(NMT) Neuromuscular Therapy

Neuromuscular Therapy (NMT) is a very specialised form of manual therapy. A therapist trained in NMT is educated in the physiology of the nervous system and its effect on the muscular and skeletal systems. The Neuromuscular Therapist is also educated in kinesiology and biomechanics and how to work in a clinical or medical environment.

By definition, Neuromuscular Therapy is the utilisation of static pressure on specific myofascial points to relieve pain. This technique manipulates the soft tissue of the body (muscles, tendons and connective tissue) to balance the central nervous system.

Neuromuscular Therapy will be used to address five elements that cause pain:
1.Ischemia: Lack of blood supply to soft tissues which causes hypersensitivity to touch
2.Trigger Points: Highly irritated points in muscles which refer pain to other parts of the body
3.Nerve Compression or Entrapment: Pressure on a nerve by soft tissue, cartilage or bone
4.Postural Distortion: Imbalance of the muscular system resulting from the movement of the body off the longitudinal and horizontal planes
5.Biomechanical Dysfunction: Imbalance of the musculoskeletal system resulting in faulty movement patterns (i.e., poor lifting habits, bad mechanics in a golf swing or tennis stroke or perhaps computer keyboarding) .

For a variety of reasons, when we strain muscles and fascia, either through impact or through a build up of chronic stress, the muscles go into spasm. This spasm can restrict blood flow and cause pain, as well as restricting mobility.
Sometimes muscles can be in tension for so long that they lack the energy to release, and form tight "knots" or "trigger points", a "contracture" or little hard bump in the muscle which can be responsible for debilitating back pain or neck & shoulder pain referring to other parts of the body. Fibromyalgia is a different condition, but it seems many patients with fibromyalgia have significant trigger point discomfort also.
Inflammation is a necessary part of the healing process, bringing nourishment into the area, and reducing flow away, which reduces the spread of infection. If allowed to continue and become chronic, however, it can lead to restrictive adhesions and thickening of connective tissue.
Neuromuscular Therapy involves releasing Trigger Points in muscles & fascia, and encouraging flexibility in muscle and connective tissue.
Pressure is applied to these Trigger Points, until the congestion diminishes. A release of tension relieves pain and increases mobility. Greater blood flow will allow the healing process to take over.
Stretching the muscle and fascia afterwards helps to consolidate the relaxation, and you will be shown some stretches to practice after the session.Your therapist should conduct a postural assessment to evaluate which areas to address.
Neuromuscular Therapy can be researched easily on the web, and it is gaining ground as a key modality for the repair of soft tissues.

Terry O'Brien

Degenerative Joint Disease

Alternative Names: Hypertrophic osteoarthritis; Osteoarthrosis; Degenerative joint disease; DJD; OA; Arthritis-Osteoarthritis.
Causes
Unfortunately most of the time, the cause of OA is unknown. It is mainly related to aging, but metabolic, genetic, chemical, and mechanical factors can also lead to OA.
The symptoms of osteoarthritis usually appear in middle age and almost everyone has them by age 70. Before age 55, the condition occurs equally in both sexes. However, after 55 it is more common in women.


The disease causes the cushioning (cartilage) between the bone joints to wear away, leading to pain and stiffness. As the disease gets worse, the cartilage disappears and the bone rubs on bone. Bony spurs usually form around the joint.


OA can be primary or secondary.
Primary OA occurs without any type of injury or obvious cause.
Secondary OA is osteoarthritis due to another disease or condition. The most common causes of secondary OA are metabolic conditions, such as acromegaly, problems with anatomy (for example, being bow-legged), injury, or inflammatory disorders such as septic arthritis.
Symptoms
The symptoms of osteoarthritis include:
Deep aching joint pain that gets worse after exercise or putting weight on it and is relieved by rest.
Grating of the joint with motion.
Joint pain in rainy weather.
Joint swelling.
Limited movement.
Morning stiffness.
Of course some people might not have symptoms.

Examination and Tests
A physical exam can show limited range of motion, grating of a joint with motion, joint swelling, and tenderness.
An x-ray of affected joints will show loss of the joint space, and in advanced cases, wearing down of the ends of the bone and bone spurs.

Treatment
The goals of treatment are to relieve pain, maintain or improve joint movement, increase the strength of the joints, and reduce the disabling affects of the disease. The treatment depends on which joints are involved.

MEDICATIONS
The most common medications used to treat osteoarthritis are nonsteroidal anti-inflammatory drugs (NSAIDs). They are pain relievers that reduce pain and swelling. Types include aspirin, ibuprofen, and naproxen.

