Clinical Applications of Neuromuscular Techniques; The Upper Body, Volume 1

by Chaitow & Delany

• ISBN13: 9780443062704
• ISBN10: 0443062706
• Format: Hardcover
• Copyright: 2000-10-23
• Publisher: Elsevier Health Sciences

Summary

This volume presents the theories, validation and techniques of manual treatment for both chronic and acute neuromuscular pain and somatic dysfunction. The book takes a regional approach to treatment, providing a structural review of each area including ligaments and functional anatomy. It then examines each muscle and joint for a particular region, and includes step-by-step protocols for each muscle to be treated, giving particular reference to the treatment of trigger points. This text ensures the safe and effective application of soft tissue techniques and provides an invaluable source of reference to all manual therapy students and practitioners.

Table of Contents

List of boxes	xv
Forewords	xvii
Preface	xxi
Acknowledgements	xxiii
Connective tissue and the fascial system	1	(14)
The fascial network	2	(1)
Fascia and proprioception	2	(1)
Fascia: collagenous continuity	2	(1)
Further fascial considerations	3	(1)
Elasticity	3	(3)
Plastic and elastic features	4	(2)
Trigger points, fascia and the nervous system	6	(1)
Summary of fascial and connective tissue function	6	(4)
Fascial dysfunction	10	(1)
Restoring gel to sol	11	(1)
Therapeutic sequencing	11	(4)
Muscles	15	(14)
Essential information about muscles	16	(1)
Types of muscle	16	(1)
Muscle energy sources	17	(1)
Muscles and blood supply	17	(3)
Major types of voluntary contraction	20	(1)
Terminology	20	(1)
Muscle tone and contraction	20	(1)
Vulnerable areas	21	(1)
Muscle types	21	(1)
Cooperative muscle activity	22	(2)
Muscle spasm, tension, atrophy	24	(1)
Spasm	24	(1)
Contracture	24	(1)
Increased stretch sensitivity	25	(1)
Viscoelastic influence	25	(1)
Atrophy and chronic back pain	25	(1)
What is weakness?	25	(1)
Trick patterns	26	(1)
Joint implications	26	(1)
When should pain and dysfunction be left alone?	26	(1)
Beneficially overactive muscles	27	(1)
Somatization -- mind and muscles	27	(2)
But how is one to know?	27	(2)
Reporting stations and the brain	29	(14)
Proprioception	29	(1)
Fascia and proprioception	30	(1)
Reflex mechanisms	30	(2)
Local reflexes	32	(1)
Central influences	32	(1)
Neuromuscular dysfunction following injury	32	(1)
Mechanisms which alter proprioception	32	(1)
An example of proprioceptive dysfunction	33	(2)
Rectus capitis posterior minor (RCPMin) research evidence	34	(1)
Neural influences	35	(4)
Effect of contradictory proprioceptive information	35	(1)
Neural overload, entrapment and crosstalk	35	(1)
Manipulating the reporting stations	35	(4)
Therapeutic rehabilitation using reflex systems	39	(1)
Conclusion	39	(4)
Causes of musculoskeletal dysfunction	43	(12)
Adaptation -- GAS and LAS	43	(1)
Posture, respiratory function and the adaptation phenomenon	44	(1)
Making sense of the picture	45	(2)
Example	46	(1)
Postural and emotional influences on musculoskeletal dysfunction	47	(3)
Postural interpretations	47	(1)
Contraction patterns	47	(1)
Emotional contractions	48	(1)
`Middle fist' functions	48	(1)
`Upper fist' functions	48	(1)
Cautions and question's	49	(1)
Postural imbalance and the diaphragm	50	(1)
Respiratory influences	50	(3)
Summary of effects of hyperventilation	50	(1)
Neural repercussions	51	(1)
Tetany	52	(1)
Biomechanical changes in response to upper chest breathing	52	(1)
Additional emotional factors and musculoskeletal dysfunction	53	(1)
