NMT: Two Versions Defined
When I was studying osteopathy and naturopathy in London in the late 1950s, I was taught neuromuscular technique (NMT) as part of our soft-tissue assessment and treatment course. The version of NMT that I learned had been developed in the 1930s by my father’s cousin Stanley Lief, ND, DC, assisted by his cousin (my uncle), Boris Chaitow, ND, DC.
Lief had modified a traditional Asian technique, taught by a Dr. Varma, an Ayurvedic physician working in Paris. It may be of peripheral interest to know that among the people who contacted Varma at that time was Ida Rolf; although, whether she incorporated any of his work into hers is not known.
Varma believed that his manual treatment method (he called “Prana-therapy”) was capable of identifying and treating local areas of obstruction to the free flow of energy, using finger or thumb strokes and pressure.
In contrast, Lief used modifications of Varma’s approach – which he called NMT – to assess and treat soft-tissue dysfunction, preparing joints for mobilisation or manipulation. And this is why we were taught NMT in our training at the then British College of Naturopathy and Osteopathy (now, the British College of Osteopathic Medicine).
At the time of my training,the early work of Janet Travell was available and we began to speak of trigger points as one of our targets in NMT assessment and treatment.
Simultaneously, the work of Raymond Nimmo, DC, was becoming more widely known. Nimmo had worked in parallel with Travell (and subsequently, David Simons) in describing localised soft-tissue changes that could generate local and distant pain. His terminology was different to Travell’s, as were his treatment methods (which he called “Receptor Tonus Technique”). He came to England to teach briefly in the early 1960s and I was privileged to attend his classes.
Lief’s (European) NMT incorporated this knowledge into a superbly effective soft-tissue assessment and treatment protocol, usually directed at Lief’s original objective of mobilising soft tissues prior to joint mobilisation as well as for locating and deactivating trigger points. The delicacy of the finger or thumb strokes used in Lief’s NMT allows for extremely fine work to be performed involving intelligent contacts that do not overwhelm restrictions, but insinuate (“melting”) their way into them, teasing and releasing, rather than aggressively forcing change.
In the United States, neuromuscular therapy evolved in a direction that was far more focused on myofascial pain in general (influenced by Travell, Simons and Nimmo), and trigger points in particular.
The modalities used in American NMT comprise soft-tissue methods developed by practitioners of massage therapy, osteopathy, chiropractic, physical therapy, manual medicine, naturopathic medicine, and others. These include methods such as effluerage (gliding strokes), trigger point release (compressive force), myofascial release, muscle energy technique, positional release, cranial manipulation and others.
- neuromuscular technique (Lief’s European version) is a subtle assessment and treatment approach to soft-tissue dysfunction.
- neuromuscular therapy (American version) is an open-ended collection of manual, rehabilitation and movement methods, largely focused (but by no means entirely) on myofascial pain. In treatment of acute and chronic pain syndromes, NMT incorporates a variety of soft-tissue techniques, as well as flexibility stretching and home care, in order to eliminate the causes of symptoms, rather than treating these as an end in itself. American NMT incorporates examination of factors such as ischemia, trigger points, nerve entrapment/compression, postural imbalances, nutritional factors as well as emotional wellbeing.
Both forms of NMT utilise standard orthopedic assessment approaches, as well as their own individual methods of assessment. Additionally, both forms of NMT incorporate moving and stationary pressures to tissues in both assessment and treatment modes, using variable pressures to achieve objectives, including inhibitory (ischemic) compression, cross-fibre friction, gliding and stretching methods.
NMT’s Broad Perspective
Despite its predominently physical/biomechanical approach to treatment of pain and dysfunction, American NMT has broad objectives. For example, in conditions involving pain and dysfunction, attention is given to adaptation demands resulting from a wide variety of influences, including:
- biomechanical (congenital, overuse, misuse, trauma, disuse features affecting both local and global structures and functions);
- biochemical (toxicity, endocrine factors, imbalance, nutritional imbalance and/or deficiencies, ischemia, inflammation, etc.); and
- psychosocial (stress, anxiety, depression, unresolved emotional states, somatization, etc.).
Note: While therapists using NMT techniques aim to take account of biochemical and/or psychosocial features, such as those listed – insofar as they may impact on the condition of the individuals consulting them – there is no suggestion that NMT is appropriate in treating these.
Two Versions Combined
In the mid-90’s, in an attempt to marry these transatlantic NMT cousins, Judith (Walker) DeLany and I decided to put together a textbook. Four years later, Volume 1 (Upper Body) of our textbook Clinical Applications of Neuromuscular Techniques (Churchill Livingstone 2000) appeared, with Volume 2 (Lower Body) arriving in 2002. A revised and expanded second edition of Volume 1 appeared in 2008, while the revised Volume 2 will be published in mid-2011.
Also published in 2000 (and republished in its 3rd edition in 2010) was my book, Modern Neuromuscular Techniques, which evaluates and describes Lief’s NMT alongside the modalities used in American NMT – incorporating a chapter on this by Judith DeLany. The rationale for writing this book (Modern NMT) was that there was a need for a more compact description, since the combined Clinical Applications texts run well over 1,000 pages. For more on NMT, see other resources listed below.
- Chaitow L. Integrated Neuromuscular Inhibition Technique. British Jnl of Osteopathy,1994;13:17-20.
- NMT Center. NeuroMuscular Therapy American Version. www.nmtcenter.com
- Ibáñez-García J et al. Changes in masseter muscle trigger points following strain-counterstrain or neuro-muscular technique. JBMT, 2009;13(1):2-10.
- Nagrale et al. Efficacy of an integrated neuromuscular inhibition technique on upper trapezius trigger points in subjects with non-specific neck pain. J Manual & Manipulative Therapy, 2010;18(1):37-43