Although NSAIDs work well, long-term use of these drugs can cause stomach problems, such as ulcers and bleeding. Manufacturers of NSAIDs include a warning label on their products that alerts users to an increased risk for cardiovascular events (heart attacks and strokes) and gastrointestinal bleeding.
Other medications used to treat OA include:
COX-2 inhibitors (coxibs). Coxibs block a substance called COX-2 that causes swelling. This class of drugs was first thought to work as well as other NSAIDs, but with fewer stomach problems. However, reports of heart attacks and stroke have led the Drug Licensing Authorities to re-evaluate the risks and benefits of the COX-2s. Ask your doctor whether the drug is 1. Still available and if so 2. Right and safe for you.


Steroids. These medications are injected right into the joint. They can also be used to reduce inflammation and pain.
Supplements. Many people are helped by over-the-counter remedies such as glucosamine and chondroitin sulfate. There is some evidence that these supplements can help control pain, although they do not seem to grow new cartilage.
Artificial joint fluid (Synvisc, Hyalgan). These medications can be injected into the knee. They may relieve pain for up to 6 months.


LIFESTYLE CHANGES
Exercise helps maintain joint and overall movement. Ask your health care provider to recommend an appropriate home exercise routine. Water exercises, such as swimming, are especially helpful.
Applying heat and cold, protecting the joints, using self-help devices, and rest are all recommended.
Good nutrition and careful weight control are also important. If you're overweight, losing weight will reduce the strain on the knee and ankle joints.


PHYSICAL THERAPY
Physical therapy can help improve muscle strength and the motion at stiff joints. Therapists have many techniques for treating osteoarthritis. If therapy does not make you feel better after 3-6 weeks, then it likely will not work at all.

BRACES
Splints and braces can sometimes support weakened joints. Some prevent the joint from moving; others allow some movement. You should use a brace only when your doctor or therapist recommends one. Using a brace the wrong way can cause joint damage, stiffness, and pain.
SURGERY
Severe cases of osteoarthritis might need surgery to replace or repair damaged joints. Surgical options include:
Total or partial replacement of the damaged joint with an artificial joint (knee arthroplasty, hip arthroplasty )
Arthroscopic surgery to trim torn and damaged cartilage and wash out the joint
Cartilage restoration to replace the damaged or missing cartilage in some younger patents with arthritis
Change in the alignment of a bone to relieve stress on the bone or joint (osteotomy)
Surgical fusion of bones, usually in the spine (arthodesis)

Outlook (Prognosis)
Your movement may become very limited. However Treatment generally improves function.
Possible Complications.
Decreased ability to walk.
Decreased ability to perform everyday activities, such as personal hygiene, household chores, or cooking.
Adverse reactions to drugs used for treatment.
Surgical complications.

When to Contact a Medical Professional
Do contact your health care provider if you have symptoms of osteoarthritis.

Prevention
*Weight loss can considerably help in the management DJD and ceratainly reduce the risk of knee osteoarthritis in overweight women.

The Silent Disease

The Silent Disease is the name that is often given to Osteoporosis, as most people don't know they have osteoporosis until it has progressed often to the point of fracture, usually in the hip, wrist or spine. Even when undiagnosed osteoporosis results in a vertebral fracture, the pain is frequently dismissed as general back pain. This lack of awareness can lead to serious illness, deformity, even death.

Osteoporosis alone does not cause back pain. It can, however, weaken the spine to where it is no longer able to withstand normal stress or minor trauma, resulting in vertebral fracture. It is the ensuing fracture that causes pain.

Osteopenia is a condition where bone mineral density is lower than normal, but not low enough to be classified as osteoporosis. While often a precursor to osteoporosis, not everyone with osteopenia will develop osteoporosis. Since a diagnosis of osteopenia puts one at greater risk for osteoporosis, patients are encouraged to seek the advice of their physicians about implementing preventive measures.

Osteoporosis Causes and Risk Factors
Bones are made of complex, constantly changing, living tissue. They are able to grow and heal, and are also susceptible to changes in diet, body chemistry, and exercise levels.
Early in life, more bone is laid down than is removed by the body. People typically achieve peak bone mass by around age 30, after which more bone is lost than is replaced. Too much bone loss leads to osteoporosis.

Both of the two primary types of osteoporosis are far more common in women than men:

Type I osteoporosis (postmenopausal osteoporosis) —generally develops after menopause, when estrogen levels drop precipitously, leading to bone loss — usually in the trabecular (spongy) bone inside the hard cortical bone.


Type II osteoporosis (senile osteoporosis) — typically happens after age 70 and involves a thinning of both the trabecular (spongy) and cortical (hard) bone.