Selective motor unit involvement	53	(1)
Conclusion	53	(2)
Patterns of dysfunction	55	(10)
Upper crossed syndrome	55	(1)
Lower crossed syndrome	56	(1)
Chain reaction leading to facial and jaw pain: an example	57	(1)
Patterns as habits of use	57	(1)
The big picture and the local event	58	(1)
Janda's `primary and secondary' responses	58	(1)
Recognizing dysfunctional patterns	59	(1)
Functional screening sequence	60	(3)
Prone hip extension test	60	(1)
Trunk flexion test	60	(1)
Hip abduction test	61	(1)
Scapulohumeral rhythm test	62	(1)
Neck flexion test	62	(1)
Push-up test	63	(1)
Trigger point chains	63	(2)
Trigger points	65	(20)
Ischemia and muscle pain	69	(1)
Ischemia and trigger point evolution	69	(1)
Trigger point connection	70	(1)
Facilitation -- segmental and local	70	(2)
How to recognize a facilitated spinal area	71	(1)
Local facilitation in muscles	71	(1)
Lowering the neural threshold	72	(1)
Different models for the evolution of trigger points	72	(2)
Awad's analysis of trigger points	72	(1)
Improved oxygenation and reduced trigger point pain -- an example	72	(1)
Nimmo's receptor-tonus techniques	72	(1)
Simons' current perspective	73	(1)
Key and satellite trigger points	74	(1)
Trigger points and joint restriction	75	(1)
Trigger points associated with shoulder restriction	75	(1)
Other trigger point sites	75	(1)
Testing and measuring trigger points	75	(5)
Basic skill requirements	75	(2)
Needle electromyography	77	(1)
Ultrasound	77	(1)
Surface electromyography	77	(1)
Algometer use for research and clinical training	77	(2)
Thermography and trigger Points	79	(1)
Clinical features of myofascial trigger points	80	(5)
Developing skills for TrP palpation	80	(2)
Which method is more effective?	82	(3)
Inflammation and pain	85	(10)
The inflammatory response	85	(1)
Acute (lag) phase of the inflammatory response	85	(1)
Regeneration phase	86	(1)
Remodeling phase	86	(1)
Difference between degenerative and inflammatory processes	86	(1)
Muscles and pain	86	(2)
Reflex effects of muscular pain	88	(1)
Source of pain	88	(2)
Is it reflex or local?	88	(1)
Radicular pain	88	(1)
Are the reflexes normal? What is the source of the pain?	89	(1)
Neuropathic pain	89	(1)
Differentiating between soft tissue and joint pain	90	(1)
When should pain and dysfunction be left alone?	90	(2)
Somatization	91	(1)
How is one to know?	91	(1)
Pain management	92	(3)
Gunn's view	92	(1)
Questions	92	(1)
Pain control	92	(3)
Assessment, treatment and rehabilitation	95	(12)
A biomechanical example	96	(1)
`Looseness and tightness' as part of the biomechanical model	96	(2)
Lewit (1996) and `loose-tight' thinking	97	(1)
Soft tissue treatment and barriers	97	(1)
Pain and the tight-loose concept	97	(1)
Three-dimensional patterns	98	(1)
Methods for restoration of `three-dimensionally patterned functional symmetry'	98	(1)
Managing soft tissue dysfunction	98	(1)
Manipulating tissues	99	(1)
Nutrition and pain: a biochemical perspective	99	(3)
Nutritional treatment strategies	100	(1)
Specific nutrients and myofascial pain	100	(1)
Allergy and intolerance: additional biochemical influences on pain	100	(1)
Treatment for `allergic myalgia'	101	(1)
Anti-inflammatory nutritional (biochemical) strategies	101	(1)
Psychosocial factors in pain management: the cognitive dimension	102	(1)
Guidelines for pain management	102	(1)
Group pain management	102	(1)
The litigation factor	102	(1)
Other barriers to progress in pain management	103	(1)
Stages of change in behavior modification	103	(1)
Wellness education	103	(1)
