What are neuromuscular techniques and how do they restore joint mobility and reduce pain.
Updated: Feb 26
Muscles, tendons, ligaments, and joint capsules are all interconnected by fascia. These various soft tissues all have a large number of nerve endings acting as sensory receptors. They provide a vast amount of different sensory information about the muscles and joints. (Levangie and Norkin 2012).
Some proved information about muscle stretch and length; others respond to muscle tension. A type of nerve known as a mechanoreceptors supply touch, pressure sensations, and proprioceptors provide information on joint position.
One type of nerve ending called nociceptors respond to a painful stimulus (Splittgerber 2019). Consequently, this pain can lead to muscle guarding, and immobilization which retards the functional mobility of a joint, as joints are primarily moved by muscles (Levangie and Norkin 2012).
This is where musculoskeletal therapy can help.
One form of osteopathic treatment is post isometric relaxation which is ‘’utilised to assist and corrected the presenting musculoskeletal dysfunction’’ John Gibbons (2013).
Current bodies of evidence suggest that pain modulation is effective, as shown by Kennedy et al’s (2016) review. Pain inhibition occurs because techniques can achieve a hypoalgesia effect by reducing nociceptive input, resulting in reduced pain, muscle guarding, and leading to normal movement. (Fagih et al 2019).
This inhibition and improved mobility are observed with Thomas et al’s (2019) study on whether a type of neuromuscular technique that is commonly used by osteopaths found they are an effective way of reducing pain, muscle guarding, and increasing mobility.
Furthermore, research has also shown improvement in posterior shoulder tightness within young athletes (Reed et al 2018). It can also enhance the resting posture of a joint, as analysed by Laudenr et al’s (2015) study, determining that treatment improved the glenohumeral (shoulder) joint position in swimmers, ultimately improving their functional mobility. With a systemic review conducted by Yeun (2017) into increasing shoulder mobility, concluding that there is a significant improvement in reduction in pain and improved mobility.
The science behind how neuromuscular techniques reduce pain
Nociceptors, when stimulated, generate nerve impulses known as action potentials that synapse with second-order neurons in the substantial gelatinous, a cluster of neuronal cell bodies in the posterior gray horn of the spinal cord. They integrate these impulses, which ascend to the thalamus in the brain via the lateral spinothalamic tract, resulting in pain perception. (Splittgerber 2019).
However, this pain pathway can be inhibited by the stimulation of mechanoreceptors and proprioceptors, the nerve endings that respond to touch and joint position, respectively. When they are stimulated by massage therapy or neuromuscular techniques, they synapse with other second-order neurones also in the substantial gelatinous (Splittgerber 2019). Causing them to release Gamma-Aminobutyric acid, which has been shown to act as an inhibitory neurotransmitter (Ngo & Vo 2019). Gamma-Aminobutyric acid inhibits the synaptic terminals receiving stimulus from the nociceptors, thereby decreasing their action potentials and the perception of pain (Pelaez et al 2015).
Additionally, the ascending lateral spinothalamic tract can stimulate the Periaqueductal Greymatter (PAG) nuclei in the midbrain. PAG synapses with other nuclei prompting the realising of the neurotransmitter’s noradrenaline and serotonin. These neurotransmitters stimulate the neurons in the spinal cord to secrete endogenous such as endorphins, which are the body’s own morphine-like inhibitory neurotransmitters (Felten and Shetty 2010).
The science behind how neuromuscular techniques restore mussle hypertonicity
As has been mentioned, the use of neuromuscular techniques to reduce hypotonicity can increase joint mobility and is achieved by another intrinsic neurological process. Known as the spinal somatic reflex pathways and rely on the muscle spindles and the Golgi tendon organs, other types of sensory neurons (Splittgerber 2019). When a muscle is under contraction the muscle spindle sends action potentials to inform the central nervous system of the change in length. For this contraction to occur the antagonistic muscle must relax. This is made possible when the incoming action potential synapses an excitatory neurotransmitter to the motor neurons, causing contraction. At the same time, it synapses with an inhibitory interneuron, inhibiting the contraction of the antagonist. This is known as reciprocal inhibition (Splittgerber 2019).
Inhibitory singles are also transmitted by the GTO, acting as a protective mechanism to stop the tendon from becoming stretched. When tension in a muscle is generated through prolonged contrition, the GTO transmits action potentials in a dysynaptic manner meaning they synapse on to two neurones. An inhibitory interneuron inhibits contrition and promotes muscle relaxation while simultaneously synapsing with an excitatory interneuron, creating a contraction in the antagonist, which like above, further relaxes the muscle that is contracted (Felten and Shetty 2010).
In summary, evidence has shown that applying these neuromuscular techniques can elitist the body's hypoalgesic effect, reducing nociceptive input and muscle guarding. Evidence-based research has also demonstrated how using spinal reflex arches can be used to reduce muscle hypertonicity. Both are having the desired effect of reducing pain and restoring joint range of motion.
Chaitow L, (2013). Muscle Energy Techniques. 4th Ed. London: Churchill Livingstone.
Chila, A (2011). Foundations of Osteopathic Medicine. 3rd Ed. Philadelphia: Lippincott
Williams & Wilkins.
