Psoas Muscle and its Global Relationships

There continues to be a a lot of discussion about strengthening the core muscles. In this article I will discuss functional relationships that will inhibit the core muscles from being strengthened. Due to dysfunctional movement/coordination patterns, even the best of core strengthening programs will not be successful unless these dysfunctional patterns are reprogrammed. My approach, using NeuroKinetic Therapy, is to identify the muscles/functions that are inhibiting the core muscles. This can be easily accomplished through therapy localization. The spot (or spots) is then released using whatever techniques you already know and then the core muscles are retested to see if they are now facilitated. If the core muscles now test strong challenge them against the ones that were inhibiting them in the first place to see if your reprogramming protocol has been successful. If yes, then assign that sequence to your client as homework.

Let’s consider the psoas muscle as our first example. Any inhibition of a muscle that is centrally located will cause the motor control system to go into action to compensate for it because these muscles are crucial in all movements of the extremities and in spinal stabilization. A common pattern that I see is the psoas inhibited by the quadratus lumborum. Ipsilaterally this is considered an antagonistic relationship. Using the NKT protocol, first manually muscle test the psoas, and let’s assume it tests weak. Then find a tender spot on the quadratus lumborum and while holding it, retest the psoas. If the psoas now tests strong you know exactly which spot to release on the quadratus lumborum. After releasing the quadratus lumborum retest the psoas. If it now tests strong, then challenge it by testing the quadratus lumborum and retesting the psoas. If the psoas is able to withstand the challenge, you have successfully reprogrammed that dysfunctional pattern.

The psoas can also be inhibited by the hip flexors in a synergistic relationship. Muscles that I find that are commonly inhibiting the psoas in this group are the TFL, the proximal portion of the rectus femoris, the iliacus, and the adductors (especially the pectineus). Use the same NKT protocol to treat.

There are also core relationships to deal with. Inhibition of the psoas can cause facilitation, tightness, and pain in the lumbar spine and the sacroiliac joint. Because the psoas attaches to the lumbar intervertebral discs, it is crucial in the management of low back pain to deal properly with these dysfunctional relationships.

The last category of relationships to consider involves kinetic chains. It is not uncommon to find the psoas inhibited by the ipsilateral scalenes, the contralateral pectoralis minor, and the ipsilateral tibialis anterior. I find many unresolved cases of neck pain alleviated by addressing the relationship of the psoas to the scalenes. This can also contribute to TOS and other neurological problems involving the brachial plexus.

It is important to remember that just because the psoas is tight that doesn’t mean it needs to be stretched or worked deeply. The question you have to ask is why is it tight? If it is weak and tight the worst thing you can do is to stretch it. A weak muscle does not like to be stretched. It will cause a panic in the motor control system and the body will rebound by tightening it even more. When a muscle is weak it protects itself by shortening. It is crucial to first test a tight psoas to determine if it is weak or strong. If it is strong you can go ahead and stretch it. If it is weak you must first figure out why it is so and then rehabilitate it. When the psoas is strong then you can go ahead and stretch it.

In future blogs, we will discuss other core muscles and their global relationships, such as the transverse abdominis, the diaphragm, and the pelvic floor.

Cervical Dystonia/Torticollis

When I was researching standard treatment for cervical dystonia, mostly what I found was that there was no cure and the usual treatment is Botox injections. The Botox is generally injected into the “overworked” SCM and Splenius Capitus. This may provide some temporary relief of symptoms but certainly is no cure. What is not explored much in the literature are the motor control issues associated with this condition. Clearly the brain is sending dysfunctional signals to the muscles of the neck. But what can be done to change that?

There are four basic patterns associated with this condition. The first is a rotation of the head to one side. The second is a lateral side bending of the head to one side. The third is forward flexion. The fourth is extension. What is commonly seen is a combination of these patterns. The most frequent of these would be rotation of the head with contralateral side bending. Let’s examine each of these and the possible treatment protocols. With rotation of the head to the left, the most active muscles would be the right SCM and the left Splenius Capitus. First test the “connectivity” of the left SCM and the right Splenius Capitus. Does inhibiting the right SCM and the left Splenius Capitus facilitate the other two muscles? This would be an example of a functional correction. Of course there are many more muscles/functions involved in turning the head to the left. The left longus colli, scalenes, and the suboccipital muscles must also be examined. Testing for right thoracic rotation and left lumbar rotation is also crucial. These would be the most common compensatory rotations for a left cervical rotation. Re-firing the muscles that create left thoracic rotation and right lumbar rotation will greatly improve your treatment.