Goal setting and pacing	103	(4)
Low back pain rehabilitation	104	(1)
Concordance	104	(1)
Patient advice and concordance (compliance) issues	104	(3)
Modern neuromuscular techniques	107	(22)
Neuromuscular therapy -- American version	108	(11)
Biomechanical factors	108	(1)
Biochemical factors	109	(1)
Psychosocial factors	109	(1)
Biomechanical, biochemical and psychosocial interaction	110	(1)
NMT techniques contraindicated in initial stages of acute injury	110	(1)
NMT for chronic pain	110	(1)
Palpation and treatment	111	(7)
Treatment tools	118	(1)
European (Lief's) neuromuscular technique (NMT)	119	(10)
NMT thumb technique	120	(1)
Lief's NMT finger technique	121	(1)
Use of lubricant	122	(1)
Variations	122	(1)
Variable ischemic compression	122	(1)
A framework for assessment	123	(1)
Integrated neuromuscular inhibition technique	124	(5)
Associated therapeutic modalities and techniques	129	(30)
Hydrotherapy and cryotherapy	131	(4)
How water works on the body	131	(1)
Warming compress	131	(1)
Alternate heat and cold: constitutional hydrotherapy (home application)	132	(1)
Neutral bath	133	(1)
Alternate bathing	133	(1)
Alternating sitz baths	133	(1)
Ice pack	134	(1)
Ice coolants as a form of trigger point treatment	134	(1)
Integrated neuromuscular inhibition technique	135	(3)
INIT method 1	136	(1)
INIT rationale	136	(1)
Ruddy's reciprocal antagonist facilitation (RRAF)	137	(1)
Lymphatic Drainage techniques	138	(1)
Massage	138	(2)
Petrissage	138	(1)
Kneading	139	(1)
Inhibition	139	(1)
Effleurage (stroking)	139	(1)
Vibration and friction	139	(1)
Transverse friction	139	(1)
Effects explained	140	(1)
Mobilization and articulation	140	(2)
Notes on sustained natural apophyseal glides (SNAGs)	141	(1)
Muscle energy techniques (MET) and variations	142	(3)
Neurological explanation for MET effects	142	(1)
Use of breathing cooperation	143	(1)
Use of eye movement	143	(1)
Muscle energy technique variations	143	(2)
Myofascial release techniques (MFR)	145	(2)
Exercise 1 Longitudinal paraspinal myofascial release	146	(1)
Exercise 2 Freeing subscapularis from serratus anterior fascia	146	(1)
Positional release techniques (PRT)	147	(6)
The proprioceptive hypothesis	147	(1)
The nociceptive hypothesis	148	(1)
Resolving restrictions using PRT	148	(1)
Circulatory hypothesis	149	(1)
Variations of PRT	149	(4)
Rehabilitation	153	(1)
Additional stretching techniques	153	(6)
Facilitated stretching	153	(1)
Proprioceptive neuromuscular facilitation (PNF) variations	154	(1)
Active isolated stretching (AIS)	154	(1)
Yoga stretching (and static stretching)	154	(1)
Ballistic stretching	154	(5)
The cervical region	159	(78)
The vertebral column: a structural wonder	159	(7)
Cervical vertebral structure	162	(1)
The upper and lower cervical functional units	163	(3)
Movements of the cervical spine	166	(2)
Upper cervical (occipitocervical) ligaments	167	(1)
Lower cervical ligaments	168	(1)
Assessment of the cervical region	168	(19)
Landmarks	169	(1)
Functional features of the cervical spine	170	(1)
Muscular and fascial features	170	(1)
Neurological features	171	(1)
Circulatory features and thoracic outlet syndrome	171	(1)
Cervical spinal dysfunction	171	(3)
Assessments	174	(5)
Assessment becomes treatment	179	(2)
Assessment and treatment of occipitoatlantal restriction (C0--C1)	181	(1)
Functional release of atlantooccipital joint	182	(1)
Translation assessment for cervical spine (C2--7)	182	(1)
Treatment choices	183	(1)
Alternative positional release approach	184	(1)
SCS cervical flexion restriction method	184	(1)
