I recently took a NeuroKinetic Therapy course in Phoenix (actually back in October; I've just been slacking on this article :) and I would like to give a little review on my thoughts on this among some other things.
NKT is a therapy protocol created by David Weinstock and is something I have looked into for awhile now. It is based around manual muscle testing and motor control theory. In a nutshell, motor control theory works like this: The Motor Control Center (which can be found in the cerebellum of the brain) takes in information from the limbic system on what is needed and then the cerebral cortex gives direction on how to give/get what is needed before it passes this info along to the spine and musculoskeletal system, which then do and accomplish the task at hand. “The Motor Control Center is stimulated by a muscle or function failure.” (NKT intro)
If we look at a baby learning to stand or an adult learning to squat correctly, there are many failed attempts to get the pattern correctly before it is done right. The MCC will light up with each failure. This center organizes all body movement and patterns and it can learn new patterns like squatting, and it can also create dysfunctional patterns in response to different kinds of trauma. When you finally learn the proper way to squat or that baby finally learns to stand, the successful information is programmed into the MCC. On the other hand, when someone gets injured, dysfunctional patterns can get stored. In his book, David uses whiplash as an example. With whiplash, the various neck extensor muscles often get very tight and painful. You can massage and stretch them all day but will often have no improvement. Why does this happen? After the injury, the Motor Control Center now “thinks” that the neck flexors are weak and vulnerable; therefore, it stays locked into the extensors to support the head and protect the joints around it. I would go farther to say that dysfunctional patterns don't always require an injury to get locked into the MCC. Using the above example, if someone trained their MCC to squat improperly for any length of time, the dysfunctional pattern will be stored and compensations will come about. If someone uses mostly machines in their training, poor motor control patterns can develop since unnatural muscle firing patterns and poor coordination patterns are trained. If someone sits at a desk all day and then gets up and goes to workout, poor patterns can develop if anterior shoulder and hip muscles are overactive from being in a shortened state all day. The list goes on. To sum things up, the Motor Control Center governs our movement patterns and it governs the firing of the hierarchy of muscles that accomplish these patterns.
All that being said, there are multiple patterns of compensation that develop from injury, poor posture/positioning (which creates undetected microinjuries) and poor movement in general. The most common relationships that are looked at with NKT are core, antagonist, synergist and kinetic chain relationships. With a core relationship, spinal/trunk muscles compensate for weakness in an extremity. For example, your lumbar erectors might be overactive and painful because of a weak or inhibited low trap. With an antagonist relationship (most common), muscles that oppose one another have problems. For example, your psoas is overactive in relation to an inhibited, non firing glute (psoas flexes the hip and glute extends it) With a synergistic relationship, muscles that work together to accomplish a task are out of whack. For example, your psoas is inhibited by your rectus femoris (both work together to flex the hip). With a kinetic chain relationship, muscles that work in sequence or along the same fascial or functional line are out of sync. If you are familiar with Thomas Myers' Anatomy Trains stuff (which you should be), this will make sense to you. For example, your neck extensors could be overactive due to your soleus not doing much. Since everything from the bottom of your foot up to the top of your head is connected with the superficial back line, anything along this posterior chain can develop compensation. Hamstrings and lumbar erectors compensating for lazy glutes, calf muscles compensating for lazy glutes or intrinsic foot muscles and any number of patterns like this are possible. All of these relationships are basically like that situation in college or high school when you had that annoying group member who didn't do jack squat to help out at all with the project. You and your other group members were then angry because the lazy one didn't do anything and then expected to get credit. Pssh.. With these relationships, one muscle is that annoying kid while the others are the angry ones working overtime to do the lazy one's job.
So basically, NKT is all about figuring out what muscles are facilitated and what muscles are inhibited based on these different relationships and pain. There are tons of specific muscle tests that are done to see if different muscles are A. Firing, B. Strong and C. Endurable. If someone comes in with anterior shoulder pain (many do), we would muscle test this area first, (lets say anterior delt) and see if it tests strong or weak. If it tests strong, we then would think about possible relationships in the area to see what might be inhibited and thus, causing anterior delt to be overactive and painful. Personally, I would look at different movement/performance screens and tests to get an idea of where I wanna go with things and then go into the NKT testing but for the purposes of simplification lets look at the most common relationships first, antagonistic.
