For the first time last weekend I ventured into a continuing
education course expecting to be disappointed.
The course I am referring to was Neurokinetic Therapy (NKT) Level 1, which I attended at Catalyst S.P.O.R.T. in New York City. Normally, I either select courses based on methods that I am sure will fit into my current skill set or to in order to get access to the brilliant mind of the instructor teaching.
From what I had seen with NKT, it appeared to be something that was in stark contrast to my methodology as a clinician. Moreover, with this particular course I had no prior knowledge of the instructor and chose the location purely based on geographic proximity.
My initial skepticism of this approach was based on several factors:
Several months before deciding to take this course I purchased and read David Weinstock’s (the founder of NKT) book, Neurokinetic Therapy: An Innovative Approach to Manual Muscle Testing. Upon finishing the book, I must say, I was highly unimpressed. To me it seemed like a simple review of manual muscle testing, which was an elementary skill I learned year one in my physical therapy education. Moreover, in clinical practice I have found manual muscle testing to be quite unreliable to the point of generally disregarding it from my assessment process.
Anyone that knows me or has read/watched anything I have written/videoed, knows that I am not a fan of isolated muscle assessment, treatment or training. Instead my philosophy is that patterns of full-body functional movement need to be assessed, deconstructed and re-educated in order to make optimal progress in rehabilitation and/or strength and conditioning. At first glance, this approach seemed to be preaching methods opposite to this philosophy.
Years back, I had done some networking with a practitioner that used manual muscle testing in an applied kinesiology framework to assess everything from my allergies to my liver function. What I got from him was plenty of unfounded theory, but no noticeable change from his interventions. Moreover, no plan of correction from his assessment was offered save for purchasing his supplements. This did not leave a good taste in my mouth regarding any approach that utilized manual muscle testing as a major element of assessment.
So with all of this being considered, my initial expectations of NKT were not high.
Nevertheless, I had been told by three different people whose judgement I trusted that this method was game changing. I had also recently made a commitment to attempt to stray from the confirmation bias that I was building with my selection of continuing education. I wanted to attack my biases, instead of doing more of the same stuff that had already been working for me.
So how did it all go?
Well, I must say I am glad that I was smart enough NOT to listen to myself.
I quickly (within the first hour) found that all my preconceived notions were completely unwarranted.
To describe my change in mindset, below is a synopsis of the tenets of NKT methodology that were most helpful to me.
TEST PATTERNS NOT MUSCLES
This concept was mentioned early and went a ways in breaking my negative biases against the practice.
It was described that the manual muscle tests performed were not testing muscles in isolation, because that is impossible. This made me nod my head in agreement, but also made me a little confused. If they were not meaning to test muscles in isolation, then why name all the tests after a specific muscle?
It was explained that naming specific muscles for the patterns tested was simply a way of standardizing the language of the patterns tested. Moreover, the angles tested are associated with the fiber orientation of the muscles named which may bias one muscle over another with the same action.
This I was on board with, and it got me intrigued to learn more.
What I soon realized was that the NKT approach thoroughly deconstructed full body movement patterns into their component parts … and did it well!
This was done by looking at the various angles of action at a joint in a proximal to distal direction (from the center out.) Through these assessments of movement competency, unique compensation patterns were able to be uncovered. A specific test/retest protocol was then utilized in order to decipher the most dominant compensation pattern leading to the patient/client’s functional movement deficit. Once positive change was elicited to the compensation pattern (via a manual or self care technique) the new pattern was “challenged” by re-training the movement that was initially deficient.
When considering this entire process I have to say it seemed to check all the boxes regarding elements that I would deem necessary for effective movement assessment, treatment and training.
THE MISSING LINK
One of the first observations I made upon entering the course was that all the assistant instructors were wearing an NKT shirt that read, “The Missing Link”.
To further demonstrate my initial skepticism, I, of course, did an internal eye roll at the notion. However, once again, my initial judgements were proven erroneous, as I quickly learned that this method was indeed a “missing link” … at least in my clinical process.
What I am referring to is that due to my aforementioned feelings regarding the lack of reliability of manual muscle testing, I had long given up exploring its use as a method of assessing change. Instead, when assessing the effectiveness of my interventions, I relied on changes to a patient/client’s pain response, mobility restrictions, and functional movement capacity.
What the NKT method demonstrated to me was that manual muscle testing does not need to be used for some arbitrary grading system of “strength” as taught in physical therapy schools. Instead, these techniques can be used simply to assess the differences of “positional competency” (can a position be held without compensation against gravity or light resistance) in various joint positions. This “positional competency” can then be re-assessed after an intervention (manual release technique or corrective exercise) is applied, in order to see the value of the technique.
It really surprised me how obvious it was to notice the positive changes when testing others at the course. These changes were not only obvious to me but also to the participants being assessed. This factor certainly went a ways in showing me the value and reliability of this type of assessment process.
By far the most beneficial aspect of the course was understanding the common movement relationships identified through the practice of NKT. Although no assumptions were made without assessing, relationships between muscles that are overworking (facilitated) with those that are underworking (inhibited) were displayed frequently throughout the weekend. These relationships were “lightbulb” moments for me, showing me connections I had previously overlooked.
These movement relationships acted as a roadmap of sorts to prioritize which muscles should be tested and in which order. Once tested, the test/retest model was able to verify whether the assumptions made were accurate by demonstrating if there was any change to the baseline measurements that had been taken. I found this combination of common movement relationships and the continuous testing and re-testing process incredibly efficient, as well as effective.
I won’t go into detail regarding the specific movement relationships that were touched upon (you will have to take the course for that), but I will say that I now look at assessing single leg stance and grip testing in a whole new light.
DR. KATHY DOOLEY, AN EDUCATIONAL PERFORMER
On a final note, another highlight of the course was what can only be described as an “educational performance,” put on by lead instructor, Dr. Kathy Dooley. Not only was Dr. Dooley hilarious, but also one of the most knowledge anatomists and clinicians I have ever had the pleasure of meeting. Her style of teaching kept you entertained, but there was no doubt she was the smartest person in the room, and her handle of the material demanded immediate respect and admiration. It’s amazing how much you can learn in two days from a skillful teacher.
So if you are thinking of taking an NKT course but are skeptical, I am telling you it is not what you think. The weekend showed me that I don't know what I don't know until I learn something new, and I learned ALOT from this approach, and I am excited to learn more.