NMT considers perpetuating factors that may be associated with the client’s complaints. For example, when a client presents with shoulder pain, the upper extremity protocol will be used as the primary examination. In addition to the muscles directly crossing the shoulder joint, muscles that attach the shoulder girdle to the torso would be included along with steps to help insure mobility of the scapula. Dysfunctions within the arm, forearm and hand often produce compensation patterns in shoulder movement, so examination of those regions should be included. Since innervation to the shoulder exits the spine at the cervical region, mobility and muscles of the neck will be considered; compression or entrapment of the nerves serving the shoulder should be ruled out.
Perpetuating factors can also include shoulder joint pathologies, postural positioning, habits of use, nutritional components, emotional wellbeing, allergies, neuroexcitants, neurotoxins, and other core elements that can masquerade as myofascial pain and dysfunction. Due to the diverse nature of perpetuating factors, astute NMT practitioners build a broad network of healthcare providers for referral of those clients whose symptoms suggest “red flag” warnings or underlying pathologies.
Most factors that cause pain and dysfunction can be easily grouped under three general headings of biomechanical, biochemical, and psychosocial factors, with the interface between these being profoundly related. Most practitioners apply strategies from only one of these categories, often resulting in improvement that plateaus before full recovery. However, a synergistic effect – often with significant relief – is obtained when all three categories are addressed. This may required a multidisciplinary approach.