I would also like that PDF file, Joe. Please send it to jason@bodywright.net Thanks for offering it to us.

The other reason I wanted to start off with the NASM v. Kurz models is that both models give a order sequence and program design parameters.

I sent the abstracts to everyone who has requested them so far.

I am not familiar with the NASM and Kurz models, at least not by name. Perhaps for myself and some others, it would be beneficial to define/explain them.
I will step in to hopefully clarify some of the science here...

Lower gamma motor neurons set the tension of the muscle spindles by contracting them so they are more sensitive to stretch and therefore more likely to trigger a stretch reflex.
Lower gamma motor neurons are largely controlled by the upper gamma motor neurons from the brain (largely from the brain stem, which is largely controlled by the amygdala, hypothalamus, and cerebellum).
So, stimulating the gamma motor system will increase the tension of the spindles, thereby increasing the stretch reflex, thereby increasing baseline "resting" muscle tone.

I am also intrigued by Steve's question about the optimal length of time for a session. I will start with the usual caveat that there is no one optimal anything for anyone and the best answer is always (as Whitney likes to say) "it depends."
Having said that, I will address this question from the point of view of being the client of massage. When I get a massage, I usually receive an hour and a half, and that amount of time is usually appropriate for me to have about half of my body worked. This is considering that I have specific myofascial complaints that I want addressed.
And... I do know of a few MTs that only book 90 minute sessions.

Hi Joseph, maybe those MTs offering 90 mins minimum are the way to go ? and of course "it depends" on so so many things. But just to stick with the time factor for a moment.
How many of you see chronic clients who have already seen a long list of "professionals" but never been allowed to explain in detail their compliants ? Allow them that opertunity, listen intently, empathise and in effect they will lead you to what treatment is needed, you do not know better than them.
Only in private practice have I been able to do this, in all other work/clinic situations the domination of the ticking clock can annialate/neutralize effective theraputic treatment.

Regards steve

Hi Stephen, check out the book "The Lost Art of Healing: Practicing Compassion in Medicine" by Dr. Benard Lown ISBN: 0345425979. He talks about the essential importance of listening and taking a coplete history.

Thanks Robert.

That's funny - the longer I go, the shorter my sessions seem to get. I would parse it as: after 30 years (break my arm patting myself on the back), my work has become effective enough so that I can give the system the info it needs to make its next step with about 30-45 minutes worth of input. More is pouring tea into a full cup. I agree that optimal time varies, and the newer a person is to the 'kinesthetic absorption process', the longer it takes. As for 'homeplay', well, that's another topic altogether. Way overused, in general.

While I agree about a complete history and allowing the client a full vent on the first go-round, at the same time I am often listening more to the tone of voice than the details (the client can only report to me about what's on his or her surface, not the depth parts where all lies in the subconscious), and I am waiting for a 'go!' signal inside myself, secure in the knowledge that I am going to find out more as we progress: "Gee, your liver feels stuck" "Oh, yeah, I guess I didn't tell you about that cirrhosis / auto-accident / bout with cocaine" - you never get the full story on the initial history-taking in any case.

Hi Tom
" you never get the full story on the initial history-taking in any case". so true

Can you or anyone else give a full explanation of homeplay. I can only guess at mo.

Hi Thomas, check out the book "What Every BODY is Saying" by Joe Navarro. He teaches med students and MDs what a patient's body language is "saying."

Another interesting slant on the "time" issue. Back in the early 90s I was working at an orthopedic clinic affiliated with Emory University. The treatment model for all the PT services there was tightly time driven. Massage sessions were scheduled on the half hour all day long. While I don't think it is the ideal time format for most of the type of work I was doing, that environment did more than anything to teach me about being efficient in my analysis and treatment of the primary issue. I really learned a great deal about getting something done with the client in a very short period of time.

Well, we definitely have a "point - counterpoint" on the time issue.

I will add a few notes on the concept of the history...

I figure that approximately 80% of the time, my diagnosis/assessment is "relatively" complete at the end of the history. That is not to say that I know "exactly" which tissues are the causative elements, but I have a sense of the direction of the problem...is it disc, etc. When I follow with the physical exam, most of the time it is to confirm what I suspect with my history.

The other thing I would like to add into the mix is something that professor of mine back at chiropractic school used to say...that is..."Don't ask the patient what is wrong with them, tell them what is wrong with them." In other words, their history can only tell you what they think, but it is up to your skills to determine what the problem is.

Heck, I'll throw one more great saying into the mix: "Give them a little of what they want, then give them what they need."

30 years, eh Tom? How old are you? :)

The first time I ever met Bob King, I said to him, "You know, you are an icon in the world of MT." He shot back, "That's what happens if you stick around long enough!" Bob has such a great wit!