In lateral side bending of the neck the ipsilateral upper trapezius dominates with help from the levator scapula and the posterior scalene. The ipsilateral longus colli and neck extensor group must also be considered. The implications for a kinetic chain start with the latissimus dorsi, obliques, hip abductors, and peroneals. Testing the contralateral kinetic chain for inhibition and making corrections again will greatly enhance your outcomes.

In flexion of the neck, the SCMs,longus colli, suprahyoid muscles, and neck extensors must all be thoroughly examined. Check the kinetic chain from the pectoral muscles, the diaphragm, the abdominals, the hip flexors, the knee extensors, and the ankle extensors. These may be inhibiting the muscles involved in the extension kinetic chain.

In extension of the neck, the same muscles that are involved in the flexion pattern must be resolved but with the opposite emphasis. Check the kinetic chain from the trapezius, levator scapula, rhomboids, Multifidi, quadratus lumborum, gluteals, hamstrings, calf muscles, and the muscles of the sole of the foot.

With a combination pattern of rotation and side bending you must mix and match the most active muscles along with their associated kinetic chains. This requires a great deal of assessment, testing, and treatment, but the results will be worth it.

Client compliance is crucial in resolving cervical dystonia. Exercises which emphasize stretching the overworked muscles followed by strengthening the inhibited muscles produce excellent results. There are many other options such as eye tracking exercises. One of my clients when looking down always turns his head to the left. Retraining of that pattern is crucial in the resolution of this condition.

In conclusion, the treatment of cervical dystonia is a complicated assessment and treatment process that requires strict client compliance with assigned exercises. Therapies which reconfigure dysfunctional motor programs in the cerebellum are likely to be the most successful.

Reactive Muscles and the Kinetic Chain

The concept of reactive muscles was introduced by David Walther in his book “Applied Kinesiology”. When two muscles are in relationships such as synergistic or antagonistic, one muscle has the ability to compensate for the other. Although the muscles may manually test strong or facilitated by themselves, in relationship one muscle may inhibit the other. This is called a “reactive pair”. Understanding this dynamic is crucial in working with dysfunctional movement patterns. A good example would be a client presenting with lower back pain. First test the transverse abdominis and it tests strong. From this you might assume that this muscle is working just fine and is not contributing to the problem. Then test the lumbar erectors. Let’s say they test strong. Then retest the transverse abdominis. Now you find that it tests weak. This reactive relationship clearly is contributing to the lower back pain. Using the NeuroKinetic Therapy protocol, the lumbar erectors are released so that the transverse abdominis becomes facilitated. This can be the underlying reason for unresolved lower back pain. This is a classic example of a reactive antagonistic relationship.

When we use our muscles in concert with each other there is a natural flow of effort transmitted from one muscle to the other. A good example of this is picking up a glass of water and drinking it. First you need to grasp the glass, requiring intrinsic and extrinsic muscles of the hand. Then the wrist and elbow must bend, requiring muscles of the forearm and humerus. Then the shoulder must flex and finally the mouth must open. This is a complex action which normally requires no conscious thought. In other words, it has become a motor program. However, if there has been an injury or a long-standing postural distortion, this normally effortless action becomes compromised. We can call this a synergistic reactive relationship. Any muscle in this chain of action can inhibit another. A tight jaw could cause a weak grip. Check this out by first testing the grip. Is the client clenching his/her jaw? If so, release the involved jaw muscles before retesting the grip. You will find that the grip now tests strong. I have found the scalenes in this kind of reactive relationship to 13 different muscles further down this chain. Is it any wonder that the client was diagnosed with thoracic outlet syndrome?

Knowing how to work with reactive muscle relationships is an essential element in rehabilitative therapy. This powerful tool can help you unlock the secrets of dysfunctional movement and coordination patterns.

