Neuromuscular Reeducation™ (NMR) is a hands-on technique/approach to the evaluation and functional treatment of soft-tissue injuries that occur via trauma, repetitive motion, or chronic postural fatigue. Both Dr. John Bisaccia and Dr. Marna Bisaccia are certified NMR practitioners. Both doctors have combined many of the NMR techniques with their previous myofascial release training and sportsmedicine to create a unique and successful way of treating muscle and joint problems.
NMR is an approach originally developed by Dr. Gary Glum and Dr. Joseph Hourigan and is currently being taught and perfected by Dr. Peter Levy. Dr. Marna and I had the pleasure of studying under Dr. Levy. We are both currently certified NMR practitioners and are performing this technique in office. We have personally combined many of the NMR techniques with our previous myofascial release training and sports medicine to create what we feel is a unique way of treating muscle and joint problems.
The NMR technique works off the fact that every muscle in the body is surrounded by a smooth, fascial sheath. Each muscular fascicle and fibril is surrounded by this fascia, which can exert pressure of over 2000 lbs. per square inch. When an area is injured, whether is it muscle, connective tissue, fascia, tendon, or some combination of these elements (as most injuries are), the body handles this inflammatory response of the tissue to trauma the only way it knows how–through a hyperplasia of the injured tissue. This is followed by fibrous healing and the laying down of a less elastic second-grade, poorly vascularized scar tissue. This is also known as an adhesion. The body does this to protect the involved area to further limit tissue damage. Adhesions form whenever damage and inflammation have occurred but they limit both strength and range of motion.
As the muscle and tendon begin to stretch and encounter an adhesion, the muscle contracts to prevent any further stretching and to protect the area involved. The result is that muscles involved are not as strong, and the range of motion of the involved joint is limited. These adhesions can affect areas that are quite small and other times there can be a number of areas that are scattered throughout a muscle group or region of the body. Patients experience these adhesions as fibrous, knotty areas that create tension and pain.
The idea behind Neuromuscular Reeducation is that if you can locate the adhesion and scarred area, you can take the muscle through a functional range of motion while using manual deep pressure to break up the adhesion and restore full range of motion. This in turn allows the body to regain its normal movement pattern, thus decreasing pain and improving function.
Please contact us if you have any questions or want more information. We would be happy to discuss any questions and/or concerns with you.
Frequently Asked Questions
1. Does the NMR therapy hurt?
It can be uncomfortable and border on painful, however, each pattern only takes a few seconds, and overall treatment on a particular group of muscles or body part lasts only between 10-15 minutes. The general consensus from patients is that they have lived with this pain for a long enough period of time that any pain as a result of treatment is not a big concern if it will help resolve the problem.
2. How long does the therapy take to work?
In all reality the application of neuromuscular reeducationism should show a definitive change in range of motion, function, and possibly pain almost immediately. When running a clinical trial on a body part, usually we will decide within four to six visits whether or not the therapy would be beneficial to the patient. If the patient hasn’t shown subjective and objective improvement in that time frame, this type of therapy is most likely not going to benefit this patient, and treatment can be terminated.
3. Will I be sore following treatment?
Many times residual soreness does occur following deep tissue release work. Ice, anti-inflammatory enzymes, extra water consumption, and exercise can all help minimize these effects. We may also use interferential physiotherapy current over the involved tissue to help decrease post treatment discomfort. There are post treatment instructions included in your packet.
4. What conditions respond best to this treatment?
Any and all areas of muscle pain, injury and loss of range-of-motion (either acute or chronic) can be treated with NMR. If you or a family member have a problem and you are not sure if this technique can help you please ask Drs. John or Marna.
Articles of Interest
NMR For Chronic Pain of the Hip
I came to Williston Chiropractic and Sportsmedicine with persistent pain in my right hip. I was suffering from soreness and stiffness and had no flexibility in that joint. It was so bad that I was walking with a limp. The pain was increasing in severity over the past three years, but first became noticeable over thirty years ago. It was so severe that it limited my sporting activities such as golf and hiking, and it was getting to the point where it was bothering me with just walking. I took Advil daily to decrease the pain, but the pain never really went away. I was told that the pain was related to arthritis and a malformed hip from childhood. I wanted to avoid hip replacement surgery if possible. I had been to a chiropractor for treatment of back pain and allergies, and it had been successful, but thinking that this pain was from arthritis and from the joint problem of years past, I did not think that treatment would be helpful.
I found Drs. John and Marna to be very professional and knowledgeable. Dr. John explained to me the problem with my hip and that it was a combination of both the joint and the muscles attached. We discussed the use of Neuromuscular Reeducation in an attempt to relax the muscles that attach into my hip joint and hopefully improve on the pain. Dr. Marna performed the NMR treatments on my hip, low back, and buttock area and Dr. John performed my adjustments.
The improvement has been dramatic!. The daily pain is gone. I can walk 18 holes of golf without pain. I never thought I would have such a dramatic change. I anticipated a 50% improvement at best, which would have been acceptable, but today, I am at least 85% better than I was. The daily Advil is gone. I believe that this is something I will continue with for the rest of my life. Everyone who knows me and the pain that I was in has been told of the relief I have gotten via the NMR treatments. I would tell people to seriously consider chiropractic as an alternative before seeking more invasive solutions. Currently all the members of my family are under care.
Thank you very much.
NMR For Neck Pain and Stiffness
I first came to Williston Chiropractic and Sportsmedicine for stiffness to my neck and left shoulder area. I had chronic tightness that came from an injury back in 1975. I’ve had on and off pain for 25-30 years that would flare-up during fatigue or stressful situations. The stiffness would continue to increase until I had severe headaches, and it was really starting to affect my day-to-day activities. I had seen a chiropractor in 1998, and enjoyed marked improvement from those treatments. I felt that this round of chiropractic care would also be helpful.
The chiropractor I visited previously was very good, but I have found Williston Chiropractic and Sportsmedicine to be more thorough and extensive with treatment. My results were excellent. I can do all the things I did earlier without the pain. My neck hasn’t felt this good in 30 years. Thanks for making me feel better.
NMR For Low Back and Groin Area
I first sought care at Williston Chiropractic and Sportsmedicine for very tight muscles and minimal flexibility. My low back and groin area were sore all the time, and I had a sharp, pinching pain in my groin and hips. It bothered me for five years. The pain hampered my ability to play soccer with full effort. This was a problem, for I am at a major university on a soccer scholarship and need to play at peak performance. I had previous treatments of massage and electric stimulation, but they were of little long-term relief. I was referred to Dr. Bisaccia through a series of doctors that I have been seeing. Friends of mine also recommended the office. I had not been to a chiropractor previously, and I was very eager to see if I could get results with this treatment.
Dr. John was very nice and felt he could help me. He had a unique approach to treating this problem (neuromuscular reeducation). I received a series of treatments (eight) over a one-month period and the results were almost immediate. At this point my whole soccer game has changed. I can now play in comfort without pain, and my speed has improved from looser muscles. Dr. Bisaccia’s treatments have done so much for me that I have told other people about chiropractic and this approach to muscle pain. I feel if after 5 years, I could be healed from my pain, just about anyone can. I’m a firm believer in chiropractic, and I can’t believe that it has done so much for me. It has really revolutionized the state of my body. Thank you Dr. John and the staff at Williston Chiropractic and Sportsmedicine.
Doctors note: This patient’s father pulled me aside following one of his son’s visits and stated that he had watched him play soccer the day before and could not believe his speed and agility. He had not seen him play pain free in years and was amazed at his performance. He was “very grateful” for my help. The son has since returned to college but promises to keep in touch to report on his progress/status.