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What do we mean when we talk of facilitated and inhibited muscles?

Often in workshops and just yesterday on Facebook, I encounter therapists inquiring about the meaning of muscle facilitation and inhibition. Why is this central nervous system process so important to bodyworkers. I'd like to hear what your take is and how you use it in a therapeutic setting.

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Comment by Erik Dalton on October 7, 2009 at 6:56am: Just noticed in an earlier post you were complaining and being treated for chronic "between-the-blade" pain. You stated: "I am in physical therapy for this exact problem pec/rhombs battle and I am waiting for my epiphany!"

Without observing you, I'd bet the house you have a condition termed a "dual-fixation". There are many presentations for this ornery disorder but if you have a flat spot between-the-blades where there should be thoracic curve, then there are a group of facets stuck closed. This can be a bilateral dysfunction or what osteopaths term "stacked non-neutrals", i.e., one stuck closed on one side and the one above on the other and so on.

When facets stick closed, the contralateral rib(s) can get stuck in internally rotation. This can be a very painful and long term dysfunction if the therapist doesn't treat the dysfunction in the proper order. The facet problem must be corrected first to restore joint play. Sometimes the contralateral rib(s) will regain movement when vertebral function is restored and all is well....but you still need to be doing wall-presses or some other home-retraining exercise to keep the facets open and moving properly to down-regulate the hyperexcited mechanoreceptors (and possibly chemoreceptors if there is inflamation from prolonged jamming of the articular cartilages or demi facets at the rib heads).

Conversely, if you have facets stuck open (FRS) in one or more of the vertebral segments, the ipsilateral adjoining rib can get stuck in external rotation. This is easier to fix but, again, the facet fixation must be fixed first. Then the therapist follows the adjoining rib laterally out to the iliocostalis muscle attachment at the rib angle and if there is exquisite tenderness at that firm attachment, you also have rib dysfunction. This is also easy to fix if the therapist is familiar with structural rib fixations.

Most good manipulative osteopaths understand this prevalent dysfunction and can get you on your way back to a pain free life. Just remember, the rhomboids, erectors and transversospinalis muscles may be weakened (neurologically inhibited) from the joint dysfunction. Any attempt to stretch the muscles crossing the dysfunctional joint(s) will only reinforce the dysfunction which will lead to greater inhibition and more pain.

This is why I believe massage therapists should be taught basic joint mechanics in massage training (like they do in many Canadian institutions). Pressing down on a facets that are already stuck closed as in the "dorsal dish" situation described above, is totally contraindicated. I'm not saying massage therapists should necessarily treat the problem, but should at least recognize what they're dealing with so proper referrals can be made. This is the basis of the Myoskeletal method.

If you're perorming deep tissue work, you need to have a good basic understanding of spinal biomechanics and the 'Laws of Spinal Motion'. Muscles and joints are inseparable...what affects one ALWAYS affects the other so it is nice to know how your deep tissue techniques are affecting the adjoining articular structures...best of luck with this enormously misunderstood problem.

Comment by Erik Dalton on October 6, 2009 at 9:35pm: I couldn't agree more SC.

Fred Mitchell Sr. developed mucle energy technique with the original intention to isolate down to the dysfunctional vertebral, SI joint or rib fixation, apply a slow contract/relax stretching force through the soft tissues, and restore joint play and proper functional alignment.

Today, muscle energy technique has expanded to include almost any kind of soft tissue contract/relax (stretching) release. However, that was not Fred's original intent according to Philip Greenman and his son Fred Mitchell Jr.

In fact, no one really knows who decided to name Fred's discovery muscle energy but his son is convinced Fred would not have picked that title since it was primarily designed to compliment (and some say take the place of) high-velocity thrust.

Probably because of the name, muscle energy today is used as a contract/relax soft tissue stretching technique applied to all the body's myofascia and joints...and that's a good thing.

Some believe it steps outside the scope of practice when the technique is used to strengthen muscle groups. Doesn't make much sense to me since so many forms of bodywork do exactly the same thing, i.e., active isolated stretching/strengthening, PNF, Thai massage, and some forms of structural integration technique.

But some people are only content when trying to control the lives of another person (or group)...much like our politicians. Everybody wants to draw lines in the sand rather than just keeping in their own little box and learning all they can to try to be the very best therapist they can be in an effort to improve the lives of the clients they serve.

Comment by SC on October 6, 2009 at 8:12pm: http://massagebodywork.idigitaledition.com/issues/8/
starting page 57

Comment by SC on October 6, 2009 at 8:07pm: I suppose positional release is okay but isn't MET considered therapeutic exercises?
I personally don't see why MTs can't learn these. I use them as I know too well that massage alone is not always sufficient. There was an article in the last Massage and Bodywork Magazine discussing how much (or how little in this case) MTs are supposed to perform and therapeutic exercises did not seem to fit the mold. Let me find that article.

Comment by Erik Dalton on October 6, 2009 at 7:51pm: Outside the scope of practice in what way?

