First I want to say thank you Robbie for inviting me to talk with you and share these stories and ideas with you and your readers.
Neuromuscular Therapy has, for me, been an amazing life long journey starting, long before I was cognatively aware of it, in my childhood. I was dazzeled by the “Brothers of Iron” Joe and Ben Weider and I remember purchasing my first bullworker in the early seventies long before Ireland had its first gym, which incendently I joined with my brother. I think it was 1978 in Mary Street, Dublin. This period and the preceeding twenty years would prove to be such an exciting time for bodywork and exercise science in general and it still is. I gained my first degree in Exercise Physiology in 1984 and had been practicing massage since the late seventies. I met Leon Chaitow in the mid eighties and have been standing on his shoulders ever since. As a young boy I was enthralled reading and learning about the life of the man who I believe was the father of health related fitness Bernarr McFadden. Combining knowledge of exercise science, anatomy and the wisdom of such great pioneers, some whom I have been blessed to work and/or study with, such as Stanley Leif, Boris Chaitow, Professor Siegfried Mense, Ida P. Rolf, Professor Kevin Sykes, Leon Chaitow, Moshe Feldenkrais, Professor David Goodman Simons, and others too many to mention just now, led to the establishment of Europes first formal qualification in European Neuromuscular Therapy. Of course now we have a Higher Diploma in Neuromuscular Therapy combining both European and American versions. We also have the newly established Masters Degree in Neuromuscular Therapy which is an exciting development and the fruition of many years work.
2. What, in your opinion, is the biggest problem you see among clinicians in dealing with pain and rehabilitation?
I want to answer this question not so much by focusing on any problem but three areas that are either completely neglected or are poorly understood. They are understanding the nature, diagnosis and treatment of the Myofascial Trigger Point, second the role of Fascia in human movement and pain. Then there is a third area which is the role of skin in human movement and pain.
Many therapists that I meet around the world have never considered the Myofgascial Trigger Point as the primary cause of a patient’s pain. Of course if a person has a pain in their tooth they will see a dentist. When that person has had root canal treatment and even gone as far as to have the tooth extracted and they are still living with the pain they are lost to know who to turn to. We are working hard to enlighten as many therapists of various stripes to consider Myofascial Trigger Point involvement and to either refer to a Neuromuscular Therapist or to get appropriate training to offer specific inttervention. I feel the Journal of Bodywork and Movement Therapy has played its role in educating more and more therapists regarding the Myofascial Trigger Point. In Ireland I have no doubt that Neuromuscular Therapists are the leading experts in treating and uderstanding Myofascial Trigger Points.
At present I am completing a Post Graduate Medical Degree in Human Anatomy in Dundee University in Scotland. My primary interest is with the connective tissue of fascia.
Fascia is fascinating as it is a continuous tensional network throughout the human body. I have written my thoughts on what I call, “MyoTensegrity” the one muscle hypothesis (1992) because we truly only have one muscle in the human body, enclosed into several hundred fascial wrappings.
Understanding this ubiquitous tissue can solve the issue of pain experienced in one body part but as a consequence of fascial tension and fibrosis in a local or more distant body part. As Ida P. Rlof used to say, “Where you think it is it ain’t”. From a medical viewpoint, medical students are thought that the fascia is a rarther fatty packing material that needs to be removed by scrapping in order to “see” the muscle. This idea makes me cringe. There are no medical textbooks showing the true image of human muscles. All or most of the fascia has been painstakingly cleared away. Most of what we know about muscle fibers and their role in creating movement needs to be addressed.
To give an example, in human bodies muscles seldom ever transmit their entire force directly via tendons into the skeleton as we are encouraged to believe. They in fact distribute a considerable amount of their tensional forces or stiffness onto the fascia. This way they not only stiffen the respective joint but several joints at some distance away. This concept blows a hole in the entire discussion concerning which muscle is responsible for what movement. This is such a misconception and has major influence on how you treat a patient or provide therapeutic physical activities. That said, I find the entire topic really exciting and I do love trying to win over new converts.
