Inhibition and hypertonicity
I have written a little about muscle inhibition and hypertonicity in other articles. This bit of info that isn’t very widely known because there is much the healthcare and fitness world unfortunately doesn’t understand about muscle function. When a muscle is functioning properly, it will fire and relax on command. Normally, the specialized receptors designed to protect the muscle send information about where your body is in space and about it’s internal as well as external environment to the central nervous system. The stretch reflex is one such hard wired reflex that’s signals don’t go up to the brain, rather to the spine and back responding predictably in order to fire a muscle that is stretching too quickly. The muscle spindle acts oppositly and will inhibit a muscle that is under too much strain. After a muscle is injured, many of these (and other) receptors will display a dysfunctional response when stimulated and a muscle will either be inhibited (switched off) or hypertonic (contracting and won’t stop). Exercising will not make the inhibited muscle strong. Stretching will not effectively “release” the neural tension that is hypertonicity. Personal trainers and PT’s can easily misread clients strength by training any muscles they can to get the job done without the specificity of isolating the synergist and checking for hypertonicity which gets overlooked as strength. As far as tough “fixations” like frozen shoulder, manipulating joints under anesthesia has been a thing for some time now, based on the observation and implementation of the crude idea that if you shut off the nervous response, there is no muscle guarding or joint splinting. We don’t need to go that far as to put people under anesthesia to gain those results but there is a lot of light shed by this discovery.
Neural tension : Hypertonicity
If Hypertonicity is created in the brain why don’t we address it and pain neurologically? Ok, You can’t stick your finger in your ear and hit the pain button but there are ways to access the neurology without machines or surgery. When reading orthopedic massage books you may run into the term neural tension. The source of neural tension is often mysterious to those who do not understand the physiological cause and effect of peripheral neurology. Many masters of orthopedics can not answer questions of where pain comes from because they are still addressing symptoms. Because they are not trying to answer where this neural tension comes from, they are satisfied to agree it is hard to unlock (so they cut it). Professionals often believe that limitations in joint mobility are structurally fixed ones when I find that many are due to neurological tension set forth by the brain (for many inherent reasons). Many things that appear to be rigid May be unlocked if the reason for the tension and the mechanism that creates it is understood. The piriformis stretch you do all the time won’t work when it is hypertonic. What if your 20 min of stretching success and deforms the tissue? The brain’s position receptors tighten and slacken the musculature in an orchestrating attempt to adapt to changes. You are simply sweeping the dirt under the rug and will “trip over it” somewhere else down the line. Perhaps it will be bending to pick up a shoe or reaching to the back seat while driving, but thats what neural compensation is. It is a living adaptation to stresses perceived to or in the body.
Work that body (and neural pathways)
Improper alignment of the musculoskeletal system has been shown to physically compromise nerves, blood vessels and organs and can create osseous, fascial and vascular degeneration as well as nervous tissue breakdown over time. This understanding is the impetus for most of the interventions used by Western and evidence based medicine. Bodywork is an umbrella term that covers any form of manual hands on interventions, manipulations or even energetic approaches to therapeutically changing something in the body. Some approaches are more manual and “evidence based” while others are movement based or energetic in nature. Orthopedic massage, Myoskeletal Alignment, Anatomy Trains and the Hesch method as I was taught them are structural approaches to resolving pain via manual postural and structural corrections. This means using special techniques to manipulate tissues that hold the body in visibly and palpably uneven positions that are known to place undue stresses on joints and nervous tissues thereby causing pain. As an integrated multidisciplinary approach, orthopedic massage as a practice ultimately aims at restoring postural balance throughout the body and addressing musculoskeletal dysfunction by stretching what looks or feels tight. Muscle strengthening protocols can also be used to affect tone in overstretched or weaker muscles to help balance the muscle groups around a joint which has been known to relieve symptoms. This approach is similar to the physical therapy model. Most therapists find that even a combined manipulation and strengthening approach, though regarded as the gold standard in rehab, have cases where this is not enough to get the desired results. The best case scenario this model often provides is one that depends on daily patient maintenance to keep symptoms at bay. Often, movement and stretching practices such as Pilates and Yoga are used by forward thinking clients in an attempt to further increase range of motion and gain strength. Unfortunately, physiologically speaking, any training done with a lingering movement dysfunction establishes a new way of movement that is rife with compensation patterns influenced by their remaining limitations. A“keep at it” mentality doesn’t always work. The long standing Clinical challenge is finding a way to stop and if possible reverse this onset of dysfunction.
Compensation begets compensation
Postural observation reveals patterns that are hard wired reflexes such as an anterior pelvic tilt that create a secondary fixation via a forward head compensation. These neuro-tonic reflexes are designed to level the eyes so that even blood flow to both sides of the brain is maintained. Massage can manually mobilize this non mobile tissue and and joint work can sometimes temporarily mobilize the area but can’t stop the return of this type of reflexively driven hypertonicity. These types of “fixations” in the articulating joints of the skeleton create predictable muscle inhibition patterns. The peripheral nervous system also creates a different type of reactive “live” compensation patterning in the neuromuscular-skeletal system based on pain avoidance. The brain creates muscle and ligament hypertonicity and inhibition to avoid stimulating high signaling dysfunctional receptors. It is important to note the distinction and to understand that these systems of postural dysfunction are neurologically created and that they must constantly adapt to balance the body in the unrelenting pressure of our atmosphere’s gravitational field. The receptors of the nervous system send information signals as long as you’re alive. If you are only manually pressing and “stripping” these compensating hypertonic tissues, you will not resolve this level of dysfunction but only temporarily ameliorate some of the symptoms. Even if you physically move the body into a more balanced place, the dysfunction is still recorded in the nervous tissues. When left long enough, The body limits your range of motion and you don’t even notice that you walk funny till someone says it. The way you move is based on the brain’s avoidance of pain. When we move less, then we gain more structural adhesion of tissues and less range of motion. It is a cycle that for most, keeps spiraling until we are old foot shufflers.
Manual Neurological Therapy
Using the most efficient and appropriate treatment plan for the case presented is always the preferred treatment of any healthcare provider. When technological or pharmaceutical advancements present themselves and proves to make work more effective, it is often the doctors with the best new approach that is top of his field. The same holds true for hands on 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. We’re all dealing with the human body after all. Thousands of years ago all we had was touch and I believe that we are both rediscovering old forms of touch that were lost as well as creating new ones based on technological advances that now allow us to see and confirm the existence of smaller and smaller parts of the body we never knew about and also have leapt ahead with advances in neuroscience.
If Most practitioners strategy is based on the idea that instability of joints is a major cause of pain so if you stretch the muscles that are tight around the joint 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 all run into is when you wrestle with the body and it doesn’t want to go along with your plan, you have to refer out. No matter how smart we are and how well thought out our plan is, we are still interpreting what we think the body needs and imposing our idea on the body through manual manipulation.
Since shifting my focus to the only system of the body that actually creates pain, creates tension in fascia, ligaments and joints and connects everything in our body (the nervous system) The manual work I do is accepted and integrated into the body without resistance or neural tension. The ultimate goal of anyone in orthopedic type bodywork is to make pain go away and make dysfunctional tissues functional. Muscles should be relaxed without tension in them until a contraction is called for and then only the appropriate amount of tension so as to not put undue stress on the joints of the skeleton. The nervous system is responsible for 100% of this coordination and the perception of our internal and external environment. In order to achieve full functionality (not just the idea that “I hardly ever notice it”) the neuromuscular system must be integrated and functioning. This is the deepest level of integration and reversal of neuro-musculoskeletal dysfunction I have been able to accomplish in the 16 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!