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Integrated Neuromuscular Inhibition Technique (INIT) - In Treatment of Pain and Trigger Points - An Introduction

© Leon Chaitow ND, DO, MRO

When the position of ease is attained (using what is known as ‘fine tuning’ in SCS jargon) in which pain vanishes from the palpated monitoring ‘tender’ point, the stressed tissues are felt to be at there most relaxed - and clinical experience indicates that this is so since they palpate as ‘easy’ rather than having a sense of being ‘bound’ or tense.

SCS is thought to achieve its benefits by means of an automatic resetting of muscle spindles - which help to dictate the length and tone in the tissues. This resetting apparently occurs only when the muscle housing the spindle is at ‘ease’ and usually results in a reduction in excessive tone and release of spasm.

Osteopathic functional technique achieves a similar positional release, without use of a pain-point monitor, relying instead on the palpatory sensitivity of the operator who is constantly monitoring for a sense of ‘ease’ in the tense tissues while trying to avoid any position which increases a sense of ‘bind’.

When positioning the body (part) in Strain/counterstrain methodology a similar sense of ‘ease’ is noted as the tissues reach the position in which pain vanishes from the palpated point (‘tender point’ in Jones’ terminology).

INIT Method 1
It would be reasonable to assume that were a trigger point being palpated by direct finger or thumb pressure, and were the very tissues in which the trigger point was lying to be gently positioned in such a way as to take away the pain (entirely or at least to a great extent), that the most (dis)stressed fibres in which the trigger point was housed would at that time (when the pain is reduced) be in a position of relative ‘ease’.

This is at what palpation seems to indicate.

We would then have a trigger point under direct inhibitory pressure (mild or perhaps intermittent) which had been positioned so that the tissues in which it lay were relaxed (relatively or completely).

In Strain/counterstrain methodology the position of pain-free (relative) ease is held for a period of time - anywhere from 30 to 90 seconds - so that (it is considered) the muscle spindles can reset themselves and spasm/contraction can be released.

Following such a period - if the patient were asked to introduce an isometric contraction into the tissues - involving the very fibres which had been repositioned to obtain the strain/counterstrain release - there would subsequently occur a degree of reduction in tone in these tissues (post isometric relaxation). These could then be gently stretched as in any Muscle Energy procedure with the strong likelihood that specifically involved fibres would be stretched.

Method 2
There is another possibility - a variation in which, instead of an isometric contraction followed by stretch being commenced following the period of ease (Strain/counterstrain position) an isolytic approach could be used.

In MET, isolytic methods utilise an eccentric isotonic manoeuvre. The muscle receiving attention is actively contracted by the patient at the same time that a stretch is introduced - resulting in mild trauma to the muscle and the breakdown of fibrous adhesions between it and its interface and within its structures.

To introduce this method into trigger point treatment, following the application of inhibitory pressure and SCS release, the patient is asked to contract the muscles around the palpating thumb or finger (lying on the now inhibited pain point) with the request that the contraction should not be a full strength effort since the operator intends to gently stretch the tissues while the contraction is taking place.

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About The Author
A practicing naturopath, osteopath, and acupuncturist in the United Kingdom, with over forty years clinical experience, Chaitow is Editor-in-Chief, of the Journal of Bodywork and Movement Therapies. He regularly lectures in the United States as well as Europe where he instructs......more
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