Neuromuscular Therapy - Brisbane MSK Clinic
What is Neuromuscular Therapy?
Neuromuscular Therapy is a form of myofascial release that uses ischemic compression to treat myofascial trigger points, pain and restrictions in mobility. The technique is a form manual therapy with origins in Osteopathic medicine. The terms Trigger Point Therapy (TPT) and Neuromuscular Technique - NMT are often used to describe similar techniques. These methods all have a lot in common with the ancient Chinese art of Acupressure. Techniques have evolved, leading to variations in name and how one performs them. Neuromuscular therapy techniques are just one of many treatment methods available at the Brisbane MSK Therapy Chronic Pain Clinic in (Morningside).
Trigger points within tissues often create pain and restrict mobility. The body tries to avoid pain by adapting how one moves, which is helpful in the short term (see the article on Soft Tissue Adaptation to activity and injury). Adaptations mean that we move differently to normal, which can lead to further changes. The human body is good at masking or hiding issues, and it may take months or years for some people to notice that there is a problem. There will likely be months or years of soft tissue adaptations and learned movement patterns in chronic pain cases (see the article on Chronic Pain Treatment for further details on aspects of such conditions and treatment). Chronic or persistent pain occurs due to issues impacting the normal tissue healing process, effectively unresolved trauma. Such a situation can arise for many reasons, such as a lack of treatment, ineffective treatment and recovery plan or further injury.
Neuromuscular technique (NMT) and Palpation
Effective treatment with NMT relies on the therapist's ability to palpate. Most forms of manual therapy require a refined sense of touch or palpation skills. Such skills take years to develop, and even though many massage therapy courses teach NMT, they do not teach palpation. Without such skills, one would be assessing by guesswork and then treating based on a guess at best. Finding Myofascial Trigger Points or Trigger Points (TrPs), for short, is not just about finding areas of pain. Equally, treating TrPs is not just about finding a painful point and pressing it until some form of relief occurs. Poor palpation and technique application skills result in an unpleasant patient experience. Furthermore, there can be a tendency to require additional treatment(s). Equally, applying any soft tissue therapy in the wrong situation can worsen symptoms. Terry at TotalMSK was fortunate enough to learn in-depth palpation skills during his six years of training at the McTimoney College of Chiropractic in the UK. Over the 16 years, he has been working in the soft tissue therapy field, these skills have evolved.
NMT and Myofascial Release (MFR)
Although NMT is a form of myofascial release - MFR, it works very specifically. MFR methods work in different ways, either directly or indirectly, with TrPs. Although one applies NMT to specific points, many other MFR techniques may cover a wide area of tissues. Petrissage Massage techniques such as "Stripping" from sports massage are a form of MFR used to treat large areas. Active Release Technique (ART) ®, is another method similar to "stripping" and Soft Tissue Release. Even Foam rolling is a form of self-myofascial release (SMFR) and works better on larger muscles and tissues. How one uses techniques depends on knowledge and experience. It is not a case of one approach being better than another, just knowing how to achieve the patient's goals best. As one might expect, effective use of NMT depends on several factors, which can vary between therapists:-
- Palpation skills
- Overall assessment ability
- Clinical knowledge
- Overall experience
- Technique use and application
Can you do neuromuscular therapy on yourself?
The short answer is yes, though there are limitations and considerations. Although the internet and social media can be excellent sources of learning, sadly, not all of that information is good. Anyone can post videos and content online with little or no understanding of anatomy or technique. Some of these videos demonstrate people using techniques in areas that are not safe to do so.
It is essential to understand that manual therapists have training in various areas or disciplines. The level and depth of training depend on the qualification. Besides the practical use of various techniques, there are also contraindications to the treatment methods. These relate to using a specific method or when it is safe to use it. Some conditions may mean that using a technique is unwise or even dangerous. In other cases, it may only be safe to use a method to treat some areas or at certain times. Equally, a diagnostic process involves a combination of knowledge and testing. Some manual therapists can legally diagnose, though many cannot provide a diagnosis. Knowing what one is treating is vital, and self-diagnosis via the internet often ends badly. These factors can impact the results of attempting self-treatment and need considering.
