Neuromuscular Therapy

During the last sixty years, Neuromuscular Therapy (NMT) has emerged as a significant methodology for assessing, treating and preventing soft tissue injuries and chronic pain. NMT, a series of treatment protocols based on the practitioner’s skill, anatomy knowledge and precise palpatory application, has found its home, not only in the treatment rooms of massage therapy, but also in occupational therapy, physical therapy, nursing, dentistry, chiropractic, osteopathic and physical medicine clinics worldwide. With a foothold planted in both holistic and traditional medicine, its future is solidly founded and holds much promise.

NMT is a thorough program of recovery from acute and chronic pain syndromes, which utilizes specific massage therapy, flexibility stretching, and home care to eliminate the causes of most neuromuscular pain patterns. This specific and scientific approach to muscular pain relief will help to bring about balance between the musculoskeletal system and the nervous system.

NMT enhances the function of joints, muscles and biomechanics (movement) and it releases endorphins, the body’s own natural painkillers. It can be part of a comprehensive program, complementing all other health care modalities.  The basis of modern NMT rests within the following 6 principals:

  1. Ischemia is a lack of blood supply to the soft tissues that causes them to become very sensitive to the touch.
  2. Trigger Points occur when nerves fire impulses at a rapid speed into an area of the body other than that which has been traumatized. This phenomenon produces an effect where the real cause of pain is far removed from the actual site of pain. Trigger points will inhibit proper blood flow, which initiates a vicious cycle of pain and discomfort.
  3. Nerve compression or entrapment is pressure on a nerve by bone, cartilage or soft tissue. As the tightness of the soft tissues that surround nerve fibers increase, more and more pressure is brought to bear on the nerve, resulting in strangulation or entrapment of the nerve against a bone or cartilaginous structure such as a disc.
  4. Postural distortion is an imbalance of the muscular system resulting from movement of the body off the coronal, mid-sagittal and horizontal plane. Trauma, gravitational pressure or psychological patterning causes the soft tissues to assume a weight-bearing function and thus become thicker, denser and harder resulting in muscle contraction, body distortion and pain.
  5. Biomechanical dysfunction is an imbalance of the musculoskeletal system resulting in faulty movement patterns. Repetitive strain of certain soft tissues results in adapted movement patterns that become muscular “habits” and must be re-educated to function properly.
  6. Nutritional, spiritual & mental wellbeing are essential factors in overall health. Unless your NMT treatment plan encompasses these elements of wellbeing, the healing process may be slowed. My approach to NMT focuses attention to anatomy, physiology, functions and dysfunctions of muscles and joints through the above defined protocols. Protocols for treatment of common pain syndromes combined with thorough anatomy knowledge are the basis for success with NMT. The central methodology I utilize with my clients focuses on the St. John’s approach to NMT. The St. John Method of NMT is based on research that identifies the fundamental causes of pain. The techniques are supported by scientific neurological laws that explain how the central nervous system initiates pain responses in the body. By understanding how pain originates and by being able to locate the source of pain in the body, St. John Neuromuscular Therapists treat the CAUSE of pain (primarily musculoskeletal dysfunction) not just the effects.

Is St. John NMT painful?

In a treatment, the St. John Therapist will palpate the soft tissues to determine if there are ischemic, trigger point, nerve compression and/or entrapment possibilities. The appropriate pressure to be used during a treatment varies depending upon age, fitness, nutritional health, postural pattern, and the extent of trauma and toxicity level in the tissues.

In the St. John Method, the therapist applies pressure for 8-12 seconds to each area being treated, prompting a therapeutic response in the tissues. Since NMT is a highly effective method of therapeutic massage, as opposed to relaxation massage, using the proper level of pressure will elicit a mild state of discomfort. If pressure is too light, it does not produce the necessary stimulation of nerve receptors to produce the desired therapeutic response.

However, pressing too hard can cause the body to treat the pressure as an intrusion, particularly if there is inflammation in the tissues. Optimal success is achieved by applying pressure to trigger points or ischemic areas 3-4 times for 8-12 seconds rather than a longer duration. This is because the therapist’s goal is to interrupt the physiopathological reflex circuits.

How was St. John Therapy Developed?

Paul St. John had a vested interest in studying and researching soft tissue pain and musculoskeletal dysfunction. He was seriously injured three times in his life: he broke his back in three places in a high school football game, was shot out of a helicopter as a Green Beret medic in Vietnam, and was later involved in a head-on automobile collision. For four years after his last injury, he woke every day to headaches and unceasing pain. Thousands of dollars in medical expenses left him with no relief.