The Kinetic Chain and its Therapeutic Application

We know the hip bone is connected to the thigh bone. Kinetic chains both closed and open have been understood and utilized by physical therapists, personal trainers, and orthopedists for many years. We are now gaining a greater appreciation of the fascia and its role in kinetic chains thanks largely to Tom Myers in his book “Anatomy Trains”. Regardless of your orientation, understanding how kinetic chains function and how to apply that knowledge therapeutically is of paramount importance to the world of rehabilitation. We know that when we use muscles in coordination with others that they work in a defined fashion along patterns of kinetic chains. For example, when you brush your teeth, you must first pick up the toothbrush using muscles in the hand and forearm. Then you must bend your elbow and bring your hand up to your mouth. This action requires muscles that affect the elbow and shoulder. Bringing the toothbrush to the mouth engages muscles of the neck. All of this happens on a subconscious level. But how did this motor program originate?

Motor programs are created in the cerebellum in the motor control center. Many unsuccessful and successful attempts are made before the brain selects the most successful program and stores it as a routine in the motor control center. This works fine as long as this routine remains functional. However, if one or more of the muscles involved in the kinetic chain become injured, weakened, or dysfunctional then other muscles in the kinetic chain must pick up the slack and compensate. This kind of compensation when performed over time can lead to injury. How is this compensation pattern evaluated?

Manual muscle testing can be performed to evaluate the strength of a muscle. However, if another muscle is compensating for a weak muscle in its kinetic chain, that weak muscle may test strong. A very important piece of information would be missed if only testing in this fashion. In NeuroKinetic Therapy, testing is performed in a very specific protocol. First,the muscle suspected to be weak is tested  followed by the one suspected to be strong. Sometimes the “weak” muscle immediately fails the test. In this case look for another muscle in the kinetic chain that is tight or sore. Find a spot on that muscle that makes the “weak” muscle test strong. This process is called therapy localization. Then release the sore muscle using whatever technique you already know. Sometimes the “weak” muscle initially tests strong. Next test the “sore” muscle and it should test strong. Finally retest the “weak” muscle and it will test weak. This is an example of a reactive muscle pair. Muscles that work together in a kinetic chain can compensate for each other and create dysfunctional movement patterns. To resolve the reactive pair simply employ the NeuroKinetic Therapy protocol, by using therapy localization, releasing the tight muscle, and finally retesting the weak muscle to make sure it is strong. When the NeuroKinetic Therapy protocol is successful, you have reprogrammed the motor control center. This is how permanent rehabilitative change is made.

Let’s go back to the example of  brushing the teeth. If the grip muscles in the hand are weakened, another muscle in the chain will compensate. For example, if someone comes to you with neck pain and you only work on the neck, the weakness in the hand may be exacerbated because you are depriving the body of the mechanism by which it stabilized the grip. For a successful outcome, first test the grip muscles to see if they are weak. If so, therapy localize the neck muscles to see if they strengthen the grip. If this is successful, release the neck muscles and retest the grip muscles. If the grip muscles become strong, you have reprogrammed the motor control center. To challenge this new program, repeat the process by retesting the grip muscles, then retest the neck muscles, and finally retest the grip muscles. If there is any failure in the challenge, simply repeat the protocol until everything tests strong.

Knowing kinetic chains  is an important part of being a good body detective. But it is not enough to simply release muscles along a kinetic chain. You must change the way the brain has coordinated those muscles in the chain in order to affect a successful rehabilitation.

Ankle Sprains and the Kinetic Chain

An ankle sprain can be a fairly serious injury. Estimates for recovery range from three months to a year. We know that ligaments heal slowly and the tissue surrounding them must be strengthened in order to regain complete functionality. But what is often ignored is the effect of the unstable ankle on the rest of the body. Understanding how kinetic chains work is essential in unwinding complicated compensation patterns from acute or chronic injuries. The motor control center in the cerebellum will create a dysfunctional coordination pattern based on the information it is getting from the ankle and the rest of the body. This pattern will persist until it is reprogrammed with a new functional one. Long-standing aggravations to the knees, hips, lower back, and neck can be traced to dysfunctional movement patterns created by an ankle sprain.

