Neuromuscular Physical Therapy
Neuromuscular physical therapy involves the examination, treatment, and instruction of persons in order to detect, assess, prevent, correct, alleviate, and limit physical disability and bodily malfunction.
The purpose of neuromuscular physical therapy is to help individuals experiencing structural distortion, biomechanical dysfunction, and the accompanying pain that is often symptomatic of the underlying problem. It is used to locate and release tissue spasms and hypercontraction; eliminate trigger points that cause referred pain; restore postural alignment, proper biomechanics and flexibility to the tissues; rebuild the strength of injured tissues and assist venous and lymphatic flow.
A physician's referral is recommended.
The practice of neuromuscular physical therapy includes the administration, interpretation, and evaluation of tests; measurements of bodily functions and structures; and the planning, administration, evaluation, and modification of treatment and instruction, including the use of physical measures, activities, and devices, for preventive and therapeutic purposes. Neuromuscular physical therapy may also be referred to as neuromuscular reeducation, physical therapy, or physiotherapy.
Neuromuscular physical therapy is employed to treat patients with a variety of health conditions and diseases including accident victims, and individuals with disabling conditions such as low back pain, arthritis, heart disease, fractures, head injuries, and cerebral palsy.
In an effort to restore, maintain, and promote overall fitness and health, neuromuscular physical therapists examine patients' medical histories, test and measure patients' strength, range of motion, balance, coordination, posture, muscle performance, respiration, and motor function. Neuromuscular physical therapists determine patients' ability to be independent and reintegrate into the community or workplace. Based on a patient's medical history and test results, therapists develop treatment plans that describe treatment strategy, purpose, and anticipated outcome.
Neuromuscular physical therapy treatment often includes exercise for patients who have been immobilized or who lack flexibility, strength, or endurance. As part of the treatment, patients are encouraged to improve flexibility, range of motion, strength, balance, coordination, and endurance. The goal is to improve an individual's function at work and home.
Neuromuscular physical therapy may involve the use of electrical stimulation, hot packs, cold compresses, or ultrasound to relieve pain and reduce swelling. Traction or deep-tissue massage may be employed to relieve pain. Patients are instructed in the use of assistive and adaptive devices including crutches, prostheses, and wheelchairs. Patients are often shown how to perform exercises to do at home.
During treatment, neuromuscular physical therapists document the patient's progress, conduct periodic examinations, and modify treatments when necessary. Therapists rely on this documentation to track the patient's progress, and identify areas requiring more or less attention.
Neuromuscular physical therapy may be used to treat a wide range of patients with conditions presenting in areas such as pediatrics, geriatrics, orthopedics, sports medicine, neurology, and cardiopulmonary physical therapy.
Length of treatment varies depending upon several factors, including the severity of the condition being treated. Treatment costs also vary depending upon a number of factors including geographic location and the diagnostic tests conducted. Many insurance policies cover neuromuscular physical therapy treatments provided that a physician's referral is obtained prior to treatment.
There are a number of alternative neuromuscular therapies. Among the most popular are the following:
The goal of this discipline is to bring the body's muscles into natural harmony. Hence it can aid in the treatment of a wide variety of neurological and musculoskeletal conditions, including disorders of the neck, back and hip; traumatic and repetitive strain injuries; chronic pain; arthritis; breathing and coordination disorders; stress related disorders; and even migraine.
People with sciatica, scoliosis, osteoporosis, osteoarthritis, rheumatoid arthritis, and neck and low back syndrome may find the Alexander technique useful in improving overall strength and mobility. Others with Lyme disease, chronic fatigue syndrome, lupus, or fibromyalgia may use it for pain management. It is also used to improve functioning in people with multiple sclerosis, stroke, or Parkinson's disease. Because the technique requires active participation by the patient, it is impossible to test its effectiveness with conventional scientific procedures.
This specialized program of physical training and massage is designed to relieve muscle tension and pain, speed recovery from injuries, and aid in general relaxation and stress reduction. It is particularly appropriate for such problems as back and neck pain, headache, and repetitive stress injuries like tennis elbow.
