NAT - Treating the Complex Shoulder
Three-Dimensional (3-D) Release
The brain has 3-D sensory and motor maps soft-wired into the cortex. Our brain (motor cortex) responds to our movement demands by coordinating complex sequences of motor units. These motor units can contract singly or collectively, and when more power is demanded, groups of units combine (recruitment). One of the key ways the motor system achieves smooth coordinated movement is by utilizing the type of triangulation known as antagonism. The triangle is formed by agonists, antagonists, and fixators (the fixators hold the joints still so that the agonist and antagonist can operate efficiently).
When a trigger point develops in one of these three groups, the others are forced to compensate. That is why it is important to treat trigger points in the antagonist as well as the agonist, in other words a 3-D release. A number of factors come into play, which magnify these effects over time. These factors are: reciprocal inhibition (where an antagonist is partially or fully switched off), pure facilitation (where an antagonist is made stronger), and co-facilitation (where increased power is routed to teams of secondary muscles).
Much of the experimental data demonstrating antagonism have been generated on healthy volunteers. we would like to suggest that in the pathological situation (such as a frozen shoulder), the brain is often forced to compromise this antagonism and, to this end, it exhibits a degree of neuroplasticity. In other words, the agonist/antagonist relationship may not operate in the classically described manner.
The frozen shoulder, for example, might be considered to be one of the built-in protective responses of our nervous system to avoid noxious stimuli (such as reactive tendinopathy and pain). Every time you try to push the frozen shoulder in one direction, it pushes against you in the opposite one. The brain is constantly working to protect against what it perceives as a threat. This manifests as a stiff and painful (frozen) shoulder, with many trigger points in many muscles. (To a certain extent, we can see this protective pattern in all painful shoulder complaints.) It is as if the brain needs to take the painful shoulder (neurologically) into a “sling-like” position and hold it there for months, or even years, after the pain stimulus has remitted. This is possibly due in part to both peripheral and central sensitization.
Having treated thousands of frozen shoulders, we have observed that in someone with acute shoulder pain the biceps brachii and triceps brachii pairing stops operating properly. Instead, the biceps brachii and the infraspinatus pair off; similarly, the triceps brachii and the pectoralis minor seem to change their functional relationship. NAT takes these functional antagonistic changes into account during treatment sequences.
You can observe this phenomenon for yourself. If you stimulate the trigger point in the infraspinatus somewhere near the lateral scapular border in a patient with a frozen shoulder when they are supine, they will almost always tell you that they can feel referred pain in the anterior shoulder region of the deltoid and (long head) of the biceps brachii. In other words, treating a trigger point in the functional antagonist may reflect pain and reproduce the trigger point symptoms in the agonist.
Treat Trigger Points in Reverse
The types of functional relationship described above become apparent in particular in muscles with chronic trigger points. In such cases, it pays to establish the primary tissues that are causing symptoms and then look at the antagonistic “holding pattern.” I have found that treating the secondary satellite or latent trigger points first, and only then the central myofascial trigger points, makes treatment more effective and longer lasting. Stimulating a sequence of three points three times (one of these points should be an STP) allows the brain to triangulate the sensory input. The motor cortex responds by automatically releasing the holding patterns, which have become established in the 3-D map. There is an old osteopathic adage: “Treat the secondary (holding) pattern and the primary problem will sort itself out.”