NMTandStyles.pdf

MASSAGENERD.COM

Presents

"The deeper the pressure...The slower the technique..."

Ryan Hoyme

CMT, NCTMB, HST

"Keep your eye on the donut, not the hole."

ÐIt's a mistake to assume that the problem is always at the place that it hurtsÑ

A finger: indicates a small area, no spreading of discomfort, problem probably not severe, relatively superficial, or both.

The whole hand: diffuse area as primary site : suggests lesion is more severe, more deeply situated, or both.

A moving hand: spreading or radiating of the pain : if along a well-defined pathway : dermatome: probably nerve root problem.

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All models are at least 18 years of age. The techniques, ideas, and suggestions in this document are not

intended as a substitute for proper medical advice! Consult your physician or health care professional before

performing or receiving a massage, particularly if you are pregnant, nursing, elderly, or if you have any chronic or

recurring conditions. Any application of the techniques, ideas, and suggestions in this document is at the reader's

sole discretion and risk.

The author and publisher of this document and their employers are not liable or responsible to any person or

entity for any errors contained in this document, or for any special, incidental, or consequential damage caused or

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General area, diffuse: most likely referred pain, possibly visceral in origin.

INDEX

* NEUROMUSCULAR THERAPY (4)

* POSSIBLE SIDE EFFECTS (7)

* TEN TIPS TO ENHANCE YOUR

TREATMENT SESSIONS (8)

* CONTRAINDICATIONS TO DEEP

BODYWORK (8)

* ACTIVE RELEASE TECHNIQUE (14)

* ROLFING (15)

* HELLERWORK (15)

* TRICKED YOU TRIGGER (22)

* CLIENT UNDER TRIGGER (22)

* FOLLOW DOWN TECHNIQUE (22)

* AMERICAN -STYLE NEUROMUSCULAR

THERAPY (15)

* EUROPEAN-STYLE NEUROMUSCULAR

THERAPY (15)

* INTEGRATED NEUROMUSCULAR

INHIBITION TECHNIQUE (16)

* GUESSING FOLLOW DOWN (22)

* FOLLOW UP TECHNIQUE (23)

* HOLDING TECHNIQUE (23)

* GIVING A DEEP TISSUE MASSAGE (8)

* RECEIVING A DEEP TISSUE MASSAGE

(8)

* ATTACK JAWS (23)

* TEASE JAWS (24)

* PAINLESS JAWS (24)

* LAWS OF NEUROMUSCULAR THERAPY

(9)

* OTHER LAWS (9)

* FELDENKRAIS (16)

* MEDICAL MASSAGE (16)

* VISCERAL MASSAGE (16)

* LEAN BACK ANGLE (24)

* LEAN BACK (25)

* TWIST THAT TRIGGER (25)

* RULES FOR NMT (10)

* MYOPRACTIC (11)

* MYOTHERAPY (11)

* BASIC TRP TECHNIQUE (16)

* ISCHEMIC COMPRESSION #1 (17)

* ISCHEMIC COMPRESSION #2 (17)

* JACKHAMMER (25)

* ASSISTIVE TRIGGER (26)

* DOUBLE TROUBLE (26)

* ORTHOPEDIC MASSAGE (11)

* PAUL ST. JOHN NEUROMUSCULAR

THERAPY (12)

* PERCUSSION AND STRETCH (12)

* MYOSKELETAL ALIGNMENT

TECHNIQUES (12)

* ORIGIN TO INSERTION CONNECTION

(13)

* ISCHEMIC COMPRESSION #3 (17)

* ISCHEMIC COMPRESSION #4 (18)

* RECOIL (26)

* SLIP (26)

* RHYTHMIC ISCHEMIC COMPRESSION

(18)

* LONGITUDE FRICTION (18)

* DISTRACTION (27)

* SQUEEGEE (27)

* FACILITATED POSITIONAL RELEASE

(27)

* EXAGGERATION OF DISTORTION (27)

* MITS TREATMENT PROTOCOL (27)

* ALEXANDER TECHNIQUE (18)

* TENSE BREATH TRIGGER (19)

