Trigger Point Techniques - What is NAT?
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 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
• Autonomic (ANS) responses
• ‘Pain Gate’
• Spinal cord reflex responses
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).
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.
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