Clinical Applications of Neuromuscular Techniques

Leon Chaitow ND DO is an internationally known and respected osteopathic and naturopathic practitioner and teacher of soft tissue manipulation methods of treatment. He is author of over 60 books, including a series on Advanced Soft Tissue Manipulation (Muscle Energy Techniques, Positional Release Techniques, Modern Neuromuscular Techniques) and also Palpation Skills; Cranial Manipulation: Theory and Practice; Fibromyalgia Syndrome: A Practitioner's Guide to Treatment, and many more. He is editor of the peer reviewed Journal of Bodywork and Movement Therapies, that offers a multidisciplinary perspective on physical methods of patient care. Leon Chaitow was for many years senior lecturer on the Therapeutic Bodywork degree courses which he helped to design at the School of Integrated Health, University of Westminster, London, where is he now an Honorary Fellow. He continues to teach and practice part-time in London, when not in Corfu, Greece where he focuses on his writing. Judith DeLany LMT has spent over two decades developing neuromuscular therapy techniques and course curricula for manual practitioners as well as for massage schools and other educational venues. Her ongoing private trainings with the Tampa Bay Rays athletic trainers (professional baseball) as well as customized trainings for noteworthy US-based spas show incorporation of NMT into diverse settings. She has contributed a chapter to Chaitow's Modern Neuromusular Techniques and Stillerman's Modalities for Massage and Bodywork and co-authored contributions to Coughlin's Principles and Practices of Manual Therapeutics and Micozzi's Fundamentals of Complimentary and Alternative Medicine. As an international instructor of NMT American versionT, co-author of three NMT textbooks, and associate editor for Journal of Bodywork and Movement Therapies, her professional focus aims to advance education in all healthcare professions to include myofascial therapies for acute and chronic pain syndromes. Judith DeLany resides in St. Petersburg, Florida where she is the director of and primary curriculum developer for NMT Center.

Section 1. Essential information Making sense of the picture. Connective tissue and the fascial system. Fascia and its nature, Fascial tensegrity, Facial postural patterns , Essential information about muscles, Muscle energy sources, Muscle blood supply, Major types of voluntary contraction, Muscle types, Cooperative muscle activity, Contraction, spasm and contracture, What is muscle weakness?, Reporting stations and proprioception, Reflex mechanisms, Facilitation - segemental and local, Manipulating the reporting stations, Therapeutic rehabilitation using reflex systems, Trigger point formation, Central and attachment trigger points, Trigger point activating factors, Ischemia and trigger point evolution, A trigger point's target zone of referral, Key and satellite trigger points, Trigger point incidence and location, Trigger point activity and lymphatic dysfunction , Local and general adaptation, Somatization - mind and muscles, Respiratory influences, Patterns of dysfunction, The big picture and the local even, Thoughts on pain symptoms in general and trigger points in particular. Section 2. Posture, acture and balance Static and dynamic posture, Key postural influences, Is there an ideal posture?, Gravitational influences and muscles, Therapeutic objectives, Muscle categorizations, Necessary assessments, Static postural assessment, Tools of postural assessment, Plumb line, Postural grid, Portable units, Computerized assessment methods, Basic postural assessment, Standing postural assessment , Supine (non-weight bearing) postural assessment, Assessment for freedom of movement, Other postural models, Posture and the mind, Latey's lower fist, Good posture and asymmetrical normality, Patterns of use and posture, Additional local features influencing posture and use, Exteroceptive and proprioceptive postural controls, Mechanisms which alter proprioception, Common causes of postural