Member Case Study: Neuromuscular Reeducation

author : AMSSM

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If one muscle has restrictions it can limit the range of motion on the connecting joint and have a domino effect as that tension and restriction is carried down the chain.

Question from co_tri_guy

I went a saw a Chiropractor today due to some lower back pain and he said I did not need to be "adjusted", but instead needed deep tissue work or manipulation. He said my muscles had too much lactic acid built up for training and this caused my sore back muscles and the way to relieve this was to do this therapy. 

I asked about the difference between this and massage and he said that this is much deeper than any massage and it should fix me up in 2-3 sessions. Anyone have any experience with this stuff?

Answer by Heather M. Gillespie, MD, MPH
Member AMSSM

Dear co_tri_guy,
The technique that your chiropractor was referring to was most likely neuromuscular reeducation. It is a specialty technique used by some chiropractors and massage therapists based upon “freeing of adhesions”.

Every muscle in the body is surrounded by fascia. When an area of the body is injured (muscle, connective tissue, tendon and/or fascia), the body may respond by creating an inflammatory response. This response can sometimes lead to hyperplasia and fibrous healing which causes adhesions within the fascia surrounding the muscle fibers. These adhesions can limit both strength and range of motion and can affect very small areas, such as a few muscle fibers, or larger areas and complete muscle groups.

The freeing of the adhesions, usually done using deep tissue work (which can be painful), is the first part of the technique. The reeducation portion of the technique involves working the joint through a full range of motion after a session of neuromuscular work. For example, the provider may have you move your ankle in a full range of motion while providing deep pressure and massage up the calf, to reeducate those muscle fibers, as opposed to lying still on the table during a typical massage.

There are many theories, but one way to think about the kinetics of the body and how it functions as one unit is to picture muscles as linking the joints in a chain. If one muscle has restrictions it can limit the range of motion on the connecting joint and have a domino effect as that tension and restriction is carried down the chain. By freeing up adhesions in one area you can potentially increase function of the entire kinetic chain.

As with any therapy or medication, you must weigh the risks and benefits and make sure you have the correct diagnosis, but many athletes have had great results with neuromuscular reeducation and it often only takes a few sessions in well educated hands to see significant results.

Specifically for your sore back muscles it is likely that your chiropractor felt that over time, you have developed adhesions and restrictions that may benefit from deep tissue release and reeducation.

Best of luck!
Heather M. Gillespie, MD, MPH
Maine Medical Center Division of Sports Medicine

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date: March 6, 2007