Chronic muscle and joint pain is a way of life for most of my new clients. Most of them have seen doctors and PT’s for help with pain or postural deviations prior to our first session. These clients often have unresolved pain or other lingering physical issues that previous practitioners treated unsuccessfully. Most healthcare practitioners spend their time trying to ameliorate pain by increasing circulation to the area or moving tissues around. Surgery for pain or stability doesn’t help everyone. Why do symptoms return for so many people? This question spurred my quest for answers.
Why address the hardware if it’s a software problem?
In P-Dtr, as taught by Dr. Jose Palomar, neurological miscommunication between the muscles or joints and the nervous system is the misunderstood component in most chronic cases. He explained that the body is the hardware and the nervous system is the software. Faulty signaling between the body and the CNS is the culprit. The effects of this neuromuscular disorganization are tight knotty muscles and locked joints. Most clinicians begin with a manual manipulation model based on moving, stretching or manipulating structures of the body. They stretch muscles, fascia or joints to reset them into a more balanced alignment. This doesn’t always work. The clinician’s view of alignment is often based on an idea of how things should be. The quandary is: A symptom is not a cause. We are better off listening instead of telling the body what to do.
Critical Thinking and Assessment
Assessment is the most valuable diagnostic tool available to bodyworkers. Critical thinking and assessment skills can only be cultivated through research and clinical experience. Throughout my career I explored different ways to gain insight into musculoskeletal system function. My goal was to be able to help more people get out of pain. Some orthopedic problems seemed to make no sense and I found that I wasn’t alone in my thinking. Like many, I wanted to know the answer why.
Into the Rabbit Hole
Standard orthopedic testing can be laborious and inconclusive so I explored new assessment methods. I trained my sense of touch to feel fascial strain patterns. Next I learned to visually assess gait, movement and static posture but it wasn’t enough. I also learned manual muscle testing to assess strength and I learned how to assess joint motion and how to apply advanced biomechanics compensation theories. I put all these tools to use and at times there still appeared to be some kind of push back from the body. Around 2005, I learned a new way of using muscle tests. I learned that by assessing strength using manual muscle tests, I could check interrelated function between muscles. Little did I know, I could go even further to find the source of neuromuscular dysfunction.
Treating Neuromuscular dysfunction
In clinical terms, it makes the most sense to treat the neuromuscular dysfunctions that cause the associated signs and symptoms. Most bodyworkers address tissues as if they can manually override the body’s hardware when it’s a software based problem. Many therapists have learned to gently guide the body into A state of relaxation that fades when real life stress takes over. Locked joints, Tight hip flexors and hamstrings and core instability are all symptoms of neuromuscular inhibition, muscle guarding or splinting. Manually addressing these tissues can not fully integrate the changes on a neurological level. Chronic muscle and joint pain comes back and everyone guesses at why. I finally got some answers.
Muscle Facilitation and Inhibition
Trauma comes in many forms. It can be physical, chemical, or emotional. It can be from small repetitive stress or a big overload to the systems of the body. They are all interpreted as a threat by the nervous system. After a muscle is injured, it will often exhibit an improper muscular response upon stimulation. The response is that a muscle will either become inhibited (switched off) or hypertonic (contracting and won’t stop). Exercising will not make an inhibited muscle strong. Stretching will not effectively “release” the neural tension that is hypertonicity. Personal trainers and PT’s can easily misread clients strength for hypertonicity which is a compensation that compresses your joints and nerves. These issues plague doctors and patients alike. Luckily there is a way to reverse Hypertonicity and inhibition.
A Puzzling Presentation
Most doctors and bodyworkers agree that it is difficult to fix chronic muscle and joint pain. Frozen shoulder is one issue that plagues most of us. Some surgeons cut or shave bones in the shoulder to “resolve” a shoulder impingement. It is not a surgery with a high success rate because the bones are not usually the source of the problem. So called “fixations” like frozen shoulder, can be mobilized by manipulating the shoulder while the patient is under anesthesia. The idea is that if you shut off the nervous system’s reflexive response, there is no muscle guarding or joint splinting. We don’t need anesthesia, but there is light shed by this discovery. When the splinting response is gone, one can mobilize the deepest tissues without painful invasive work.
Neural tension = Hypertonicity
If Hypertonicity is created in the brain why don’t we address it and pain neurologically? Most doctors, PT’s and Bodyworkers don’t know how to do it. Their focus is increasing blood flow and mobility through stretching. You can’t stick your finger in your ear and hit the pain button but there are ways to address the neurology without machines or surgery. Many books on pain in the body describe neural tension, muscle guarding, Splinting, or hypertonicity. The source of neural tension is still mysterious to the venerated masters of orthopedics. Few professionals can resolve this type of pain because they are still addressing the symptoms instead of the source.
Are Joint Fixations Really Fixed?