I am at 25 years myself.

Joe

Medical history-taking often is unstable, according to psychiatrist Arthur Barsky, MD. "Patients frequently fail to recall (and therefore under-report) the incidence of previous symptoms and events; tend to combine separate, similar occurrences into a single generic memory; and falsely recall medical events and symptoms that did in fact occur," Barsky explains.

In both acute and chronic neck/back pain clients, history often relates to individual personality characteristics, state of health and mind at the time of recall, and preformed beliefs about symptoms and prognosis.

Most of us would agree that clients also are less likely to recount distant events accurately than they are more recent occurrences. Therefore, some of us may find it beneficial to incorporate these factors when interpreting a client's history:

1. Establish anchor points or memorable events that might help clients recall their symptoms.
2. Encourage clients to convert generic memories of symptoms into more concrete episodes.
3. Ask clients to recall their symptoms in reverse order, starting from the present.
4. Take the history in a similar way each time.

Questioning clients about events surrounding traumas or work-related injuries during the therapy session often reveals new and helpful insights. The addition of touch not only calms nervous system hyperexcitability, allowing thoughts to flow more freely, but also triggers tissue memory as the injured area is being worked.

Accurate, focused assessment is crucial, particularly in chronic cases, since time might have elapsed since the event(s) leading up to the painful condition. Therapeutic outcomes sometimes improve dramatically as we begin developing creative, yet consistent methods of helping clients present an accurate portrait of their past and present musculoskeletal health problems.

Homework has such a negative connotation and tends to reduce 'patient compliance'. I seek something that is playful for the client to do, on whatever level - they are more likely to do it!

Here is my first attempt to "parameterize" the various stretching models (just a rough draft). I will start with NASM Static Stretching.

Name: Static Stretching (specifically the NASM protocol)

Originator: NASM

Theory: Mechanically "decreases a muscle's passive resistance to a stretch force. Appears to affect the viseoelastic component of neuromyofascial tissue. Neurologically appears to decrease motor neuron excitability, possibly through the inhibitory effects from the Golgi tendon organs-autogenic inhibition as well as possible contribution from the Renshaw recurrent loop (NASM)."

Research: Brady, et al. static and active stretching improved hamstring flexibility with static stretching producinfg 2x as much ROM as compared to active stretching. Davis, et al. static v. PNF. Only static stretching produced significant ROM. On the topic of static stretching before activity, the Nelson et al. study was called into question because of causing possible fatigue. Young and Behm, Church, et al., Knudson, et al., and Church, et al., were either open to interpretation or found no adverse effect on subsequent activity (NASM). In re: to warm-up before static stretching the NASM protocol states that it is not neccessary, although NASM does state to do Self Myofascial Release prior to static stretching.

Program Design: Frequency-usually daily/ Sets-Not Applicable/ Reps-1 to 4/ Duration of Reps-20 to 30 seconds and up to 60 seconds for people 65 years old and above

Precautions: Special Populations a/o Neuromuscular disorders

Contraindications: Acute muclse injury, strain, or tear of muscle targeted to be stretched a/o Acute rheumatoid arthritis.

Opinion of:

Anectdotal Evidence/Success or Failure with:

Other:

Hmm... I would be interested in first starting with the bigger picture of the world of stretching.

In other words, stretching musculature can be done because of a "mechanical" component (viscoelastic change) and a neural component (neural inhibition component). Stretching techniques that "primarily" rely on the mechanical component might be divided into static and active (aka dynamic) stretching. Stretching techniques that "Primarily" rely on the neural inhibition component are CR (contract relax, aka PIR, post-isometric relaxation) and AC (agonist contract) stretching (the term PNF, proprioceptive neuromuscular facilitation, is often used for the either of these, especially the first). Etc, etc...

Would anyone like to continue this breakdown/organization and/or add to it???

Homeplay = compliance. I like the sound of that.

3. "Ask clients to recall their symptoms in reverse order, starting from the present".

The symtoms belong to the client, the order of revelation should therefore be theirs ? why make their revelation unecessarily burdensome ? Why seek to dominate this process by imposition ?

I would add to this that even though the symptoms are theirs, it is our job to put everything into an order that makes sense so we can create the clinical picture, i.e., make an accurate assessment. For that reason, the order in which you gather the history is very important. Having said that, we do want the client to be able to recount with accuracy and ease their history, but I do not think that asking them to recount it in a certain order would necessarily be "burdensome." In the rare case where it is, then certainly let them free flow if needed to recount the information, keeping in mind the logistics of life in that they are being charged for the time that you are spending doing the history with them...

