Positive Health Online

I have written on Neuroskeletal Re-alignment Therapy (NSRT) in Positive Health in the past (information at www.neuroskeletal.co.uk). I studied this in 1997 because as a massage therapist I became frustrated that I could not be as effective as I wanted with massage alone on people with back problems, joint pain, etc. By using NSRT, I can treat the underlying cause (mis-alignment) and then use massage as 'the icing on the cake' to treat the muscles and get the body back into complete balance. Normally you would not use massage and NSRT in the same session, but if the client wants it, you can give a massage first. This is because many clients enjoy a massage and if the 'customer is always right', then it is nice to be able to mix the therapies to suit individual needs and requirements. Once an alignment has been completed, the client is advised that no other therapy should be done for at least 48 hours and to rest and take it easy, even if they do feel terrific!

Once the body has been re-aligned and pain or other symptoms have either reduced or disappeared, I book patients in for deep tissue work to release muscles that have been in spasm, often for many years. I found normal therapeutic massage to be useful, but by adding in remedial and trigger point therapy I am able to pinpoint the problem areas and get excellent results. I have trained in these disciplines, but with experience, have now developed a routine that I teach, which is specific to the types of back and joint pain seen in clinic. The diploma course I offer at Morley College in London (www.morleycollege.ac.uk) includes training in remedial massage and trigger point therapy, and that is one of the reasons why the entry requirements ask that you already hold a recognized Anatomy and Physiology and massage qualification. The course teaches you to work in this area focusing on orthopaedics; hence you need to already have a basic understanding of several body systems. Details of the course can also be found at www.neuroskeletal.co.uk where there is a link so you can book a place on-line. The course receives funding so is only £395 and covers eight weekends once a month; places are limited.

The remedial massage is usually done on the third visit, so by that time they have already received two NSRT treatments. During the follow-up consultation I will proceed with massage as long as the pain or original problem has reduced. A back massage is always indicated as most people suffer from tight muscles in the neck and shoulders as part of modern living, but you may also be treating the area because of a pathology or accident trauma, such as whiplash injury. Trigger points commonly need to be worked in the levator scapulae and rhomboid muscles as well as the trapezius. Remedial massage is very different to an ordinary relaxing massage where people drift off to sleep. The practitioner needs to communicate with the patient constantly and release the trigger points using breathing. The points are often quite painful and patients regularly joke that I should have a piece of leather for them to bite down on! However, once the points have been activated, the relief is immediate and patients always come back for more if needed, an indicator that it is effective. You do not bruise your patients but sometimes the point can feel a little bruised after it has been worked. Patients love to have this work done because they feel they have finally found someone capable of getting in and dealing with the problem. Quite often massage therapists have only been trained in basic techniques and really only work the superficial muscles. This means that they either get no or only temporary relief before the pain comes back again. By using this combination of therapies I am always delighted to be told that they have finally found someone who can genuinely help.

Once you have dealt with the muscles around the scapulae, you will have to target all the muscle groups that move the arms, and check to see if there are any other points that need releasing. I also massage down the arm into the wrist extensors and flexors and give a firm hand massage as well as stretches to really get the whole area relaxed.

When working on lower back pain there are a number of factors to consider. You first always need a medical diagnosis to make sure you are targeting the right areas. NSRT combined with inversion therapy can treat disc problems but this is a different approach than that taught on the diploma course. General back pain, attributable to 95% of presenting patients, will require triggering the quadratus lumborum as well as the gluteals and giving a good buttock massage. Clients are quite happy to expose their cheeks as long as you explain the reasons why. By this time the pain is commonly chronic and they literally no longer care! You can also carry out the piriformis release on people suffering from sciatic pain that is not related to nerve root impingement. These people will also require their legs and feet massaged because any mis-alignment of the pelvic/sacro-iliac region will influence how they have been walking. You will need to target the TFL (tensor fascia lata) as well as the hamstring and quadriceps groups. There are trigger points all along the individual muscles in these groups and we work across the direction of muscle fibres at the attachment and origin sites. For many this will also affect the soleus and gastrocnemius as well as the tibialis anterior (muscles in the legs). A good foot massage is always a bliss!