Based on the work of Drs. Janet Travell and Raymond Nimmo, neuromuscular therapy, or trigger point myotherapy, is an appropriate and effective technique for medical and sports massage. Learn why neuromuscular therapy is recognized as one of the most effective types of bodywork for relieving lower back pain.

Neuromuscular Therapy for Lumbar Spasms
by Nicole Cutler, L.Ac.
American Massage Therapy Association

Neuromuscular therapy (NMT) is the application of static pressure and applied stretching techniques to specific myofascial points for pain relief. Additionally, NMT employs soft tissue manipulation to balance the musculoskeletal and central nervous systems. To relieve pain, NMT directly addresses the following pain-causing elements:

1. Ischemia: The lack of oxygen due to reduced blood supply that can cause pain.

2. Nerve Compression or Entrapment: Pressure on a nerve by soft tissue, cartilage or bone.

3. Postural Distortion: Imbalance of the muscular system resulting from the movement of the body off the longitudinal and horizontal planes.

4. Biomechanical Dysfunction: Imbalance of the musculoskeletal system resulting in faulty movement patterns.

Lumbar Muscle Spasms
Lumbar muscle spasms are involuntary contractions typically occurring as a result of a muscle strain. Strains in the lumbar region are commonly due to exercising excessively or performing a movement beyond a muscle's range of motion. Sudden movements that claim a majority of lumbar sprains, include:

• Unexpected jarring, such as an automobile accident
• Quick twisting, such as a vigorous tennis backhand stroke
• Excessive muscle loading, such as picking up a heavy object

The body's response to a muscular strain is to protect the involved muscle from further injury. This protection is accomplished through contraction of its fatigued fibers to prevent any further stretching. Unfortunately, a chain of pain-causing events can follow a muscle sprain:

1. The contraction of strained muscles typically restricts adequate blood flow to the area, causing ischemia and lactic acid accumulation. Lactic acid accumulation itself can initiate muscle spasms.

2. Depending upon the muscle's location, its contraction can put pressure on a nearby nerve. Termed nerve entrapment or compression, muscles squeezing a nerve can illicit intense radiating pain.

3. A muscle strain can disrupt the body's musculoskeletal balance. Postural distortion is the body's mechanical method of protecting and compensating for an injury. Unfortunately, this distortion off the body's midpoint sets the individual up for a perpetuation of muscle strains, contractions and even more pain.

4. When an injury continues to disrupt body function, the individual may adapt their movement patterns in an effort to minimize pain. This adaptation solidifies a musculoskeletal imbalance and can transform a simple strain into whole body pain and dysfunction.

Muscle spasms can also occur as a reflex phenomenon caused by injured ligaments, infections, tumors or chronic disc problems.

Lumbar Disc Problems
Many disc abnormalities are actually a result of the aging process. Although pain from a herniated disc may come on suddenly, its cause generally occurs gradually, sometimes taking years to develop. Starting in young adulthood, discs naturally begin to dry up. The most likely location for changes to begin is the lower lumbar region, at the disc between the fourth and fifth lumbar vertebrae. Medical professionals speculate that this disc is most vulnerable due to the stress accentuated by the spine's lumbar curve.

As a result of the degeneration associated with aging, the disc slowly loses its ability to bounce back. In the first stage of anatomic abnormality, the soft interior of the disc bulges outward. This bulging disc presses against the ligament holding it in place. The pressure on the involved ligaments can pull on and therefore strain nearby muscles, resulting in lumbar muscle spasms. Additional pain can ensue because the pressured ligament can impinge neighboring nerves. A worsening of this condition leads to disc herniation, where the inner core of the disc extrudes back into the spinal canal.

Breaking the Cycle
Fortunately, massage therapists practicing NMT have the tools to break the chain of events that can follow a lumbar sprain. NMT uses trigger points to identify and release pain referral patterns that are typical of lumbar sprains in the following ways:

• The application of static pressure on a trigger point disperses any built-up lactic acid, allowing the affected muscle to accept a clean supply of oxygen and blood flow. This circulation can release entrapped nerves and stop a muscle's spasm.

• Because NMT involves postural evaluation, the practitioner can identify and treat the muscular source of a painful spasm pattern.

• Additionally, NMT involves muscle fiber stretching to correct the imbalances fostered by unintentional muscular contraction.

In our society, lumbar spasms are one of the most encountered conditions prompting healthcare visits. As endorsed by the American Academy of Pain Management, including NMT in a massage therapy session can save your clients from the intense and unremitting pain of lumbar muscle spasms.

REFERENCES

www.bucklandmassage.com, What is Neuromuscular Therapy?, Buckland Massage and Neuromuscular Center, May 2004.

www.findarticles.com, Muscle Spasms and Cramps, Richard Robinson, Gale Research, 1999.

www.massagetherapy101.com, Neuromuscular Therapy, massagetherapy101.com, 2006.

www.spine-health.com, Neuromuscular Massage Therapy, spine-health.com, 2006.