I find history-taking to be a pretty natural event. The first session "meet & greet" must be focused, but follow-up sessions are, as Tom says, more 'playful'. We chat it up while assessing landmarks, exploring tissues and taking notes when the time seems right. Talk & touch keeps us in the 'moment' and allows them to relax and become involved in the process. Soon, something (consciously or unconsciously) kicks-in and you suddenly sense direction that may lead to the key lesion.

A problem I've had to deal with during the history intake is mentally "boxing" a client's condition. After many years of practice, I sometimes get the feeling that I've seen it all and, as a result, sometimes catch myself daydreaming as they spout out symptoms . I've already decided what's wrong with them and I'm ready to get it on. But during the assessment, I realize, I was headed down the wrong path. This is when I back up and begin reviewing their history more carefully.

Whitney made a good point about the time factor. Sometimes, working in a time-restricted setting helps forge a bond where two people find themselves more motivated to come together and solve the problem as one. The energy of the room changes when the body's innate wisdom allows your unconscious to join in...love those moments.

Joseph, yes free flow, vitally importantant.

Eric " Soon, something (consciously or unconsciously) kicks-in and you suddenly sense direction that may lead to the key lesion." and
"The energy of the room changes when the body's innate wisdom allows your unconscious to join in...love those moments." ...Me to !

30 mins for specific injury work yes!..... but to get in that special "zone" Eric discribes above = where some real multilevel healing can free flow and intigrate needs more time imo.

Yeah, Erik, so I hate forms people fill out in the waiting room, hate to be given such forms - boxes people into an illness mode "let's see, do I have arthritis?" rather than a developmental, integrated mode "I wonder what's going to happen?" My interview form is a blank sheet of paper.

Joe I'm a new therapist, been in practice for 6 months. My most difficult issue is kinesiology. I can't seem to remember all of the actions of the muscles. Do you have any sugggestions?

Hi Jacqueline. Welcome. :)
Yes, my first recommendation would be to always try to figure out the actions of a muscle by reasoning them out from the line of pull of the muscle relative to the joint it is crossing. A muscle is nothing more than a pulling machine (I say that with all respect for muscles). IF you can see the direction of the fibers of the muscle, it gives you the line of pull. Simply picture placing a rubber band in place of the fibers and picture what the rubber band would do if it pulled in toward its center. Once you see this for a muscle, then extrapolate it to ALL the muscles that cross that joint in the same location (i.e., anteriorly, posteriorly, laterally, etc) with the same direction of fibers (i.e., vertically or horizontally).
This requires you to have to memorize the attachments of the muscle. Other than a muscle whose name tells you its attachments (e.g., coracobrachialis), there is no way around that. SO... spend a lot of time looking at pictures of muscles and try to see their general location.
Beyond this, I strongly recommend the 3rd edition of my The Muscular System Manual. Besides beautiful illustrations with muscles and bones drawn over photos of real people, and an excellent intro chapter that explains what I have written above more thoroughly, there is an interactive CD included in the book that allows for any combination of muscles to be placed on the base figure of the person with the bones drawn in; and it allows you to change the opacity of the muscle to be able to see through it and see what is deep to it. No one has anything like it. And, the book comes with downloadable MP3 files that have the overviews of the muscle groups and the specific attachments and actions that you can listen to with an iphone, blackberry, or any other such device. If you go to my website (www.learnmuscles.com), there is a link to the publisher to order it. Otherwise, you can go to Amazon.com or barnesandnoble.com etc.
BTW, there are also a number of interactive exercises that come with the book and there are also a number sitting on my website (just go to the "quiz yourself" page).
Please let me know how you do. :)

Joe, with regard to learning the muscles in this manner, can you recommend a high quality skeleton with accurate articulation? I recently found the following model, please use the link if you would like to check it out:
http://www.shopanatomical.com/ProductDetails.asp?ProductCode=3B-A15...
And Jacqueline, I recently purchased the books that Joe recommended to you and his Muscoloskeletal Anatomy Coloring Book (2nd ed) which I find very helpful for learning and understanding muscle attachments and fiber direction/placement relative to the joint(s) crossed.

Hi Jason,
I had not been familiar with this particular skeleton, but I took a look at it and it looks excellent. A bit pricey, but worth it for the features.
I will warn that all skeletons have an excessively "high waist" (space between the 12th rib and the iliac crest), and the head of the humerus always sits too far from the glenoid fossa due to the mechanism they put in to allow it to move/rotate...

