A confusing element relating to the term NMT emerges, because of its use by Dvorak et al (1988), when they describe what are, in effect, variations on the theme of the use of isometric contractions in order to encourage a reduction in hypertonicity. These methods, all of which form part of what is known as muscle energy technique (MET) in osteopathic medicine and proprioceptive neuromuscular facilitation (PNF) in physiotherapy, are described briefly in Chapter 8, and form the focus of a further title in the series of which this book is part (Chaitow 2001, 2006).

Dvorak et al (1988) have listed various MET methods (as NMT) as follows:

1. Methods that involve self-mobilization by patient action, to encourage movement past a resistance barrier, are described as ‘NMT 1’.

2. Isometric contraction and subsequent passive stretching of agonist muscles, involving postisometric relaxation, are called ‘NMT 2’.

3. Isometric contraction of antagonists, followed by stretching, involving reciprocal inhibition, are described as ‘NMT 3’.

Use of the terms NMT 1, 2 and 3 in these ways, by Dvorak et al (1988), in order to describe these methods, succeeds in adding to, rather than reducing, semantic confusion, and it is hoped that this aberrant set of descriptors will not persist.

Unique aspects of NMT

What is unique to NMT, as discussed in this book, is its concentration on the soft tissues, not just to give reflex benefit to the body, not just to prepare for other therapeutic methods such as exercise or manipulation, not just to relax and normalize tense fibrotic muscular tissue, and not just to enhance lymphatic and general circulation and drainage, but to do all these things and, at the same time, to be able to offer the practitioner diagnostic information via the palpating and treating instrument, which is usually the thumb.

NMT can usefully be integrated in treatment that is aimed at postural reintegration, tension release, pain relief, improvement of joint mobility, reflex stimulation/modulation or sedation. There are many variations of the basic technique, as developed by Stanley Lief, the choice of which will depend upon particular presenting factors, or personal preference. Similarities between some aspects of NMT and other manual systems (see Ch. 8) should be anticipated, as techniques have been borrowed and adapted from other systems where appropriate. For example, in Chapter 11 Dennis Dowling demonstrates the clinical value of using progressive inhibition of neuromuscular structures (PINS), a unique way of utilizing NMT effects, in pain control. Use of PINS in pain control offers an example of the evolution of new applications of the basics, which NMT provides (Dowling 2000).

And just as there are current evolutionary paths involving NMT principles, so there have been parallel evolutions of methods that derive from similar backgrounds. In Chapter 12 Howard Evans describes Thai yoga massage methods that are truly a blend of the model of manual care that evolved in Thailand, based on the same root approaches deriving from Ayurvedic massage which let to Lief’s NMT. Evans’ approach is further influenced by having studied Lief’s methods giving him a useful Western and Eastern set of approaches which he has fused and described (Evans 2009).

NMT can be applied generally, or locally, and in a variety of positions (with the patient seated, supine, prone, side-lying, etc.). The order in which body areas are dealt with is not regarded as critical in general treatment, but seems to be of some consequence in postural reintegration (Rolf 1977).

In Chapter 13, Cohen describes both the historical work of Raymond Nimmo, and the continuing evolution of his methods, which form a major part of American Version NMT, as described by DeLany in Chapter 10.

Most used NMT approaches – and ‘variable pressure’

The basic spinal NMT treatment and the basic abdominal (and related areas) NMT treatment (see Ch. 7) are the most commonly used, and will be described in detail in this and the next chapter. The methods described are in essence those of Stanley Lief ND DC and Boris Chaitow ND DC, both of whom achieved a degree of skill in the application of NMT that is unsurpassed. The inclusion of data on reflex areas and effects, together with basic NMT methods, provides the practitioner with a useful therapeutic tool, the limitations of which will be determined largely by the degree of intelligence and understanding with which it is employed.

As Boris Chaitow has written (personal communication, 1983):

The important thing to remember is that this unique manipulative formula is applicable to any part of the body for any physical and physiological dysfunction and for both articular and soft tissue lesions.

To apply NMT successfully it is necessary to develop the art of palpation and sensitivity of fingers by constantly feeling the appropriate areas and assessing any abnormality in tissue structure for tensions, contractions, adhesions, spasms.

It is important to acquire with practice an appreciation of the ‘feel’ of normal tissue so that one is better able to recognise abnormal tissue. Once some level of diagnostic sensitivity with fingers has been achieved, subsequent application of the technique will be much easier to develop. The whole secret is to be able to recognise the ‘abnormalities’ in the feel of tissue structures. Having become accustomed to understanding the texture and character of ‘normal’ tissue, the pressure applied by the thumb (in general), especially in the spinal structures, should always be firm, but never hurtful or bruising. To this end the pressure should be applied with a ‘variable’ pressure, i.e. with an appreciation of the texture and character of the tissue structures and according to the feel that sensitive fingers should have developed. The level of the pressure applied should not be consistent because the character and texture of tissue is always variable. These variations can be detected by one’s educated ‘feel’. The pressure should, therefore, be so applied that the thumb is moved along its path of direction in a way which corresponds to the feel of the tissues.

This variable factor in finger pressure constitutes probably the most important quality any practitioner of NMT can learn, enabling him to maintain more effective control of pressure, develop a greater sense of diagnostic feel, and be far less likely to bruise the tissue.

Variation of applied digital pressure during the application of NMT is probably the most important single feature that deserves emphasis and re-emphasis to anyone learning or using these methods. This feature of NMT is discussed again later in this chapter.