imbalance and retraining options, 'Normal' balance is age related, Causes of disequilibrium, Stabilization, Disequilibrium rehabilitation goals and strategies. Section 3. Gait analysis Normal joint and segment motion during the gait cycle, Musculoligmentous slings and influences and the gait cycle, Energy storage during gait, Potential dysfunctions in gaiting, Observation of gait, Multiview analysis, Muscular imbalance and gait patterns, Chains of dysfunction, Liebensons clinical approach, Altered hip extension, Altered hip abduction, Various pathologies and gait, Neurological gait patterns, Pediatric gait, Podiatric considerations and gait Section 4. The close environment The bodyworker's close environment, Acture guidelines for bodywork students and practitioners, Automobile influences, Driving: the vibration factor, Automobile risk factors, Seatbelts and airbags, Gender issues in accident after-effects, Multiple symptoms and fibromyalgia syndrome(FMS) following vehicle injuries, The vehicle injury close environment, Sitting on an airplane, Shoes, Neutral entrapment and shoes, Orthotics, Effects of clothing, jewelry, other accessories and aids, Sitting posture, Chairs as a health hazard, Better chair design as an answer, Chair criteria, An Alexander perspective on correct sitting, The art of sitting down, What are the risks of poor sitting habits?, Computering work and posture, Sleeping positions, Repose, Changing sleeping position due to nasal influences, Problems relating to the posture of musicians, Examples, Assessment, Conclusion. Section 5. Adaptation and sport First principles, An osteopathic perspective, Specific adaptation to imposed demand ('training'), Training variations, Strength training, Edurance training, Sprint training, Overtraining issue, Overuse injuries and the young soccer player, How widespread is the problem of overuse injury in youngsters?, Prevention of overuse injuries, Signs of overuse injury in young soccer players, Handling overuse injuries, Tibial stress fracture, Enhanced human performance or treatment of dysfunction?, Athletics, Hamstring injuries and the athlete, How to choose where and what to treat within the kinetic chain?, A model of care for hamstring injuries, Nutrition, Bodywork and rehabilitation, Groin strains and the athlete, Gymnastics and dance, Weight training and the low back: key points, Water sports, American football, Rotational activities, Golf, Tennis, Baseball, Risk in other sports, Skiing, CyclingRugby, football, Volleyball and basketball. Section 6. Contextual influences: Nutrition and other factors Chronobiology, Sleep and pain, Pain and inflammation: allergic, dietary and nutritional factors, Nutritional approaches for modulating inflammation, Intolerances, allergies and musculoskeletal dysfunction, Mechanisms, Mast cells, immune responses and inflammation, Muscle pain and allergy/intolerance, Allergy-hyperventilation 'masqueraders', Defining food intolerances, Allergy, the hyperreactive immune function and muscle pain, Allergy, the hyper-reactive immune function, and muscle pain, Treatment for 'allergic myalgia'?,Other therapeutic choices - Testing for allergy/intolerance, Some evidence for exclusion diet benefits with allergy, Strategies, The breathing connection, The biochemistry of hyperventilation, The biochemistry of anxiety and activity, Summary, Diet, anxiety and pain, Glucose, Alcohol, Caffeine, Anxiety and deficiency, Detoxification and muscle pain, Water, Liver detox, Thyroid hormone imbalance and chronic musculoskeletal pain, Osteoporosis. Section 7. Self-help strategies Aims and sources, Coherence, compliance, concordance, Biochemical self-help methods, Hydrotherapy self-help methods, Psychosocial self-help methods, Biomechanical self-help methods Section 8. Patient intake Where to begin?, Outline, Expectations, Humor, Thick file patients, Unspoken questions, Starting the process, Leading questions, Some key questions, Body language, The physical examination, The therapeutic plan, A summary of approaches to chronic pain problems, Choices: Soft tissue or joint focus? Section 9. Summary of modalities The global view, The purpose of this chapter, General application of neuromuscular techniques, NMT for chronic pain, Palpation and treatment, Neuromuscular therapy 'American version', Gliding Techniques, Palpation and compression techniques, Muscle energy techniques (MET), Positional Release Techniques, Integrated neuromuscular inhibition technique, Myofascial release techniques, Acupuncture and trigger points, Mobilization and articulation, Rehabilitation. Section 10. The lumbar spine Functions of the lumbar spine, Lumbar vertebral structure, Transitional areas, The spinal column - its structure and function, Flexible stability, Adaptability = tolerance, Identification of imbalances - essential first step, Stress factors and homeostasis, The contextual environment, Soft tissue spinal support, Choices muscles make, Specific muscle involvement in stabilization, Endurance factors, Imposter symptoms, Making sense of low-backache, The 'simple' backache, Nerve root pain, Distortions and anomalies, Serious spinal pathology, The stabilizing role of thoracolumbar fascia, Using assessment protocols, Sequencing, Lumbar spine assessment protocols, Lumbar spine myofascial elements, Lumbar spine NMT treatment protocols,Latissimus dorsi, NMT for latissimus dorsi, MET treatment of latissimus dorsi, PRT for latissimus dorsi 1, PRT for latissimus dorsi 2, Serratus posterior inferior, NMT for serratus posterior inferior, Quadratus lumborum, NMT for quadratus lumborum, MET for quadratus lumborum 1, MET for quadratus lumborum 2, PRT for quadratus lumborum, The thoracolumbar paraspinal muscles (erector spinae), Superficial paraspinal muscles (lateral tract), Additional assessments for erector spinae, NMT for erector spinae, MET for erector spinae, PRT for erector spinae (and extension strains of the lumbar spine), Deep paraspinal muscles (medial tract): lumbar lamina, Multifidi, Rotatores longus and brevis, NMT for muscles of the lumbar lamina groove, Interspinales muscles, NMT for interspinales, Intertransversarii lateralis and mediales, MET for multifidi and other small, deep muscles of the low back, PRT for small deep muscles of the low back (induration technique), Muscles of the abdominal wall, Obliquus externus abdominis, Obliquus internus abdominus, Transverse abdominis, NMT (and MFR) for lateral abdominal muscles,Rectus abdominus, Pyramidalis, NMT for anterior abdominal wall muscles, MET for abdominal muscles, PRT for abdominal muscles, Deep abdominal muscles, Psoas major, Psoas minor, Assessment of shortness in iliopsoas, NMT for psoas major and minor, MET treatment of psoas, PRT for psoas. Section 11. The pelvis Different pelvic types, Pelvic architecture, The pelvic girdle or ring, Pregnancy and the pelvis, The innominates, The symphysis pubis, The sacrum, The coccyx, Ligaments of the pelvis, The sciatic foramina, The sacroiliac joint, Gait and the pelvis, Therapeutic considerations, Homeostatic subtext, Pelvic problems and the low back, Lower crossed syndrome, Treatment sequencing, Recognizing inappropriate firing sequences, Possible trigger point movement, Screening, Janda's tests, Prone hip extension test, Hip abduction test, Tests for weakness, Strength and stamina testing for gluteus maximus and medius, Strength testing for piriformis, Pelvic tilts and inclinations, Testing and treating pelvic, sacral, iliac and sacroiliac dysfunctions, Thoughts on treatment strategies, Hypermobility issues, Iliosacral or sacoiliac?, Static innominate positional evaluation, Static sacral positional evaluation, Sacral torsions, Standing pelvic assessments , Standing pelvic orientation evaluation, ('tilt'), Standing pelvic balance test, Standing PSIS symmetry test, Standing flexion test, Standing iliosacral 'stork' or Gillet test, Standing hip extension test, Spinal behaviour during flexion tests, Standing and seated spinal rotoscoliosis tests, Seated pelvic assessments, Seated flexion (sacroiliac) test, Supine pelvic assessments and treatment protocols, Pelvic