Almost all ankle sprains are caused by a twisting of the foot which overstretches and tears the ligaments around the lateral malleolus (inversion sprain). What happens next is very interesting. It becomes very difficult to put weight on the outside of the foot because that causes pain. The foot then tends to be more comfortable in eversion, placing more weight on the inside of the foot. This causes the lower body to lean to the opposite side. What muscles must engage to make that happen? The evertors of the foot, adductors of the ipsilateral hip, abductors of the contralateral hip, the contralateral quadratus lumborum, the contralateral obliques, and the ipsilateral lateral neck flexors(upper body leaning ipsilaterally to counterbalance lower body). This will cause strain to the medial portion of the ipsilateral knee (medial meniscus strain), to the lateral portion of the contralateral knee (ITB syndrome), tightening of the contralateral quadratus lumborum and obliques (hip and shoulder level differences and leg length discrepancy), and tightening of the ipsilateral upper trapezius (neck problems such as persistent subluxations).

Clearly the dysfunctions along the kinetic chain must be addressed. I have seen neck problems of many years traced back to an ankle sprain. Changes in gait resulting from such a sprain can cause knee, hip, and lower back injuries. How would you treat this? I use the NeuroKinetic Therapy protocol to assess and treat such conditions. First I would manual muscle test the strength of the ankle and find what muscles/functions are compensating for that weakness. Then I would release the compensating muscles and retest the weak/inhibited ankle function. The same process can be applied to the knee, hip, lower back, and neck. I often find that when I asked my client to laterally flex their neck to the opposite side as the sprained ankle, it will inhibit many functions along that kinetic chain. Conversely, because the lateral neck flexors are bracing for those weak functions they can never relax. Each client will present a different combination of the above, so proceed slowly and investigate with great detail all the possibilities.

Having a global approach to injury is a very crucial aspect of successful rehabilitation. Treating injuries myopically can only lead to further dysfunction. Understanding how an injury can affect an entire kinetic chain is the key to unraveling the mysteries of chronic pain.

NeuroKinetic Therapy for the Treatment of Carpal Tunnel Syndrome

With the widespread use of computers, carpal tunnel syndrome and repetitive stress injuries (CTS/RSI) are quickly becoming one of the leading causes of workplace absenteeism in the United States. But computer operators are not the only ones affected with these maladies. Cashiers, hairdressers, massage therapists and countless other professionals can be seen wearing wrist braces in the line of duty. Allopathic medicine treats these conditions with anti-inflammatories, cortisone injections and ultimately surgery. However, almost all the physical therapists I’ve talked to who specialize in wrist and hand therapy agree that this surgery is mostly unsuccessful. Why? Because the underlying weaknesses and disorganization of the neuromuscular system have never been addressed. After surgery, patients return to work and continue harming themselves, because they are still using the same maladaptive biomechanics as before. What can be done?

I divide CTS/RSI into two distinct stages. In the first or more acute stage, the client cannot tolerate any pressure applied to the muscles of the forearm or hand without a severe rebound effect. With this scenario, very gentle myofascial release techniques are applied (over several sessions if necessary) until the pain diminishes and medium to deeper pressure can be used. Once this is accomplished, the client moves into the second stage where NeuroKinetic Therapy  (NKT) can be used to remedy those underlying weaknesses and disorganization. Some clients enter therapy at stage two and can benefit from NKT immediately.

How does NKT work? With the use of very specific muscle tests, NKT can detect muscle weaknesses. These tests can also define complex compensation patterns which can be the origin of stubborn, recurring problems. More importantly, the tests cue the motor control center in the cerebellum. When the movement patterns are reorganized in a healthy fashion in the motor control center, then true and lasting changes can be realized. Other neuromuscular techniques may affect the loop from the spinal cord to the muscles, NKT, with its use of a specific muscle testing protocol, actually affects the motor control center.

In NKT we recognize three basic patterns of muscle relationship. The first is “functional opposites,” where the antagonist inhibits the agonist. For instance, someone who uses a computer will overuse his finger flexors (flexor digitorum superficialis and profundus). This might create weakness in the finger extensors. Is it enough to just recommend exercises to strengthen the extensors? No. This could exacerbate the imbalance because the flexors are inhibiting the extensors. The motor control center would actually instruct the flexors to work harder, thus creating a vicious cycle.

