Issue link: https://www.massageandbodyworkdigital.com/i/790815
with pin and stretch technique, the most effective manner in which to perform the technique is to place the pin as close to the trigger point as possible, on the side of the trigger point that is away from the attachment being moved. Which Attachment Do We Move? When the target tissue of the pin and stretch technique is in a muscle in which both attachments are easily mobile, it is possible to focus the force of the stretch toward either end of the muscle. Again, let's use the upper trapezius as our example. In the first example (Images 1A–1C), the cervicocranial attachment was moved, so the stretch force was focused toward the cervicocranial attachment end of the muscle. But if the trigger point that we want to focus the stretch on were toward the scapuloclavicular attachment, then we would need to instead move the scapuloclavicular attachment when performing the pin and stretch technique. So, if the trigger point is toward the scapuloclavicular attachment, we would want to place our pin as close to the trigger point as possible, but on the other side of the point—in this case the cervicocranial side—and then move the scapuloclavicular attachment away from the client's head and neck, as seen in Image 3. Unfortunately, for most muscles, only one attachment is easily mobile, and that is usually the distal attachment. For this reason, the pin and stretch technique is usually most effective when the goal is to focus the stretch on a region of the muscle that is closer to the more mobile—usually distal—attachment of the muscle. Two excellent examples of this, one in the upper extremity and one in the lower extremity, are shown in Images 4 and 5. Images 4A–4B show the pin and stretch technique being performed on the right flexor carpi radialis, with two positions of the pin shown. Images 5A–5C show the pin and stretch technique being performed on the right piriformis, with three positions of the pin shown. 54 m a s s a g e & b o d y w o r k m a r c h / a p r i l 2 0 1 7 X Essentially, stretching is a mechanical process of applying a physical tensile force to a soft tissue. However, when stretching musculature, mechanical stretching can be enhanced by adding neural inhibition techniques. These techniques take advantage of nervous system spinal cord reflexes that relax/inhibit muscle tone. Classically, it has been stated that there are two nervous system reflexes that can be utilized to relax musculature and, therefore, facilitate a stretch. They are the Golgi tendon organ (GTO) reflex and reciprocal inhibition (RI) reflex. The GTO reflex occurs when a muscle's contractile tension increases, thereby pulling on its tendons. This tension at the tendon feeds back into the nervous system to inhibit that muscle (and its synergists) from contracting so hard. This reflex is often interpreted as protecting the tendon from being torn by an excessively forceful muscle contraction. RI reflex occurs when a muscle concentrically contracts and shortens. The nervous system receives this input and reflexively relaxes (inhibits from contracting) the antagonistic musculature so that it can lengthen, thereby allowing the contracting muscle to successfully shorten. The GTO reflex has been said to be operative in the stretching technique known as contract relax (CR), which is also known as postisometric relaxation (PIR) or proprioceptive neuromuscular facilitation (PNF) stretching. And RI has been stated to be the operative reflex in agonist contract (AC) stretching, the basis of Aaron Mattes's Active Isolated Stretching (AIS) technique. (Note: AC stretching is also sometimes referred to as PNF stretching, which can create confusion with the GTO-mediated technique.) In recent years, there has been controversy regarding the role of the GTO reflex. It appears that higher nervous system centers in the brain might also be involved, but it still seems likely that the GTO reflex is a part of the inhibition process with CR/PIR/PNF stretching. NEURAL INHIBITION STRETCHING TECHNIQUES Pin and stretch to the right upper trapezius. The shoulder girdle (scapuloclavicular) attachment is the attachment that is moved. The red Xs indicate the focus of the stretch. The location of the trigger point is indicated by the yellow X. 3