Like most forms of bodywork and movement training, Aston patterning does not lend itself to controlled clinical trials, and its effectiveness has therefore not been scientifically verified. Furthermore, it requires a significant patient commitment; it involves much more than a program of passive massage.
The Feldenkrais method is a supportive therapy that may help in situations where improved movement patterns (and awareness of those patterns) can help with recovery from illness or injury. Practitioners consider it useful for many types of chronic pain, including headache, temporomandibular joint disorder, other joint disorders, and neck, shoulder, and back pain. It is sometimes used as supportive therapy for people with neuromuscular disorders, such as multiple sclerosis, cerebral palsy and stroke. It is also helpful for improving balance, coordination, and mobility. Many athletes, dancers, and other performers use the Feldenkrais method as part of their overall conditioning.
Hellerwork is a combination of deep tissue massage and movement reeducation. It is advocated by its practitioners for a variety of problems related to muscle tension and stress. Hellerwork is said to relieve respiratory problems, sports injuries, and pain in the back, neck, and shoulders. Like most forms of bodywork, it has under-gone little in the way of scientific testing.
This light, gentle form of massage seeks to release deeply ingrained tensions, promoting a sense of relaxation and freedom. It may be helpful for those with chronic neuromuscular pain, including back problems and sciatica, and it has also been advocated for stress-related conditions, high blood pressure, strokes, migraine, and asthma. Proponents say that it can benefit patients with polio, multiple sclerosis, and muscular dystrophy as well.
There are no typical pre-treatment preparations. However, a physician's referral is recommended.
Patients are often shown how to perform exercises to do at home.
There are a number of beneficial results realized through neuromuscular therapy, including decreased body toxicity, greater flexibility, greater freedom of movement, increased circulation, increased energy and vitality, increased sense of well-being, and improved postural patterns.
Health care team roles
Neuromuscular physical therapists often consult and practice with physicians, dentists, nurses, educators, social workers, occupational therapists, speech-language
Neuromuscular physical therapists practice in hospitals, clinics, and private offices. They may also treat patients in the patient's home or at school.
Over two-thirds of neuromuscular physical therapists are employed in either hospitals or physical therapists' offices. Other work settings include home health agencies, outpatient rehabilitation centers, physicians' offices and clinics, and nursing homes. Some neuromuscular physical therapists maintain a private practice and provide services to individual patients or contract to provide services in hospitals, rehabilitation centers, nursing homes, home health agencies, adult daycare programs, or schools. They may be engaged in individual practice or be part of a consulting group. Some therapists teach in academic institutions and conduct research.
Neuromuscular physical therapists are required to pass a licensure exam after graduating from an accredited educational program before they can practice.
According to the American Physical Therapy Association, in 1999 there were 189 accredited programs. Of the accredited programs, 24 offered bachelor's degrees, 157 offered master's degrees, and eight offered doctoral degrees. By 2002 the Commission on Accreditation in Physical Therapy Education will require all physical therapist programs seeking accreditation to offer degrees at the master's degree level.
American Physical Therapy Association. Guide to Physical Therapist Practice, 2nd Edition. American Physical Therapy Association., 2001.
Carr, Janet and Shepherd, Roberta. Movement Science: Foundations for Physical Therapy in Rehabilitation, 2nd Edition. Aspen Publishers, Inc. 2000.
American Center for the Alexander Technique (ACAT). 129 West 67th Street New York, NY 10023. 212-799-0468.
American Physical Therapy Association, 1111 North Fairfax Street, Alexandria, VA 22314-1488. <http://www.apta.org>.
Aston Training Center. P.O. Box 3568 Inclined Village, NV 89450. 702-831-8228.
Feldenkrais Guild. P.O. Box 489 Albany, OR 97321. 503-926-0981 or 800-775-2118.
Hellerwork. 406 Berry St. Mount Shasta, CA 96067. 916-926-2500.
Trager Institute. 33 Millwood Mill Valley, CA 94941. 415-388-2688.
Bill Asenjo, PhD, CRC