Niel Asher Technique (NAT)
Utilizing the neurophysiology behind myofascial trigger points in a novel and deliberate way
NAT is an advanced trigger point technique—advanced because it utilizes the neurophysiology behind myofascial trigger points in a novel and deliberate way. The technique 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, as discussed above, stimulating the pain pathways has many profound effects on the nervous system, including the attenuation of peripheral and central sensitization.
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).
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.
Many thousands of patients have now been successfully treated with NAT. It is evidence based and is now used to treat a wide range of musculoskeletal conditions by over 40,000 therapists worldwide.
Intentionally stimulating mechanoreceptors embedded within and around the trigger points (and joints) generates a novel “neural signature,” which affects the spinal cord and the somatic cortices. NAT deliberately utilizes some of the automatic reflexes associated with trigger points, including:
• Reciprocal inhibition
• Post-isometric relaxation
• Post-activation depression
• Pure facilitation
• Autonomic (ANS) responses
• “Pain gate”
• Spinal cord reflex responses
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 (such as with spondylolisthesis) and/or treat protective spasm around joint problems (such as an arthritic hip).
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.
NAT Clinical Trials
Evidence for this phenomenon has been supported by research at Addenbrooke’s Hospital in Cambridge, UK (Weis et al. 2003). Patents 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 Trigger Point Peer Reviewed Evidence
Presented in (peer reviewed) IJOM Journal this study followed the progress of 153 patients with adhesive capsulitis treated by 4 independent practitioners in the Unites States, UK, and Israel.
The evidence strongly supported the notion that the trigger point technique NAT improves ROM, decreases pain, and is independently reproducible.