If anterior delt is a problem, we can check posterior delt, lat, infraspinatus, etc. Since anterior delt flexes, adducts, horizontally adducts and internally rotates the shoulder, we would think about muscles that do the opposite (hence the listing of samples I just made). If we find that posterior delt tests weak, we would then find a localized spot on anterior delt (usually the site of an adhesion that causes their pain), tension it and recheck the posterior delt. If posterior delt now tests strong, we conclude that anterior delt was inhibiting posterior delt. NKT calls the process of tensioning that localized spot on the facilitated muscle therapy localization. It allows you to see what is truly inhibiting what. When that posterior delt tested weak, the Motor Control Center was stimulated and we have a window to store a new pattern. By then using TL to see if our spot on the anterior delt is inhibiting the posterior delt, we can move forward with treatment. So, we would then release the anterior delt (I would probably use ART) and then retest the post delt. If it now tests strong, we have successfully reprogrammed the MCC. The catch is we now have to frequently hit this pattern to get it ingrained in our brain; otherwise, things will go back to the way they were. In my opinion, we also need to reintegrate this new firing pattern into full body compound movement. In this case, we could train something like pushups or some press variation.
If we went the synergistic route, we could check biceps, pec major, finger extensors, etc. in relation to the anterior delt. I have personally seen anterior delt being overactive because of weak/inhibited finger extensors multiple times since I've taken this course. These are all examples of muscles that work together to accomplish different tasks. If we went the core route, we might see a thoracic muscle that is out of whack in relation to anterior delt, such as longissimus thoracis. There is no set route to go so you need to know your functional anatomy, get some experience dealing with these types of imbalances and then solve each puzzle as it comes your way. Its actually pretty fun and really challenges your thought process.
Overall, I really enjoyed the course and it really expands on some things I was already doing. With a variety of imbalances being so common and so many people coming in with random aches and pains, NKT gives some great tools to help assist with treatment and exercise prescription. I think that it works most effectively when combined with other assessment tools and I really like that they come out and say that this is a great “tool” to combine with other “tools.” Relationships and assessments that can be done with NKT get much deeper than what was mentioned here but I wanted to give an decent overview of things.
I also took an SFMA course (Selective Functional Movement Assessment) last year, which basically looks at fundamental human movement patterns and breaks down dysfunction and pain with those patterns. Combining things that I see with movement from SFMA, FMS patterns and multiple other assessment modalities that I have picked up over time with the manual muscle testing of NKT has been very effective for me. Combining an effective treatment like ART (Active Release Techniques) and effective exercise prescription with assessments like these takes things even farther. Basically, if a movement pattern is dysfunctional, I can break down that pattern and then see what kinds of muscle firing relationships are a part of that pattern in order to most effectively correct things. I can treat what needs to be treated and then program the right exercise to get back to good again.
Taking things a step farther, I just went through PRI's Myokinematic (Postural Restoration Institute) home study videos and will soon be traveling to Indy to take their Respiratory course. With PRI, they look at common patterns of asymmetry that the human body often displays and base much of their assessment and treatment on positioning. I will expand on this more in the near future after I do the breathing course but just the other day I was doing some NKT testing on a client who was getting some posterolateral left hip pain. I found that her left posterior glute medius and tfl (important muscles on the outside of your hip) were inhibiting her left quadratus lumborum (important spine and pelvic stabilizer which she coincidentally used to have problems with) and that she was standing with her right hip hiked up. These are all things that are found with a common PRI pattern known as Left AIC (again, will expand on this soon) where people get stuck in their right hip with their right ab wall overactive and left outer hip overactive among other things. So, my NKT testing led me to a PRI pattern. When I looked at her forward flexion, which can be found with the SFMA stuff, there was some dysfunction there as well. Her pelvic positioning affected her firing pattern and her movement and vice versa. The point I am trying to make is that all of these different assessment processes, techniques, etc. at some point come together and complement each other. The body is a complex thing and regardless of what protocols or modalities you use to figure out your treatment or training, you are still looking at the body. I believe that the more tools you can have at your disposal, the more effective you can be at improving optimal performance of the body. I also believe that these modalities I mentioned are some of the most powerful and logical paths out there and am beyond excited to see how much better I can get at helping people as I continue to master them. (Or at least try to master them; don't know that its possible to ever fully master any of this stuff since the body is so amazing with how it works)
In conclusion, if you are looking for a powerful assessment tool to help you more effectively perform manual therapy on clients or more effectively prescribe exercises, definitely look into NKT. If you are not a professional in these fields but have pain or some kind of issue related to the things discussed, there is probably an answer for your troubles. This all ties into my basic philosophy: the cause of your issues is hardly ever at the site of trouble. You need to look at POSITION, FIRING PATTERN and MOVEMENT. They are almost always all related and need to be evaluated to get the full picture. It is very uncommon for a muscle to actually be “tight” to a point where it needs to be stretched. In my experience, 9 times out of 10, a muscles seems “tight” because of issues with one of the big three listed above. Its overactive because it has no other choice. Restore position, reset the motor control pattern and/or fix the movement. If your therapist or trainer is not looking at these things, then find someone who is. This does not even touch on the realm of psychosomatic issues, which opens up a whole other door of possibilities and is a topic that some colleagues whom I respect greatly are beginning to dig deeper into. Time to go learn more; Be Awesome!