Yes, the Coloring Book is excellent for anyone who learns kinesthetically by coloring. Another excellent kinesthetic approach is to learn to palpate each muscle (then I would recommend my Palpation book) because ID'ing a muscle via palpation often/usually requires having it contract and that requires use of the knowledge of the actions of the muscle.

Thank you for your review, Joe. I figure that if I'm going to buy one then it darn well should be a good one :)
My wife and I are going through your palpation book and accompanying DVD guides together.

Joe, i purchased your The Muscular System Manual and it is much better than the book that i used in school. I have started it and really enjoy all of the information presented as well as the CD! I have a thirst to learn everything but i am starting into this new profession with a 46 year old brain, children, husband which means there are alot of distractions at times as wwell as alot of things floating around in my brain. I am a visual learner.
I have been disappointed by the director of my school as well as a mentor that i had while i was in school. Both are awesome therapists but neither are willing to help me with questions about how to treat my clients. I have my own practice within a chiropractor's office so i don't work around other therapists. Its been lonely but i am plowing forward finding my own answers. This forum has been a great place for me. Thanks for the kinesiology advice.

Jacqueline, I agree that Joe's book is awesome. I also picked up his Kiniesology book and the trigger point flip chart. I was 44 when I first jumped headfirst into this profession. Being the oldest in class definitely made me set my standards a little higher. But, now, at age 54 and working for myself....I can say it was worth all of the hard work and perseverance.....and distractions

Hi Joe
I have read your article on fascial contraction
http://www.learnmuscles.com/Fascial%20Contraction%20-%20MTJFA08_Bod... and see that you wrote it in 2006 are you writing up, or do you know where, we can go to get the latest info on fascial contraction ?
Thanks

Joe:
You can find the very latest information on fascial contraction concepts in the conference proceedings from the Fascia Research Congress. I have the 2007 book and it is excellent. Haven't read the proceedings from the 2009 conference in Amsterdam yet. Here's a link to the documents:
http://www.fasciacongress.org/2007/dvd-book-purchase.htm

Actually, there are two books from the 2009 Fascial Research Conference - a 'pre-book' of research findings form the presenters (Fascial Research II) and then there will be (or already is) both a book and the DVD's of the proceedings. I was there in Amsterdam, the new research is amazing, especially that of Jaap van der Waal.

Does anyone know where the next Fascial Research Conference will be held and the dates?

Thanks Whitney and Tom, the books covering 2007/9 come in at $60 each or $100 for both and the dvds are $200 each or $300 for both.

Michelle the 2010 congress will be in Vancouver see Don Solomon's site for updates.

http://www.massageprofessionals.com/group/fasciaconnectivetissuesan...

The next Fascial Research Conference will be in Vancouver BC in the spring of 2011. I don't believe the dates have been finally set yet, but they may have.

ooops meant 2011

Leon says the next conference will be in 2012, dates not confirmed yet. Stay tuned!

Wow, I was away teaching all day and come back to a question posed and already answered multiple times by other folks. How wonderful! Thanks all. I do have the 2007 book and it was great. I look forward to the newer info will be coming out. BTW, there will also be a soft tissue conference at the University of Pittsburgh sometime soon (I can't seem to find the dates at the moment). I believe that Leon is one of the presenters.

Hey Stephen (and everyone else),

A major mea culpa...

I wrote in that fascial contraction article that the elasticity of muscle is due to the fascial component! Major error that I have been trying to figure how to correct on the pdf on my website!

The elasticity of muscle tissue is due to protein titin molecules!

Sorry folks!

Joe

Hey Everyone,

I just wanted to alert you to an upcoming myofascial conference being held at the University of Pittsburgh. Leaders in research and hands-on will be there. The dates are May 7th and May 8th.

Joe

May Poster PDF.pdf

I am curious about contracting the diaphragm eccentrically. It seems possible by inhaling deeply and then forcefully contracting the abdominals concentrically yet controlling the exhale by co-activating the diaphragm. Any thoughts?

Hmm... This is a very interesting question.
Normally eccentric contractions are done to slow down a mover (agonist) force that is external, and if left unchecked would move us too quickly. Gravity is the usual mover force. In this case, the mover force is another muscle/muscle group of our body, the anterior abdominal wall muscles. When the mover force is our own musculature, it is simpler and more efficient to simply contract them less if we want them to not move us as quickly. So, I am not sure that we would "need" to eccentrically contract the diaphragm in this case.
Having said that, I would think that we could certainly choose to do this. And, I see no reason why the diaphragm, like any other muscle, could not be told to contract with a force that is less than the opposing mover force (regardless of its origin, i.e., it is from another muscle in our body), which would by definition create an eccentric contraction. After all, the diaphragm is a skeletal muscle like any other, except that it is also controlled subconsciously by the nervous system instead of just voluntarily like other skeletal muscles.
Great question!
Does anyone else out there have anything to add to this discussion?