alignment in supine prior to assessment, Supine shear dysfunction assessment , MET of a superior innominate shear, Pubic dysfunction assessment, MET treatment of pubic dysfunction, Positional release methods for pubic shear/inguinal dysfunction (or suprapubic pain), Supine iliosacral dysfunction evaluation, MET of iliac inflare, MET treatment of iliac outflare, MET of anterior iliac rotation: prone position, MET of anterior iliac rotation: supine position, MET of posterior iliac rotation: prone position, Supine functional sacroiliac assessments, Prone pelvic assessment and SI treatment protocols, Pelvic landmark observation and palpation, Mobility of the sacrum assessment in prone, Prone activity straight leg raising test, Prone SI joint gapping test (and MET treatment), MET for SI joint dysfunction, Sacroiliac mobilization using MET, Prone sacral PRT for pelvic (including SI joint) dysfunction, Sacral foramen tender points, Mobilization with movement (MWM) treatment of SI joint dysfunction, Muscles of the pelvis, Iliacus, NMT for iliacus, Positional release for iliacus, Gracilis, Pectineus, Adductor longus, Adductor brevis, Adductor magnus, NMT for adductor muscle group, MET treatment of shortness in short adductors of the thigh, PRT for short adductors, Tensor fasciae latae, Lewit's TFL palpation, NMT for TFL: supine, Supine MET treatment of shortened TFL, Positional release for TFL, Quadratus lumborum, NMT for quadratus lumborum: sidelying position, Glutus maximus, NMT for gluteus maximus: sidelying position, Gluteus medius, Gluteus minimus, NMT for gluteal muscle group: sidelying, Lief's European NMT for the gluteal area, MET self-care for gluteus maximus, Positional release for gluteus medius, Piriformis, NMT for piriformis: sidelying, Sidelying MET and compression treatment of piriformis, NMT examination of iliolumbar, sacroiliac and sacrotuberous regions, Iliolumbar ligament region, NMT for iliolumbar ligament region, Sacroiliac ligament region, NMT for sacral region, Positional release for sacroiliac ligament, Sacrotuberous ligament, Sacrotuberous ligament method: prone position, Positional release for sacrotuberous ligament, Other muscles of the pelvis, The muscles of the pelvic diaphragm, NMT for intraraectal region. Section 12. The hip Capsule, ligaments and membranes, The hip's fibrous capsule, Synovial membrane, Iliofemoral ligament, Pubofemoral ligament, Ischiofemoral teres, Ligamentum teres, Transverse acetabular ligament, Stability, Angles, Angle of inclination , Angle of torsion of the femur, Movement potential, Muscles producing movement, Relations, Vessels and nerve supply to joint, Assessment of the hip joint, Differentiation , Muscular involvement: general assessments, Signs of serious pathology, false alarms, Testing for hip dysfunction , Hip assessment tests involving movement under voluntary control, Muscles of the hip, Hip flexion, Iliopsoas, Rectus femoris, MET treatment of rectus femori, Sartorius, NMT for rectus femoris and sartorius, Adduction of the thigh, Gracilis, Pectineus, Adductor longus, Adductor brevis, Adductor magnus, NMT for adductor muscle group: Sidelying position, Abduction of the thigh, Tensor fasciae latae, NMT for tensor fasciae latae in sidelying position, Gluteus medius, Gluteus minimus, NMT for gluteus medius and minimus, Rotation of the thigh, Gluteus maximus, NMT for gluteus maximus: prone position, Piriformis, Gemellus superior, Obturator internus, Gemellus inferior, Obturator externus, Quadratus femoris, NMT for deep six hip rotators, Supine MET for piriformis and deep external rotators of the hip, PRT of piriformis' trochanter attachment, Extension of the thigh, Biceps femoris, Semitendinosus, Semimembranosus, NMT for hamstrings, MET for shortness of hamstrings 1, MET for shortness of hamstrings 2, PRT for hamstrings. Section 13. The knee The femotibial joint , The femur, The proximal tibia, Menisci, Fibrous capsule and synovial membrane, Bursae, Ligaments of the knee joint, Relations, Movements of the knee joint, The patellofemoral joint, Patellar