In addition, certain medications and medical conditions can damage bone and lead to what is known as “secondary osteoporosis”. Patients being treated for any of the following conditions should discuss the risk of osteoporosis with their physicians:

Endocrine disorders

Marrow disorders

Collagen disorders

Gastrointestinal disorders

Seizure disorders

Eating disorders (such as anorexia or bulimia)

It is important to distinguish between primary and secondary causes of osteoporosis because treatment is often different. To determine the cause, a thorough medical history, physical examination, and appropriate diagnostic tests need to be conducted (see Diagnosing Osteoporosis).

Key risk factors for developing osteoporosis include:

Advanced = age over age 65.

Gender = Women are four times more likely to develop osteoporosis than men.

Heredity = Family history of osteoporosis or fracture on the mother’s side.

Personal history = any type of fracture after age 45.

Race = Caucasian and Asian women are at greater risk.

Body type= small-boned women weighing less than 127 pounds.

Menstrual history = Normal menopause increases the risk of osteoporosis and early menopause can exacerbate this risk.

Lifestyle = calcium and/or vitamin D deficiency; little or no exercise (especially weight-bearing exercise); alcohol abuse; smoking; too much cola/soda.

Testosterone deficiency (hypgonadism) = in men.

Why women are at greater risk for developing osteoporosis

Estrogen plays an important part in maintaining bone strength. Starting at about age 30 through onset of menopause, women lose a small amount of bone every year as a natural part of the aging process. When women reach menopause and estrogen levels decrease, the rate of bone loss increases for approximately 8 to 10 years before returning to premenopausal rates.

Osteoporosis Symptoms

Osteoporosis can go undetected for years and fracture is typically the first outward sign. Advanced osteoporosis is potentially disabling, often leading to one or more of the following:
fractures of the spine, wrist or hip

spinal deformity (e.g., lost height, hunched back)

chronic or severe pain

limited function and reduced mobility

loss of independence

decreased lung capacity

difficulty sleeping

Osteoporosis is the leading cause of spine fractures, especially in women over age 50, but only about one third of all spine fractures are diagnosed.

Most osteoporotic spine fractures (vertebral compression fractures) start with sudden back pain, usually after routine activity (lifting or bending) that slightly strains or jars the back. After a month or two, this acute pain is usually replaced by an achy pain (see Diagnosing vertebral compression fractures).

Osteoporosis Prevention

Postmenopausal (Type I) osteoporosis can be significantly influenced by preventive measures. Most of these behaviors are up to the individual and should be started as early in life as possible. For those genetically predisposed to osteoporosis, the following practices are even more important:
Exercise regularly weight-bearing exercises (activities that work one’s bones and muscles against gravity) are essential to maintaining bone health.

Ensure adequate calcium intake, Calcium plays a key role in keeping bones strong. Vitamin D is also essential, as it helps ensure absorption and retention of calcium in bones. Calcium and vitamin D requirements vary depending on age and gender.

Eat a balanced, healthy diet Certain foods provide excellent sources of calcium, while diets high in protein and/or sodium increase calcium loss.

Quit smoking - Smoking has a detrimental effect on bone density, leading to greater risk of injury and longer recovery times.

Limit alcohol consumption - While the exact way alcohol affects bone isn’t entirely understood, excessive alcohol use has been proven to accelerate bone loss.

Limit intake of colas/sodas - recent research indicates that too much cola or soda can increase the risk of osteoporosis.

Undergo bone density testing - every 1-2 years if you are postmenopausal, over age 65, or have other risk factors. Bone mineral density (BMD) tests indicate normal, low or osteoporotic bone density levels, as well as any increased risk of fracture.

For more information, see How to prevent osteoporosis.

Osteoporosis Treatment

Once osteoporosis has been diagnosed, patient and physician should work together to develop a treatment plan where the goal is to slow bone loss and prevent fractures. Treatment may include:
Education on diet/nutrition - see Food for Thought: Diet and Nutrition for a Healthy Back.

Exercise (if no fracture) - to help maintain bone density and reduce the risk of falls.

Medication - to slow bone loss and prevent fractures. Osteoporosis medications fall into two categories:

medications that slow or stop bone resorption (loss);

medications that increase bone formation.

Treatment for vertebral fractures, which may include:

rest, though long-term rest accelerates bone loss;

rigid back braces to support the spine;

ice/heat and pain medications;

surgery (kyphoplasty or vertebroplasty), which may be necessary in certain situations where the fracture is causing severe pain and/or deformity, or has failed to respond to three months of non-surgical treatment.

Do be positive because even once osteoporosis has been diagnosed, it is possible to slow bone loss, build bone density and prevent fractures. Continually advancing osteoporosis and related fractures are not an inevitable outcome of being diagnosed with osteoporosis.



Terry O’Brien
Back Trouble UK.