* TENSE BREATH BOTH (19)

* ORIGIN & INSERTION TRAP (13)

* SOFT TISSUE RELEASE (13)

* TANDEM POINT THERAPY (13)

* TENSE BREATH OPPOSITE (19)

* BREATHE INTO TRIGGER (20)

* PFRIMMER (20)

* ILIAC CREST HOOK-UP (28)

* ILIAC CREST HOOK-DOWN (29)

* TROCHANTER HOOK (29)

* TRIGGER POINT PRESSURE RELEASE

(14)

* MYOFASCIAL RELEASE (14)

* TRAGER (20)

* RUSSIAN MASSAGE (20)

* IN & OUT INTENSE TRIGGER (21)

* PSOAS (30)

* DEEP TRANSVERSE FRICTION (14)

* MUSCLE RELEASE TECHNIQUE (14)

* RESIST INTENSE TRIGGER (21)

NEUROMUSCULAR THERAPY

(A.K.A. - DEEP TISSUE MASSAGE)

www.nmtcenter.com/history/history.html

Neuromuscular Therapy (NMT) is the manual application of specialized strokes and pressure, usually delivered by a finger or thumb for

diagnostic (assessment mode) and therapeutic (treatment mode) objective. The treatment aims to restore circulation and reduce pain in an area. Also, the

aim is to normalize imbalances in fibrotic tissue where adhesions of scar tissue and calcium deposits have restricted movement in a joint.

Basics

By definition, NMT is the utilization of static pressure on specific myofascial points to relieve pain. There are many different beliefs with NMT;

the main reason behind the therapy of NMT is to reduce the clients pain (Not a relaxing form of massage). The depth and pressure of the work is kept

within the comfort range of the client. Ask the client to assign a number to the level of pain they are feeling - on a scale of one to ten, ten being the most

painful and the average pressure for theÑ hurt so goodÑ pain is 7-8. Anything more 7-8 is not as beneficial to the client and the client is more than likely to

tense up and causes more pain (everyoneÓs pain threshold is different, communicate with the client and talk them through the pain). NMT is considered a

deeper form of Swedish massage, but is altered to fit the client. Neuromuscular therapists treat the fascia, tendons, ligaments, muscle belly, muscle

origins, and muscle insertions.

Techniques

The first rule is to warm the area up, the reason behind this theory is to have the muscle relaxed as much as possible so the muscle is less likely

to be sore and to bruise after the treatment. The slower you move with your techniques, the better you will be at palpating problem areas.

NeuroMuscular Therapy addresses the release of tissues in layers, superficial to deep, and is performed at a moderate speed with light

lubrication. Treating origins and insertions, as well as the belly of a muscle is also of critical importance. It doesnÓt require a great deal of pressure to be

effective, which is a benefit to the patient.

The techniques vary from therapist to therapist and no therapists with perform the same techniques in order. Therapists use many techniques:

gliding friction (primary technique), ischemic compression (trigger point therapy), and skin rolling and stretching.

Striping technique or Longitude friction - involves the application of slow, deep, gliding pressure along the length of the muscle fibers

(Some therapists call it longitude friction). With each time you massage over a specific area, you can increase the pressure to find the tender

area. Therapists start out with the superficial layer of the muscle, and then gradually go to the deeper layer.

Deep transverse friction or Cross fiber friction or Cross Friction - Dr. James H. Cyriax was the first to thoroughly and

systematically study soft tissue lesions of the orthopedic system, and devise a specific massage technique for their treatment called deep

transverse friction. Cross fiber friction is a deep non-gliding and oil-less friction technique that moves across the grain of a muscle, tendon or

ligament. The main reason behind this technique is to break-up adhesions or scar tissue. With this technique, the clientÓs range of motion can

be increased. The technique must be performed directly over the site of lesion and pain. The fingers move with the skin and do not slide over

it. Technique must be performed across the grain of the affected tissue. The thicker the structure, the more friction is given.

Compression - Consists of pressure exerted perpendicular to the surface of the muscle.

Pincer Palpation/Compression - Grasp the tissue between the thumb and the tips of the first two or three fingers, or the outside of the

bent index finger.