NKT is a therapy protocol created by David Weinstock and is something I have looked into for awhile now. It is based around manual muscle testing and motor control theory. In a nutshell, motor control theory works like this: The Motor Control Center (which can be found in the cerebellum of the brain) takes in information from the limbic system on what is needed and then the cerebral cortex gives direction on how to give/get what is needed before it passes this info along to the spine and musculoskeletal system, which then do and accomplish the task at hand. “The Motor Control Center is stimulated by a muscle or function failure.” (NKT intro)
If we look at a baby learning to stand or an adult learning to squat correctly, there are many failed attempts to get the pattern correctly before it is done right. The MCC will light up with each failure. This center organizes all body movement and patterns and it can learn new patterns like squatting, and it can also create dysfunctional patterns in response to different kinds of trauma. When you finally learn the proper way to squat or that baby finally learns to stand, the successful information is programmed into the MCC. On the other hand, when someone gets injured, dysfunctional patterns can get stored. In his book, David uses whiplash as an example. With whiplash, the various neck extensor muscles often get very tight and painful. You can massage and stretch them all day but will often have no improvement. Why does this happen? After the injury, the Motor Control Center now “thinks” that the neck flexors are weak and vulnerable; therefore, it stays locked into the extensors to support the head and protect the joints around it. I would go farther to say that dysfunctional patterns don't always require an injury to get locked into the MCC. Using the above example, if someone trained their MCC to squat improperly for any length of time, the dysfunctional pattern will be stored and compensations will come about. If someone uses mostly machines in their training, poor motor control patterns can develop since unnatural muscle firing patterns and poor coordination patterns are trained. If someone sits at a desk all day and then gets up and goes to workout, poor patterns can develop if anterior shoulder and hip muscles are overactive from being in a shortened state all day. The list goes on. To sum things up, the Motor Control Center governs our movement patterns and it governs the firing of the hierarchy of muscles that accomplish these patterns.
All that being said, there are multiple patterns of compensation that develop from injury, poor posture/positioning (which creates undetected microinjuries) and poor movement in general. The most common relationships that are looked at with NKT are core, antagonist, synergist and kinetic chain relationships. With a core relationship, spinal/trunk muscles compensate for weakness in an extremity. For example, your lumbar erectors might be overactive and painful because of a weak or inhibited low trap. With an antagonist relationship (most common), muscles that oppose one another have problems. For example, your psoas is overactive in relation to an inhibited, non firing glute (psoas flexes the hip and glute extends it) With a synergistic relationship, muscles that work together to accomplish a task are out of whack. For example, your psoas is inhibited by your rectus femoris (both work together to flex the hip). With a kinetic chain relationship, muscles that work in sequence or along the same fascial or functional line are out of sync. If you are familiar with Thomas Myers' Anatomy Trains stuff (which you should be), this will make sense to you. For example, your neck extensors could be overactive due to your soleus not doing much. Since everything from the bottom of your foot up to the top of your head is connected with the superficial back line, anything along this posterior chain can develop compensation. Hamstrings and lumbar erectors compensating for lazy glutes, calf muscles compensating for lazy glutes or intrinsic foot muscles and any number of patterns like this are possible. All of these relationships are basically like that situation in college or high school when you had that annoying group member who didn't do jack squat to help out at all with the project. You and your other group members were then angry because the lazy one didn't do anything and then expected to get credit. Pssh.. With these relationships, one muscle is that annoying kid while the others are the angry ones working overtime to do the lazy one's job.
So basically, NKT is all about figuring out what muscles are facilitated and what muscles are inhibited based on these different relationships and pain. There are tons of specific muscle tests that are done to see if different muscles are A. Firing, B. Strong and C. Endurable. If someone comes in with anterior shoulder pain (many do), we would muscle test this area first, (lets say anterior delt) and see if it tests strong or weak. If it tests strong, we then would think about possible relationships in the area to see what might be inhibited and thus, causing anterior delt to be overactive and painful. Personally, I would look at different movement/performance screens and tests to get an idea of where I wanna go with things and then go into the NKT testing but for the purposes of simplification lets look at the most common relationships first, antagonistic.
