Clinical Techniques an overview

One thing that people are surprised with when they enter my clinic is that I do an awful lot of hands-on manual therapy. This is due to the assumption that all a physiotherapist will do is prescribe a list of magic exercises that will make the problem go away. This is not the case. As a neuromuscular therapist I will look at which areas of the body may have adhesions and restrictions of the fascia and muscular tissue, which postural elements are impeding certain movements such as tilts , rotations, hikes and everything in between. Ultimately the aim is to remove restrictions, restore mobility, Improve function and improve global function of the somatic body. During the course of treatments I use a lot of different hands-on techniques and the reason behind doing some of these might surprise you so let's take a quick dive into some of the techniques I use and why I use them!

Massage

A lot of my manual treatments have an element of massage in them. Generally I would use massage based therapy to stimulate fresh blood flow and as part of an assessment to gauge the quality of the underlying tissue. It can be easy to palpate areas of restriction by getting hands on with tissue. This doesn't mean jamming my fingers and thumbs into the soft tissue but more so having a move and feel and sense of the pressures and textures of the tissue. Adhesions between muscle fibres can be broken with cross fibre strokes and tissue and blood flow restored to areas of hypoxic tissue. There is an element of myofascial release with this type of work which is non specific and can help with function but with a particular area of restriction other modalities will be needed. Muscles are equipped with proprioceptors which refer feedback to the brain about the conditions in that tissue. Some tissues have higher degrees of these receptors and love friction and stimulation, Some larger muscles don't have the same levels of these tissues and have a high likelihood for the development of restrictions.

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Soft Tissue Release

Soft tissue release(STR) or active release therapy (ART) is a type of release method known as a pin and stretch technique. This will involve me isolating a contact point close to the region of soft tissue dysfunction and either passively or actively (patient led) moving the muscle ; Thus a pin and stretch. This produces a longitudinal sliding motion of the soft tissues beneath the anchored point of contact. This is particularly good in areas of deep restriction where the tissue is rigid and immoveable and can also be a good tool to use when an injury is healed to restore function and movement to the area. 

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Harmonic technique

This is a gentle rocking of the body or limb and has a multitude of uses in a clinical setting. Some of these include dropping sympathetic muscle tone and aiding the patient to relax, An increase in Hyaluronic acid (HA) production in the tissues and can also be used as a fascial integration tool to stimulate the fascial system connections.

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Muscle Energy Technique

This is a highly versatile technique I use in the clinic. It consists of a small isometric contraction of the muscle against a force which is therapist pressure after a certain amount of time the patient relaxes the contraction and the therapist can move the muscle to a new Range. This increase in moveable range can happen for a number of reasons. WHen the isometric contraction is held there is a period of relaxation of the muscular feedback system to the brain. This means for a few seconds the monosynaptic reflex arc can be slightly bypassed to move to a new area of bind or new end point of tissue Range of motion. This can aid in the changing  of tissue texture, Breaking of restrictions from muscle fibre to fibre, Nerve to fascia and fascia to fascia. This technique can also be used during the treatment of myofascial trigger points. When a tissue harbouring myofascial trigger points is under contraction the trigger point will be tensioned. When tensioned correctly and precisely it can be enough to open some of the stuck fibres and channels and restore motion and reduce pain sensations. Another great use of this technique is in the retraining of tissue following an injury. Often it can be the first technique used in order to restore nervous activity in the inhibited muscle following an injury and be the first step in restorative rehabilitation.

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Reciprocal inhibition 

Reciprocal inhibition is a fascinating tool for any NMT to dabble with. It is very similar to MET but is used in reverse. Where the client will contract and instead of lengthening the muscle the muscle will be shortened thus lengthen the opposition muscle. It can be used for the same reasons as above however more frequently it is used to restore motion and balance to reciprocal muscular pairs or agonists and antagonists. This can sometimes be a small missing link following injuries which can help prevent reinjury and further adaptation.

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NMTQ

Neuromuscular technique

This can be used as multiple stages of the treatment process. It's a technique in which a stimulus or pressure is applied to tissue for the purpose of affecting it positively. In an area of tension it can help increase HA levels and soften tissue. This can also be said the same for its use in harder tighter muscles as it aids to increase blood flow via ischaemic technique.Its more precisely used to treat Myofascial trigger points via the same mechanisms. It can attract blood flow into a hypoxic area and restore function to muscle units which are caught in contraction. This works very well as part of a multi technique treatment and may be the best technique for pain level reductions.

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Positional Release

This is probably the most understated technique in a therapist's arsenal. It is subtle and powerful and can have huge impacts on certain tissues. This in short is used to hold the tissue in a shortened position for an extended period of time. During this time the tissue is shortened and the feedback being received by the brain from the proprioceptors is that of lack of tension and ease. With this feedback the nervous system can let go of any unnecessary tension it may be harbouring as a result of the reflex arc. This means that any spasm activity in the muscle can relax. This can be used when Painful muscular spasms interfere with movement and also when a muscle is so tight and tense that any sustained pressure becomes too painful for the patient to deal with. It can prove very useful as a reset tool following a body of work across a limb. Again it can be used to aid in the treatment of myofascial Trigger points.

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Myo fascial Release

Myo fascial release is a subtle yet powerful technique I use in order to work with the fascia rather than the muscle tissue itself. We know that the muscles are wrapped in fascia and also that the fascia will run through the muscle also. Fascial Sheets and fascial systems run all the way through the body from head to foot from finger to toe. There are hypothesised directions of pull and force such as tom myers anatomy trains and kinetic chains but in reality these chains are working together with everything all the time. When we have a fascial restriction the fascia can contract and pull out limbs and anatomy into postures which may be contributing to the pain experienced and the overall health and function of the tissue. Myofascial release is a technique used to aid in the unwinding of fascia allowing for better blood and nutrient flow into tissues but also aiding in reducing the tension across certain tissues. It can be used Alongside Structural integration as a means of rehabilitating postural issues.

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These are just a few techniques of the many that are used in my clinic. I have gone too much into the science behind how they act on the tissue and how they provide their therapeutic benefit but this serves as a little introduction. Other techniques I use in my clinic include Balanced ligamentous tensions, Movement based rehabilitations , breathwork, strain counterstrain , cupping and Frequency specific microcurrent which I will write a full blog on.

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The take home message as with all my blogs is this. All of these treatments are designed to aid in the fixing of a problem.Problems have multiple causes and until those causes are dealt with this will help but it won't stop the issue from occurring. If you're not moving properly this will need to be addressed through increasing movement ranges and activities. If you don't eat properly and you are nutrient deficient this will need to be corrected. If you're dehydrated you need to drink water. If you're not sleeping you're not recovering physically or mentally. Do the 90% before looking for the extra 10%.

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