Art of the 3-N-1 approach at Be Well Chiropractic is prepping the area for an adjustment. Depending on what is necessary that day, for that patient, they may utilize myofascial release, neuromuscular therapy, trigger point, ART, muscle shortening techniques, ligament holds, PNF stretching, or passive stretching.
Below are some definitions from Wikipedia and expanded explanations from Dr. Janelle Hutti, DC:
Myofascial release: treats skeletal muscle immobility and pain by relaxing contracted muscles, improving blood and lymphatic circulation, and stimulating the stretch reflex in the muscles. (The fascial part involves the thin ligament that covers all muscles and is what ‘makes’ scar tissue.) Fascia is a thin, tough, elastic type of connective tissue that wraps most structures within the human body, including muscle. Fascia supports and protects these structures. The theory is that the soft tissue can become restricted due to psychogenic disease, overuse, trauma, infectious agents, or inactivity, often resulting in pain, muscle tension, and diminished blood flow. (Soft tissue mobilization and manipulation utilize this technique. Likewise, foam rolling at home breaks up this fascia to muscle junction.)
Neuromuscular therapy is a form of deep tissue massage. The neuromuscular junction is the area where the ends of the nerve fibers meet the muscle. This is where the chemical reaction happens that makes the muscle work. The nerve must tell the muscle to move through these reactions. Think about it. A new york strip is a cow’s muscle flexor for their leg…sitting on your plate. In the cow, connected to the nervous system, it works. Not connected, dead, dumb, and delicious!
The way the body overrides pain through movement can be described in this way. If you have a whole pie (cross-section of a nerve), a quarter of it would be pain receptors. The other 2/3 are soft-touch, deep touch, hot/cold, and movement! When these areas are activated, they override the pain. In fact, the good fibers are big A-fibers, and the pain is little C fibers. Movement is a neurologically correct way to decrease pain. This is why chiropractic adjustments are so effective. They retrain the body to self-regulate.
Trigger points: are described as hyperirritable spots in the fascia. They feel like palpable nodules in taut bands of muscle fibers. The theory is unexplained pain radiates from these points of local tenderness to broader areas. They have been mapped for referral pain patterns, which means if you work in one area, the pain dissolves in another.
Active release technique: began 30 years ago with Dr. Michael Leahy. He was working on elite athletes to treat soft tissue disorders so that they could get back to peak performance as quickly as possible. He actually studied engineering before becoming a chiropractor and combined the theories. Dr. Janelle feels this is actually brilliant. The body is a biomechanical structure and works a certain way. It is not an opinion. It is literally on a lever system and has a cause and effect system. Knowing the body allows a chiropractor to adjust and mobilize it correctly to work well by itself! In my opinion, ARTworks best in the last 10% of the muscle’s healing needs. Meaning, it needs to be mostly healed and then getting that last optimal 10% for full healing.
Muscle shortening techniques: An opposite theory Dr. Janelle learned from Dr. Tim Brown (see Intelliskin). When you bring the fibers together, they actually relax, contract, and you can break them up in this position. This keeps an injury from being strained while also being worked on. It is a less painful technique and is very helpful in acute injuries where inflammation and pain are high.
Ligaments hold (see basic technique). Ligaments hold bone to bone. They should be released and held, not stretched. An overstretched ligament is actually a sprain.
PNF stretching technique: is used to facilitate the relaxation of muscles to gain range of motion. This method uses an isometric contraction rather than an isotonic (static) one. The limb is placed in pain-free motion, and the contraction is sustained. Passive stretching would be utilized for severe injuries when the patient is in too much pain to help the stretch.