Modern Neuromuscular Techniques

279 Pages·2003·1.82 MB·English

by  Leon Chaitow ND DO

Copyright

Modern Neuromuscular Techniques
For Churchill Livingstone:
Editorial Director, Health Professions: Mary Law
Project Development Manager: Katrina Mather
Project Manager: Wendy Gardiner
Design: Judith Wright
Modern Neuromuscular Techniques
with accompanying CD Rom
Leon Chaitow ND DO
Registered Osteopathic Practitioner and Senior Lecturer
University of Westminster, London, UK
With contributions from
Judith (Walker) Delany LMT (Chapter 10: American neuromuscular therapy)
Director of Neuromuscular Therapy Training Center,
St Petersburg, Florida, USA
Dennis J Dowling DO FAAO (Chapter 11: PINS technique)
Professor and Chairman
The Stanley Schiowitz DO FAAO Department of Osteopathic Manipulative Medicine,
New York College of Osteopathic Medicine, New York Institute of Technology
New York
Foreword by
David Peters MB ChB DO
Clinical Director, School of Integrated Health, University of Westminster, London, UK
Illustrated by
Graeme Chambers BA (HONS)
Medical Artist
SECOND EDITION

EDINBURGH LONDON NEW YORK OXFORD PHILADELPHIA ST LOUIS SYDNEY TORONTO
CHURCHILL LIVINGSTONE
An imprint of Elsevier Science Limited
© Pearson Professional Limited 1996
© Harcourt Publishers Limited 2000, 2001, 2002
© 2003, Elsevier Science Limited. All rights reserved.
The right of Leon Chaitow to be identified as author of this work has been asserted by him in accordance
with the Copyright, Designs and Patents Act 1988
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by
any means, electronic, mechanical, photocopying, recording or otherwise, without either the prior permission
of the publishers (Permissions Manager, Elsevier Science Limited, Robert Stevenson House, 1-3 Baxter's
Place, Leith Walk, Edinburgh EH1 3AF), or a licence permitting restricted copying in the United Kingdom
issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1T 4LP.
First edition 1996
Second edition 2003
ISBN 0 443 07158 6
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloguing in Publication Data
A catalog record for this book is available from the Library of Congress
Note
Medical knowledge is constantly changing. As new information becomes available, changes in treatment,
procedures, equipment and the use of drugs become necessary. The author/contributors and the publishers
have taken care to ensure that the information given in this text is accurate and up to date. However,
readers are strongly advised to confirm that the information, especially with regard to drug usage, complies
with the latest legislation and standards of practice.
Neither the publishers nor the author will be liable for any loss or damage of any nature occasioned to or
suffered by any person acting or refraining from acting as a result of reliance on the material contained in
this publication.
Foreword

This welcome new edition updates what was already a striking synthesis of theories and
techniques. In it, clinicians will find diverse maps and explanations for the tantalising
patterns of tender and trigger points they encounter every day. Having revealed a truly
extraordinary overlapping of different systems of body mapping the author reviews and
analyses them, making links to ways of evaluating each system and for using Neuro-
Muscular Therapy (NMT) treatment.
This material alone would make the book essential reading, but in addition there are
chapters explaining the origins of soft tissue distress and the generation of trigger and
tender points.
The breadth of the book is impressive: while many of its sources are straight from the
bodywork 'hall of fame' (F M Alexander, Barlow, Cyriax, Feldenkrais, Lewit, Janda,
Stoddard) it also touches on less familiar territory: the emotional and even energetic
anatomy of Rolf, Reich, Upledger and Boadella. In so many different ways this book made
me aware of the wider horizons of therapeutic bodywork.
The second edition includes a great deal of new information expanding on the concept of
NMT. Having found the first edition's section on fibromyalgia especially useful (and been
particularly struck by the list differentiating it from myofascial pain syndrome) I was glad to
find new sections on trigger point phenomena and myofascial release as well as the latest
ideas on NMT in the treatment of fibromyalgia. In explaining the how and why of modern
neuromuscular techniques, Leon Chaitow has been assisted by Judith (Walker) DeLany,
who has presented details of American NMT. The section on associated techniques has
grown too, with a chapter by Professor Dennis Dowling on progressive inhibition of
neuromuscular structures (PINS) technique which incorporates up-to-date findings on
ischaemic compression. Included too is a review of Dr Nimmo's original research (an
American chiropractor who was a pioneer of trigger point therapy) which clearly adds to
our understanding of NMT. A CD ROM containing the complete text and video clips
demonstrating techniques completes this rich offering.
I predict that almost every reader will find enlightening new avenues of knowledge and
technique here, for the book outlines in effect, a whole curriculum on soft tissue work.
Perhaps the most important knowledge presented is on the diagnostic and therapeutic
value of tender reflex points related to viscero-somatic and somatico-visceral reflexes. It
seems more osteopaths have become interested in this area since the first edition -
perhaps in part because of it and I am sure the subject deserves more research to
support NMT's potential role across many fields of healthcare. For those who want to
explore further, the very extensive references given will enable them to do so.
Leon Chaitow has put the methods of European neuromuscular technique, originated by
Stanley Lief DO and his cousin Boris Chaitow DC, into a broader context, and made NMT
accessible and credible to a wider range of practitioners and therapists. NMT as Leon
presents it, has already made a long-lasting impact on the ways many bodyworkers
practice. The book's popularity and the need for a second edition surely confirm that this
work will continue to be internationally influential.
Dr David Peters
2003
About the author

