Vail Daily health column: Neurokinetic therapy addresses the causes of dysfunctional movement | VailDaily.com

Vail Daily health column: Neurokinetic therapy addresses the causes of dysfunctional movement

Julie Peterson

Conventional wisdom would have you think a tight muscle needs to be stretched and a weak muscle needs to be strengthened. Sounds simple, but it doesn't always work.

What about the people who stretch their psoas (the only major muscle that connects the lower body to the torso) every day for years but are still tight? Or those who can't fire a quad muscle eight months after knee surgery despite faithful compliance with therapy? It was these types of questions that lead me to neurokinetic therapy.

Neurokinetic therapy is a sophisticated assessment and treatment technique that addresses the causes of dysfunctional movement. It uses specific muscle tests to identify which muscles are not firing properly (inhibited) and those that are overworked (facilitated). The key to success is finding these dysfunctional pairs. The protocol is to release the facilitated muscle and, within 30 to 60 seconds, strengthen the inhibited muscle. This allows for retraining in the motor control center in the brain.

If we just release (dry needle, massage, trigger point, surgical release, etc.) the overworked muscle it will simply come back on when we go to perform a task. The brain has learned to use that muscle as its "go to" for that particular function. Likewise, if we try to strengthen the inhibited muscle without first releasing the facilitated muscle, it will stay weak. Until the motor control center in the brain is retrained, it will remember and use the dysfunctional pattern.

Take for instance the shut-down quad after knee surgery. A small amount of swelling in the knee has been shown to inhibit the vastus medialis (core of the quad). To protect the knee, the brain looks for something close by to do the job. The poplitues (tiny muscle on the back of the knee, functionally opposite to the vastus medialis) fires up to 300 percent of normal following knee surgery. The motor control center has lost the correct pattern, and learned a new and faulty one. Until the relationship is righted, the dysfunction will continue. (I have seen this in patients 10 or more years after ACL surgery.)

Another example is with plantar fasciitis. It hurts in the foot, so we focus there. What's really happening is that the calf muscles are overworked. Why? Glute amnesia. Hours spent working in a sedentary position, plus faulty mechanics lead to decreased glute activity. So, the brain looks for something along the kinetic chain to do the task. Calves share a similar function, so the brain chooses them. Now we have our calves acting on behalf of our glutes. The overburdened calves pull on the plantar fascia causing it to tighten and become inflamed. Release the calf in relation to the glute and the symptoms resolve.

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The beauty of neurokinetic therapy is that you can see the results instantaneously. You find what is inhibited (tests weak), then look for what is inhibiting it. The moment you release the overactive muscle, the weak muscle will test strong.

The homework is focused on resetting this pattern. With positive repetition, the correct patterns are re-established. It may take a few rounds to peel down the layers of dysfunction, but the results are impressive. Once the brain has the correct patterns in place, the ability to tolerate activity and exercise is restored.

Stop chasing pain. Identify the source and the symptoms will resolve.

Julie Peterson, owner of Concierge Physical Therapy, is the only physical therapist in the Vail Valley certified to perform neurokinetic therapy. Peterson has a strong background in manual therapy and functional movement. She can be contacted by email at info@conciergePTcolorado.com or by phone at 970-306-3006.