What is Myotherapy

　Myotherapy is a physical therapy for the Peripheral Nerve Dysfunction utilizing vibration therapy, soft tissue mobilization and joint mobilization/manipulation in order to improve the blood (oxygen) supply to the nerves.
　Peripheral Nerve Dysfunctions were caused by inflammation and ischemia-reperfusion of blood flows. With inflammation on or near the nerves, nerves may be damaged by the cytokines such as IL-6 via blood circulation (Eliav E 1999, Chacur M 2001). This type of the nerve damage caused by inflammation can not be avoided in our daily life. With ischemia for more than 2 hours and then reperfusion of the blood supplying the nerves, nerves may be damaged by free radicals such as ･O2－ , HO･ and so on that is produced during the ischemia (Coderre TJ 2004, Schmelzer JD 1989). This type of nerve damage can be prevented by keeping our body moving at least once in one hour or so in our daily life, and can be treated by relaxing and loosening the shortened muscles and tight connective tissues (Klein L 1977, Chiang H-Y 1977, Li Y 1997) especially at the deeper layers of the body. This can be done by Myotherapy that is to increase the blood circulation of the damaged nerves that is situated in deep layers of the body. When the nerves were damaged they become supersensitive. This supersensitivity occurs with nerves, glands and all muscles including skeletal (extrafusal and intrafusal), smooth and heart muscles. With sensory (pain) nerves’ supersensitivity, allodynia and hyperalgesia will be presented. With muscles, they become shortened and tight including the connective tissues, e.g., stiff shoulder, neck and back, and eventually with the limb muscles (Klein L 1977, Chiang H-Y 1977, Li Y 1997).
　With Myotherapy examination and treatment, peripheral nerves can be divided into 3 parts, i.e., 1) nerve roots and posterior rami at the back and posterior neck, 2) anterior rami at 4 limbs and anterior neck and 3) within the muscles after the nerve entered the muscles. The treatment of nerve roots always precede to the one of other parts of the nerves. For instance, if you have back pain at L4-5 area, you always treat T10 before you treat L4-5 area since the afferents from the deep tissues such as perioteum, ligaments, fascia, etc. at L4-5 area enters at T9 (Table 1) and create reflexive muscle hardening and tender points at T10 (Motor nerves from T9 goes to around T10 region). With Carpal Tunnel Syndrome (Upton ARM 1972, Hurst LC 1985, Smith TM 2008), for instance, we have to examine and treat the muscles and connective tissues such as neck muscles that constrict the vertebral foramen (radiculopathy), anterior scalenus and middle scalenus (scaleni impingement), pectoralis minor (thoracic outlet syndrome), pronator teres (the Medain nerve penetrate this muscles), flexor retinaculum and ligaments that consists carpal tunnel, mobility of the carpal bones and thenar muscles ? the full length of the Median Nerve.
　With MyoVib, your palpating thumb is always placed at the side of the Tip and the spinous processes when you are treating the nerve roots and/or posterior rami. As you are holding the MyoVib (the stabilizer) at the lower border of the pectoralis major with your elbow flexed at about 100 degrees, your right index finger are pressing the patient’s skin, and you are stabilizing the Tip between the right index finger and the left thumb if you are right handed (Figure 1, 2, 3). Your palpating thumb is feeling the spreading of its vibration waves (Figure 4). Your anterior portion of the right shoulder (arm pit) should feel the Tip sinking into the muscles you are treating.
　You should hold the Tip vertically against the muscles you are treating, otherwise the Tip will slip on the fascia and produce unnecessary pain (Figure 5, 6). Once the Tip was stabilized in a pit of the muscls, you can use the Pivot Technique as you keep the tip of the Tip at the same spot and move the Stabilizer of the MyoVib in order to change the direction of the vibration waves. It is just like you are hitting the inside of the bowl 360 degrees. You are holding the Tip at the same spot until the give-way stops ? it may take 10 to 20 seconds. It is depending upon the amount of the nerve damage and its chronicity. Do not stay too long like 60 seconds or so for instance. It may damage the skin that the Tip is contacting and pressing on.
　With acute nerve problems, you are aiming to desensitize the nerves at the treating spots, and on the other hand, you sensitize the nerves in chronic conditions. This means that you stop the acute treatment as the pain disappeared and you stop the chronic treatment as your patients felt more pain on pressure; sensitization of the nerves produce neurogenic inflammation, i.e., increased blood supply to the area which will eventually gives more oxygen to the damaged nerves.
　By using Squeezing and Releasing (of the Tip) Techniques (Figure 7, 8), you can control the amplitude of vibration. The larger amplitude produces the faster and deeper relaxation of the muscles, and the smaller amplitude produces less relaxation of the muscles. It is easer to use the larger amplitude on the back muscles or on the bulky muscles in the limbs, but it is better to use the smaller amplitude to those small muscles such as in the neck and upper limb for instance. For neck treatments “Squeezeing” more than “Releasing” of the Tip should be used, and repetition of shorter duration instead of longer duration is more important.
　When the blood supply to the damaged nerves is increased, those damaged nerves become “alive”, and then they become more sensitive. Small-diameter nerves first recuperate because they need less oxygen compare to the large-diameter nerve fibers. Quality of the pain changes from dull ache to sharp pain. This means the chronic stage became the acute stage of the condition. After your patients experienced the change of pain sensation, sensation like touch and pressure will become clear and more discriminative, and the motor nerves recuperate at the last. Once the blood supply became sufficient to the damaged nerves, signs and/or symptoms of the recuperated nerves will be shown, e.g., skin becomes soft, moist, elastic and so on; sensation of the skin become clear; recovery of the muscle power; pain becomes sharp from dull then disappears; body becomes more flexible; and so on.
　MyoFit that is based on Myotherapy theory and exercise of Iyengar Yoga poses can be started as the signs and/or symptoms showed the recovery of the damaged nerves. Yoga poses should be selected to each individual for the shortened muscles and/or connective tissues that are preventing the sufficient blood supply to the nerves will elongate the shortened tissues and release the entrapment of the vessels and nerves (Figure 9, 10). In order to elongation of the shortened muscles, you need to instruct the patients how to contract the shortened muscles. “Not Stretching but Contraction” will elongate the shortened tissues (Vrbova G 1995).