3. How did you come about setting up the NTC?
It just happened over time. I began by offering workshops and masterclasses and then through demand I established the first Irish fitness instructors course in Exercise and Health Studies, that was in 1985 and the rest is history. To be honest NTC is now very different with a formal structure involving committees, advisory boards, policies and procedures within five schools and more about the world class tutors who deliver the various programmes and the great staff in general, all highly motivated and interested in the learner. I am very proud that I started the ball in motion. I have to mention our graduates who over the years have gained a reputation for excellence which others have kindly given them credit for. Our graduates are generally very loyal and that is a reflection of their educational experience at the NTC.
4. There seems to be a big discussion in the field at the moment since Thomas Myers talk at Providence as to what is the most optimal way to increase an athletes flexibility. I know that you personally have some strong opinions with regards to static stretching. Could you give us your thoughts on this subject?
We really need a long time to discuss this topic. I did not hear Tom’s presentation in Providence but I am very familiar with his work. The main point I would make is that there is little room for the classic static type stretching that we see so many athletes and non athletes participate in. I geuss I have been beating this drum now for more than twenty nine years at at times it felt like no-one was really paying attentiuon.
I wrote the following in my book (The Concise Book of Neuromuscular Therapy a trigger point manual) concerning stretching;
My understanding of myotactic reflexes and the role of fascia has led me to avoid recommending static and ballistic stretching in most situations of physical activity over the past twenty-eight years. As static poses are an integral part of some sports, such as the start of a run or swim, we should not rule out static poses. However, I refer to this as static dynamic.
Static stretching may have a therapeutic benefit when used correctly by a knowledgeable and well-trained therapist. Static stretching can cause architectural damage and may interfere with the structural integrity of the connective tissue. Great care is needed to ensure it is the correct intervention to take. The notion that people should be trying to increase range of motion every time they stretch is not one to be supported. The rationale of holding muscles under a static stretch is one that I believe can contribute to increased muscle tension, reduced potential neuromuscular efficiency and a reduction in relative strength.
In the pursuit of wishing to elongate muscle fibres, I propose that the additional lengthening of nerve tissue could, in turn, result in temporary reduced reaction times while the elongation of muscle fibres disassociates the actin /myosin proteins thereby reducing potential strength and neuromuscular efficiency.
Inappropriate static stretching, I propose, has the potential to pull the walls of individual sarcomeres in opposite directions. This could disassociate the contractile proteins, in many sarcomeres, from each other. In effect this could possibly reduce force output while causing distortion to the sarcomeres in series. Over time, repeated static stretching could lead to increased, or at least maintained, hypertonicity in the muscle. This hypertension becomes self-perpetuating as excessive tension retards both blood and nerve tissues. This retardation leads to tissue hypoxia and additional tissue tension. This in turn may be the foundation for the development of trigger point activity. Many people feel the need to stop and statically stretch their muscles only minutes into their warm-up. Remember warm-up activities should be low in intensity and focused on gradually raising body temperature from the core to the extremities.
The word “Stretching” means so many different things to so many people. We need to take care to ensure we are all speaking the same language so that a good debate can take place. Of course we should all be ready to change our views based on new information or research. That is the nature of science as it proves nothing but rather provides evidence based on current investigations using specific modus operandi.
5. Who has had the biggest influence on you as a therapist?
Many people without a doubt have had major influences on me professionaly and in my private life not least my mother. Cleary though, it is of course Leon Chaitow who has been so supportive to me over so many years. We have not and do not always agree, but that is one of Leon’s great strengths. He involves himself and surrounds himself with people of varying opinions and provides them with a platform to be heard. We have great conversations when we teach together and go out for a meal, which is no easy event as Leon is strictly a non meat eater. Leon has shared his wealth of knowledge openly with me over the years. Of course due to Leon I am on the editorial board of the Journal of Bodywork and Movement Therapy and traveling to so many conferences with leon has introduced me to many of our leading researchers and pioneers. I appreciate the privelaged position that has afforded me and I pay tribute to Leon at all my presentations. Of course my close relationship with David Simons is one I am very grateful for. David wrote the forward to my book. Sadly David passed away this April and his family invited me to speak on behalf of his professional friends and colleagues at his funeral. I felt very privelaged and of course I was honoured to do so.