Leon Chaitow, Registered Osteopathic Practitioner and Senior Lecturer, University of
Westminster, London, is an internationally known and respected lecturer, writer and
osteopathic practitioner. He is the author of two other books in the series Advanced Soft
Tissue Techniques (Muscle Energy Techniques and Positional Release Techniques).
Additional books include Palpation and Assessment Skills, a book about assessment and
diagnosis through touch; Cranial Manipulation Theory and Practice, which presents the
latest thinking on the use of this valuable technique together with the latest research
evidence to support its use; and Fibromyalgia Syndrome: A Practitioner's Guide to
Treatment, which gives a multidisciplinary perspective on the management and treatment
of fibromyalgia syndrome. All these books are supported by one or more videos, which
may be purchased separately from the books. In collaboration with Judith DeLany he has
co-authored Clinical Applications of Neuromuscular Technique: Volume 1. The Upper
Body and Volume 2. The Lower Body. With Dinah Bradley and Christopher Gilbert he has
co-written Multidisciplinary Approaches to Breathing Pattern Disorders, which is intended
to help healthcare practitioners to understand the causes and the mechanics of
disordered breathing and to provide them with strategies and protocols to help their
patients to overcome these problems and restore normal breathing. Leon Chaitow is also
the Editor of Churchill Livingstone's Journal of Bodywork and Movement Therapies.
Acknowledgements

Acknowledgements are divided between the heroes of the past, who developed NMT,
and the clinicians and teachers of today, who have helped to widen the use of modern
NMT. NMT has evolved over the past three quarters of a century to a position of
international usage. It is now widely taught and practised in the USA and Europe,
primarily in the UK. This would not have happened without the pioneering work of Stanley
Lief ND DO DC, his son Peter Lief DO DC, and Stanley's cousin Boris Chaitow ND DC.
As discussed in Chapter 2, Stanley Lief based his early version of NMT on the work of
Ayurvedic physician Dewanchand Varma MD, who can therefore justifiably be regarded
as the fountainhead of European NMT.
Boris Chaitow, with whom I was privileged to work in the early 1960's, died in 1995,
during the editing of the first edition of this book. Boris happily contributed his thoughts
and memories of the evolution of NMT in the days when he worked with Stanley Lief at
Champneys, Tring, Hertfordshire in the mid-1930s (see some of Boris's quoted material in
chapters 2, 6 and 8 in particular). To Boris in particular I wish to express appreciation for
the diligent instruction he provided in this apparently simple, yet fiendishly subtle
approach to assessment and treatment of soft tissue dysfunction.
To Stanley and Peter Lief, Brian Youngs ND DO (extensively quoted in this text), Tom
Moule ND DO, and his son Terry Moule ND DO (also quoted at length in Chapter 9) and
the many others who helped to create NMT, my profound thanks.
NMT is now taught within the undergraduate bodywork scheme at the School of
Integrated Health, University of Westminster, London, where its evolution can safely
continue. My thanks to all those colleagues at the School, who helped to create this safe
environment for NMT to be taught, free of political/professional influences.
The American version of NMT, which has undoubtedly been influenced by the European
version, but which owes much to the work of Raymond Nimmo DC, Janet Travell MD and
David Simons MD, is now safely taught by a number of excellent tutors, including Judith
(Walker) DeLany (see Chapter 10) and Paul St John. To all of these I need to express
profound thanks for keeping NMT at the forefront of manual therapy. In particular my
thanks go to Judith DeLany for her contribution to this book, and for her continuing time,
effort and skill in conveying the NMT message to her profession, massage therapy, and to
a wider audience of chiropractors, dentists and physical therapists.
To Denis Dowling DO, who has contributed the chapter on his evolution of an NMT
variation, PINS, my profound thanks.
This book, as was the first edition, is affectionately and gratefully dedicated to the
memory of Stanley and Peter Lief, and Boris Chaitow.
Abbreviations