SCS cervical extension restriction method	185	(1)
Stiles' (1984) general procedure using MET for cervical restriction	185	(1)
Harakal's (1975) cooperative isometric technique (MET)	186	(1)
Cervical treatment: sequencing	187	(50)
Cervical planes and layers	187	(1)
Posterior cervical region	188	(1)
Upper trapezius	188	(2)
NMT for upper trapezius in supine position	190	(1)
MET treatment of upper trapezius	191	(2)
Myofascial release of upper trapezius	193	(1)
Variation of myofascial release	194	(1)
NMT: cervical lamina gliding techniques-supine	195	(1)
Semispinalis capitis	196	(1)
Semispinalis cervicis	196	(1)
Splenii	197	(1)
NMT techniques for splenii tendons	198	(1)
Spinalis capitis and cervicis	199	(1)
NMT for spinalis muscles	200	(1)
Longissimus capitis	200	(1)
Longissimus cervicis	200	(1)
Iliocostalis cervicis	200	(1)
Multifidi	201	(1)
Rotatores longus and brevis	201	(1)
Interspinales	201	(1)
NMT for interspinales	202	(1)
Intertransversarii	202	(1)
Levator scapula	203	(2)
NMT for levator scapula	205	(1)
MET treatment of levator scapula	205	(1)
Suboccipital region	206	(1)
Rectus capitis posterior minor	207	(1)
Rectus capitis posterior major	208	(1)
Obliquus capitis superior	208	(1)
Obliquus capitis inferior	208	(1)
NMT for suboccipital group -- supine	209	(2)
Platysma	211	(1)
NMT for platysma	212	(1)
General anterior neck muscle stretch utilizing MET	212	(1)
Sternocleidomastoid	213	(2)
NMT for SCM	215	(1)
Treatment of shortened SCM using MET	216	(1)
Suprahyoid muscles	217	(1)
Infrahyoid muscles	217	(1)
Sternohyoid	218	(1)
Sternothyroid	218	(1)
Thyrohyoid	219	(1)
Omohyoid	219	(1)
NMT for infrahyoid muscles	219	(2)
Soft tissue technique derived from osteopathic methodology	221	(1)
Longus colli	221	(1)
Longus capitis	222	(1)
NMT for longus colli and capitis	223	(1)
MET stretch of longus capitis	224	(1)
Rectus capitis anterior	225	(1)
Rectus capitis lateralis	225	(1)
NMT for rectus capitis lateralis	226	(1)
Scalenes	226	(2)
NMT for scalenes	228	(2)
Treatment of short scalenes by MET	230	(2)
Cervical lamina -- prone	232	(1)
NMT for posterior cervical lamina-prone position	232	(1)
NMT for posterior cranial attachments	233	(4)
The cranium	237	(58)
Cranial structure	237	(26)
Occiput	238	(5)
Sphenoid	243	(3)
Ethmoid	246	(2)
Vomer	248	(1)
Mandible	249	(3)
Frontal	252	(2)
Parietals	254	(2)
Temporals	256	(4)
Zygomae	260	(1)
Maxillae	260	(1)
Palatines	260	(3)
Cranial treatment techniques	263	(32)
Muscles of expression	263	(1)
Mimetic muscles of the epicranium	264	(1)
Occipitofrontalis	264	(1)
Temporoparietalis and auricular muscles	264	(1)
NMT for epicranium	265	(1)
Positional release method for occipitofrontalis	266	(1)
Mimetic muscles of the circumorbital and palpebral region	266	(1)
NMT for palpebral region	267	(1)
Mimetic muscles of the nasal region	267	(1)
NMT for nasal region	268	(1)
Mimetic muscles of the buccolabial region	268	(1)
NMT for buccolabial region	268	(1)
Muscles of mastication	269	(1)
External palpation and treatment of craniomandibular muscles	269	(1)
NMT for temporalis	269	(7)
NMT for masseter	276	(2)
Massage/myofascial stretch treatment of masseter	278	(1)
Positional release for masseter	278	(1)
Lateral pterygoid	278	(1)
NMT for medial pterygoid	279	(1)
Stylohyoid	279	(1)
External palpation and treatment of styloid and mastoid processes	280	(1)
Intraoral palpation and treatment of craniomandibular muscles	281	(1)
Intraoral NMT applications	281	(1)
Temporalis	282	(1)
NMT for intraoral temporalis tendon	282	(1)
Masseter	282	(2)
NMT for intraoral masseter	284	(1)
