resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Do You Teach Patients How to Breathe Properly?
Spinal manipulation often produces quick results in terms of pain alleviation and improved range of motion. Unfortunately, once the patient is no longer in pain, they may discontinue therapy, only to be plagued by the same complaint at a future date.
Yo San University Helps Make LA Communities Healthier
An element of healthcare training often overlooked is the residual benefit to communities served by Acupuncture and Oriental Medicine (AOM) schools nationwide.
Osteoporosis Isn't Always the Case
What is your diagnosis? The patient is a 58-year-old female with back pain. I am sure all of you see the compression fracture at L2; however, there are some findings that suggest this is not a compression fracture due to osteoporosis.
The Future of Functional Neurology
Functional is the hot buzzword in health care these days; witness the rising popularity of functional medicine, functional testing and yes, functional neurology.
The Roots of Insomnia
One of the most common clinical presentations is insomnia. Next to digestive disorders, sleep disorders are one of the most common complaints the clinician will encounter in daily practice.
How to Humanize Your Content to Create Stronger Relationships
Content marketing is about building relationships, whether that is through updates on social media, offers on your website, blog posts, email campaigns, or even printed material. Now days a business needs to make a human connection.
Percussion Therapy: An Experiment
My study of qi began more than 20 years ago — long before my study of TCM, points or pathways. It all started with an awareness in my hands and physical manifestations in the way of blockages while working on clients.
East Meets West
Gung Hay Fat Choi. Welcome to the year of the Monkey. There will be fireworks for both January and February this year. What great celebrations.
Elevated Shoulder? Check the QL
As you know, posture reveals a great deal about the body. Posture is a unique mental and physical landscape revealing compensations and adaptations to life. It's a classic mind-and-body story.
Window of the Sky Points
The acupuncture points known as Window of the Sky are a modern creation. There is no reference in Chinese medical texts for an acupuncture point category called Window of the Sky.
Interprofessionalism: What it Means and Why You Should Care
Interprofessionalism in education and in practice is a growing trend across health care in the United States. The idea that team-based care and collaborative practice can improve health care has been around more than 50 years.
From Antiquity to Modernity: Huang Qin Tang at Yale Medical School, Part 1
Traditional Chinese medicine is a coherent medical system with several unique characteristics: it originated almost 3,000 years ago; in its area of origin, it has been practiced without interruption since its inception.
We Get Letters & Email
In the Dec. 1, 2015 issue, we have Donald Petersen reporting on "the adapting chiropractic practice," which includes multidisciplinary practice as an option; a ChiroPoll indicating 59 percent of DCs are seeing at least 21 patients per day and 27 percent are seeing more than 40.
The MRI: When and Why to Order One
As I lecture around the country to both chiropractors and medical specialists, it's clear one of the main disconnects between the two professions is that of an accurate diagnosis.
Forgotten Options for Musculoskeletal Health
Challenges with musculoskeletal health are of tremendous concern for many people today.
Sell Out: Using Research for the Wrong Reasons
The above chorus is from the ska band Reel Big Fish's 1997 hit song, "Sell Out," from their album, "Turn the Radio Off." In the song, the singer sarcastically relates the plight of a musician who is tired of "flipping burgers" and is willing to get "lots of money" by playing "what they want you to hear" in order to get a recording contract.
Spine Surgery: A Tale of Greed and Corruption
All too often, where there's substantial money to be made, greed and corruption inevitably follow.
Changing the Cultural View of Medicine
Many hospitals in the U.S. are incorporating integrative clinics that include Traditional Chinese Medicine. Cleveland Clinic has led the charge for adding a traditional Chinese herbal medicine clinic to their existing acupuncture program.
Preventing ACL Injuries in Female Athletes
For female athletes, the key to optimal athletic health lies in preventing ACL injuries. In medical terms, the anterior cruciate ligament (ACL) is the primary restraint to the anterior displacement of the tibia on the femur at all angles of the knee flexor.
News in Brief
A Winner in and Out of the Office; Ready for the "Have-A-Heart" Campaign? New Integrative Medicine Journal.
Ethics: The Glue That Holds Us Together
Kudos to the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) for creating a code of ethics for the nationwide profession and for deciding to make courses in ethics a requirement for certification renewal.
Billing and Coding for Moxibustion
Q: I am trying to locate a code for cupping and moxibustion, and have had various fellow acupuncturists indicate that they bill using the existing codes for heat, 97010 hot packs or 97026 infra-red for moxa and 97016 vasopneumatic device for cupping.
Integrative Medicine Can Shape the Profession
As the AOM profession struggles to define the role of "integrative" medicine within their practices their schools and organizations, students, faculty, alumni and administrators at schools wrestle with discussions of how much, where, how, and what to "integrate."
Top 10 Fitness Trends for 2016
The American College of Sports Medicine (ACSM) published its annual fitness trend forecast in the November / December 2015 issue of ACSM's Health & Fitness Journal.
The Amazing Clinical Versatility of Milk Thistle (Part 1)
Most of us know that the standardized extract from the seeds of milk thistle (Silybum marianum) is probably the best-proven herb for protecting the liver from chemical and inflammatory damage.
September, 2010, Vol. 10, Issue 09
Advanced Stretching: Using Neural Inhibition to Enhance the Stretch, Part 1
By Joseph E. Muscolino, DC
There is an art and a science to practicing manual and movement therapies. The science yields a set of guidelines that provide the structure for our therapy. We develop this science as an extension of our understanding of the anatomy, physiology, and kinesiology of the body.The art of our practice involves how we apply and combine these guidelines for the optimal treatment of the client who is on our table. As an artist, the medium of the client's body that we primarily work upon is the myofascial system of muscles, tendons, ligaments, and other dense and loose fascial structures. We could look upon this myofascial system as the canvas upon which we work.
