating Trigger Points, effectively, requires the employment of appropriate techniques. Combined with gait and movement reeducation, the results may be improved blood and nervous flow, reduction or elimination of pain, better flexibility, relaxation and return of the body to normal neuromuscular integrity and balance.

Factors to consider

Trigger points may be associated with Vitamin B-6 and other      vitamin deficiencies. Usually after a trauma or stressful event,      the body is lacking in B-6, magnesium or Vitamin C. Trigger      points are more likely to develop.
Trigger point are usually bilateral, with one side being more      symptomatic than the other. Both sides need to be treated.
Trigger points may be a result of underlying visceral disease,      arthritic joints, or other trigger points.

Some of the conditions that are commonly treated are cervical strain, whiplash, low back strain, temporal-mandibular joint dysfunction, tendonitis, carpal tunnel syndrome, fibromyalgia, tennis elbow, athletic injuries, sciatica, crania-mandibular pain, rotator cuff injuries and chronic and short-term stress and tension.

The St. John Method of Neuromuscular Therapy considers five most common principles that cause pain:

Postural distortion - muscular imbalances resulting from the body's movement off the coronal, mid-sagittal, and horizontal planes, as the body tries to compensate for the pull of gravity.

Biomechanical dysfunction - musculoskeletal imbalances caused by habitual faulty gait and movement or repetitive strain;

Myofascial Ischemia and hyper-tonus - These conditions may cause lack of blood flow to muscle tissue, which typically causes sensitivity to touch as well as compromise the flexibility and endurance of affected soft tissue structures - muscles, tendons etc. ;

Trigger points - Areas of high neurological activity, which when irritated or compressed, send acute, referred sensations to areas of the body which may be far from the actual site of pain. These referred sensations may include pain, tingling, numbness, burning, coldness or itching.

The Stages of Rehabilitation

When rehabilitating injured tissue, certain steps should be followed, and a proper order established, to achieve the fastest possible recovery without re-injury.

Remove hyper-contraction and spasms and ischemia in the      tissue (Neuromuscular Therapy)
Restore efficient biomechanics (gait re-patterning and      movement exercises)
Restore flexibility to the tissue (stretching exercises)
Rebuild strength of injured tissue (appropriate weight bearing      exercises)
Rebuild endurance ( aerobic exercises)

The clinical experience is that if rehabilitation does not follow this order, re-injury and other set-backs usually occur.Emergency Care of An Acute Injury: R I C E - Rest Ice Compression Elevation

More Useful Information:

Location of Trigger-points

Trigger points may develop any where in the body, but are most commonly found at the sites of the greatest mechanical and postural stress.

Possible Causes

Acute overload, overwork, fatigue, direct trauma, chilling.

skeletal asymmetry such as short leg or pelvic imbalances.
Other trigger points can cause new points to occur.
Arthritic joints can cause trigger points.
Visceral diseases such as ulcers, renal colic, myocardial      infarction, gall stones, kidney problems, and irritable bowel      syndrome can cause trigger points.
B-6, magnesium, vitamin C, folic acid deficiencies which are      common after injuries or trauma may cause trigger points
hypoglycemia
chronic infection from a viral or bacterial disease.
food allergies or intolerances. Wheat and dairy products      should be checked first.
toxicity due to exposure to organic chemicals or heavy metals

Factors that can worsen trigger points

fatigue, improper sleep
chronic infection
severe stress (mental, emotional, physical)
nerve entrapment, compression
excessive creatine in urine
postural imbalances
nutritional health of the tissue
food allergy, allergies in the respiratory system
visceral (organ) disease - gall bladder problems, ulcers,      kidney problems, irritable bowel syndrome
exercise may worsen an active trigger point, but may help to      heal latent trigger points

Cautions

Though Trigger-point therapy may relieve the pain of angina,      myocardial infarction and acute abdominal distress, Always      refer clients to a physician and seek medical attention in case      of an episode.
Rule out such conditions as: Tendonitis, bursitis, giant cell      arthritis, neuralgia, infection (both viral and bacterial),      neuropathies, disc problems, and disc herniations.
Check for thyroid malfunction, anemia, hypoglycemia and      vitamin deficiencies.