Faqih A, Bedekar N, Shyam A Sancheti P (2019). Effects of Muscle Energy Technique on Pain, Range of Motion and Function in Patients with Post-Surgical Elbow Stiffness: A Randomized Controlled Trial. Hong Kong Physiotherapy. 39 (1), 25–33.
Felten D, Shetty A (2010). Netter’s Atlas of Neuroscience. 2nd Ed. Philadelphia: Saunders Elsevier.
John Gibbons (2013). muscle energy techniques a practical guide for physical therapists. 2nd ed. California: lotus.
González Z, Pavez-Baeza A, Espinoza G Huerta O (2018). The Effectiveness of Joint Mobilization Techniques for Range of Motion in Adult Patients with Primary Adhesive Capsulitis of The Shoulder: A Systematic Review and Meta-Analysis. Medwave. 18 (5), 34-56.
Hertling D, Kessler R, (2006). Management of Common Musculoskeletal Disorders Physical Therapy Principles and Methods, Philadelphia: Lippincott Williams & Wilkins.
Juneja P, Hubbard J. (2018). Anatomy, Joints. Available: https://www.ncbi.nlm.nih.gov/books/NBK507893/. Last accessed 21st November 2019.
Loyd D, Henry M, Hargreaves K, (2013). Serotonergic Neuromodulation of Peripheral Nociceptors. Seminars in Cell & Developmental Biology. 24 (1), 51-57.
Kim J, Sung D, Lee J(2017). Therapeutic Effectiveness of Instrument-Assisted Soft Tissue Mobilization for Soft Tissue Injury: Mechanisms and Practical Application. Journal of Exercise Rehabilitation. 13 (1), 12-22.
Khyathi V, Babu K, Kumar S, Asha D, (2015). Comparative Effect of Spencer Technique Versus Mulligan’s Technique for Subjects with Frozen Shoulder – A Single Blind Study. International Journal of Physiotherapy. 2 (2), 448-458.
Laudner K, Wenig M, Selkow N, Williams J, Post E. (2015). Forward Shoulder Posture in Collegiate Swimmers: A Comparative Analysis of Muscle-Energy Techniques. Journal of Athletic Training. 50 (11), 1133–1139.
Levangie P, Norkin C (2012). Joint Structure and Function, A Comprehensive Analysis. 5th Ed. India: F. A. Davis Company.
Loghmani T and Whitted T (2016). Soft Tissue Manipulation: A Powerful Form of Mechanotherapy. Journal of Physiotherapy & Physical Rehabilitation. 122 (1), 365-373.
Magee D (2014). Orthopaedic Physical Assessment. 6th Ed. Canada: Elsevier Sunders.
Magee D, Zachazewski J, Quillen W (2007). Scientific Foundations and Principles of Practice in Musculoskeletal Rehabilitation. Missouri: Saunders Elsevier.
Ng J, Kersh M, Kilbreath S, Tate M. (2017). Establishing the Basis for Mechanobiology-Based
Physical Therapy Protocols to Potentiate Cellular Healing and Tissue Regeneration. Frontiers in Physiology. 8 (1), 303-318.
Ngo D, Vo T, (2019). An Updated Review on Pharmaceutical Properties of Gamma-Aminobutyric Acid. Molecules. 24 (15), 1-23.
Nicholas A, Nicholas E (2012). Atlas of Osteopathic Techiques. China: Wiliams & Wikins.
Noten S, Meeus M, Stassijns G, Van Glabbeek F, Verborgt O, Struyf F. (2016). Efficacy of Different Types of Mobilization Techniques in Patients with Primary Adhesive Capsulitis of
The Shoulder: A Systematic Review. The American Congress ofRehabilitation Medicine. 97 (5), 815–825.
Okamoto T, Masuhara M, Ikuta K. (2014). Acute Effects of Self-Myofascial Release Using A Foam Roller on Arterial Function. J Strength Cond Res. 8 (1), 69-73.
Peláez S, Taniguchi S, (2016). The Gate Theory of Pain Revisited: Modelling Different Pain Conditions with a Parsimonious Neurocomputational Model. Neural Plasticity. 2016 (1), 1-14.
Reed M, Begalle S, Laudner G, Phd (2018). Acute Effects of Muscle Energy Technique and Joint Mobilization on Shoulder Tightness in Youth Throwing Athletes: A Randomized Controlled Trial. International Journal of Sports Physical Therapy. 13 (6), 1024–1031.
Splittgerber R (2019). Snell’s Clinical Neuroanatomy. 8th Ed. China: Lippincott Williams & Wilkins.
Thomas E, Cavallaro A, Mani D, Bianco A, Palma A, (2019). The Efficacy of Muscle Energy Techniques in Symptomatic and Asymptomatic Subjects: A Systematic Review. Chiropractic & Manual Therapies. 27 (35), 18.
Tortora G, Derrickson B (2017). Principles of Anatomy & Physiology. 15th Ed. Unites State of America: John Wiley & Sons.
Yeun Y, (2017). Effectiveness of Massage Therapy on The Range of Motion of The Shoulder: A Systematic Review and Meta-Analysis. Journal of Physical Therapy Science. 29 (2), 365-369.