Lateral pterygoid	284	(1)
NMT for intraoral lateral pterygoid	285	(1)
Medial pterygoid	286	(1)
NMT for intraoral medial pterygoid	287	(1)
Musculature of the soft palate	287	(1)
NMT for soft palate	288	(1)
Muscles of the tongue	289	(1)
NMT for muscles of the tongue	290	(1)
Suprahyoid muscles -- the floor of the mouth	291	(1)
NMT for intraoral floor of mouth	292	(3)
Shoulder, arm and hand	295	(126)
Shoulder	295	(82)
Key joints affecting the shoulder	296	(6)
Janda's perspective	302	(7)
Therapeutic choices	309	(4)
Infraspinatus	313	(1)
Levator scapula	313	(1)
Latissimus dorsi	314	(1)
Pectoralis major or minor	314	(1)
Supraspinatus	314	(1)
Subscapularis	314	(1)
Upper trapezius	315	(1)
Is the patient's pain a soft tissue or a joint problem?	315	(1)
The Spencer sequence	315	(5)
Treatment	320	(1)
Trapezius	320	(5)
NMT for upper trapezius	325	(1)
NMT for middle trapezius	326	(1)
NMT for lower trapezius	326	(1)
NMT for trapezius attachments	327	(1)
Lief's NMT for upper trapezius area	328	(1)
MET treatment of upper trapezius	328	(1)
Myofascial release of upper trapezius	328	(1)
Levator scapula	329	(1)
NMT for levator scapula	330	(1)
MET treatment of levator scapula	331	(1)
Rhomboid minor and major	331	(2)
NMT for rhomboids	333	(1)
MET for rhomboids	334	(1)
Deltoid	334	(1)
NMT for deltoid	335	(1)
Supraspinatus	336	(1)
NMT treatment of supraspinatus	337	(1)
MET treatment of supraspinatus	338	(1)
MFR for supraspinatus	339	(1)
Infraspinatus	339	(1)
NMT for infraspinatus	340	(1)
MET treatment of short infraspinatus	340	(1)
MFR treatment of short infraspinatus	341	(1)
PRT treatment of infraspinatus	341	(1)
Triceps and anconeus	342	(1)
NMT for triceps	342	(2)
MET treatment of triceps	344	(1)
NMT for anconeus	345	(1)
Teres minor	345	(1)
NMT for teres minor	345	(1)
PRT for teres minor	346	(1)
Teres major	346	(2)
NMT for teres major	348	(1)
PRT for teres major	349	(1)
Latissimus dorsi	350	(1)
NMT for latissimus dorsi	351	(1)
MET treatment of latissimus dorsi	352	(1)
PRT for latissimus dorsi	352	(1)
Subscapularis	353	(2)
NMT for subscapularis	355	(1)
MET for subscapularis	356	(1)
PRT for subscapularis	356	(1)
Serratus anterior	357	(1)
NMT for serratus anterior	358	(1)
Pectoralis major	359	(4)
NMT for pectoralis major	363	(1)
MET for pectoralis major	364	(1)
Alternative MET for pectoralis major	365	(1)
MFR for pectoralis major	366	(1)
Pectoralis minor	366	(1)
NMT for pectoralis minor	367	(1)
Direct (bilateral) myofascial stretch of shortened pectoralis minor	368	(1)
Subclavius	369	(2)
MFR for subclavius	371	(1)
Sternalis	371	(1)
Coracobrachialis	372	(1)
NMT for coracobrachialis	372	(2)
MFR for coracobrachialis	374	(1)
PRT for coracobrachialis	374	(1)
Biceps brachii	374	(2)
NMT for biceps brachii	376	(1)
MET for painful biceps brachii tendon	377	(1)
PRT for biceps brachii	377	(1)
Elbow	377	(12)
Humeroulnar joint	378	(1)
Humeroradial joint	378	(1)
Radioulnar joint	378	(1)
The ligaments of the elbow	379	(1)
Biceps reflex	380	(1)
Brachioradialis reflex	380	(1)
Triceps reflex	380	(3)
Treatment	383	(1)
Brachialis	383	(1)
NMT for brachialis	383	(1)
Triceps and anconeus	384	(1)
NMT for triceps	384	(1)
NMT for anconeus	384	(1)
Brachioradialis	385	(1)
NMT for brachioradialis	385	(1)
MFR for brachioradialis	385	(1)
Supinator	385	(1)
NMT for supinator	386	(1)
MFR for supinator	387	(1)
Pronator teres	387	(1)
NMT for pronator teres	387	(1)
MFR for pronator teres	387	(1)
PRT for pronator teres	388	(1)
Pronator quadratus	388	(1)
NMT for pronator quadratus	389	(1)
