Clinical Applications of Neuromuscular Techniques: The Lower Body,

624 Pages·2002·55.95 MB·English

by  Leon Chaitow

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CHAPTER TITLE
Clinical Application of Neuromuscular Techniques
Volume 2 The Lower Body
-
Dedicated, in loving memory, to Janet G. Travell, MD.,
whose lifework provides insight, inspiration and understanding
of the treatment of myofascial pain syndromes.
Speciaclolmym issioned:
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ForC hurchLiilvli ngstone:
PublishDiinrge ctHoera,l Pthr ofessMiaorny sL:aw
ProjeDcetv elopmMeannta geKra:tr ina Mather
ProjeMcatn ageJarn:e Dingwall
DesigDni rectJiuodinth: W right
CliniAcpapll icatoifo n
NeuromuscuTleacrh niques
Volume2 TheL owerB ody
-
leon Chaitow
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SenioLre cturSecrh,o oolf I ntegraHteeadl tUhn,i versoifWt eys tminster, ULoKn don,
Judith Walker Delany
LMT
LecturienNr e uromuscuTlhaerr apDyi,r ectofoN rM T CenteSrt,P etersbuFrlgo,r iUdSaA,
Foreword by
DaviGd Simons
MD
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Contents
List of abbreviations xiii Respiratory influences 24
Patterns of dysfunction 25
List of boxes and tables xv
The big picture and the local event 26
Foreword xix Thoughts on pain symptoms in general and
trigger points in particular 26
Preface xxi
2 Posturaec,t uraen db alance 31
Acknow ledgements xxiii
Static and dynamic posture 31
1 Essentiianlf ormation 1 Key postural influences 32
Making sense of the picture 2 Is there an ideal posture? 32
Connective tissue and the fascial system 3 Gravitational influences and muscles 32
Fascia and its nature 4 Therapeutic objectives 33
Fascial tensegrity 6 Muscle categorizations 33
Fascial postural patterns 6 �ecessaryassessments 35
Essential information about muscles 7 Static postural images 35
Muscle energy sources 9 Static postural assessment 38
Muscles and blood supply 9 Tools of postural assessment 38
Major types of voluntary contraction 10 Plumb line 38
Muscle types 10 Postural grid 38
Cooperative muscle activity 11 Portable units 38
Contraction, spasm and contracture 12 Computerized assessment methods 39
What is muscle weakness? 13 Basic postural assessment 39
Reporting stations and proprioception 13 Standing postural assessment 40
Reflex mechanisms 16 Supine non-weight bearing postural
Facilitation -segmental and local 16 assessment 50
Manipulating the reporting stations 17 Assessment for freedom of movement 53
Therapeutic rehabilitation using reflex Other postural models 55
systems 18 Posture and the mind 56
Trigger point formation 18 Latey's lower fist 59
Central and attachment trigger points 19 Good posture and 'asymmetrical normality' 59
Trigger point activating factors 20 Patterns of use and posture 61
Ischemia and trigger point evolution 21 Additional local features influencing
A trigger point's target zone of referral 21 posture and use 61
Key and satellite trigger points 21 Exteroceptive and proprioceptive postural
Trigger point incidence and location 21 controls 63
Trigger point activity and lymphatic Mechanisms which alter proprioception 64
dysfunction 21 Common causes of postural imbalance and
Local and general adaptation 22 retraining options 65
Somatization -mind and muscles 23 '�ormal' balance is age related 65
vi CONTENTS
Causes of disequilibrium 66 Problems relating to the posture of musicians 120
Stabilization 68 Examples 123
Disequilibrium rehabilitation goals and Assessment 124
strategies 68 Conclusion 124
3 Gaita nalysis 73
5 Adaptatiaonnd s port 127
Normal joint and segment motion during
First principles 128
the gait cycle 73
An osteopathic perspective 128
Musculoligamentous slings and influences
Specific adaptation to imposed demand
and the gait cycle 77
('training') 129
Energy storage during gait 78
Training variations 129
Potential dysfunctions in gaiting 80
Strength training 129
Observation of gait 82
Endurance training 130
Multiviewanalysis 82
Sprint training 130
Muscular imbalance and gait patterns 83
Overtraining issues 130
Chains of dysfunction 84
Overuse injuries and the young soccer
