Issue link: https://www.massageandbodyworkdigital.com/i/1102144
4 from the shoulder girdle attachment, then the line of tension of the stretch force is spread out along the entire upper trapezius. However, if we place a pin on the upper trapezius, perhaps halfway along the muscle (Image 4), and the head/ neck attachment is now moved away from the shoulder girdle attachment, then the stretch force is focused between that pin point and the head/neck. This results in the stretch force being more powerful for the region of the tissue being stretched. So, the general concept of the pin-and-stretch technique is that it allows the therapist to focus the stretch to the region of the tissue located between the pin point and the attachment that is being moved. Neural Inhibition Up until now, the stretching protocols we have described have essentially been simple mechanical lengthening of the target tissue. However, a nervous system component can also be added. Neural inhibition stretching is a general term that describes how we can augment the mechanical stretch by adding in a neural component, namely a neural reflex that relaxes/inhibits muscle tone. There are two neural reflexes that may be used: reciprocal inhibition (RI) reflex and the Golgi tendon organ (GTO) reflex (Images 5A and 5B). Reciprocal Inhibition Reflex and Agonist Contract Stretching. RI reflex occurs when the client actively contracts mover/ agonist musculature and the antagonist musculature to that movement is inhibited so that it can lengthen to allow the motion to occur. It is called reciprocal inhibition because the antagonistic musculature on the other side of the joint is inhibited (the term reciprocal refers to a mutual relationship between the mover and antagonist on opposite sides of the joint). This type of stretching technique is described as agonist contract (AC) stretching because agonists (movers) of the motion contract so that the antagonist musculature—our target tissue located on the other side of the joint—is inhibited and relaxed, facilitating its stretch. This technique is sometimes described as antagonist contract (luckily, still AC) because JOINT MOBILIZATION Grade IV slow oscillation joint mobilization, that can be legally and ethically performed by properly trained and licensed massage therapists in most of the United States, is effectively a form of the pin-and-stretch technique. The difference is that the pin is not placed in the middle of myofascial tissue; instead, it is placed on one bone, and then the adjacent bone at the joint is moved away from the pinned bone. The target of Grade IV pin-and- stretch joint mobilization is to stretch the intrinsic fascial tissues of the joint. Facilitory signal Inhibitory signal Antagonist inhibited Mover stimulated (+) (-) Spinal cord Bone Golgi tendon organ Muscle Sensory neuron Alpha LMN Inhibitory interneuron (-) Pin-and-stretch technique for the right upper trapezius. The stretch is focused on the region of the muscle between the pin point and the head/neck attachment. 5A: Reciprocal inhibition (RI) reflex. 5B: Golgi tendon organ (GTO) reflex. Permission Joseph E. Muscolino, DC, Kinesiology: The Skeletal System and Muscle Function, 3rd ed. ( Elsevier, 2017). 5A 5B Ta k e 5 a n d t r y A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 69 it is looked at from the perspective of having the client contract the antagonists to the target musculature. It is sometimes described as proprioceptive neuromuscular facilitation (PNF) because a proprioceptive neuromuscular reflex, the RI reflex, is used to facilitate the stretch (caution should be used when employing the term PNF because this term is also used for the other type of neural inhibition stretching technique, contract relax stretching, that will be described next). And it should be noted that AC stretching technique is the basis for Aaron Mattes's Active Isolated Stretching (AIS) technique. AC stretching technique will be demonstrated later in the article (Images 17A–17C). Golgi Tendon Organ Reflex and Contract Relax Stretching. The GTO reflex occurs when the client actively contracts musculature, causing the same musculature to be neurally inhibited/relaxed. This reflex is named the Golgi tendon organ reflex because it is activated by GTOs located in the tendons of the muscle (these tendon organs were named for Camillo Golgi, an Italian physician and researcher). This reflex is usually described as a protective reflex that prevents the muscle from contracting