Youngs (1964) has described what it is that the palpating fingers are seeking and finding and, as in NMT diagnosis and treatment often take place together, what they are achieving:

The changes which are palpable in muscles and soft tissues associated with reflex effects have been listed by Stanley Lief. They are essentially ‘congestion’. This ambiguous word can be interpreted as a past hypertrophic fibrosis. Reflex cordant contraction of the muscle reduces the blood flow through the muscular tissue and in such relatively anoxic regions of low pH and low hormonal concentration, fibroblasts proliferate and increased fibrous tissue is formed. This results in an increase in the thickness of the existing connective tissue partitions – the epimysia and perimysia, and also this condition probably infiltrates deeper between the muscle fibres to affect the normal endomysia. Thickening of the fascia and subdermal connective tissue will also occur if these structures are similarly affected by a reduced blood flow. Fat may be deposited, particularly in endomorphic types, but fibrosis is most pronounced in those with a strong mesomorphic component – a useful pointer for both prognosis and prophylaxis.

Fibrosis seems to occur automatically in areas of reduced blood flow, e.g., in a sprained ankle – where swelling is marked and prolonged, in the lower extremities where oedema of any origin has been constant over a period, in the gluteals where prolonged sitting is a postural factor, and in the neck and upper dorsal region where psychosomatic tension is frequent to a marked degree – depending upon the constitutional background. Where tension is the aetiological factor, fibrosis seems teleological.

Many devices have been developed to ease the strain on muscles which tend to be permanently contracted, e.g., locking of the knee joint, or the exact balance of the head on the shoulders, where only gentle contraction is needed to maintain postural integrity. If postural integrity is lost through some cause or another, then the strain on the muscle may be eased by structural alteration and the increase of fibrous tissue in the muscles acts to maintain normal position of the head. Fibrous tissue can then take the strain instead of the muscle fibres. It is this long-term homeostatic reflex which apparently operates in all cases of undue muscle contraction, whether due to strain or tension.

From this one can amplify Stanley Lief’s beneficial effects of neuromuscular treatment as follows:

1. To restore muscular balance and tone.

2. To restore normal trophicity in muscular and connective tissues by altering the histological picture from a patho-histological to a physiologic–histological pattern with normal vascular and hormonal response.

3. To affect reflexively the related organs and viscera and to tonify them naturally.

4. To improve drainage of blood and lymph through the areas subject to gravitational or postural stasis, e.g., abdominal vessels not necessarily connected with viscera.

5. To reduce fatty deposits.

Thus the hyperaemia, resulting from [NMT] treatment automatically operates to reverse the original patho-histological picture and consequently normality will be approached.

Trigger points

In clinical terms it is safe to say that a chronic state of dysfunction exists if soft tissues have been consistently stressed for more than a few weeks, for after such a short period fibrotic adaptations begin to be palpable.

There is clinical evidence that trigger points have a consistent distribution, and their localization can be predicted by studying the patterns of referred dysfunction and pain to which they give rise. Similarly patterns of referred pain are predictable if the trigger point can be located (Travell 1957, Travell & Simons 1992).

A patient with unexplained pain, the examination of which reveals no local cause, may well have trigger points feeding pain messages into the target area. Thus the point at which the patient feels pain, and the point at which the pain originates, are often not the same, and knowledge of the reference patterns as illustrated in Chapter 3 (see Fig. 3.6) is therefore important.

Whether treatment of trigger points consists of anaesthetic injections, acupuncture, cryotherapy, or pressure and stretch techniques (NMT), or combinations such as INIT (see Ch. 9), the diagnostic aspect remains the same. Deep palpation and pressure on the located point must reproduce the symptoms in the target area in order to ‘prove’ the connection.

Zones of dysfunction: connective tissue changes

As well as trigger points there exist a number of palpable and often visible (Box 5.1) zones of soft tissue alteration, possibly involving viscerosomatic activity, in which diseased or stressed organs negatively influence soft tissues paraspinally and elsewhere (Bischof & Elmiger 1960). Viscerosomatic reflexes and the processes of facilitation (sensitization) were discussed in Chapter 3. Some of these zones overlap and incorporate ‘trigger’ points, so a general awareness and knowledge of their existence is useful if an understanding of what can be achieved in NMT is to be more complete (Fig. 5.3).

Box 5.1 Assessing the dominant eye

In making a visual diagnosis it is important for the practitioner/therapist to be sure of the information he or she is acquiring. American osteopathic physician Edward Stiles (1984) made a valuable contribution to this area by pointing out that it is often for reasons of position, in observing structure, that a student or practitioner fails to see what is obvious: