Most rehabilitation and wellness professionals eventually
end up asking themselves: “Why do patients/clients come in with pain, go
through a treatment session, leave pain-free or with significant improvement
noted, and then return the next week with the same symptoms (often times over
and over again)?”
It is important to keep an open mind to new treatments as we never have all the answers and the only thing a closed mind will do is limit ourselves to possibilities or modalities that may benefit our practice and our patients. Neurokinetic Therapy offers us new ways of evaluating and treating patients.
It is important to keep an open mind to new treatments as we never have all the answers and the only thing a closed mind will do is limit ourselves to possibilities or modalities that may benefit our practice and our patients. Neurokinetic Therapy offers us new ways of evaluating and treating patients.
Neurokinetic Therapy was developed by David Weinstock, and
expert bodyworker who has been practicing and teaching in the field of Bodywork
for over 35 years. Briefly, NKT is a technique that looks at compensation
patterns from a motor control perspective. Neuroscience tells us that the Motor
Control Center (MCC) of the brain in the cerebellum stores movement patterns. This
occurs in normal development, in response to our repeated habits and
activities, or as a result of injury as the body attempts to protect itself and
avoid pain. Often times these movement patterns may be faulty or dysfunctional,
and pain results from imbalance, overuse, or overloading of tissues. The site
of pain may not even be in the area of the dysfunction, but merely is a result
of it.
NKT utilizes manual muscle testing to identify and address
compensation patterns in which muscles may test weak (or inhibited) due to other
muscles which have become overactive (or facilitated). A commonly seen example
of this in the hip would be facilitated obturators [obturator externus and
internus are hip rotators] inhibiting the rectus femoris [an assisting hip
flexor], or a facilitated iliacus inhibiting the psoas muscle [a main hip
flexor].
Another concept looks at the idea of relational inhibition,
whereby one muscle, when activated, results in inhibition of one or more other
muscles. Relationships can be found when looking at muscles that are functional
opposites (traditionally we think of agonist/antagonist scenario), synergists
or along functional fascial lines
The manual muscle testing in NKT can be looked at as the key
to unlock the MCC to elicit lasting change in movement patterns. The MCC is
open to learning most effectively by failure, meaning, you perform muscle
testing and find a muscle that is inhibited. The lack of a successful outcome
(i.e. a ‘strong’ test) engages the MCC which now has a window of opportunity to learn from the failed muscle test.
It is attention to the motor control component which is
often missing in traditional muscle testing and drives the question posed above
about why treatment effect doesn’t stick. The muscles which are inhibited or
facilitated may vary greatly, and may arise for a variety of reasons. Take hip pain
for example: common relationships seen are the gluteus maximus and psoas
inhibited by a facilitated iliacus; rectus femoris inhibited by facilitated
obturators; and TFL inhibited by peroneals [outside of the lower leg]. In this
example the amount of large muscle inhibition and facilitation of smaller
musculature also results in increased compression of the hip joint, as the body
attempts to create more stability.
Over time, this scenario may lead to increased wear and
potential pathology of the articular cartilage, labrum, and soft tissues that
cross over the hip joint. Often times the facilitated muscles are also areas of
pain and/or trigger points due to the development of soft tissue restrictions
and increased tissue tension. Treatment is often aimed at stretching or soft
tissue mobilization, which may provide some temporary relief at the tissue
level. However, symptoms tend to return as a result of the underlying movement
patterns which have not yet been addressed. NKT allows us to access the motor
control center and gives us an opportunity to alter the faulty movement
pattern. (The process of how this is done by the clinician is beyond the scope
of this blog post).
It is also important to recognize that the MMT is not
utilized in the traditional sense of strength testing and rating on a 0-5 point
scale as I had learned in PT school. The testing in NKT is done very lightly,
and it’s a key into the nervous systems response: either it activates or it doesn’t. You can’t fake it!