Comment by SC on October 6, 2009 at 7:40pm: Not to ignore the last couple of posts, I'll say, I don't understand much of that discussion and to go back to the original questions:
I think this is potentially out of the massage therapist scope of practice but understanding the muscle spindle and the the glogi tendon functions (which produce the facilitation and inhibition) would be important if one intends to use positional release and muscle energy technique to relax the client's muscle tone and improve range of motion.

Comment by Erik Dalton on October 6, 2009 at 7:02pm: When we begin discussing the function of 'core' stabilizers, i.e., multifidus, respiratory diaphragm, transversus abdominis and pelvic diaphragm, we're led down a very slippery slope beginning with the goofy 1996 study by Hodges and Richardson which kicked off the core co-contraction revolution with the transversus abdominis as the mantra. Probably need to first review the latest studies by Stuart McGill...the foremost authority (in my opinion) of this subject.

Meantime, here are some earlier studies that refute the importance and/or existence of core stability and co-contraction. (The explanations for this referenced material appears in my "Don't Get Married article @ http://erikdalton.com/article_DontGetMarried.htm )

In Spine, 2006, Brown, et al., reported that people in an externally loaded state appear to select a natural activation pattern appropriate to sufficiently maintain spine stabilization. Any attempt to make conscious adjustments to individual muscles disrupted their natural pattern and decreased stability and the margin of safety.2

Kavic, et al’s Spine research found that no single muscle dominated in the enhancement of spine stability. Individual roles continuously changed according to specific tasks. Their advice was to focus on enhancing motor patterns that incorporate many muscles rather that targeting only a select few.3

In 2006, Mens, et al., found that increasing intra-abdominal pressure caused patients to exert potentially damaging forces on pelvic ligaments. The authors recommend teaching patients techniques to reduce intra-abdominal pressure as opposed to core stability exercises.

Dr. Tim Noakes, professor of exercise and sports science at the University of Cape Town in South Africa, stated in his research, “There is no basis to expect training effects from one exercise to transfer to any other form of exercise. Training is absolutely specific.”

In Manual Therapy, 2006, MacDonald, et al., reported that EMG studies refute the belief that the multifidus is tonically active during static posture, trunk movement or gait, making it unlikely that core stability training of the multifidus can restore normal function.4

It's an interesting subject if we want to go down that path...

Comment by SC on October 6, 2009 at 6:25pm: Thank you Ken for your plain english. I am glad to realize that I am practicing these techniques instinctively.
I guess our clients's bodies remain our first teachers!

Comment by Jeff Sims on October 6, 2009 at 4:23pm: the law of reciprocal inhibition is broken when we perform antagonist co-contraction... the role of postural muscle fibers

Comment by Ken Nelson on October 6, 2009 at 4:02pm: The theory of facilitation is best explained in my opinion by Professor Michael Patterson. He states,” The concept of the facilitated segment states that because of abnormal afferent or sensory inputs to a particular area of the spinal cord, that area is kept in a state of constant increased excitation. This facilitation allows normally ineffectual or subliminal stimuli to become effective in producing efferent output from the facilitated segment, causing both skeletal and visceral organs innervated by the affected segment to be maintained in a state of overactivity.”
I love my wife and it is because of her that I remain grounded. I love to study. Although I find the above statement extremely enlightening, when I begin explaining theories as above to my clients, my dear wife pulls me aside and gently says “stop it, they do not have a clue what you are talking about”.
Erik, that is when I really want to get out my old Alice’s Restaurant album and 8”x 10” glossy photos of people exhibiting upper cross syndrome. As the album plays with its three part harmony, I will explain why they have pain. Calmly stating,” One can’t keep dumping the garbage over the cliff by eating donuts, coffee and being in a flexion position sixteen hours a day and not have one’s body react.” Haha!
However, I gently put then in a standard anatomical postural position and have them feel their muscles and then let them fall back to their ‘normal’ position and have them describe how they feel as I point to positional agonist and antagonist muscles.
I tell them that we have two types of muscles. One type of muscle (phasic) is for moving the body. The other type (tonic) is to maintain the body’s posture and support the body against gravity. When the body is abused or stressed like sitting at a computer for hours at a time day after day, the body begins to react. The phasic muscles upon stress tend to become more elongated, weak and inhibited to normal flexion. The tonic posture/support muscles tend to get tighter, and it gets worse. They become neurologically facilitated, that is nerve communication from the brain keeps them working even when they are not supposed to be working. Two apposing muscle groups can not contract at the same time.
As the agonist (facilitated muscle) takes over and the antagonist muscle continues to be inhibited the structural integrity and range of motion of the joint is lost.
I, through Myoskeletal Alignment Techniques, will normalize the joint movement and pain by balancing the muscle length tension across the joint. I will do this by releasing, stretching and calming down the continued nerve input of the facilitated and tight muscles and help activate, and excite the nerve to strengthen the weak muscles.