The appropriate protocol is to first test the extensors for strength. There could be weakness, for instance, at a distal interphalangeal (DIP) or proximal interphalangeal (PIP) joint and it could be anywhere in the joint’s range of motion. It is also necessary to test the wrist extensors. The second step is to release the flexors. In NKT, passive or active spindle cell releases are used, but many kinds of release work can be employed. Therapy localization technique is used to ascertain the exact spot in the flexors that is inhibiting the extensors. When a point in the flexor is touched while testing the extensor and the extensor is strengthened, we know that is the exact point we want to release. The third step is to retest the extensors. If they don’t test strong, we find another point on the flexor to release. If they do test strong, we then activate the flexor and challenge the extensor again to make sure it can withstand the rigors of repetitive motion in a new coordination pattern. This process is repeated four or five times to ensure the muscle’s new capability doesn’t disintegrate under duress.

The above example shows how overuse creates inhibition and that creates a new use pattern in the motor control center. The messages to the extensors are inhibited. The NKT protocol allows for a reprogramming of the motor control center and lays down a new and healthy pattern. Your results with bodywork will be temporary unless you address the coordination patterns in the motor control center.

The second pattern is “core to extremity.” We find in this case that the muscles along the spine compensate for weaknesses in the extremities. For example, a weakness may be discovered in wrist extension that can’t be resolved in relation to the flexors. Instead, points along the upper thoracic and lower cervicals might be found which are compensating for wrist extension. The pattern is then released using the NKT protocol of test, release and retest.

The third pattern is “functional synergists.” Muscle weaknesses are compensated for by other muscles that have similar functions or fibers running in the same direction. For example, overuse of the thumb often leads to weakness in the thumb extensors (extensor pollicis brevis and longus). Muscles which can compensate include the extensor carpi radialis and ulnaris, brachioradialis, triceps, middle deltoid, supraspinatus, upper trapezius and scalenes. Specific tests determine the compensations and restructure the pattern. This is one of the most common situations I find in repetitive stress injuries, thereby making NKT an invaluable piece in resolving a puzzling pattern.

Grip strength is compromised in carpal tunnel syndrome. If the median nerve is compressed by swelling of the tendons of the flexor digitorum superficialis and profundus, the hand becomes weak and numb. If there is substantial tenderness, first use gentle myofascial release. Later, NKT is used to rebalance the finger flexors. One contributing factor can be a reciprocal inhibition imbalance between the opponens pollicis and opponens digiti minimi. Another is a functional synergy extending from the thumb through the flexor carpi radialis, palmaris longus and pronator teres to the internal rotators of the shoulder. Another is a”kinetic chain” from the little finger through the flexor carpi ulnaris, the supinator and the external rotators of the shoulder. This is a crucial piece in carpal tunnel syndrome rehabilitation where NKT really shines because it addresses all of the relevant elements with its elegant detail and specificity.

Of course there are other factors that contribute to CTS/RSI. The brachial plexus must be freed up, with attention paid to the scalenes and the pectoralis minor. Cervical and thoracic subluxations, as well as subluxations of the shoulder, elbow and wrist, must also be addressed. Proper rest, splinting, posture, ergonomics and exercise are crucial elements in rehabilitation. Again, proper exercise is best implemented after unwinding the compensation patterns. I have seen too many disastrous results from clients improperly exercising, especially during weight-bearing activities for which their bodies are not properly organized. I have found the NKT approach, in combination with client cooperation, to be an excellent treatment for CTS/RSI.

Repetitive Strain and the Elbow

The elbow is one of the areas of the body most subject to repetitive strain because of all the tendinous attachments. Not only do the flexor and extensor tendons attach there, but also the tendons of the finger flexor and extensor muscles, and the tendons of the muscles that produce pronation and supination. With all these tendons having to operate within such a small area, it is easy to see why the elbow is vulnerable to injury. Tennis and golfer’s elbow are the most commonly known elbow injuries, but the use of the mouse has also created its own brand of elbow strain. Overuse of the finger flexor muscles also contributes to elbow tendinitis. One of the most common ways to treat elbow tendinitis is cross fiber massage. The theory is that by breaking up adhesions, the function of  the tendon will be restored. I do not disagree with this. However, I believe this to be an intermediate step in a successful treatment program. First we have to ask ourselves, what causes elbow tendinitis?