NKT can be used in a variety of ways. Some use NKT and manual
therapy primarily, with a little corrective exercise to reinforce and re-educate.
I personally like using the Functional Movement Systems (FMS) or Selective
Functional Movement Assessment (SFMA) as a movement screen. The screening gives
me an idea of where to target treatment as well as focus manual therapy and
correctives. NKT becomes a bridge between the assessment and treatment. It is
an assessment in that it helps identify the relationships and compensations in
muscle balance (inhibition/facilitation) and has manual therapy built into part
of the NKT reset. Subsequently, you can then retest the patient’s top tier SFMA
after treatment and see what effect the intervention had.
Thanks, Kris, for sharing your insights to NKT! This is me,
Anna-Lena, again. Hip pathology often leads to a number of complex muscle
relationships, imbalances and compensation patterns. Labral tears cause the
muscles around the hip to work a little harder. I believe NKT can fill an
important function in muscle re-education after hip surgery – or other
surgeries and pathologies too. I do think it is like finding a puzzle piece
that’s been missing for many patients. There are other muscle activation
techniques but NKT takes muscle testing and re-education it a bit further.
I explain a lot of the muscles and concepts (such as
relational inhibition) mentioned by Kris in my book because I believe that understanding
our anatomy and pathologies is essential to actively participate in the
rehabilitation process. The more detailed feedback we can give our healthcare
providers (doctors and physical therapists etc.), the more likely we are to
have good outcomes – having a great PT is absolutely crucial!
As a patient of Kris, I’m impressed with NKT and the
patterns of facilitation and inhibition that the testing has revealed me. Getting
the treatment to stick is an equation of how much dysfunction there is, and, is
of course individual. Imagine how long it’s taken you to acquire some of your
muscle firing patterns. Undoing them can take time – or be quick.
The NKT
testing has led me and my physical therapist to look in the direction of pelvic
floor muscles. I think they are more often than not overlooked by doctors and
PTs, and that might even be an understatement. How many hip patients’ PTs
really dive that deep into muscle dysfunction? Stay tuned for more on pelvic
floor in relation to hip musculature and core dysfunction!
Interesting. Thank you for the post. Re-training the muscles to function in proper order definetely was an issue for me. My piriformis muscle likes to take over the work of the glutes and causes sciatic nerve pain. Even at 18 months post surgery, if I over due it, the piriformis muscle kicks in and causes pain. I really have to concentrate on using the right muscles in the right order to be pain free. This post confirmed what I already thought I knew. Thank you!
ReplyDeleteWow! I never had hip issues until my children were born...then wham-o...lose of range of motion, clicking, pain, leg muscle weakness...MRI shows a little degeneration of the joint but no answers. I believe weak or damaged pelvic floor muscles are the culprit. Where do I go from here??? Anyone in Las Vegas that can do NKT testing?
ReplyDeleteEmail me at theentrepreneurialpatient@gmail.com. I'll get you the names and everything I know about where to go for these issues in Las Vegas. Best regards, Anna-Lena
DeleteI recently came across your blog and have been reading along.I'm impressed. You're truly well informed and very intelligent. You wrote something that people could understand and made the subject intriguing for everyone. I'm saving this for future use.
ReplyDeleteHi Charlie,
DeleteThanks for your kind words. Feel free to check out my book too on Amazon. That is where the biggest treasure of patient-friendly information is to be found.
Best regards,
Anna-Lena
http://www.amazon.com/Entrepreneurial-Patient-Patients-Guide-Impingement/dp/0988637200/ref=sr_1_1?s=books&ie=UTF8&qid=1378256041&sr=1-1&keywords=hip+impingement
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ReplyDeleteNeurokinetic therapy is totally a new concept of learning for me because hat we have heard about physiotherapy is just pushing and pressing of muscles but this technique basically is related to MCC in cerebellum of our brain and clinical pilates would be the best source to provide relief to the patient in case of any pain.
ReplyDelete