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I t p a y s t o b e A B M P C e r t i f i e d : w w w. a b m p . c o m / g o / c e r t i f i e d c e n t r a l 35 Douglas Nelson is the founder and principal instructor for Precision Neuromuscular Therapy Seminars and president of the 16-therapist clinic BodyWork Associates in Champaign, Illinois. His clinic, seminars, and research endeavors explore the science behind this work. Visit www.nmtmidwest.com, or email him at doug@nmtmidwest.com. fully. Muscles can heal relatively easily, but joint injuries can last a lifetime, so the brain will always sacrifice a muscle to protect a joint. When muscles contract fully across a joint, it increases joint pressure, so after an injury, the contractile capacity of those muscles may be shut down to prevent any further damage." At this point, I began by carefully examining both the flexor digitorum superficialis and profundus muscle and tendon associated with the index finger. While K. had full range of motion, there were some surprisingly tender areas in the muscle belly. "Wow. That really is tender. Is it very tight?" she asked. "Not tight, but injured and inhibited. Muscles essentially do one thing—they contract. When they are injured, they do that one thing less well, which you experience as weakness. So it looks like my goal here is not to increase range, but to increase strength. What about this muscle?" I asked, palpating the extensor indicis. "That pain is even worse," she replied. "What role does that muscle play?" "This muscle is the one that pulls your finger backward, like you showed me in the beginning. I am beginning to think the problem isn't the flexors being too tight to allow full extension, but this extensor muscle being too weak." "So both of these muscles were inhibited by the injury to the joint," K. summarized. "And now the flexor muscle is so weak that pushing on a bottle of hairspray is hard, while the extensor muscle is too weak to pull the finger backward to the same distance as the other fingers." "Exactly. The system is very functional in the short term. The joint injury sent a message to the muscles to shut down to prevent further injury. Unfortunately, when the joint was no longer at risk, the muscles didn't get the memo that it was safe to resume full activity. This could go on indefinitely without treatment." For the next 20 minutes, I alternated treating the extensor and flexor muscles of the index finger using moderately deep, unidirectional friction movements in the direction of the muscle fiber. I also did cross- fiber friction of the ligaments at the MCP joint. When K. returned a week later, the swelling was visibly less and the finger's extension was just shy of normal. TABLE LESSONS "It is much stronger," she stated happily. "The biggest difference is that I find myself using this finger during daily activities again." "I'm thrilled it is much better," I told her. "Now, one more thing: I just want to be very clear about how you injured your hand. When you dove in front of the oncoming car, reaching out with your right hand to save the child who had just wandered out into the street ..."