||Frequently Asked Questions
|| Neuromuscular Therapy
|What makes neuromuscular therapy
different from massage therapy?
|| A neuromuscular therapist thinks holistically
and works specifically. It’s as much about the way the therapist
thinks as about the techniques that are used. What distinguishes NMT
most from MT is the treatment of trigger points (areas of hyperactive,
dysfunctional myofascial tissues that are tender to pressure and that
refer pain or other symptoms to another part of the body). Location
of these trigger points, knowledge of their pain patterns, and techniques
to stop their dysfunctional activities are contained in two major
2-volume texts which guide the therapist in analyzing and treating
both chronic and acute pain conditions. Besides trigger points, five
other factors are considered: ischemic tissue, neurovascular entrapment,
structural imbalances; nutritional, metabolic and systemic factors;
and negative stressors, both psychosocial and physical.
The techniques used are somewhat different from massage. NMT techniques
involve primarily the use of flushing (called effleurage in massage)
to warm up the tissues and clear waste products; lightly lubricated
slow gliding strokes to examine, soften and lengthen a muscle; compression
and static pressure to release contractions, often with pressure bars
or other tools; and digital manipulation to stimulate a change in
static dysfunctional tissue. Other complementary techniques or modalities
may be used, for example active or passive stretching, lymphatic drainage,
skin rolling, “myofascial release,” ice or heat, and “muscle
energy” or “positional release” techniques.
The setting for NMT is often more medical or clinical than MT. Clients
at The Abbott Center wear a hospital gown or towel for draping rather
than a top sheet. Relaxing music is not necessarily used since communication
between patient and therapist is essential.
In general, a neuromuscular therapist works more deeply and more specifically
on the area of concern. At The Abbott Center, full body work is never
done because the work is always focused only on the muscles that are
contributing to the pain pattern.
|Where and when did Neuromuscular
|| Neuromuscular Therapy is the American version
of the European term Neuromuscular Techniques. Neuromuscular Therapy
(NMT) in America originated in the 1980’s with Paul St. John
and Judith Walker (now Delany) who used the information gleaned by
Nimmo and Vannerson combined with the medical research and writings
of Drs. Travell and Simons to develop a step-by-step system of assessing
and treating myofascial pain and dysfunction. European techniques
developed in the mid-1900’s among chiropractors and naturopaths
and have been developed by osteopaths and naturopaths since then.
Myofascial trigger points has become a whole new field of study, pursued
mostly by Doctors of Physical Medicine also called Physiatrists.
|What does a Neuromuscular Therapy
National costs for a Neuromuscular Therapist
range from $70 to $135 per hour depending on location, demand, skill
level and experience. At The Abbott Center, the senior NMT with
13 years experience costs $90 per hour. Staff NMTs start at $75.
|Does insurance cover the cost
|| Insurance in Massachusetts is lagging behind
other states in payment for bodywork, so coverage will most often
depend on what is termed “medical necessity.” Victims
of automobile accidents are usually reimbursed, workers compensation
claims will sometimes be reimbursed depending on the case manager
and doctor, treatment for poorly understood syndromes like fibromyalgia
and other painful chronic conditions such as headaches, are usually
not taken seriously.
|What credentials should a Neuromuscular
|| Both the International Academy of Neuromuscular
Therapies and the St. John Seminars provide a Certificate to graduates
of their programs. Most NMTs will also be graduates of a 500 hour
program at an accredited school of Massage Therapy.
|Is Neuromuscular Therapy painful?
|| The general guideline is that a treatment
should be uncomfortable, but not painful. A number scale of pain sensation
from 1-10 is used to communicate discomfort to the therapist. The
patient should be aware that highly sensitized tissues and trigger
points can cause pain in a very specific part of a muscle where _
inch away it feels fine. So in the process of examining or treating
a muscle, the therapist may glide over a painful “hot spot.”
Treatment of that spot is important in resolving the complaint, so
it will be subsequently approached gently and slowly. The patient
should also be aware that pain in soft tissue is a gauge of the dysfunction
of that tissue. If there is no discomfort, the muscle is healthy.
|When should I have Neuromuscular
Therapy instead of Massage Therapy?
|| If your pain has a radiating quality, if you’re
worried about nerve involvement, or if your presenting complaint does
not resolve as quickly as you or your massage therapist expect, you
might request a NMT evaluation to explore the perpetuating factors
or the existence of trigger points. Chronic conditions usually require
some NMT intervention. Once the pieces of your pain puzzle have been
put together and the dysfunction understood and treated, massage therapy
is appropriate for the balance of the recovery until tissue health
is restored and then for maintenance to prevent recurrence.
|How long does it take to resolve
a painful complaint?
It seems, judging by statistics taken from a
large case load of patients at The Abbott Center, that patients
who will do well in treatment will see a “breakthrough”
between the 10th and 15th treatment. If the tissues are capable
of healing completely, the body seems to take over and require less
manual therapy over time. Those with chronic pain for long periods
of time can also recover, but will take usually much more time to
come to a non-chronic state. A rule of thumb is to take the length
of time from the onset of pain to the occasion of appropriate therapy
and work backwards. Some patients, because of factors that cannot
be resolved, may find it necessary to participate in a significant
self-care program to come to a comfortable resolution.
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