Forearm, wrist and hand	389	(32)
Capsule and ligaments of the wrist	390	(1)
Ligaments of the hand	390	(3)
Key (osteopathic) principles for care of elbow, forearm and wrist dysfunction	393	(1)
Ganglion	394	(1)
Carpal tunnel syndrome	394	(4)
Carpometacarpal ligaments	398	(1)
Metacarpophalangeal ligaments	398	(1)
Range of motion	398	(1)
Thumb ligaments	399	(2)
Anterior forearm treatment	401	(1)
Palmaris longus	401	(2)
Flexor carpi radialis	403	(1)
Flexor carpi ulnaris	403	(1)
Flexor digitorum superficialis	403	(1)
Flexor digitorum profundus	404	(1)
Flexor pollicis longus	405	(1)
NMT for anterior forearm	405	(2)
MET for shortness in extensors of the wrist and hand	407	(1)
PRT for wrist dysfunction	407	(1)
MFR for areas of fibrosis or hypertonicity	408	(1)
Posterior forearm treatment	409	(1)
Superficial layer	409	(2)
Extensor carpi radialis longus	411	(1)
Extensor carpi radialis brevis	411	(1)
Extensor carpi ulnaris	411	(1)
Extensor digitorum	411	(1)
Extensor digiti minimi	412	(1)
NMT for superficial posterior forearm	412	(2)
Deep layer	414	(1)
Abductor pollicis longus	414	(1)
Extensor pollicis brevis	414	(1)
Extensor pollicis longus	414	(1)
Extensor indicis	415	(1)
NMT for deep posterior forearm	415	(1)
Intrinsic hand muscle treatment	416	(1)
Thenar muscles and adductor pollicis	417	(1)
Hypothenar eminence	417	(1)
Metacarpal muscles	418	(1)
NMT for palmar and dorsal hand	418	(3)
The thorax	421	(34)
Structure	421	(2)
Structural features of the thoracic spine	421	(1)
Structural features of the ribs	422	(1)
Structural features of the sternum	422	(1)
Posterior thorax	423	(6)
Identification of spinal levels	423	(1)
Spinal segments	423	(1)
Palpation method for upper thoracic segmental facilitation	424	(1)
Red reflex assessment (reactive hyperemia)	424	(1)
Biomechanics of rotation in the thoracic spine	425	(1)
Coupling test	425	(1)
Observation of restriction patterns in thoracic spine	426	(1)
Breathing wave assessment	426	(1)
Breathing wave -- evaluation of spinal motion during inhalation/exhalation	426	(1)
Passive motion testing for the thoracic spine	427	(1)
Flexion and extension assessment of T1--4	427	(1)
Flexion and extension assessment of T5--12	427	(1)
Sideflexion palpation of thoracic spine	427	(1)
Rotation palpation of thoracic spine	428	(1)
Prone segmental testing for rotation	428	(1)
Anterior thorax	429	(6)
Respiratory function assessment	429	(3)
Palpation for trigger point activity	432	(1)
Alternative categorization of muscles	432	(1)
Rib palpation	433	(1)
Specific 1st rib palpation	433	(1)
Test and treatment for elevated and depressed ribs	433	(1)
Rib motion	433	(1)
Tests for rib motion restrictions	433	(2)
Discussion	435	(1)
Thoracic treatment techniques	435	(20)
Posterior superficial thoracic muscles	435	(3)
NMT: posterior thoracic gliding techniques	438	(2)
NMT for muscles of the thoracic lamina groove	440	(1)
Spinalis thoracis	441	(1)
Semispinalis thoracis	441	(1)
Multifidi	441	(1)
Rotatores longus and brevis	442	(1)
NMT for thoracic (and lumbar) lamina groove muscles	443	(1)
PR method for paraspinal musculature: induration technique	444	(1)
Muscles of respiration	445	(1)
Serratus posterior superior	445	(1)
Serratus posterior inferior	445	(1)
Levatores costarum longus and brevis	446	(2)
Intercostals	448	(1)
NMT for intercostals	448	(1)
Influences of abdominal muscles	449	(1)
NMT assessment	449	(1)
PR of diaphragm	449	(1)
MET release for diaphragm	450	(1)
Interior thorax	450	(1)
Diaphragm	450	(2)
NMT for diaphragm	452	(1)
Transversus thoracis	452	(3)
Index	455