It is possible to self-treat with NMT or Trigger Point Therapy (TPT). It is pretty easy to worsen symptoms by misusing a method or in the wrong situation. Equally, tissue tension changes when self-applying most methods, angles are different, and it can be difficult to control pressure levels. Even with Terry's knowledge, he can treat some areas and not others. The article on self TPT using a massage ball offers some hints and the limitations of this method.
What is better Neuromuscular Therapy or Dry Needling?
There may well be similarities in how NMT and Trigger Point Dry Needling (DN) work. Both methods work with MTrPs and involve finding these and then applying a form of pressure or ischemic compression. Dry Needling is more invasive, as the method uses a filament needle to pierce the skin (not that one always feels this). The actual tissue release for both methods feels similar, almost a melting sensation. Again, what one feels may vary between therapists and based on the factors covered earlier. Currently, there are good theories on how both methods work, but nothing concrete. One can use both techniques very precisely with the right level of anatomy knowledge and palpation skills. Besides the similarities between the methods in locating and treating myofascial trigger points and the releasing sensation, there is also evidence of the techniques producing similar effective results. Studies demonstrating the benefits of NMT methods include those for headaches , Neck and shoulder pain [2,3,4,5], upper arm pain , carpal tunnel syndrome , lower back pain , knee pain  and ankle pain .
There are advantages and disadvantages for techniques, and NMT or other ischemic compression techniques are no different. Dry Needling (DN) has additional risks due to the invasive nature of the method, though these are easily manageable. Also, Dry Needling requires direct skin contact/access and various ancillaries. Few risks are associated with using Neuromuscular Therapy techniques, and there is no need for direct skin contact or access. It is sometimes unsafe or higher risk to access some of the deeper muscles within the body using a needle, yet it is possible with NMT methods. On other occasions, a needle may prove more effective in releasing a deep muscle over NMT.
Myofascial Pain Relief - Treatment and Techniques
- 1) A sonographic comparison of the effect of dry needling and ischemic compression on the active trigger point of the sternocleidomastoid muscle associated with cervicogenic headache: A randomized trial.
- 2) Dry needling versus trigger point compression of the upper trapezius: a randomized clinical trial with two-week and three-month follow-up.
- 3) Compression at Myofascial Trigger Point on Chronic Neck Pain Provides Pain Relief through the Prefrontal Cortex and Autonomic Nervous System: A Pilot Study.
- 4) Evidence for the Use of Ischemic Compression and Dry Needling in the Management of Trigger Points of the Upper Trapezius in Patients with Neck Pain: A Systematic Review.
- 5) Chronic shoulder pain of myofascial origin: a randomized clinical trial using ischemic compression therapy.
- 6) Effectiveness between Dry Needling and Ischemic Compression in the Triceps Surae Latent Myofascial Trigger Points of Triathletes on Pressure Pain Threshold and Thermography: A Single Blinded Randomized Clinical Trial.
- 7) A randomized controlled (intervention) trial of ischemic compression therapy for chronic carpal tunnel syndrome.
- 8) Effects of compression at myofascial trigger points in patients with acute low back pain: A randomized controlled trial.
- 9) Comparison of dry needling and ischaemic compression techniques on pain and function in patients with patellofemoral pain syndrome: a randomised clinical trial.
- 10) The immediate effect of soleus trigger point pressure release on restricted ankle joint dorsiflexion: A pilot randomised controlled trial.
Massage and Myotherapy Registrations
Terry brings over 16 years of experience treating in the MSK Therapy field back to Brisbane from the UK. He is highly qualified with relevant education and training spanning from Certificate level through to higher education and a Masters. His training and experience cover many assessment methods, treatment types and soft tissue therapy (STT) skills. Besides the sixteen years of clinical experience, Terry has a further eight years of experience training and working at the highest physical performance levels within the elite British forces environment. He has a personal experience with a range of running injuries and a vast amount of professional treatment experience. He is still an avid distance runner to this day. Such knowledge has proved highly valuable in the treatment of elite-level athletes and members of the public. His ongoing sporting activities, experiences and interests have naturally led to him specialising in human performance and treating trauma and myofascial pain. He also taught as a senior course coach on the first myotherapy course in Brisbane. His skills are now available at the Morningside clinic, where he works as a Myotherapist.