Last week I blogged about the situation when the nervous system becomes "reset" to a faulty position: if you remember, at times when we're habitually tensing our muscles, then the nervous system will "reset" to this new position as if it's normal. Then when nerve impulses are sent to the muscle telling it to relax, all the muscle does is reset back to this new state... which isn't relaxed at all!
In circumstances like this, a variety of different remedial soft tissue therapy techniques are used: deep tissue massage on it's own isn't likely to produce particularly good results. Recall that we're not just dealing with tight muscle - we're also having to deal with the nervous system which is keeping the muscle tight.
Generally, combining a couple of the techniques below (often with deep tissue work) will help best. The truth is that everybody is different, and a technique that may work in isolation on one person's system, may not necessarily work on another's.
Below are a few of the techniques used. To make it easy to read I've given an example of when each technique might be used - but remember, in reality each situation will require judgement about the combination of techniques.
NMT works by inflicting pain on a muscle: basically the therapist grabs the offending muscle and squeezes for up to a minute.
The levator scapulae muscles respond really well to NMT. These are the muscles that are really tight in someone who's stressed or who's head is kept forward (from driving, sitting at a desk... basically anyone).
Before I use NMT on a client I'll always give them warning by saying, 'on a scale of 1 to 10, where 1 is I'm tickling you, and 10 is "shit that must be what childbirth is like", I'm aiming for a 5. So this is meant to hurt but not be excruciating.'
Everyone's pain threshold is different, and some people will not want to admit that it hurts in front of the therapist. So a good therapist will be very alert to body language as he or she starts to apply pressure.
The pressure is kept on the muscle for up to a minute. Usually by then it'll have started to relax (basically we think the nervous system is saying "ok, ok, I surrender!") - the muscle will start to slip through the therapists fingers. There's not really much point in keeping the pressure on for too much more than a minute, to be honest - if the nervous system hasn't hit on the right strategy in that time, it's unlikely to even if pressure's applied for longer.
Because we're interested in the muscle relaxing by itself, rather than us pushing the muscle through our fingers to "massage" it, NMT needs to be done with non-greasy hands. So I'll always do anyareas that need neuromuscular treatment 1st, before I start using massage lotion.
The fact that I can be gentle (sometimes) has been (at least until today when I'm announcing it to the world) my best kept secret.
In 2 situations light massage (effluerage) is the most effective treatment: whiplash and when the client's lower back is in genuine spasm (that is, completely "locked up").
We've already seen, from last week's post, that it's the nervous system that controls muscles. One of the most important jobs of the nervous system is to protect 2 relatively fragile joints in the body: one at the base of the neck the other at the base of the spine. If those joints are threatened (e.g. in a car accident with the head whipping forward and back at high speed), then the nervous system will send emergency signals to the muscles around the joint to "lock down" in order to prevent injury to the joint.
In these cases, the nervous system needs persuading that the danger is past and that it's safe to relax the muscles. This is where gentle massage comes to the fore.
Rocking is another technique aimed at nervous system: it's the nervous system equivalent of hypnotherpy! I use it sometimes with clients whose backs are in spasm. The last time a grown person was gentle rocked was probably decades ago in their parents arms. Remembering that the "lock down" signals don't come from the brain but rather from the more primitive nervous system, the body may respond to this "memory" of being comforted. It's a long shot, admittedly, but sometimes it works.
Trigger points can occur pretty much in any muscle of the body. They're basically localised hypertonic muscle tissue - that is small areas of an individual muscle that have the faulty "reset" setting.
Applying pressure for up to a minute can often cause trigger points to release, for the same reasons that we talked about above with NMT.
I'll often use trigger point therapy on clients with massive calf muscles, for example.
It's worth reminding ourselves that sports massage is what's called an "alternative therapy." And although it's well respected, has been used by professional athletes for decades, and is practised by ISRM members in a clinical setting, it's not a science.
It's not possible to say with certainty what specific treatment will work with a given client, so experience, gut instinct, training and competence all come into play.
As ever, if you think I can help, give me a call.