by Judith (Walker) DeLany, LMT
(This article first appeared in AMTA Florida, Autumn 1999. Reprinted by permission, and with minor revisions.)
During the last several decades, neuromuscular therapy (NMT) has emerged as a significant method for assessing, treating and preventing soft tissue injuries and chronic pain. NMT is composed of a series of manual treatment protocols based on the practitioner’s skill, anatomy knowledge and precision during palpation. It has found its home, not only in the treatment rooms of massage therapy, but also in physical and occupational therapy, nursing, chiropractic, osteopathic and physical medicine clinics worldwide. With a position firmly anchored in complementary, integrative and traditional medicine, its future holds much promise. A look at its past, present and future is worthwhile.
The Roots of Modern NMT
Neuromuscular therapy techniques emerged in both Europe and North America, almost simultaneously, over the last half-century. It is interesting to note that the earliest developers knew little, if anything, about each other, yet the theoretical basis of all the modern NMT protocols are similar. This is most likely because they are each rooted soundly in physiological principles.
Between the mid-1930s and early 1940’s, European-style neuromuscular techniques (as NMT is called in Europe) first emerged, developed by the skillful hands of Stanley Lief and Boris Chaitow. These cousins, trained in chiropractic and naturopathy, studied with teachers like Dewanchand Varma and Bernard Macfadden and integrated solid concepts of assessment and treatment steps for soft tissue dysfunction. Their practice of NMT was set in Lief’s world-famous health resort, Champneys, at Tring in Hertfordshire, England where they were presented with a wide variety of conditions on which to test their theories and methods.
Many osteopaths, naturopaths and practitioners from other fields, including Peter Lief, Brian Youngs, Terry Moule, Leon Chaitow (nephew of Boris), John Sharkey and others, have taken part in the evolution and development of European neuromuscular techniques. In the 1990s a program developed (in part) by Leon Chaitow, DO formed an elective module as part of a Bachelor of Science (BSc(Hons)) degree at the Complementary Health Sciences at the University of Westminster, London. Although this was the first undergraduate degree setting to include NMT, it is now commonly taught in osteopathic and sports massage settings in Britain. Leon Chaitow has also made significant contributions as the author of dozens of books and textbooks that feature detailed application of NMT, particularly the European version.
A few years after neuromuscular techniques first emerged in Europe, across the ocean in America, Raymond Nimmo and James Vannerson published their newsletter, Receptor Tonus Techniques, where they wrote of their experiences with what they termed ‘noxious nodules’. Over the next several decades, a step-by-step system began to emerge, supported by the writings of Janet Travell and David Simons. Travell and Simons’ two volume set of textbooks, Myofascial Pain and Dysfunction: The Trigger Point Manual (upper body published in 1983 and lower body in 1992) impacted the medical, dental, physical therapy, massage and other therapeutic communities with documentation, research and references for a whole new field of study - myofascial trigger points.
Eventually, several of Nimmo’s students began teaching their own treatment protocols, based on Nimmo’s work. Among them was Paul St. John, who began teaching his own system in the late 70’s. In the mid-1980’s, Judith (Walker) DeLany became St. John’s first additional instructor of his method of neuromuscular therapy. DeLany (then Judith Walker) worked with St. John for five years (1984-89), where she assisted in the development of NMT techniques and protocols for massage therapy application.
In 1989, St. John and DeLany separated their work into two styles, NMT St. John Method and NMT American version™, respectively. Both systems retained a strong focus on Nimmo's original protocols, although each developer significantly influenced his or her own particular foundations and teaching methodology with unique insights and new techniques. DeLany continues to teach the NMT American version™, which has evolved significantly, as discussed below. St. John eventually sold NMT St. John method and seminars to a new owner. Although the new owner no longer teaches the method, many St. John certified NMTs continue to use it as the foundation of their work.
In the mid-1990s, NMT American version™ was piloted as a school program, taught within the curriculum of three massage schools and delivered by school instructors. It was immediately recognized that the school format allowed for a slower pace for the program, more continual access to the instructors and more repetition of the protocols than the seminar format, which allowed students to graduate with clinical skills for integration into almost any health care setting. With two decades of success in a variety of schools across the country as well as in coast-to-coast seminar trainings, NMT American version™ grew to be a well-established method for addressing myofascial pain and dysfunction.
