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Trigger Point Techniques - What is NAT?

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Dr. Joseph Duchene - Experience with NAT 


NAT utilizes the neurophysiology behind myofascial trigger points in a novel and deliberate way

NAT uses deep stroking massage and compression/ inhibition techniques blended together in a choreographed algorithm. In NAT, trigger points are regarded not as the familiar knots of muscular dysfunction, but as ‘inputs’ to the spinal cord and central nervous system.

This is because trigger points are exquisitely painful - and stimulating the pain pathways has many profound effects on the nervous system, including the attenuation of peripheral and central sensitization.

The Importance of Sequence

During most hands-on treatments, a haphazard stream of various mechanoreceptors are stimulated. In NAT, the number of inputs is reduced to an absolute and purposeful minimum.

Inputs are made via the trigger points in repeatable sequences, which always include the manipulation of STPs as well as trigger points in agonists and antagonists.

Part of the NAT input sequence is performed three times. Repeating something three times (either verbally or somatically) seems to help the nervous system ‘get the point’.

Stroking massage is performed in ‘one direction’ only, and compression techniques are performed to the point of pain (and are sometimes held for up to 10 minutes).



"trigger points are regarded not as the familiar knots of muscular dysfunction, but as ‘inputs’ to the spinal cord and central nervous system"


NAT and Frozen Shoulder Syndrome

NAT was originally developed in 1999 to treat frozen shoulder syndrome (adhesive capsulitis). The shoulder is one of the most complex regions in the body, involving four joints and eighteen muscles.

A frozen shoulder is considered by many to manifest the worst components of all other shoulder problems put together.

It is in many ways an enigma, and like other enigmas, solving the puzzle helps us gain many truths and insights of the inner workings of the nervous system.

We observed that specific tender/trigger points seemed to be present in the same distribution in every single patient.

To our surprise, by manipulating these points in a sequence, we discovered that our patients’ long-standing frozen shoulders seemed to melt away in as few as one or two treatments.

This rapid “defrosting” could only be explained by a neurological process which led to the current theoretical model. 


 Chris Packard, Chiropractor, successfully integrates NAT techniques in his practice


NAT Theory

NAT is all about intentionally stimulating mechanoreceptors embedded within and around the trigger points (and joints) to generate a novel “neural signature”. This affects the spinal cord and the somatic cortices.

NAT deliberately utilizes some of the automatic reflexes associated with trigger points, including:

• Co-coordination
• Reciprocal inhibition
• Post-isometric relaxation
• Post-activation depression

• Pure facilitation
• Co-facilitation
• Autonomic (ANS) responses

• ‘Pain Gate’
• Spinal cord reflex responses

• Neuroplasticity

Trigger Points as Inputs to the Nervous System

The nervous system responds to these input sequences by releasing the ‘holding pattern’, normalizing motor unit output, and improving co- coordination.

Clinically, after each NAT session, patients describe a sense of joints being ‘oiled inside’ or feeling that ‘normal’ muscular control has been regained.

With regard to somatic dysfunction, NAT is readily used to reinvigorate and release protective joint postures and/or treat protective spasm around joint problems (such as an arthritic hip).

Performance Enhancement

Furthermore, NAT sequences seem to tone or re-activate the muscles around the joint. As an automatic response, there is also an increase in strength and power. This is one of the reasons why NAT was successfully used by physical therapists for members of the Canadian and Australian teams in the 2012 London Olympics.

Evidence for this phenomenon has been supported by research at Addenbrookes Hospital in Cambridge, UK (Weis et al. 2003).

Patients with long-standing shoulder pain and weakness treated with NAT demonstrated a significant improvement in active range of motion (P<0.002) and in strength and power (P<0.046) over and above standard physical therapy and a hands-on placebo, even though no exercises were given to the NAT group.

NAT is now used to treat a wide range of musculoskeletal conditions by over 60,000 therapists worldwide.


Case Studies 

My Journey with NAT - Stuart Hinds (Soft Tissue Therapist)

My Journey with NAT - Michael Coffee (Licensed Massage Therapist)

My Journey with NAT - Suzanne Hibberd (Osteopath) 

My Journey with NAT - Martin Bates (Chiropractor)

My Journey with NAT - Andy Eckley (Soft Tissue Therapist)



Find a Trigger Point Professional in your area

More Articles About Frozen Shoulder

More Articles About the Rotator Cuff

Dry Needling for Trigger Points

NAT Professional Courses

Certify as a Trigger Point Therapist

Trigger Point Workbooks 


About NAT Courses

As a manual therapist or exercise professional, there is only one way to expand your business - education!

Learning more skills increases the services that you offer and provides more opportunity for specialization.

Every NAT course is designed to build on what you already know, to empower you to treat more clients and grow your practice, with a minimal investment in time and money.

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About Niel Asher Education

Niel Asher Education is a leading provider of distance learning and continued education courses.

Established in the United Kingdom in 1999, we provide course and distance learning material for therapists and other healthcare professionals in over 40 countries.

Our courses are accredited by over 90 professional associations and national accreditation institutions including the National Academy of Sports Medicine (NASM) and National Certification Board for Therapeutic Massage and Bodywork (NCBTMB). Full details of all international course accreditations can be found on our website.  

Printed course materials and other products offered on our websites are despatched worldwide from our 3 locations in the UK (London), USA (Pennsylvania) and Australia (Melbourne).

More About Us



We are honored to have received the 2017 "Excellence in Education" Award from the National Association of Myofascial Trigger Point Therapists.

Since 1999 Niel Asher Education has won numerous awards for education and in particular for education and services provided in the field of trigger point therapy.

Read Full Article 


Award Winning Instructors

Niel Asher Healthcare course instructors have won a host of prestigious awards including 2 lifetime achievement honorees - Stuart Hinds, Lifetime Achievement Honoree, AAMT, 2015, and Dr. Jonathan Kuttner, MD, Lifetime Achievement Honoree, NAMTPT 2014.

Meet the Instructors


NAT Certification

If you are a qualified/licensed manual therapist or exercise/fitness professional you can expand your credentials with NAT certification.

In addition to national accreditation for continued education, each course that we offer includes "NAT Learning Credits". By taking and completing courses you can accumulate NAT credits to qualify for NAT certification.

There are currently 3 levels of NAT certification. Certifying NAT is a valuable way to show your clients that you take continued education seriously, and to promote your skills and qualifications.

About NAT Certification


Niel Asher Technique

Since 1999 the Niel Asher Technique for treating trigger points has been adopted by over 100,000 therapists worldwide, and has been applied to the treatment of a number of common musculoskeletal injuries.

The Niel Asher Technique for treating frozen shoulder was first introduced and published in 1997 and has been widely adopted by therapists and exercise professionals working within elite sports and athletics.

Read More


Worldwide Free Shipping

Most of our courses are available as either "Printed" or 'Download" editions. When you purchase a download edition, you receive immediate lifetime access to all course material. Course texts can be downloaded and printed if required. 

When you purchase a "Printed" edition, you will also receive free access to the download edition.

We ship Worldwide from locations in the USA, UK, and Australia. Most items are despatched within 24 hours and shipping is FREE for all orders over US$50.
















This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell. 





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  • Really cool to see our video on the blog post! Just to let everyone know that NAT is still getting awesome progress with shoulder problems. It has become my go to technique, especially when I have a hard case come in. Thank you, Dr. DuChene

    Dr Joseph DuChene on
  • Really brilliant approach to trigger points. Has changed my practice and I’m a big fan ever since I attended your workshop in Bedford last year (which was brilliant)!

    Jordan Brown on

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