History Continued

As I experimented with the "stroke" I did notice that the results were far better if I worked on the trigger points in a direction towards the insertion of the muscle.  This essentially stretched the muscle and allowed for far better results than anythig that I had seen to that point or that I have yet to see to this day.

Other things that I experimented with beside the direction of the "stroke" was the pressure that I used, the speed of the "stroke". Over a period of time, these three things seemed to be the difference between fair results and great results.  As This technique developed, two other elements were included intot he mix, which were the contact point used for the treatment and amount of work that was done on a particular area.

Elements

Though you will be able to use you intuition when treating your patients, there are five elements which you will need to understand to be better able to use this technique.  The best part of this technique is that you will be able to adjust what you are doing in a way that is beneficial to both you and your patient!

Direction

The direction of this work should always be from origin to insertion.  The only exception to this "rule" is when you are working against gravity.  You must be aware that as gravity pulls a body either forward or down, the work must be done to correct the force that gravity exerts.

Pressure

Adjusting the pressure to be the most effective is something that is an art form, and must be changed not just from patient to patient, but from patient visit to patient visit and from one part of the body to another.  Finding the right pressure is very difficult, yet once you become proficient at it, it is something thatwill become second nature to you.  The best guide to the amount of pressure that you will need is just enough pressure to move the muscle- No more and no less.

Speed

This work must be done at the proper speed for it to be effective.  If you apply pressure too fast the muscle will contract against that pressure.  The muscle will allow you in if you give it a chance to give under your pressure.  If you work too fast, the reaction of the muscle will be to contract.  It is a similar reaction to the one that you will get if you work too deep.

Contact Point

Using the proper contact point may be a given, yet it is important that you use the appropriate part of your body to work different body parts of your patient.  The best rule of thumb is to use the largest contact point that is comfortable for both you and your patient.  As an example, it would be inadvisable to use a pinky when working on a gluteal muscle or an elbow in the scalenes.  By trial and error, you must be able to discern the best contact point for the body part that you are working.

Duration

This therapy is very effective and your goal of releasing spasm and elongating muscles can be accomplished relatively quickly.  Because of this, many therapists have a tendency to overwork the muscle and the whole area of involvement.  Once you begin to feel the release of a muscle, it is time to leave that area and move on.  You can always go back to that area and work it later in the treatment to see if you can get further movement, but you must give the muscle some time to adjust to its new length.

Performance steps

1. Start by working one of these three points:
         - The proximal edge of the belly of the muscle
           - The proximal edge of the trigger point
           - The proximal edge of the muscle spasm

2. When working on a muscle it is best if you keep it in the most neutral position possible.

3. The action of the movement of the stroke is like the  NikeTM "swoosh".  The muscle is contacted
at one of the three points stated in step 1, then pushed (or pulled) towards the insertion.

4. Remember that the pressure to be used is just enough to move the muscle tissue.

5. The contact point will depend upon the size and tenderness of the area being worked.  
     - Generally speaking the smaller the area, the smaller the contact point
     - The larger the contact point, the more comfortable it is for the patient

6. It is very important not to overwork the muscle.  The muscle will generally follow a  
    pattern when it is worked.
     - As pressure is applied to the area, the skin will stretch and then stop.
     - As the pressure continues, fascia will stretch, and then muscle will stretch         
       (though this may happen simultaneously).
     - The muscle will stop stretching.  It is now time to leave the area.

7. It is imperative that the pressure att he osseous attachments is lessened to reduce 
    the risk of increased pain at the attachment.

8. Once the stretch has been competed, cross-fiber friction of the attachments,
    both proximal and distal, can be done.

9. This process can be repeated with increasing pressure after the muscle has been
    allowed to relax in its elongated state.  The effects of the treatment will continue
    even after the treatment is completed, so it is important not to try to do too much 
    at once.  Overstretching the muscle will cause the muscle to contract post 
    treatment.    
             

Overview of INM Treatment

1. Prior to treatment, survey the body both in the standing position and in the lying
   position.  You should be looking for the following:
          - Imbalance from side to side and front to back at the hips and shoulders
          - A tilting of the head from side to side or front to back
          - The position of the feet, whether they are inverted or everted.
          - Whether the patient can stand comfortably in one position with the pressure
             being equal on both legs.
          - A gait pattern that is equal.
          - The first four above should be repeated in a prone, lying position.

2. During this time, it is imperative that you ask questions, which will help you to
   determine some of the potential causes of the problems.  Some questions could
   include:

          - Is this a result of a trauma?  What are the speifics of that trauma?
          - What are the physical activities that your patient typically does? This
             includes work, home, hobbies, sports activities and exercise programs.
          - Are there any times or activities which cause an increase in the pain?  A
             decrease in the pain?

3. Palpate the body while continuing toask questions.  Palpation and the answers to
    your questions are the primary source of the infomation that you will use to treat
    your patient. 

4. Use this time to familiarize yourself with the patient's condition, especially all of the
   tight areas and areas of potential dysfunction. Note whether the muscle is in spasm
   or hard. Develop a plan of action for treating the client based on this information.

5. Further warm up the muscles by applying either compression or effleurage,
   depending upon the use of lubricants.  The muscles will warm up due to the increase
   in blood flow.

6. The primary difference between this treatment and other types of treatments is the
   direction of the the movbement, which is fromt he origin to the insertion.  Put
   another way the movement is from the most stable tot he least stable.

7. Use your own personal technique to accomplish the goal of stretching the
   musculature to its proper length.  It is appropriate to use your fingers, fists, hands
   elbows or forearms when performing this technique.

8. You can work with or without lubrication.  The smaller amount of lubricant that you
    use, the more effective the stretching will be, for you will be able to grip the muscle
    far better if you are not slipping over the tissue.  I have found that the greatest
    success come when no lubricant is used at all.

9. It is imperative that you use the proper pressure and speed when working the 
   tissue.  The tissue should be worked slowly, for if it is worked too fast, the muscle
   will "fight" against the work and contract.  For the very same reason, you should not
   work too deeply either.

10. The contraindications for INM are the same as for any other bodywork.  There are
     no additional contraindications for this type of work.

11. There are patient variables that must be considered when using all massage 
     techniques, this technique is no exception.  Some of the variables to consider
     include, but are not limited to:
          - Age
          - Physical condition of the patient
          - Emotional condition of the patient
          - Any diseases which could effect the reaction to the treatment
          - Tolerance to the treatment

For more information about INM and classes, you can contact Lewis at:

Southern Rehab & Therapy, Inc.
2260 Palm Beach Lakes Blvd #214
West Palm Beach, Florida 33409

Phone: 561-684-2624
Fax: 561-478-2155