Leon Chaitow and David Simons
6. What are you all-time favourite books in the following areas:
Some aspects of these books do not always square with what I think but they are grteat reads
- Physical Therapy Rehabilitation: Effective Management of Musculoskeletal Injury-Andrew Wilson
- Nutrition: University of California at Berkely-Wellness newsletter and Annual http://www.wellnessletter.com/html/wl/wlAbout.html
-Business: Annual Built to Last; Successful Habits of Visionary Companies-James Collins and Jerry Pottas. Harper Collins Canada
-Random: The War on Pain. Scot Fishman M.D. Newleaf Publishers
7. What do you do to for your continuing education (Seminars attended etc)?
I travel to a number of conventions worldwide each year. Some I present at which offers me the unique chance to speak to the other presenters and often times go for a bite to eat in the evening so we can talk “shop”. I did that recently at the International Fascia Conference where I presented. I went for a few beers with (amounst others over the four days) Philip Beach and we had a great chat. You should look out for Philips new book which will be on sale soon.
8. What resources that are out there, would you recommend to young up and coming coaches (Podcasts, Websites, Blogs, Products)?
Of course the Journal of Bodywork and Movement Therapies is a must. We are bridging the gap between the bodywork therapist and the exercise specialist with the JBMT. I also encourage people to visit my friend Dr Stepen Levein at BioTensegrity.com
9. Could you give my readers a basic summary of what your methodology on rehabilitation is (eg. Assessment, treatment protocols)?
I think we all offer similar time to the majority of our patients and so we need shot gun techniques. A full body kinetic chain assessment is vital. Identify and treat those muscles and fascia that are short and spastic first using release techniques, GTO response and so on. Then treat the Inhibited, often tight and not necessarily lengthened muscles and fascia with spindle approaches. Avoid treating more than five muscle in any one session. Wait for automonic responses, pay attention to and work with the breath and remember change requires energy. Remember Soft tissue releases. The autonomic nervous system discharges. Discharge implies a whole body, multi systems release and this requires your patient to have the energy to cope with such changes. Work slowly, speed is the enemy.
Once we provide a neuromuscular and fascial balance to the body we can then introduce corrective physical activity. Remember the forces used to move the upper limbs must be generated in the lower limbs and pass through the lumo-pelvic-hip complex. For the most part avoid classical “sit-ups”, certainly reduce the number of repititions of this exercise which has little or no functional relationship to human movement and sets up bad neuromuscular engrams. The body is the hero. We heal nothing. The body has a potential to heal. Movement is life.
I steal any good technique or concept from other educators or therapies as that is what my work is all about, giving and sharing. In Neuromuscular Therapy we consider Nutrition, Fascia, Muscle, Nervous system involvement, Myofascial Trigger Points, stress (repetive and emotional).
I hope that helps
10. Last question, what advice would you give to young therapist, like myself getting into the field?
Follow your dreams not an ego. Be honest and true and really be concerned while demonstrating true empathy. Be prepared to listen and recognise that change is difficult. Other opinions are great and should be welcome. If we all thought the same way and held just one opinion life would be truly boring. Be patient. You are the new pioneers and you all have something new to offer.
RB: John, thank you so much for your time. Where can my readers find out more about you, and any projects that you may have coming up?
JK: Thank you Robbie, it was good chating to you. I feel you are setting a great example to others and I want to say well done and keep up the great work you are doing. All our courses and workshops are on the NTC web site, actually we have a new site coming on line very soon if people care to take a look. I wish evryone success !! john