Neuromuscular 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.

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.

At The Abbott Center, the Senior Certified NMT (CNMT) with 27 years of experience costs $105 per hour and does not accept tips for her work. The Assisting Certified NMT with over 20 years experience costs $90 for an hour.

Patients can often get reimbursed for therapy in auto accident claims or worker’s compensation injuries or where, through an appropriate review process including a statement of medical necessity from your doctor, special cases are approved. In such cases your therapist will give you receipt for each treatment giving the insurance company all the information they need for processing. Some employers have a “cafeteria plan” where pre-tax dollars are set aside for uninsured medical uses. Receipts recording dates of service and fees charged are given in these cases. The Abbott Center does not do any third-party billing.

Both the International Academy of Neuromuscular Therapies and the St. John Seminars provide a Certificate to graduates of their programs. Certification requires that the therapist complete four 20-hour courses, each covering one of the four areas of the body (Torso and Pelvis, Cervical and Cranium, Upper Extremity and Lower Extremity) with a closed book written exam and a practical exam of hands-on knowledge and technique. Most NMTs will also be graduates of a 500 hour program at an accredited school of Massage Therapy or the equivalent in a specialized and related area of formal training at an accredited higher educational institution.

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 a fraction of an 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.

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 expects, 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.

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.