One of the major objectives of a massage therapist is to loosen these soft myofascial tissues when they become taut. Taut tissues may be overly contracted muscles. They may also be musculature or other soft tissues that have accumulated fascial adhesions. The problem with taut soft tissues is that they decrease flexibility of the body. Whenever a joint moves in one direction, soft tissues on the "other side of the joint" need to lengthen to allow this motion to occur. Taut soft tissues do not lengthen, therefore they limit motion of the body.
Massage therapy treats these taut tissues by the use of soft tissue manipulation. This manipulation is often direct as in the case of actual massage strokes such as gliding, kneading and compression. The use of hot and cold therapy can also be used. Another extremely effective treatment option, and one that is within the scope of practice of massage therapists, is stretching. When combined with heat and massage therapy, stretching can make a critical difference in the progress of our clients.
Stretching is essentially a mechanical process wherein we place a tension (pulling) force into the client's body, causing a lengthening of the target soft tissues. Although standard stretching performed in this manner often works quite well, there are advanced stretching options that are usually more effective. (With all forms of stretching, it is critically important that the force of the stretch is never excessive, or a muscle spindle reflex may be triggered that results in spasming of the muscle, defeating the purpose of the stretch.)
Advanced Stretching Techniques
The most commonly practiced type of advanced stretching technique is one in which a neurologic reflex is used to inhibit, in other words, relax the target muscle that is being stretched. Creating neural inhibition then allows greater stretch of the musculature when the mechanical tensile force of the stretch is applied. There are two types of advanced neural inhibition stretching techniques: contract relax (CR) and agonist contract (AC). (We will discuss AC stretching in-depth in Part 2 of this series.)
Contract Relax (CR) Stretching
CR stretching is also known as postisometric relaxation (PIR) stretching. AC stretching is the basis for Aaron Mattes' Active Isolated Stretching (AIS) technique. Both CR and AC stretching are often described as proprioceptive neuromuscular facilitation (PNF) because they utilize a proprioceptive neuromuscular reflex to facilitate the stretch.
CR Stretching: The basis of CR stretching is the Golgi tendon organ (GTO) reflex. GTOs are proprioceptive receptors that are located in the tendons of a muscle and are sensitive to stretch. If a muscle belly contracts forcefully, it pulls on and stretches its tendon; this stretching force is detected by the GTO. If the muscle belly contracts too forcefully, the tendon might be torn; therefore the role of the GTO is to protect the tendon by monitoring the stretch forces that are placed on it. The GTO prevents tearing of the tendon by sending a signal into the spinal cord that triggers the GTO reflex, which then inhibits the muscle from contracting, in other words relaxing it. We can make use of the GTO reflex to more effectively stretch a muscle.
CR stretching is performed by asking the client to contract the target muscle to trigger the GTO reflex. We then ask the client to relax and we stretch the target muscle, taking advantage of the increased relaxation (inhibition of the muscle) caused by the GTO reflex. The usual CR stretching protocol steps are carried out as follows. The right lateral flexor (RLF) group of the neck is used as our target musculature in this example (Fig. 1):
a. Have the client begin in a neutral starting position.
b. "Pre-stretch" the client into left lateral flexion (LLF) until the beginning of tension is felt.
c. Ask the client to gently isometrically contract the RLF target musculature against your resistance for approximately 5-8 seconds to trigger the GTO reflex. The client can either exhale or hold in the breath during this step. When providing resistance, it is important to not push against the client, but rather to simply meet and resist whatever contraction force the client is creating.
d. Have the client relax, wait a split second, and then further stretch the client into LLF. This completes one repetition. Typically 3 to 4 repetitions are done, each one beginning at the end (stretched) position of the previous repetition; and the client is asked to increase the force of contraction with each repetition. Although CR stretching usually involves isometric contraction, the client could be allowed to concentrically contract the muscle instead. Also, even though each repetition most often begins where the previous repetition ended, it is possible to ease off the stretch and begin the next repetition from a less-stretched position. What is important with CR stretching is that the target muscle contracts with sufficient strength so that the GTO reflex is triggered.
Clinically, the choice to use standard mechanical stretching or to employ an advanced technique such as CR stretching should be made based on the needs of the client on the table. Any stretch can be converted into a CR stretch.
As a clinical therapist, it is important to have as many treatment tools in our tool chest as possible. CR stretching does require participation on the part of the client; and generally there is a learning curve for both the therapist and client to become efficient and smooth when performing it. However, once the protocol becomes familiar, it is quite easy to employ and incorporate into the treatment session. CR stretching is especially valuable when working on clients who have not responded well to massage and standard stretching. If you have not yet worked with CR stretching, try adding this tool to your practice.
Part two of this article explores the other advanced neural inhibition stretch, agonist contract (AC) stretching. It also compares CR with AC stretching, and discusses the contract relax agonist contract (CRAC) stretching technique.
Joseph E. Muscolino, DC, has been a massage therapy educator for 24 years, teaching both core curriculum and continuing education classes. He currently teaches anatomy and physiology at Purchase College, SUNY. He is the owner of The Art and Science of Kinesiology in Stamford, Conn., and is the author of The Muscle and Bone Palpation Manual, with Trigger Points, Referral Zones, and Stretching; The Muscular System Manual, 3rd edition; and Kinesiology, The Skeletal System and Muscle Function, 2nd edition (Elsevier, 2009, 2010, 2010), as well as other publications. For more information or to contact Joseph, visit www.learnmuscles.com.
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