ACh: acetylcholine
ASIS: anterior superior iliac spine
ATP: adenosine triphosphate
CFS: chronic fatigue syndrome
CNS: central nervous system
CSF: cerebrospinal fluid
CTM: connective tissue massage
EAV: electroacupuncture according to Voll
EMG: electromyography
FMS: fibromyalgia syndrome
FPR: facilitated positional release
GAS: general adaptation syndrome
HIV: human immunodeficiency virus
HSZ: hyperalgesic skin tone
HVLA: high-velocity low-amplitude
HVT: high-velocity thrust
INIT: integrated neuromuscular inhibition technique
LAS: local adaptation syndrome
MET: muscle energy technique
MI: mechanical interface
MPS: myofascial pain syndrome
MRT: myofascial release technique
NGF: nerve growth factor
NGP: noxious generative point
NMT: neuromuscular technique/therapy (USA)
PINS: progressive inhibition of neuromuscular structures
PIR: post-isometric relaxation
PNF: proprioceptive neuromuscular facilitation
PRT: positional release technique
PSIS: posterior superior iliac spine
RI: reciprocal inhibition
SCM: sternocleidomastoid
SCS: strain/counterstrain
STM: soft tissue manipulation
TCM: traditional Chinese medicine
TFL: tenor fascia lata
TMJ: temporomandibular joint
Chapter Contents

CHAPTER ONE
Somatic dysfunction
Coherent and incoherent patterns
Reporting stations
Effect of contradictory information
Neural cross-talk
Mechanisms that alter proprioception
Trophic neural influences
Neural influences on gene expression
Maitland and Butler: 'abnormal neural movement'
The role of neuromuscular techniques
General adaptation syndrome (GAS) and local adaptation syndrome (LAS), and connective
tissue
A biomechanical stress response sequence
Causes of soft tissue dysfunction
Stressing the soft tissues
Understanding pain
Other models of pain genesis
Different responses in postural and phasic muscles
Role of the muscles in low back problems
Muscle types
Postural and phasic muscle lists
Fibrositis
The fascial network
Functional fascial continuities
Soft tissue changes - energy and fascial considerations
Fascial stress responses and therapeutic opportunities

CHAPTER TWO
NMT: a brief historical overview
A brief history
Tissues involved in NMT
Judith Delany's overview of NMT in the USA

CHAPTER THREE
Pain patterns
Difference between referred phenomena and radicular pain
Non-radicular patterns of referred pain
Other reflexogenic models
Understanding facilitation
Tension headaches and facilitation
Viscerosomatic reflexes
Palpating facilitated spinal tissues
Causes of local facilitation
Trigger points
STAR or TART
Trigger points: symptoms other than pain
Production of trigger points
Identifying trigger points
Trigger points features
Trigger point deactivation
Other views on trigger points
The stress burden and trigger points
Hyperventilation: an example of compound stress influences
Pathophysiology of fibromyalgia/fibrositis/myodysneuria
Conclusion and hypothesis

CHAPTER FOUR
Reflex patterns and areas
Acupuncture points
Acupuncture points and their morphology
Acunpuncture and applied kinesiology
Ah Shi points
Alarm points, Associated points, Akabane points
Bennett's neurovascular reflex points
Chapman's reflexes
Connective tissue massage
Jones' tender points
Periosteal pain points
Confusion?