References

• 1. Eliave E, Herzberg U, Ruda MA and Bennett GJ: Neuropathic pain from an experimental neuritis of the rat sciatic nerve. Pain, 83:169-182, 1999.
  2. Chacur M, Milligan ED, Gazda LS, Armstrong C, Wang H, Tracey KJ, Maier SF and Watkins LR: A new model of sciatic inflammatory neuritis (SIN): induction of unilateral and bilateral mechanical allodynia following acute unilateral peri-sciatic immune activation in rats. Pain, 94:231-244, 2001.
  3. Coderre TJ, Xanthos DN, Francis L and Bennett GJ: Chronic post-ischemia pain (CPIP) : a novel animal model of complex regional pain syndrome – Type I (CRPS-I; reflex sympathetic dystrophy) produced by prolognged hindpaw ischemia and reperfusion in the rat. Pain, 112:94-105, 2004.
  4. Schmelzer JD, Zochodne DW and Low PA: Ischemic and reperfusion injury of rat peripheral nerve. Proc Natl Acad Sci USA, 86:1639-1642, 1989.
  5. Klein L, Dawson MH and Heiple KG: Turnover of collagen in the adult rat after denervation. J Bone Joint Surg, 59-A:1065-1067, 1977.
  6. Chiang H-Y, Huang I-T, Chen W-P, Chien H-F, Shun C-T, Chang Y-C and Hsieh S-T: Regional difference in epidermal thinning after skin denervation. Exp Neurol, 154:137-145, 1998.
  7. Li Y, Hsieh S-T, Chien H-F, Zhang X, McArthur JC and Griffing JW: Sensory and motor denervation influence epidermal thickness. Exp Neurol, 147:452-462, 1997.
  8. Upton ARM and McComas AJ: The double crush in nerve-entrapment syndrome. Lancet, 2:359-361, 1973.
  9. Hurst LC, Weissberg D and Carroll RE: The relationship of double crush to carpal tunnel syndrome: an analysis of 1,000 cases of carpal tunnel syndrome. J Hand Surg, 10-B:202-204, 1985.
  10. Smith TM, Sawyer SF, Sizer PS and Brismee J-M: The double crush syndrome: A common occurrence in cyclists with ulnar nerve neuropathy – A case-control study. Clin J Sport Med, 18:55-61, 2008.
  11. Vrbova G, Gordon T and Jones R: Nerve – Muscle Interaction, 2nd Ed., Chapman & Hall, 1995.