Neuromuscular Reeducationism™ (NMR)
Neuromuscular Reeducationism™ (NMR) is a hands-on technique / approach to the evaluation and functional treatment of soft tissue injuries that occur via trauma, repetitive motion, or chronic postural fatigue. It is an approach originally developed by Dr. Gary Glum and Dr. Joseph Hourigan and is currently being taught and perfected by Dr. Peter Levy. I had the pleasure of studying under Dr. Levy. I am a certified NMR practitioner and am performing this technique in office and have personally combined many of the NMR techniques with our previous myofascial release training to create what I feel is a unique way of treating muscle and joint problems.
What is the standard of health? You are born loose, and you die stiff and any loss of motion in between is a loss of vitality, a loss of function. This is usually only at a microtraumatic/microscopic level most of the time, but it adds up to a point where finally an injury limits your joint and tissue tensile strength and range of motion and you find you just can’t do what you used to do. And you don’t know where it went.
The key to understanding the technique of neuromuscular reeducation is learning about adhesions.
When an area is injured, whether it’s muscle, connective tissue, fascia, tendon or some combination of these elements, as most injuries are, the body handles it with an inflammatory response to those tissues (swelling). This is the only way the body knows how to handle an injury. This becomes a hyperplasia (increased buildup) of the affected tissue, followed by a fibrous healing, laying down of less elastic, second grade, poorly vascularized scar tissue to protect involved areas. Adhesions occur wherever damage and inflammation have occurred and they limit both strength and range of motion.
There may be an overall range of free movement, but at the joint level, even regular biomechanics are being altered by the adhesions. This causes joint restrictions. These restrictions act like layers of an onion; as one set of adhesions are set up in the muscles and joints, overlying layers infiltrate as we slowly began to lose our physiological adaptive capacity. We further lose our flexibility and spontaneity of motion, which eventually leads to trauma pain and restriction of motion. Adhesions can affect areas that are quite small, sometimes just a few muscle fibers and at other times, there can be a number of areas scattered throughout a muscle group.
For example, if you are doing a squat and even a small segment of the quadriceps (thigh) muscle stops contracting, you can put a lot of stress on the weakened area or on the other involved muscles that suddenly have to take up the slack. Also, if adhesions prevent the muscle from reaching proper extension the increased stress on the tendons can contribute to tendonitis.
Neuromuscular reeducation (NMR) locates restrictions and adhesions that are specifically related to abnormal motion. These restrictions are due to old trauma. As time goes on the restrictions feel normal to the patient and slowly full function of the joint is lost. The removal of theses adhesion and restrictions are critical to proper function. The muscles and tendons and ligaments are brought back into normal motion by applying deep and what most people would consider painful pressure to the specific areas of all the muscles that cross a specific joint not just to the areas where the pain is. There is no other technique quite like neuromuscular reeducation, because it works from the origin to the insertion of the muscles involved. Typically, most people find an increased range of function even after one session. This coupled with chiropractic manipulation makes for faster healing time.
Freeing the adhesions, however, is only part of the battle. Each person has a subtle complex or unconscious perception of his or her own body. When you have pain and limitation of motion due to an injury that lasts for weeks never mind years, you adapt your body image to fit that limitation. This unconscious mental adaptation, often persists long after an injury has resolved. It isn’t enough to just clear up a problem, we also have to convince the patients that the problem is gone. Otherwise they persist in favoring the area that was causing them pain.
Patients may often limp for several months after a hip, low back, shoulder or leg problem has been eliminated. Therefore, an important part of the treatment is in making the patient aware so that they can adapt their behavior to the new physical reality.
This is accomplished by:
- Working each individual muscle and involved joint to the fullest possible range of motion during each session.
- Removing fixations and subluxations with chiropractic manipulation.
- Sending the patient back to the activity that was causing them pain and problem as soon as possible to demonstrate that the problem has been resolved
Most bodybuilders and other athletes hope they can free adhesions on their own by forceful contractions and stretching. But this maneuver fails because:
- The inhibitory feedback signals from the affected area prevent sufficient contracting or stretching to accomplish this,
- The adhesions are not necessarily parallel to the muscle fibers and can lieany which way which prevents their reduction by stretching.
Neuromuscular reeducation is affective in chronic as well as acute conditions and one of the best parts of this work is that active people get better faster. It is rarely a long-term project with the exception of major tears and other injuries. If people need further attention we refer them to the top specialists in the area.