Modern Neuromuscular Techniques, ed 2.

Modern Neuromuscular Techniques, ed 2

Chaitow L. Philadelphia, PA 19106, Churchill Livingstone Inc, 2003, paperback (with accompanying CD-ROM *), 272 pp, illus, ISBN: 0-443-07158-6, $62.95.

The author of this book, Leon Chaitow, is a practicing osteopath who has written numerous other texts on related techniques and has lectured internationally. This text consists of 7 chapters and has an accompanying CD-ROM that complements the book with video clips that demonstrate the different techniques. The CD-ROM also contains an electronic version of the text.

The first chapter, "Soft Tissue Distress," delves into the anatomy, physiology, and neurophysiology of fascia, muscles, and other soft tissues. Different theories regarding "energy" concepts are introduced in this chapter. The author theorizes about the effect that muscle contractions, postural stresses, and gravitational forces have on the body's energy. Total energy of the body and its surroundings, according to the author, are to remain constant, and the energy will change from one form to another.

The history of neuromuscular technique (NMT) is the focus of the second chapter. Stanley Lief developed the initial techniques in the 1920s and later enlisted the help of Boris Chaitow (the author's cousin) to refine them. This chapter describes NMT as a palpation technique that can be used in the evaluation and treatment of various lesions.

In the third chapter, "Myofascial Trigger Points and Other Reflex Phenomena," Chaitow cites Wall and Melzack's Textbook of Pain, which states that trigger points are part (often a major part) of all chronic pain conditions. In this chapter, the theories and uses of trigger point therapy for nonmusculoskeletal pain (eg, gastritis, bad breath, constipation) are discussed. Common trigger points and their target areas are illustrated in several body diagrams. The next chapter, "The Variety of Reflex Points," defines and compares acupuncture points, Chapman's reflexes, Bennett's neurovascular points, connective tissue massage, Jones' tender points, and periosteal pain points.

Chapter 5, "Diagnostic Methods," focuses on using palpatory skills to assess the soft tissues for the presence of trigger points and soft tissue dysfunctions. Various techniques are illustrated, and the book refers readers to the CD-ROM for the video demonstration of these techniques. Chapters 6 through 9 discuss and demonstrate various NMT techniques. Once again, the video clips on the CD-ROM supplement the text and provide valuable visual information. The practioner's posture and alignment to the patient and treatment table are addressed best by the video clips. The basic treatment regimens for the spine and the abdominopelvic region, along with associated techniques, are covered in detail in chapters 6 through 9. These chapters also illustrate specific treatments for the psoas, piriformis, and tensor fascia lata muscles and the iliotibial band. The author introduces other techniques such as chill and stretch, muscle energy techniques, massage, integrated neuromuscular inhibition technique, strain/counterstrain, and proprioceptive adjustments. The ninth chapter deals with the clinical use of NMT. The reader is urged by the author to think of a patient's symptoms in terms of the physical and psychological environment. The author describes the use of "emotional releases" for soft tissue changes that ate purportedly related to emotional or psychological problems.

Chapter 10 compares the American version of NMT to the European version. The main difference is that the American approach is more structured and prescriptive. The American version also uses tools such as pressure bars, whereas the European version relies primarily on the practitioner's fingers and thumbs. The last chapter, "Progressive Inhibition of Neuromuscular Structures (PINS) Technique," discusses another technique that uses various points on the body to treat musculoskeletal problems.

The author has obvious expertise in the material. The diagrams and pictures are well done. The biggest strength of this book is the addition of video clips on the CD-ROM. The author shows various techniques on a model in the video instead of the drawings that are found in the book. There is an audio component that helps to describe the techniques and provides a step-by-step description of the treatment being shown. The reader is able to reverse, stop, and replay the techniques at any time. The hand contacts are easily visible.

There are some shortcomings to the book. The book includes a controversial statement that women have a higher sensitivity to pain. The book does not discuss evaluating a patient's functional status as part of the initial evaluation of as part of the evaluation of the patient's response to treatment. The book also makes several references to the use of NMT in the treatment of nonmusculoskeletal complaints. The author makes specific note of some of the nonmusculoskeletal complaints--such as gall bladder blockage, spastic colon, uterine fibroids, and gallstones--that he believes can be treated by NMT.

Perhaps most important, the majority of the evidence offered in this book to support the use of NMT appeared to be anecdotal rather than evidence-based. A great deal of the references were personal communications between the author and other clinicians. The specificity and reliability of the examination and treatment techniques were never mentioned by the author. The reader is not informed until the ninth chapter that statements that do not have a citation are the author's personal opinion and are based on his clinical experiences.

This book is appropriate for any physical therapist who treats the soft tissues and can critically evaluate the material for appropriateness. I would not recommend this book as an introductory text for physical therapist students because of the lack of evidence behind these techniques and theories and, because of the omission of functional status in the examination and treatment of patients. The techniques shown on the CD-ROM would be beneficial for any level of therapist who is interested in learning more about NMT.

Jeff Yaver, PT

Kaiser Permanente Medical Center

Manteca, Calif

Mr. Yaver is a clinical specialist whose practice focuses primarily on patients with a variety of musculoskeletal dysfunctions.

* Note: System requirements for CD-ROM: For PC: 486SX processor or faster, 16 MB RAM (32 MB recommended), 2x CD-ROM drive or faster, color monitor with SVGA card (800 x 600 resolution, 256 colors) or better, Microsoft Windows 95 or later, Internet Explorer 4.0 or Netscape 4.5. For Macintosh: G3 processor, OS 9, 64 MB RAM or better.