Neuromuscular Therapy (St. John Method)
Neuromuscular Therapy or NMT (St. John Method) is a specific hands-on approach to resolving soft tissue pain in the human
body. The St. John Method embodies a wide variety of effective therapeutic techniques and applications that work toward
restoring homeostasis (balance) between the muscular and nervous systems.
Owners Erma and James Pacheco have served as core St. John Neuromuscular Therapy instructors, and have presented this work
throughout the United States and in Canada. They maintain a staff of highly trained St. John NMT therapists and physical
therapists that are eager to help you resolve injury or pain concerns.
On (or prior) to the first visit, the patient will be asked to fill out a health history form. Then, the therapist will
evaluate posture, gait, strength, and range of motion. A hands-on evaluation will then follow. During the hands on evaluation,
the therapist will very specifically examine the involved soft tissues (muscles ligaments, tendons, fascia, etc.) to gauge their
overall health and relationship to the pain condition. These findings are then documented and formulated into the best plan for
Therapeutic Applications of the St. John Method Include:
Ischemic Compression – Ischemia in simple terms refers to a lack of blood flow to an area of the body. Ischemia
leads to pain, poor movement and postural problems. Ischemic compression is a hands-on pressure therapy designed to restore
circulation, reduce muscular tension, and promote healing.
Trigger Point Therapy (Travell and Simons based) – Similar to ischemic compression however it also alleviates
localized and remote (referred) sensations such as:
- Aches and pains.
- Nerve sensations such as pins and needles or numbness and tingling.
- Thermal sensations such as burning
Trigger points can develop in ischemic areas of soft tissues such as muscles, tendons, or ligaments. When a trigger point
becomes stimulated or stressed, it will cause a referred sensation that is usually remote from the trigger site. For example, if
a trigger point develops in a neck muscle and becomes active because of injury, poor posture, repetitive motion or stress, it
will commonly cause referred sensation into certain areas of the head (headaches) or cause upper back, shoulder, or arm pain.
The trigger site can also refer other sensations such as numbness, tingling or burning. Another example involves active trigger
points that develop in low back or hip muscles that can cause hip and leg sensations that are very similar to sciatic pain. Trigger
point therapy is very useful to help alleviate pain of all kinds.
When it comes to active trigger points, the cause of the person's pain is often remote from where they sense and feel the
pain. At the Colorado Center for Physical Therapy, our therapists are trained to find the root cause of pain and
Transverse Friction – Also known as cross-fiber friction. Transverse friction is a deep tissue massage
therapy technique describing how a therapist will apply thumb or finger pressure to a muscle, ligament or tendon. The therapist
will then glide the thumb in a transverse direction (across the muscle fibers) several times in an effort to break up fibrous
adhesions and restore circulation to the area. This is a very useful technique that helps to heal and restore normal function
in chronic conditions.
Muscle Energy Techniques (MET) – Therapist assisted techniques that help to lengthen soft tissues or re-position a
joint. For example, the therapist may first have a person contract a muscle or muscle group against the therapists resistance,
then assist the person in stretching the same muscles. This sequence will be repeated until the desired length of the muscle or
muscle group is reached.
Hydrotherapy (applications of heat or cold) – depending on the level of inflammation or nature of the problem, your
therapist will determine if a heat or cold based applications are appropriate for you. Cold applications are applied when the
problem is acute (within the first 72 hours of injury). A combination of heat and cold (contrast therapy) will sometimes be
applied during the sub-acute stage (after 72 hours). A heating approach is generally useful in chronic pain conditions (if the
pain persists beyond 2 months). Heat is also applied after deep tissue massage therapy to promote relaxation and decrease the
possibility of soreness.
Pelvic Stabilization – Because the body's center of gravity is located at the pelvic level, it is very important
that a person is able to hold proper pelvic position. If there is a pelvic rotation, it will cause unwanted postural changes and
dysfunctional movement patterns that ultimately lead to pain. Trauma will also cause pelvic distortions and de-stabilize the
center of gravity. Our therapists are trained to recognize pelvic rotations and distortions and know how to restore balance
to this area of the body. This will assist other areas of the body to heal.