resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
The Way We Are Designed: A Conversation with Gil Hedley, PhD
I was first introduced to the work of Gil Hedley by Tom DiFerdinando. He gifted me Gil's DVD series.
Joint Supplements for Athletes (Part 2)
A fairly recent discovery in nutrition supplemental medicine has proven to be a breakthrough in maintaining athletic joint health. Research suggests a combination of undenatured type-II collagen and tetrahydro-iso-alpha acids helps revitalize joint function and performance in athletes.
Managing Tibialis Posterior Tendon Injuries
The tibialis posterior is the deepest, strongest and most central muscle of the leg, with fibers originating from the tibia, fibula and interosseous membrane.
An Excerpt from TCM Case Studies: Pediatrics
This excerpt is reprinted with permission from Jamie Wu. TCM Case Studies: Pediatrics was released in 2014 by People's Medical Publishing House.
Striking a Blow to the Medical Monopoly
The U.S. Supreme Court has issued a landmark ruling in North Carolina State Board of Dental Examiners v Federal Trade Commission.
What Do You Know About Physician Compare?
Physician Compare is a website that allows consumers to search for and obtain information about physicians and other health care professionals who provide Medicare services.
TCM Congress in Rothenburg is Largest in Western World
In the medieval town of Rothenburg, deep set within the Bavarian countryside in Southern Germany, the TCM Kongress Rothenburg each year draws around 1.200 participants from more than 40 different countries to attend the biggest TCM conference in the Western world.
Keep Seniors Safe: Age-Proofing the Home
I want to give Dr. Claudia Anrig kudos for her Dec. 1, 2014 column, which highlighted safety issues youngsters might encounter in the home.
Treating GERD and Incontinence: Focus on Trigger Points
Gastroesophageal reflux disease (GERD) is defined as the regurgitation of stomach acid in the esophagus. Previously, it was thought that GERD was caused by a hiatal hernia, but recent trials suggest the cause is an inability of the hiatal sphincter to contract normally.
A Well-Kept Secret: 5 Element Acupuncture, Part II
Supervising acupuncture interns at a TCM college, it has always struck me how funny it is to hear the clinic manager tell the patients that the Five Element clinic specializes in treating emotions, as if patients with physical pain have no emotions!
There Really is No Room for Sexism
Recently, Matteo* (a transgender male) approached me during a break in an advanced shiatsu class in Berlin where he was one of two men in a group of 20 women. "Pamela. Don't forget to remind the translator to include male endings."
Older Patients, Stroke Risk and Manipulation
The first population-based study in the United States to evaluate stroke risk following spinal manipulation – and the first involving older adults – suggests that "[c]hiropractic cervical spine manipulation is unlikely to cause stroke in patients aged 66 to 99 years with neck pain.
Viewpoints: Massage Reduces Nonspecific Shoulder Pain, Improves Function
While seemingly universal, pain and stiffness in the shoulders can be a significant cause of disability. Often a pain that does not go away on its own, shoulder complaints tend to linger, sometimes for 12 months or longer.
Pain Is Only a Piece of the Puzzle
More often than not, when a patient presents to the office, it is for a pain complaint: headache, neck pain, low back pain, sciatica, carpal tunnel, etc.
Recreational Cannabis Use and TCM
Many people are drawn to cannabis for its effects physically, mentally and emotionally. Medically, cannabis has some legitimate uses, however the scope of this article is limited to the recreational use of cannabis.
Will You Be an Amplifer or a Mute?
These times are changing, and changing quickly. There have been many challenges to this profession throughout the past few years. The challenge is to talk, then talk and talk some more about this medicine.
The Need for a New Medical Model: A Challenge for Biopsychosocial and Ecopsychologica Medicine
Chinese medicine speaks of alignment between humans, heaven and earth. It is a complex view with a focus upon relationship. These are comprehensive ideas with no specific terms in contemporary medical practice.
Treating Beyond Pain
More often than not, when a patient presents to the office, it is for a pain complaint. Headache, neck pain, low back pain, sciatica, carpal tunnel... The pain is often the focus of the patient's mindset, and they don't often have any thought of what comes after the pain.
News in Brief
ACA Exec. Vice President Out, Acting EVP In; F4CP Executive Director Retires; New ED Named.
Synergy Doesn't Happen in Silos: Acupuncture in Hospitals and Other Healthcare Settings
As acupuncture and traditional East Asian medicine continue to intersect and integrate with biomedical approaches, the conversation about integration expands and becomes richer.
God and the Chiropractor
My wife went to church last Wednesday night and brought home a CD of the pastor's message. As she handed it to me, she said, "You should listen to this; you'll like it." Our family regularly goes to church and our faith plays a major role in our lives.
Converting More Patients to Your Practice
In 2013 and 2014, the theme was "the money is in the list." This meant that if you had a big email list, you were really making some "cha-ching." Unfortunately, having thousands of emails doesn't equate to thousands of dollars in profit.
The Dietary Supplement Research Dilemma
I do not care what the truth is, one way or another; I just want to know it. And when it comes to dietary supplements, the truth can be hard to find for a number of reasons.
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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