Liebenson's clinical approach 85
player 131
Altered hip extension 85
How widespread is the problem of overuse
Altered hip abduction 86
injury in youngsters? 131
Various pathologies and gait 87
Prevention of overuse injuries 133
Neurological gait patterns 88
Signs of overuse injury in young soccer
Pediatric gait 89
players 133
Podiatric considerations and gait 89
Handling overuse injuries 134
4 Thec loseen vironment 95 Tibial stress fracture 135
The bodyworker's close environment 96 Enhanced human performance or treatment
Acture guidelines for bodywork students of dysfunction? 136
and practitioners 96 Athletics 136
Automobile influences 101 Hamstring injuries and the athlete 136
Driving: the vibration factor 101 How to choose where and what to treat
Automobile risk factors 101 within the kinetic chain 137
Seatbelts and airbags 102 A model of care for hamstring injuries 137
Gender issues in accident after-effects 102 Nutrition 138
Multiple symptoms and fibromyalgia Bodywork and rehabilitation 138
syndrome (FMS) following vehicle Groin strains and the athlete 138
injuries 102 Gymnastics and dance 140
The vehicle injury close environment 103 Weight training and the low back: key points 143
Sitting on an airplane 104 Water sports 145
Shoes 107 American football 145
Neural entrapment and shoes 109 Rotational activities 146
Orthotics 109 Golf 146
Effects of clothing, jewelry, other accessories Tennis 146
and aids 109 Baseball 146
Sitting posture 111 Risk in other sports 146
Chairs as a health hazard 112 Skiing 146
Better chair design as an answer? 112 Cycling 146
Chair criteria 112 Rugby, football 147
An Alexander perspective on correct sitting 112 Volleyball and basketball 147
The art of sitting down 113
What are the risks of poor sitting habits? 116 6 Contextuianlf luencneust:r itiaonndo ther
Computer work and posture 117 factors 149
Sleeping positions 118 Chronobiology 150
Repose 119 Sleep and pain 150
Changing sleeping position due to nasal Pain and inflammation: allergic, dietary and
influences 120 nutritional factors 151
CONTENTS vii
Nutritional approaches for modulating A summary of approaches to chronic pain
inflamma tion 151 problems 187
Intolerances, allergies and musculoskeletal Choices: soft tissue or joint focus? 188
dysfunction 151
Mechanisms 152 9 Summaryo fm odalities 193
Mast cells, immune responses and The global view 193
inflammation 152 The purpose of this chapter 195
Muscle pain and allergy /intolerance 153 General application of neuromuscular
Allergy-hyperventilation 'masqueraders' 153 techniques 196
Defining food intolerances 154 NMT for chronic pain 196
Allergy, the hyperreactive immune Palpation and treatment 197
function and muscle pain 154 Neuromuscular therapy: American version 198
Treatment for 'allergic myalgia'? 154 Gliding techniques 199
Other therapeutic choices 155 Palpation and compression techniques 202
Testing for allergy /intolerance 155 Muscle energy techniques (MET) 202
Some evidence for exclusion diet benefits Positional release techniques 206
with allergy 156 Integrated neuromuscular inhibition
Strategies 156 technique 208
The breathing connection 156 Myofascial release techniques 208
The biochemistry of hyperventilation 156 Acupuncture and trigger points 209
The biochemistry of anxiety and activity 157 Mobilization and articulation 210
Summary 157 Rehabilitation 210
Diet, anxiety and pain 157
Glucose 157 10 The lumbsapri ne 215
Alcohol 158 Functions of the lumbar spine 215
Caffeine 158 Lumbar vertebral structure 216
Anxiety and deficiency 159 Transitional areas 223
Detoxification and muscle pain 159 The spinal column: its structure and function 224
Water 160 Flexible stability 225
Liver detoxification 160 Adaptability tolerance 225
=
Thyroid hormone imbalance and chronic Identification of imbalances: essential first
musculoskeletal pain 160 step 225
Osteoporosis 161 Stress factors and homeostasis 225
The contextual environment 227
7 Self-hesltpr ategies 165
Soft tissue spinal support 227
Aims and sources 165
Coordi na tion 227
Coherence, compliance and concordance 165
Central and peripheral control 228