Forearm Glide - The ulnar aspect of the forearm provides a broad surface for deep, gliding compression of long, straight muscles.

Elbow Compression - The Olecranon process of the ulna.

Heel of Hand Compression - The heel of the hand, or thenar and hypotherar eminences.

Fist Compression - Closed fist.

Knuckle Compression - The proximal interphalangeal joints, or knuckles, of the index and middle fingers can be used for compression.

Thumb or Finger Compression - Still or gliding compression using the tip of the thumb or fingers.

All the different types of stretching.

Styles of NMT

Neuromuscular Therapy (NMT) - a system of soft-tissue manipulation

techniques that were developed in the 1930Ós in England by Dr Stanley Lief.

Paul St. John is the biggest teacher of Neuromuscular Therapy today and his

form is called ÐSt. John Neuromuscular TherapyÑ.

Russian massage - a system of therapeutic and sports massage developed in the

former Soviet Union. The four main techniques are: Petrissage, Effleurage,

Friction and Vibration.

Rolfing technique - developed by Ida P. Rolf, Ph.D., is a system for integrating

the human physical structure. There is a series of ten treatments, treating

different areas of the body. It is a form of connective tissue (fascial)

manipulation and education.

Hellerwork - a series of one-hour sessions of deep tissue bodywork and

movement education designed to realign the body and release chronic tension

and stress. Joseph Heller in the USA formulated this form in 1978.

Myopractic - integrates Swedish massage, trigger point, myofascial release, and

even structural integration techniques to form an integrated system. The three

main techniques are: Compression Stretching, Clearing, and Separating.

Myotherapy - Bonnie Prudden developed this style. Myotherapy treatment is a

two-step process. The therapist first locates and diffuses the trigger points of

pain through applying pressure to those locations (5-7 seconds). This process

relieves the pain and also relaxes the muscles associated with the specific

discomfort. Secondly, during the therapy session the patient undergoes a series

of exercises to progressively stretch the muscles that have been relaxed by the

pressure therapy.

Canadian Deep Muscle Massage - This work was created by Will Green,

founder of the International Massage Association (IMA Group) and owner of

Georgetown Bodyworks in Washington, DC. It is derived from a system of

cross-fiber massage that began in northern Canada in the 1940Ós. Green added

insights gained from the works of Therese Pfrimmer, Joseph Pilates, Ida Rolf,

Dr. Samuel West, and Debra Smith. This technique begins gently and

progresses deeply as the outer muscle fibers relax, allowing the second and

third layer of muscle to be addressed.

Pfrimmer Deep Muscle Therapy (PDMT) - a highly refined system of

corrective treatment designed to aid in the restoration of damaged muscles and

soft tissue throughout the entire body. Using a specific series of cross-tissue

movements applied to the muscles, a fully trained Pfrimmer Deep Muscle

Therapist concentrates on all layers of muscle that have become depleted of

their normal blood and lymphatic flow.

Neuromuscular Therapy will be used to address five elements that cause pain:

1. Ischemia: Lack of blood supply to soft tissues which causes hypersensitivity to touch.

2. Trigger Points: Highly irritated points in muscles which refer pain to other parts of the body.

3. Nerve Compression or Entrapment: Pressure on a nerve by soft tissue, cartilage or bone.

4. Postural Distortion: Imbalance of the muscular system resulting from the movement of the body off the longitudinal and horizontal planes.

5. Biomechanical Dysfunction: Imbalance of the musculoskeletal system resulting in faulty movement patterns (i.e., poor lifting habits, bad

mechanics in a golf swing of tennis stroke, computer keyboarding).

*American-style Neuromuscular Therapy - uses a medium-paced (thumb or finger) gliding strokes.

*European-style Neuromuscular Therapy - use a slow-paced, thumb-drag method.

Pressure Techniques

Myotherapy (also called trigger point therapy) - Seven second

pressure to the trigger point, followed by stretching, popularized by

Bonnie Prudden.

Neuromuscular therapy - Repeated pressure to the trigger point,

followed by stretching.

Myofascial release - Pressure to one point in a taut band or one end

of a taut band plus stretching.