Clearly, a repetitive action that the body cannot withstand is the cause. But what conditions have made the elbow vulnerable? For example, in lateral epicondylitis, quite often the tendon of the extensor carpi radialis brevis becomes inflamed. Why? Is it possible that is compensating for a weak muscle that shares its function? I often find that the extensor carpi radialis brevis is compensating for weakness in the grip or in the finger extensor muscles. Test the grip by either the shaking the person’s hand (if this produces pain in the elbow you know you have a compensation). You can also place the thumb and pinky finger together and try to pull them apart. If this tests weak and produces pain in the elbow, you know you have a compensation pattern. This assessment technique can also be applied to any of the muscles that attach to either the lateral or medial epicondyle. A weak supinator muscle can cause pain and tightness in the pronator teres. Overuse of the finger flexors during such activities as typing can cause the finger extensors to become weak, thus creating inflammation in the carpal tunnel. But how do we treat this?

The NeuroKinetic Therapy protocol allows the practitioner to integrate into it any release technique that he or she already knows. First test the muscle you think is weak. Then, find a tender spot on a muscle that you think is compensating for the weak one. Keeping your finger there, retest the weak muscle. If it tests strong, then release that spot. This is called therapy localization. After 30 to 60 seconds of release, retest the weak muscle. If it tests strong, you have successfully reprogrammed the dysfunctional movement pattern. For homework, have your client stretch the tight muscle first followed by strengthening the weak muscle. It is crucial that the exercise is done in this exact fashion. For a wonderful therapeutic device for the elbow please go to

NeuroKinetic Therapy is the perfect complement to many bodywork techniques because it’s protocol allows the practitioner to incorporate whatever release technique he or she already utilizes. In the case of repetitive strain to the elbow, assessing the compensation patterns, followed by treating them and assigning an exact therapeutic exercise, leads to a successful outcome.

Repetitive Strain and the Computer

Much has been written about the problems associated with the overuse of the computer. Computer professionals and enthusiasts often suffer from a particular combination of symptoms. First of all, because of the length of time in a seated position, compression of the lower back is common. Most people do not engage their deep abdominal muscles or their psoas muscles when seated, resulting in an increased lordosis and lumbar disk compression. Even with the most expensive and ergonomically designed chair, the strain of remaining in a seated position takes its toll. What can be done? After an ergonomic evaluation and postural analysis are performed, there needs to be some change in the way the person works so that they are not seated for long periods of time. My suggestion is to work standing up part of the day. This can be accomplished by using a desk that converts to standing or by using a device called the “Kangaroo Pro”. This is a very clever and inexpensive desktop device that fits on any desk. For more information please go to I have many clients currently using the Kangaroo Pro, and they report that their low back pain has improved significantly. Of course releasing the lower back muscles followed by strengthening the weak abdominal muscles is crucial in any rehabilitation program.

Aside from the problems with the elbow, wrist, and fingers (which we will cover at a later date), the next greatest complaint is of pain in the upper back and neck. We must remember that the neck muscles start at the bottom of the shoulder blades and end at the base of the skull. Our heads weigh between 15 and 20 pounds. People who use laptops generally speaking do not use laptop stands and thus are constantly looking down at their computers. The muscles in the back of the neck are then stretched and are straining to keep the head from falling further forward. This posture also inhibits the muscles in the front of the neck creating a further imbalance. What can be done? First of all, make sure you are at eye level with your monitor. If you have a laptop get a laptop stand. If you’re using bifocals get special computer glasses. This will prevent you from looking up and down which strains the muscles at the base of the skull. Working standing up can also greatly alleviate this problem. Testing the strength of the neck flexors in relation to the neck extensors will often reveal a significant weakness in the neck flexors. Start by releasing the muscles as far down as the bottom of the shoulder blades and up to the occiput. Then retest the neck flexors. If they test strong, mission accomplished. If they still test weak, continue releasing the neck extensors. Teach your client how to release the muscles in the back and how to strengthen the muscles in the front of the neck.

We will continue to see musculoskeletal problems associated with the overuse of the computer. As professionals we must educate our clients about posture, sitting for prolonged periods of time, and the proper use of a laptop. Employers must also be educated about ergonomic devices and exercises that can benefit their employees and reduce their workers compensation payments. Lower back pain and neck pain are the leading causes of missed work. There is certainly an opportunity for the manual therapist to benefit his or her clients and impact the workplace.

How Do You Treat Plantar Fasciitis?

