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100 m a s s a g e & b o d y w o r k j u l y / a u g u s t 2 0 1 9 technique MYOSKELETAL ALIGNMENT TECHNIQUES Enhancers in Action Movement Cues Engage Clients, Improve Outcomes By Erik Dalton, PhD 1 2 • Relieve protective muscle guarding and nerve compression syndromes. • Reward the client through proprioception and body awareness. CASE STUDY Luke was referred by his personal trainer for neck mobility issues resulting from a direct blow to his left shoulder during football practice six months earlier (Image 1). Although most of his neck pain had subsided, Luke still struggled to left rotate his head enough to look in his rearview mirror while driving. Upon seated examination, his passive range of motion into right cervical rotation, flexion, and extension was normal. However, he could only manage 30 degrees of left cervical rotation and sidebending. In Image 2, I demonstrate the first step in a myoskeletal routine to help address Luke's football injury. Notice how I begin with my right hand slowly left rotating Luke's head to the first (nonpainful) restrictive barrier as my soft left fist resists the effort. This creates a mild counterforce between the two hands. Luke is then asked to inhale deeply while gently right rotating his head against my resistance to a count of five and relax. With my left fist still pinning the hypertonic upper traps, scalenes, and splenius cervicis muscles, Luke is asked to look over his left shoulder (eye enhancer) while actively left rotating his head against my fist's resistance. It is through the tactile sense, beginning with touch between parent and child, that we first learn about our bodies and the surrounding world. As manual therapists, we help people through touch, and for the most part, all forms of caring touch are good. However, a new study shows some types of touch may be more powerful than others. 1 This recent research, published in the Proceedings of the National Academy of Sciences, suggests that because the brain attempts to predict the sensory consequences of every action, it attaches less importance to self- touch, as this stimuli is predictable. The brain pays more attention to touch by others, or novel stimuli, because it is unable to predict the outcome. Taking these findings a step further, we could say that novel touch during a therapy session, with the client actively engaged, should enhance sensory input even more—leading to increased nervous system stimulation and greater therapeutic impact. So, how do we put this insight into practice? In Myoskeletal Alignment Techniques (MAT), we use "enhancers" to actively engage our clients and amplify the power of novel touch. A MAT enhancer is a therapist- directed movement cue that neurologically boosts, intensifies, and heightens a therapeutic outcome. MAT enhancers serve three primary purposes: • Retrain the brain using graded exposure stretching techniques. A side-to-side whiplash injury strain to muscles, nerves, and joints. To address the client's left rotation restriction, my right hand slowly left rotates his head to the first restrictive barrier as my soft left fist resists. The client takes a deep breath and gently right rotates against resistance to a count of five, then relaxes. The client is asked to look over his left shoulder while actively left rotating his head against my fist's resistance. Repeat 3–5 times and retest.

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