Biomechanical self-help methods 166
Choices muscles make 229
Hydrotherapy self-help methods 173
Specific muscle involvement in stabilization 230
Psychosocial self-help methods 174
Endurance factors 230
Biochemical self-help methods 176
Imposter symptoms 231
8 Patieinntt ake 179 Making sense of low backache 231
Where to begin? 179 The 'simple backache' 235
Outline 179 Nerve root pain 236
Expecta tions 179 Distortions and anomalies 247
Humor 180 Serious spinal pathology 247
Thick-file patients 180 The stabilizing role of thoracolumbar fascia 248
Unspoken questions 181 Using assessment protocols 249
Starting the process 181 Sequencing 250
Leading questions 181 Lumbar spine assessment protocols 250
Some key questions 182 Lumbar spine myofascial elements 251
Body language 183 Lumbar spine NMT treatment protocols 253
The physical examination 184 Latissimus dorsi 253
The therapeutic plan 187 NMT for latissimus dorsi 254
viii CONTENTS
MET treatment of latissimus dorsi 255 Pregnancy and the pelvis 303
PRT for latissimus dorsi 1 257 The innominates 306
PRT for latissimus dorsi 2 257 The symphysis pubis 307
Serratus posterior inferior 257 The sacrum 307
NMT for serratus posterior inferior 258 The coccyx 310
Quadratus lumborum 258 Ligaments of the pelvis 312
NMT for quadratus lumborum 260 The scia tic foramina 313
MET for quadratus lumborum 1 261 The sacroiliac joint 314
MET for quadratus lumborwn 2 262 Gait and the pelvis 316
PRT for quadratus lumborum 262 Therapeutic considerations 317
The thoracolumbar paraspinal muscles Homeostatic subtext 318
(erector spinae) 263 Pelvic problems and the low back 318
Superficial paraspinal muscles (lateral tract) 263 Lower crossed syndrome 318
Additional assessments for erector spinae 267 Treatment sequencing 319
NMT for erector spinae 268 Recognizing inappropriate firing sequences 320
MET for erector spinae 269 Possible trigger point involvement 321
PRT for erector spinae (and extension Screening 321
strains of the lumbar spine) 271 Janda's tests 321
Deep paraspinal muscles (medial tract): Prone hip extension test 322
lumbar lamina 272 Hip abduction test 322
Multifidi 272 Tests for weakness 323
Rotatores longus and brevis 273 Strength and stamina testing for gluteus
NMT for muscles of the lumbar lamina maxim us and medius 323
groove 273 Strength testing for piriformis 324
Interspinales muscles 274 Pelvic tilts and inclinations 325
NMT for interspinales 274 Testing and treating pelvic, sacral, iliac and
Intertransversarii lateralis and mediales 275 sacroiliac dysfunctions 326
MET for multifidi and other small, deep Thoughts on treatment strategies 327
muscles of the low back 275 Hypermobility issues 327
PRT for small deep muscles of the low back I1iosacral or sacroiliac? 329
(induration technique) 276 Static innominate positional evaluation 330
Muscles of the abdominal wall 276 Static sacral positional evaluation 330
Obliquus externus abdominis 279 Sacral torsions 331
Obliquus internus abdominis 279 Standing pelvic assessments 331
Transverse abdominis 280 Standing pelvic orientation evaluation
NMT (and MFR) for lateral abdominal ('tilt') 332
muscles 281 Standing pelvic balance test 332
Rectus abdominis 283 Standing PSIS symmetry test 332
Pyramidalis 284 Standing flexion test 332
NMT for anterior abdominal wall muscles 286 Standing iliosacral 'stork' or Gillet test 333
MET for abdominal muscles 289 Standing hip extension test 333
PRT for abdominal muscles 290 Spinal behavior during flexion tests 333
Deep abdominal muscles 290 Standing and seated spinal rotoscoliosis
Psoas major 291 tests 334
Psoas minor 292 Seated pelvic assessments 334
Assessment of shortness in iliopsoas 294 Seated flexion (sacroiliac) test 334
NMT for psoas major and minor 295 Supine pelvic assessments and treatment
MET treatment of psoas 297 protocols 334
PRT for psoas 298 Pelvic alignment in supine prior to
assessment 334
11 Thep elvis 301 Supine shear dysfunction assessment 335
Different pelvic types 301 MET of a superior innominate shear 335
Pelvic architecture 302 Pubic dysfunction assessment 335
The pelvic girdle or ring 302 MET treatment of pubic dysfunction 337