surface of the femur, The patella, Soft tissue and joint dysfunction and assessment protocols, Sprains and strains, Characteristic pain signs, Gross swelling /effusion, Aspiration of fluid from the knee, Common (named) disorders of the knee, Patellofemoral pain syndrome (PFPS), Tracking problems, Patellar tendon tendonitis, Osgood-Schlatter disease, Chondromalacia patellae, Bursitis, Positional release first aid for the painful patella, Osteoarthritis (OA) of the knee, Soft tissue manipulation and joints, Examination and testing for soft tissue, Damage to the knee, Physical examination of the injured knee, Palpation of the injured knee, Range of motion testing, Effusion 'tap' test, Active physiological movement (including overpressure), Passive physiological movement, Stress testing of the knee joint, Compression mobilization in rehabilitation after knee surgery, Positional release methods for knee damage and injury involving ligaments and tendons, Muscles of the knee joint, Extensors of the knee: the quadriceps femoris group, Rectus femoris, Vastus lateralis, Vastus medialis, Vastus intermedius, Articularis genus, NMT for quadriceps group, Positional release for rectus femoris, Flexors of the knee, Satorius, Gracilis, NMT for medial knee region, Biceps femoris, Semitendinosus, Semimembranosus, PRT for treatment of biceps femoris, PRT for semimembranosus, Popliteus, NMT for popliteus, Positional Release for popliteus, Gastrocnemius. Section 14. The leg and the foot The leg, The proximal tibiofibular joint, Mobilization with movement (MWM) to release the fibula head, MET for releasing restricted proximal tibiofibular joint, The ankle joint and hindfoot, The ankle ligaments, Movements of the ankle joint , The talocalcaneal (subtalar) joint , Ankle sprains, Assessment (and treatment) of the ankle joint and hindfoot , MET treatment of dorsiflexion restriction at the talotibiofibular joint, MET treatment of plantarflexion restriction at the talotibiofibular joint, PRT treatment of medial (deltoid) ligament dysfunction, PRT treatment of anterior talofibular ligament dysfunction, MWM treatment of restricted talotibiofibular joint and for postinversion sprain, MWM for eversion ankle sprains, Common disorders of the hindfoot, Calcaneal spur syndrome (and plantar fasciitis), Epiphysitis of the calcaneus (Sever's disease), Posterior Achilles tendon bursitis (Haglund's deformity), Anterior Achilles tendon bursitis (Albert's disease), Posterior tibial nerve neuralgia, The midfoot, Talocalcaneonavicular (TCN) joint, Transverse tarsal joint, Tarsometatarsal (TMT) joints, The arches of the foot ,Common disorders of the midfoot, Pes planus (flat foot), The forefoot, Sesamiod bones of the feet , Common disorders of the forefoot, Metatarsalgia, Morton's syndrome, Hallux valgus, Bunion, Calluses and corns, Plantar warts, Gout, Hallux rigidus, Functional hallux limitus (FHL), Neuromusculoskeletal assessment of the foot, Muscles of the leg and foot, Muscles of the leg, Posterior compartment of the leg, Gastrocnemius, Soleus, Achilles tendon, Plantaris, NMT for superficial layer of posterior leg, NMT for Achilles tendon, MET assessment and treatment of tight gastrocnemius and soleus, PRT for gastrocnemius and soleus, Flexor hallucis longus, Flaxor digitorum longus, Tibius posterior, NMT for deep layer of posterior leg, PRT for deep layer of posterior leg, Lateral compartment of the leg, Peroneus longus, Peroneus brevis, NMT for lateral compartment of the leg, Anterior compartment of the leg, Tibialis anterior, Extensor hallucis longus, Extensor digitorum longus, Peroneus tertius, NMT for anterior compartment of the leg, PRT for tibialis anterior, PRT for extensor digitorum longus, Muscles of the foot, Dorsal foot muscles, NMT for dorsal intrinsic muscles of the foot, Plantar foot muscles, Actions of the intrinsic muscles of the foot, NMT for the plantar intrinsic muscles of the foot, Goodheart's positional release protocols, Mulligan's MWM and compression methods for the foot, Patient self-help exercises. Appendix, Index.