In the world of manual therapy there are an infinite variety of techniques and approaches to dysfunctional patterns. I have been engaged in a conversation with other manual therapists about how to treat plantar fasciitis. Some want to treat the symptoms by ice therapy, splint therapy, or ultrasound. I agree that these techniques are very useful. But do they change the biomechanics that cause the dysfunction in the first place? Other therapists want to do cross fiber friction on the plantar fascia. When someone’s plantar fascia is extremely irritated and inflamed, this technique can cause an exacerbation. Myofascial therapists would work the calf muscles and locate trigger points that would mimic the pain in the heel. This I believe is a step in the right direction. Hypertonic calf muscles will cause a pull on the plantar fascia causing it to tighten and become vulnerable to inflammation. The question we have to ask ourselves now is what is causing the calf muscles to be tight?

When a muscle is tight and strong it is almost always compensating for a weak muscle. We know that to be true from scientific evidence ( please see my blog on the scientific basis for NeuroKinetic Therapy ). The motor control center in the cerebellum will select a related muscle to compensate, either an antagonist or a functional synergist. In this case I find that the calf muscles are compensating for weak gluteal muscles. Is it any wonder that the gluteal muscles are weak? We have a majority of our population working in a sedentary position. This is not to say that the calf muscles are always compensating for the gluteals. They can also compensate for weak hamstrings, quadriceps, or hip flexors. The job of a good manual therapist is to figure out which of these patterns is operating within the motor control center and to restore it to proper function.

NeuroKinetic Therapy is designed to accomplish such a task. In this case first test the calf muscles. If they test strong then test the gluteal muscles. If they test weak then touch a spot ( usually a sore spot ) on the calf and retest the gluteals. If the gluteals now test strong, you know you have to release that point on the calf. Continue releasing that point until the gluteals test strong in the clear. This is an example of the protocol of NKT. It is simple to do. You can use whatever technique you like to perform the release part of the protocol. The testing, releasing, and then retesting reprograms the dysfunctional pattern that has been stored in the motor control center. Once that is accomplished, the client must perform a home program. In this case it would be stretching the calf muscles followed by strengthening the gluteal muscles. It is important that this is done twice daily so that a new pattern can be burned into the motor control center. It is through repetition that the brain changes itself.

The question for us as manual therapists is do we want to treat symptoms or causes? I know all of us intend to heal our clients. Unless we find a way to identify the causes of dysfunction and treat them, we are simply working in the dark hoping things will get better.

Do You Treat Symptoms or Causes Part Three

One of the areas of the body where emotional baggage powerfully interacts with the neuromuscular system is the jaw. Temporomandibular joint dysfunction, also known as TMJD or TMJ, is said to be 90% emotionally based. Other causes include forceps delivery, malocclusion, poor orthodontia, and whiplash. Dentists treat TMJD with various techniques, such as night guards, splints, and treatments with TENS units. These therapies can sometimes be effective but mostly prove to be temporary. When someone clenches or grinds their teeth at night, clearly there is an unconscious emotional component. Some therapists say it is unexpressed anger. If that is the case, and I believe it to be, then what do we do as therapists to treat TMJD? On a physical level, the jaw muscles can compensate for almost any other muscle in the body. Have you not observed someone clenching their teeth to open a jar or perform a difficult task? When a muscle is overloaded, the motor control center will recruit whatever it can to perform that task. Using manual muscle testing, one can unravel the compensation patterns associated with the jaw muscles. For example, the jaw muscles can compensate for weakness in the grip, in the neck flexors, or in the hip flexors. These are just a few of the possibilities. Working intraorally, especially on the pterygoid muscles, and finding the compensation patterns associated with them, is also a very powerful technique.

In the end however, without treating the emotional component, all of this may be for naught. When treating someone for TMJD I always recommend seeking out a therapist who practices EMDR. I particularly like this technique because it deals with the unconscious mind where the source of the trauma is located. Just as I like to work with the unconscious mind using NeuroKinetic Therapy, I believe that quicker and better results can be obtained with EMDR. It was developed for posttraumatic stress for Vietnam vets. It uses rapid eye movement. Treating the emotional cause of TMJD in combination with unraveling the compensation patterns associated with the jaw muscles is a powerful tool.

It is important to remember that even though our clients present with physical symptoms, that not all of these are caused by purely physical reasons. A good therapist, using his or her detective mind, can identify the emotional causes of dysfunction, and work in combination with other therapists to determine what is best for the client.