European and American NMT Cross Paths
European and American versions of NMT have similar theoretical platforms, yet subtle differences developed within their hands-on application. In the exploration to uncover contracted bands or muscular nodules, American-style neuromuscular therapy uses a medium-paced (thumb or finger) gliding stroke whereas European-style neuromuscular techniques use a slow-paced, thumb-drag method of discovery. They also have a slightly different emphasis on the method of application of ischemic compression when treating trigger points. Both versions emphasize the need to develop a home-care program and encourage the client's participation in the recovery process.
In 1996, a landmark event for American NMT occurred when NMT American version™ was overviewed in Leon Chaitow's Modern Neuromuscular Techniques, as contributed by Judith DeLany. This significant text was the first to offer both the European and American methods within the same volume. Although this was only a brief chapter contribution for the American version, it did offer international exposure for DeLany’s work that led to a broad future.
Chaitow and DeLany, as well as internationally known athletic trainer Benny Vaughn and chiropractor/author Craig Liebenson, formed the editorial team for the first peer-reviewed journal in the field of bodywork, Journal of Bodywork and Movement Therapies. The first issue of JBMT was published in October 1996 and, with four issues each year for almost two decades, has proven to be a tremendously resourceful multidisciplinary publication with a strong presence of all manual modalities. Its articles focus strongly on the clinical application of all forms of soft tissue therapies and the integration of multiple disciplines of health care.
Shortly after JBMT emerged, Chaitow and Delany published the first definitive academic textbooks on NMT, integrating the American and European versions. Clinical Application of Neuromuscular Techniques, Vols. 1 & 2 (later published as second editions), with accompanying study guide, established a high standard of academic excellence for NMT. A moderate degree of integration of the two methods was achieved through the authors' discussions, debates and determination to weave together material from osteopathy and massage therapy, while also retaining each method's individual identity.
NMT American Version™ Today
In 1999, a second edition of Travell and Simon's classic 1983 text, Myofascial Pain and Dysfunction, The Trigger Point Manual, (Vol. 1 Upper Half of Body), was published. It presented substantial new ideas in the theories of trigger point formation as well as in applications to treat them, altering the platform of NMT once again. It had been fifteen years since the first edition was published and voluminous research had been conducted worldwide to substantiate and debate the theories that Simons, Travell and Simons (along with contributors and an editorial team) presented in their second edition. Even decades later, The Trigger Point Manuals are still considered by many to be the gold standard in trigger point treatment protocols. It includes a substantial emphasis on massage therapy applications and other manual techniques, and emphasizes the urgent need for academic research and continual revision of foundational beliefs about trigger points and myofascial pain.
The adoption of Simons et al's integrated hypothesis by Chaitow and DeLany was the first major change in trigger point concepts in both European and American NMT in decades. In recent years, new theories as well as research evidence regarding trigger points and fascia has emerged, insuring that the foundational platform of NMT remain in an ever-evolving state.
Shortly after the turn of the 21st century, NMT received a significant spotlight when John Sharkey and staff at the National Training Centre in Dublin, Ireland developed a NMT Higher Diploma (NMT HDip) program designed for serious practitioners who wanted to acquire advanced knowledge and a broad collection of skills. The program is open to manual therapists already in practice, includes approximately 14 weekends of training spread over 2 1/2 years, and provides expert instructors from across the globe to build a comprehensive approach to clinical practice. The HDip program teaches both European and American NMT philosophies and techniques, much of which is delivered by Leon Chaitow, Judith DeLany, and John Sharkey as well as trusted members of their teaching staff.
In 2013, a Master's degree program in NMT, associated with the University of Chester, was offered for the first time. Spearheaded by John Sharkey, this program was implemented with the highest standards of professionally recognized education with an aim to graduate a diverse range of skilled practitioners who can effectively and ethically treat of fascia, myofascial trigger points, acute injuries and chronic pain. The program aims to enable the participants to develop competence and confidence in all aspects of professional practice by encouraging autonomy and criticality in thinking and action.