It is important to address the blocked joints of the body when they are painful and inhibit movement. The only medical option is repeat PT visits, medication or surgery. What do you do when repeated adjustments or multiple surgeries don’t fix a recalcitrant problem? Some professionals believe that many limitations in joint mobility are structurally fixed. I have experienced that most locked joints are due to neurological tension created within the nervous system. When this neurological tension is removed, rigid structures can be unlocked. This process elucidates the true mechanical dysfunctions behind the secondary muscle and joint compensations. Even pain from issues like arthritis, joint degeneration and stenosis can be relieved when the process creating them is reversed. Most professionals address symptoms and can miss the source of the problem.
Evidence Based Bodywork
Compression can physically compromise nerves, joints, blood vessels and organs and can create tissue breakdown over time. This fact has been the basis for most diagnosis’ relating to joint and muscle pain. The 2017 medical guidelines recommended bodyworkers over doctors for relief. Bodywork is a term that covers any form of massage, muscle or joint manipulation and even energetic approaches to create therapeutic change in the body. Some approaches are more “evidence based” while others are movement based or energetic in nature. Both have been shown to be helpful and many people practice integrated forms of therapeutic bodywork. Evidence based means there is research to back up why it works but often implies conservative and commonplace treatment. Most of the work I practice is evidence based. Neurology is still a medical mystery and working with it seems phenomenal most. Science is often slow to change but not me.
For years I focused on structural approaches to resolve pain. I primarily used specialized muscle, fascial and articular stretches to mobilize the tissues, joints and ligaments to restore balance throughout the body. I helped hundreds of people. My focus stayed on those who didn’t. A combined approach of tissue manipulation and strengthening is regarded as the gold standard in rehab. Still, there are lots of cases where this is not enough. The best case scenario is one of daily maintenance to keep symptoms at bay. Unfortunately, any strength training done with lingering movement dysfunction establishes compensation patterns. A“keep at it” mentality doesn’t always benefit us. When clients leave the table, they have to interact with unseen stressors. We can’t treat people as body parts and see the whole picture. We have to look more at how the body functions and less at symptoms.
The Compensation Conundrum
Postural deviations like a posterior pelvic tilt can create a reflexive secondary forward head compensation. This neuro-tonic reflex is designed to level the eyes so that blood flow to both sides of the brain is maintained. Massage can increase blood flow in this tight tissue and joint work can temporarily mobilize the area. Manual work can’t stop the return of this type of reflexively driven hypertonicity. These systems of postural compensation are created neurologically. If you are only manually pressing and “stripping” these compensating hypertonic tissues, you will not resolve the neurological dysfunction. Even if you can physically move the body into a more balanced place, the injury is recorded in the nervous tissues. After time, the body limits your range of motion. The result is chronic muscle and joint pain. It is a cycle that for most, keeps spiraling until we are old foot shufflers.
Using the most efficient and appropriate treatment for the case presented is the preferred treatment of any healthcare provider. When technological or pharmaceutical advancements prove to make work more effective, it takes courage to abandon old ways. The same holds true for hands on therapy. Chronic muscle and joint pain don’t always respond to traditional manual therapy. My teachers have been at the top of their fields for so long because they dared to venture into new ground and to learn from other massage and bodywork styles. I have followed suit and learned novel forms of manual therapy that address the neurology. Beyond the muscles and joints, P-DTR laid out a way to manually assess the receptors that give info to the nervous tissues. Now I practice a more comprehensive manual therapy practice that takes the deepest connections into consideration.
The Common Game Plan
Most practitioners’ strategy is based on the idea that instability around joints is a major cause of pain. If you stretch the muscles that are tight, and strengthen the muscles that are weak around the joints you can release and relieve the uneven pressure. Then you can mobilize and encourage soft tissue to be molded back into alignment. The problem we therapists run into is when you wrestle with the body and it doesn’t want to go along with your plan. When in doubt you have to refer out. No matter how well thought out our plan is, we are still interpreting what we think the body needs and imposing our ideas on the body through manual manipulation. Chronic muscle and joint pain is recalcitrant unless the changes are integrated on a neurological level.
The Way of NYOM
Treatment begins with balancing the nervous system. It is the system of the body that creates pain and tension in fascia, ligaments and joints in our body. The ultimate goal of anyone in orthopedic bodywork is to make pain go away and make dysfunctional tissues functional while adding the least amount of stress to the system. The nervous system interprets our internal and external environments and coordinates the info with our muscles. The neuromuscular systems communication is improved in order to achieve optimal functionality. Expert massage and mobilization unlock stubborn adhesive tissues and musculoskeletal balance is restored. This is the deepest level of integration and reversal of neuro- musculoskeletal dysfunction I have been able to provide my clients in the 20 years I have been practicing. If you want to get to the root of your dysfunction and move like you did before injuries, make an appointment today!