Trigger point pressure release - Gentle pressure along the taut

band and the trigger point, recommended in the most recent volume

of Myofascial Pain and Dysfunction.

Deep tissue massage - Including cross-fiber friction.

Percussion and stretch - Tap the trigger point slowly with a

mallet, 10 times, then stretch.

Tandem Point therapy - Pressure to a trigger point, plus pressure

to another trigger point in the taut band or to a point in a pain

referral pattern, plus acupressure to an acupuncture point, plus

stretching.

Soft tissue release - Pressure to a series of points in a taut band,

plus stretching.

Rules

ÐWork the non-affected side of pain first, then the specific area of pain, then back to non-affected sideÑ

1. The reason you massage the unaffected side first is so you can relax the muscles and to perform a test (when muscle testing you want to

stretch the unaffected side, then the affected side and back to the unaffected side to get a good reading).

2. Once you massage the unaffected side, you can move to the affected side (always keep in mind what the unaffected side felt like and

compare).

3. After you are done massaging the affected side, you can then massage the unaffected side again (keep in mind what the difference is

between the affected and the affected side).

You might need to explain this theory to the client, because they want you to massage mostly the affected side. This theory will prevent the

muscles from tensing up and causing a spasm. If one side of the body is injured, the other side over compensates.

Do not over treat an area and come back to the problem area after 5-10 minutes to see if any improvements have happened. Giving the client

time to rest between problem areas is beneficial and it gives you time to relax your muscles.

Before you start

Always ask the client where the pain is, how much pain are they in, how frequent do they have the pain, how often do they have pain, what

makes the pain worse or better and so on. Posture evaluation is a great device for locating pain and cutting down your time in guessing. With posture

evaluation, you need to find what side or area of the body is more contracted (usually the contracted area in protecting).

If someone comes in your clinic with low back pain, do not just treat the low back; it could be other areas around the tender area that is the real

pain (that goes for any other area of the body).

Communication

With good communication between the client and the therapist is vital, without communication the treatment will not work. Communication

does not have to be verbal; the actions of the client speak a lot louder than words. Watch for curling the toes or fingers, tensing up the other side of the

body and breathing patterns (when client holds their breath, ask them if they would like you to back off the pressure or have them breathe through the

pain). Be sure to tell them that they are in control of the session and that their feedback is important to the session.

Breathing through the pain helps to relax the muscle faster and it brings oxygen to that area. Some clients will scoot around the table or have a

physical or emotional release when you are working on them, just be cautious with this type of client, because they might not know their own pain

tolerance and cause problems for you down the road. One good way to tell if a client is tensing up is to have your hand resting on the opposite muscle

group (the client is more than likely going to tense up on the opposite side and try to handle the pain on the affected side). Release can come about in

many ways: shaking, moving, yawning, sighing, crying, yelling & screaming (be prepared to have any of these happen).

First time client

It does not matter if they had many massages before, all what matters is that they never had a massage from you before (you might want to

explain to the client that the first session that you will not take the pain level to a 7-8 on a regular basis). For first time NMT client you can ask permission

to call them at home the next day and ask them how their treatment went and to answer any questions they might have. The average client viewpoint is, "I

do not want a light massage, I want to feel my body being worked, therefore I must want deep tissue massage."

Tools

The main tools used by a NMT are: thumbs, fingers, palms, forearms and elbows. Some therapists even use actual tool like a T-Bar (T-shaped

tool with a rubber stopper on the end to reduce the pressure of the tool). Do not over use your thumbs, they are very small muscles compared to other parts

of your body. Oil is used in smaller amounts, because your goal is not to slip on the muscles and traction is better with minimal amount of oil. Other

things the therapist can use are coco butter sticks, massage lotion, and massage cream.

How often

If you know any body builders, their belief is not to concentrate on one part of the body for two days. The muscles need rest, if the client does

want a massage two days in a row, you can perform Deeper work only once out of those two days (a better idea is to give them a relaxing massage one

day and a deeper massage the next day). Clients with chronic pain can be your favorite clients, if it is possible to try to recommend them to receive a

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