Frustration and fear led him to medical libraries where he began his research on pain. He studied pain mechanisms, spending many hours in medical libraries learning about the functioning of the nervous system and the neurological laws that govern the workings of the body. Through this research he found that most pain conditions stem from problems in the muscular system. In fact, Paul discovered a great deal of literature on the interrelationship between muscles, tendons, ligaments and fasciae, and the role they play in causing pain. With this information he began to study his own body and the pain patterns developing from his injuries.

He became familiar with “receptor tonus technique,” which prompted him to attend a course with Dr. Nimmo, DC.  He found that by pressing on the tissues of his neck, back and shoulders, he was able to get temporary relief from his pain. Encouraged by this, Paul began perfecting the receptor tonus technique and incorporating his knowledge of the body into his work. He started teaching others how to treat his tissues, and for the first time in four years, he was pain free. Out of this, he began to integrate the teachings of such notables as Marianno Racabado, PT, Janet Travell, MD, John Barnes, PT, Raymond Nimmo, DC, Dr. John Christopher, Dr. Bernard Jensen, and other orthodox and non-conventional teachers into the development of the St. John Method of Neuromuscular Therapy. Over the next 25 years, Paul and the therapists who worked under him would treat thousands of people in pain, changing their lives and the lives of their families forever.


The St. John Method of Neuromuscular Therapy can help individuals who are experiencing structural distortion, biomechanical dysfunction and the accompanying pain that is often a symptom of the underlying problem. It is a whole-body approach to treatment, so most people find that when they are treated for their back pain, their knee pain, headaches, bladder dysfunction, and other problems they thought couldn’t be helped or “weren’t a big deal” are also addressed.

Some of the conditions NMT is successful with are: Headaches, Migraines, Scoliosis, TMJ, Whiplash, Herniated Disc Syndrome, Back Pain, Neck Pain, Shoulder Pain, Hip Pain, Knee Pain, Foot Pain, Osteoarthritis, Plantar Faciitis, Torticollis, Carpal Tunnel Syndrome, Sciatica, Thoracic Outlet Syndrome, Shin Splints, Tendonitis, Spasms, Cramps, Strains, Postural Distortions, Fibromyalgia, Post Polio Syndrome, and the list goes on and on…

How is St. John Neuromuscular Therapy performed?

A St. John Therapist’s first goal in relieving pain is to achieve structural balance in the body. They do this by looking at the body as a four-dimensional object, and using the techniques of the St. John Method to correct distortions in the horizontal, coronal and/or mid-sagittal planes of the body. Their second goal is to develop a precise treatment protocol for rehabilitating the affected soft tissues. St. John Therapists believe that the healing process should also be an educational process, so they teach the patient about their health, structure, biomechanics, and anything else that may be influencing their pain condition.

In addition, they will work with other healthcare practitioners such as neuromuscular dentists, orthopedic shoe technicians, nutritional counselors, and various other supportive professionals. The client is actively involved in the process of healing by helping the St. John Therapist understand his or her particular condition. During the initial visit, which is generally 90 minutes, the therapist measures various structures of the body to evaluate for postural distortions and biomechanical dysfunction. This analysis will point to the cause and effect of pain.

The St. John Therapist then palpates the soft tissues to determine if there are problems with ischemia, trigger points, and nerve compression/entrapment. Once the evaluation is complete, the therapist will follow a specific protocol of rehabilitation, designed to produce the most efficient and long-lasting results. The steps in this protocol are as follows: Locate and eliminate spasms, hyper-contraction and trigger points from the soft tissues; restore postural alignment, proper biomechanics or movement patterns; restore flexibility and increase blood flow to the tissues; Rebuild strength of the injured, weak, and/or atrophied tissues; build endurance of the tissues for permanent results; and a comprehensive nutritional and mental assessment is performed and incorporated into the clients overall treatment plan.

How many treatments?

This question varies with each individual, depending upon the severity of their condition, nutritional and emotional health, age, fitness, and the skill of the therapist. Generally after about 10 sessions the patient feels a great improvement in their health. Once the problem is eliminated, the patient should have a treatment every few months to maintain their health and help prevent future imbalances from occurring.

St. John Therapists believe the healing process should also be an educational process, and they educate the patient about their health and how to improve and maintain it on their own. A good St. John Therapist is not after “lifetime memberships” or client “annuities,” their goal is to relieve their client’s pain as efficiently and permanently as possible.


See NMT website.