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 NEUROMUSCULAR THERAPY (NMT)

What is it?
DEFINITION AND EXPLANATION OF NEUROMUSCULAR THERAPY
Neuromuscular Therapy (NMT), or Neuromuscular Massage, is a specialized, advanced form of rehabilitative bodywork characterized by constant, focused pressure on specific areas called "trigger points." Trigger points are small areas of spasm within a muscle that are localized or that transfer or "refer" pain to another area.

What is it used for?
CONDITIONS NEUROMUSCULAR THERAPY CAN HELP

NMT is commonly used to treat these chronic and acute pain conditions:

- Tightness or ischemia in muscles or tissues
- Back or neck pain and stiffness
- Carpal tunnel syndrome and other ailments resulting from repetitive action
- Sciatica
- Muscle spasms or weakness
- TMJ
- Sports injuries or accidents
- Pain, numbness and tingling in the appendages (arms, hands, legs, and feet)

Where did it come from?
HISTORY OF NEUROMUSCULAR THERAPY
NMT evolved from European "Neuromuscular Techniques." European chiropractors and naturopaths began exploring and developing soft tissue pain relief techniques in the mid-1900s, which were further refined by osteopaths throughout the century.

Between the mid-1930s and early 1940’s, major progress in European-style neuromuscular techniques is credited to cousins Stanley Lief and Boris Chaitow, both trained in osteopathy and naturopathy.

Stanley Lief's childhood was marred by poor health. One day he noticed an American magazine titled "Physical Culture" in his father's store. The magazine, which promoted health and fitness, inspired Lief to eventually travel to America to study with its founder Bernarr MacFadden, the U.S. "Father of Health Related Fitness." In 1925 Lief founded the British College of Naturopathy.
Along with his cousin, he practiced and developed NMT at his Hertfordshire, England health resort where they were able to test their theories and methods on a wide variety of conditions.

The prolific publications of osteopath/naturopath/acupuncturist Leon Chaitow through the latter part of this century have provided a major contribution to the establishment of European Neuromuscular Therapy as an important adjunct to complementary medicine. European neuromuscular techniques are now taught widely in osteopathic and sports massage settings in Britain.

American NMT was pioneered in the '80s by Paul St. John and later his student and colleague Judith DeLany (nee Walker). St. John was a student of one of NMT's major American researchers Dr. Raymond Nimmo, D.C.
St. John came to NMT as man on a quest for relief. Serious injuries had left him in chronic debilitating pain despite four years of chiropractic, neurological, osteopathic, and even psychiatric treatments. In his frustration, he began looking for answers in medical libraries studying pain mechanisms, researching the functioning of the nervous system and the neurological laws that govern the workings of the body. During this process he discovered the work of Nimmo and the underpinnings of NMT, which he credited with his eventual full recovery. He began teaching his system in the late '70s.  He continues to teach and treat patients and further refine his methods through the St. John/Clark Center in Clearwater, Fla.

DeLany worked alongside St. John for five years, assisting in the development of NMT techniques and protocols for massage therapy application. She also began scholarly writing on NMT.  After separating from St. John in 1989, DeLany developed, taught and wrote about the NMT American Version. DeLany now directs the NMT Center in St. Petersburg, FL.  She also contributes to the training of European therapists seeking a Higher Diploma in NMT through the National Training Centre in Ireland with exercise physiologist John Sharkey and Leon Chaitow. NMT National Qualification certification is now offered at the National Training Centre. 

What is it based upon?
THEORY OF NEUROMUSCULAR THERAPY
NMT is based on the concept that six aspects of the physical and mental life can affect pain:  nutrition, emotional stress, ischemia, nerve compression, trigger points, and poor posture or biomechanics.  By evaluating the relationships and interactions between these six factors NMT can help resolve the pain that stems from these muscle, skeletal, and nervous system issues.

What distinguishes NMT most from other forms of massage is the treatment of trigger points (areas of hyperactive, dysfunctional myofascial tissues that are tender to pressure and that refer pain or other symptoms to another part of the body). Therapists are trained to locate and analyze these trigger points and their pain patterns, and master techniques to relieve chronic and acute conditions. Therapists apply pressure using fingertips, knuckles, elbows, or a small rubber tipped tool called a "t-bar."  The pressure is perpendicular to the body and may be applied after warming the tissue with Swedish massage, counterirritant salves or heated towels.

How is it done?
CLINICAL PRACTICE OF NMT
The setting for NMT is often more clinical than a relaxation massage.  External sounds such as music or other noises are minimized since patient-therapist communication is critical.  In general, a neuromuscular therapist works more deeply and more specifically on the area of concern rather than on the full body. The patient should be aware that the general guideline is that treatment should be uncomfortable, but not painful.  Patients are asked to let the therapist know if discomfort is experienced using a scale of one to ten.  Highly sensitized tissues and trigger points feel like "hot spots" of pain in a very specific part of a muscle, while the rest may not be sensitive. Resolving and treating these “hot spots” is necessary to eliminating the pain, so they will be treated in a gentle and gradual way.  NMT therapists generally believe that the degree of pain experienced is a measure of the dysfunction of the underlying tissue.  An absence of discomfort indicates the muscle is healthy.

NMT techniques involve the use of long strokes toward the heart (called "effleurage" in massage) to warm up the tissues and clear waste products; lightly lubricated slow gliding strokes to examine, soften and lengthen a muscle; compression and static pressure to release contractions. The therapist may also utilize a variety of techniques including applying ice or heat, stretching the patient, and possibly performing myofascial release or positional release.

The primary and desired goal of NMT is pain relief.  However the patient may enjoy other benefits such as higher energy levels, improved poster, great flexibility, and better muscle tone.

Who does it?
NEUROMUSCULAR THERAPY PRACTITIONERS
NMT practitioners study a specialized curriculum to acquire an in-depth understanding of the physiology of the nervous system and its effect on the muscular and skeletal systems, kinesiology and biomechanics and how to work in a clinical or medical environment.

NMT requires additional training in addition to basic massage licensure, ideally along with practical application in a clinical setting under the guidance of experienced professionals. Certification is optional, and training ranges from home study courses to the equivalent of a Masters Degree. Guidelines vary greatly by state and facility.