If anterior delt is a problem, we can check posterior delt, lat, infraspinatus, etc. Since anterior delt flexes, adducts, horizontally adducts and internally rotates the shoulder, we would think about muscles that do the opposite (hence the listing of samples I just made). If we find that posterior delt tests weak, we would then find a localized spot on anterior delt (usually the site of an adhesion that causes their pain), tension it and recheck the posterior delt. If posterior delt now tests strong, we conclude that anterior delt was inhibiting posterior delt. NKT calls the process of tensioning that localized spot on the facilitated muscle therapy localization. It allows you to see what is truly inhibiting what. When that posterior delt tested weak, the Motor Control Center was stimulated and we have a window to store a new pattern. By then using TL to see if our spot on the anterior delt is inhibiting the posterior delt, we can move forward with treatment. So, we would then release the anterior delt (I would probably use ART) and then retest the post delt. If it now tests strong, we have successfully reprogrammed the MCC. The catch is we now have to frequently hit this pattern to get it ingrained in our brain; otherwise, things will go back to the way they were. In my opinion, we also need to reintegrate this new firing pattern into full body compound movement. In this case, we could train something like pushups or some press variation.
If we went the synergistic route, we could check biceps, pec major, finger extensors, etc. in relation to the anterior delt. I have personally seen anterior delt being overactive because of weak/inhibited finger extensors multiple times since I've taken this course. These are all examples of muscles that work together to accomplish different tasks. If we went the core route, we might see a thoracic muscle that is out of whack in relation to anterior delt, such as longissimus thoracis. There is no set route to go so you need to know your functional anatomy, get some experience dealing with these types of imbalances and then solve each puzzle as it comes your way. Its actually pretty fun and really challenges your thought process.
Overall, I really enjoyed the course and it really expands on some things I was already doing. With a variety of imbalances being so common and so many people coming in with random aches and pains, NKT gives some great tools to help assist with treatment and exercise prescription. I think that it works most effectively when combined with other assessment tools and I really like that they come out and say that this is a great “tool” to combine with other “tools.” Relationships and assessments that can be done with NKT get much deeper than what was mentioned here but I wanted to give an decent overview of things.
I also took an SFMA course (Selective Functional Movement Assessment) last year, which basically looks at fundamental human movement patterns and breaks down dysfunction and pain with those patterns. Combining things that I see with movement from SFMA, FMS patterns and multiple other assessment modalities that I have picked up over time with the manual muscle testing of NKT has been very effective for me. Combining an effective treatment like ART (Active Release Techniques) and effective exercise prescription with assessments like these takes things even farther. Basically, if a movement pattern is dysfunctional, I can break down that pattern and then see what kinds of muscle firing relationships are a part of that pattern in order to most effectively correct things. I can treat what needs to be treated and then program the right exercise to get back to good again.
Taking things a step farther, I just went through PRI's Myokinematic (Postural Restoration Institute) home study videos and will soon be traveling to Indy to take their Respiratory course. With PRI, they look at common patterns of asymmetry that the human body often displays and base much of their assessment and treatment on positioning. I will expand on this more in the near future after I do the breathing course but just the other day I was doing some NKT testing on a client who was getting some posterolateral left hip pain. I found that her left posterior glute medius and tfl (important muscles on the outside of your hip) were inhibiting her left quadratus lumborum (important spine and pelvic stabilizer which she coincidentally used to have problems with) and that she was standing with her right hip hiked up. These are all things that are found with a common PRI pattern known as Left AIC (again, will expand on this soon) where people get stuck in their right hip with their right ab wall overactive and left outer hip overactive among other things. So, my NKT testing led me to a PRI pattern. When I looked at her forward flexion, which can be found with the SFMA stuff, there was some dysfunction there as well. Her pelvic positioning affected her firing pattern and her movement and vice versa. The point I am trying to make is that all of these different assessment processes, techniques, etc. at some point come together and complement each other. The body is a complex thing and regardless of what protocols or modalities you use to figure out your treatment or training, you are still looking at the body. I believe that the more tools you can have at your disposal, the more effective you can be at improving optimal performance of the body. I also believe that these modalities I mentioned are some of the most powerful and logical paths out there and am beyond excited to see how much better I can get at helping people as I continue to master them. (Or at least try to master them; don't know that its possible to ever fully master any of this stuff since the body is so amazing with how it works)
In conclusion, if you are looking for a powerful assessment tool to help you more effectively perform manual therapy on clients or more effectively prescribe exercises, definitely look into NKT. If you are not a professional in these fields but have pain or some kind of issue related to the things discussed, there is probably an answer for your troubles. This all ties into my basic philosophy: the cause of your issues is hardly ever at the site of trouble. You need to look at POSITION, FIRING PATTERN and MOVEMENT. They are almost always all related and need to be evaluated to get the full picture. It is very uncommon for a muscle to actually be “tight” to a point where it needs to be stretched. In my experience, 9 times out of 10, a muscles seems “tight” because of issues with one of the big three listed above. Its overactive because it has no other choice. Restore position, reset the motor control pattern and/or fix the movement. If your therapist or trainer is not looking at these things, then find someone who is. This does not even touch on the realm of psychosomatic issues, which opens up a whole other door of possibilities and is a topic that some colleagues whom I respect greatly are beginning to dig deeper into. Time to go learn more; Be Awesome!
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