Hi everyone,

I recently posted a new "quiz yourself" figure for the muscles of the anterior thigh on my website (www.learnmuscles.com). You will find it by clicking the link for "quiz yourself."
See how well you know the muscles of the thigh. :)
Enjoy!
Joe Muscolino

Hello everyone,

I am looking to create some home-study courses and need to do a "pilot study" for the ncbtmb. So, I am looking for 5-7 volunteers to participate. It would involve reading chapters of my kinesiology textbook and then taking the quizzes. You would receive the CE credit for this...and if you do not have the kinesiology textbook, I will send you one that you could keep.
Anyone interested? You could email me at jemredd@optonline.net

Thanks!

Joe Muscolino

I would like to volunteer
Mike McAleese

my timeline is probably 1-2 months. I actually need people to do the Muscular System Manual, 3ed. or the Muscle and Bone Palpation Book because the Kinesiology textbook will have a new edition out this Autumn, so it would make more sense to hold on that one until I have the new edition for people to do.

I'd like to volunteer

Hi Folks,

I will be presenting a webinar "Using Palpation as an Assessment Tool for Orthopedic Massage" at the World Massage Conference on Monday, June 7th, at 10:00 PM EST. Please join in. CE credit via the NCBTMB. There is a link to sign up at my website: www.learnmuscles.com.
I hope you can be there!
Joe Muscolino

Hi there!
I'm so excited to be a featured speaker at the World Massage Conference this year. I'd love for you to join me.
It starts this Monday so if you haven’t registered already, you can do it now…
http://www.1shoppingcart.com/app/?af=1181329

This is a "virtual " conference. That means that it’s done online (and simulcast by phone if you’re not near a computer). You just log into the website and through the marvels of technology you are listening to some of the greatest educators from around the world live.
It’s super convenient. You can listen from your home or office. And if you miss any presentations, recorded replays are available to listen to online or to download to your MP3 player.
You can IM the presenter questions during their live presentations and can chat with most presenters personally in the chat room immediately after the event. This year the focus is more centered on techniques and treatments and there are some great videos associated with almost every presentation.
If you register now for the June 7th and 8th conference, you’ll get complimentary access to the Fall 2010 conference. It’s over 50 hours of continuing education. You can get free certificates of completion for CE purposes and if you need NCBTMB certificates specifically, these are available for a small one-time fee of only $25 per conference.
Reserve your place now by clicking this link…
http://www.1shoppingcart.com/app/?af=1181329

You can download a printable schedule for the Spring 2010 from the home page of the site. I'm going to be joined by some of the top authors, educators and thought leaders afrom around the world:. Here’s just a partial list of some of the 2010 presenters:
Eric Dalton - The 42-Pound Head; Sandy Fritz - Documentation for Better Outcomes; Andrew Biel – Trail Guide to the Human Body; Til Luchau – Banishing Headaches; Dr. Kerry D’Ambrogio - Muscle Energy Technique; Mary Nelson - Founder of La Stone Therapy; Robert Schleip - International Fascial Congress Report; Laura Allen - Ethics in Massage Therapy; Doug Alexander - Nerve Mobilization; Thomas Myers - Anatomy Trains; Dr Leon Chaitow - Research in Massage and Bodywork; Natalie Celia - Bamboo Fusion; Dr Joe Muscolino - Assessment through Palpation; Bruce Baltz - Active Isolated Stretching; Cherie Sohnen-Moe - Women in Bodywork Busines; Ruth Werner - Women in Bodywork Business; Diana Thompson - Record Keeping for MTs; Whitney Lowe - Orthopedic Assessment; Michael Buck - Vedic Thai Yoga; Ben Benjamin – Treating Low Back Pain; and many, many more…
For complete information and to register go here now:
http://www.1shoppingcart.com/app/?af=1181329

One last thing, they are doing a draw for $1,000 in prizes: Massage equipment and supplies including a new massage table package. If you register soon, you may still be eligible.
I'll see you at the conference,
Joe Muscolino
PS Oh yes, one more thing... Feel free to forward this email to your friends and colleagues. This is something they should know about.

I'd like to volunteer for your pilot study. I just sent you an email at the address you provided below.

Hi Jacqueline (and everyone else),
thank you so much for responding and volunteering to be a part of the pilot study, but the power of the internet is such that I had it filled literally within a few hours of putting it out there. I do also have a waiting list in case some people cannot complete it. So, I do not need anyone else right now, but will let you know if I do.
Again, thank you so much for volunteering!

Joe