Naprapathic treatment can be aimed directly at the structure or function causing the patient's symptoms, or indirectly at areas that in turn affect it. How the naprapath combines the different techniques depends on the clinical assessment and the patient's individual circumstances. Two people with the same symptoms may therefore be treated differently.
When choosing a treatment, the naprapath also weighs up any risks for the individual patient, based on the medical history, examination and clinical assessment. Further examinations are sometimes needed to establish the diagnosis or to decide whether a particular treatment is appropriate.
The naprapath also takes into account where the patient is in the healing process, for example in the acute or subacute phase, whether the problems are recurring and whether there is an underlying pathology. Most injuries follow a natural healing process if the body's ability to heal is intact. If it is not, treatment and rehabilitation should be started in good time. Treatment therefore need not be the same from one visit to the next, even for the same injury.
The treatment plan is based on factors such as which structure is injured, what functional change is present, the extent of the injury, the intensity of the symptoms, the patient's general physical and mental health and their individual circumstances. The naprapath combines techniques such as manipulation, mobilisation, nerve mobilisation and soft-tissue treatment, usually alongside an exercise or rehabilitation programme and, where needed, ergonomic advice. The aim is a balance between mobility, strength and coordination.
In manipulation therapy, the naprapath places their hands on a chosen contact point in relation to the joint being treated and then performs a quick movement. The movement goes beyond the joint's physiological range of motion, but without exceeding its anatomical limit.
The aim is to stretch the connective tissue and muscles around the joint and normalise function in the joints of the spine and limbs.
Mobilisation is a manual technique in which the naprapath moves the joint once or repeatedly within or at the limit of its passive physiological range of motion, without any quick thrust. The aim is the same as in manipulation: to stretch the connective tissue and muscles around the joint and restore its function and mobility, and with it the function of the surrounding connective tissue, muscles and nerves.
Oakley Smith, the founder of naprapathy, combined manipulation with mobilisation from the very beginning, and this has shaped naprapathy ever since. The first mobilisation techniques were the stout and thrill techniques. In both, the naprapath adapts the pressure to the resistance and direction of the restricted movement. The pressure is held for about 20 seconds, eased for the same length of time and then applied again – as continuous pressure in the stout technique and as rhythmic pulses or stretches in the thrill technique.
Today, muscle energy technique (MET) and post-isometric relaxation (PIR) are also used. In MET, the joint is taken to the end of its range, where the naprapath holds the segment while the patient gently contracts the muscles in the direction opposite to the restricted movement. In PIR, the patient makes no conscious muscular effort but instead looks in different directions and breathes in and out as instructed, so that the tissue maintaining the restriction relaxes.
The effect is usually explained by the Golgi tendon organs, which respond to stretching and inhibit muscle tension. When the muscle contracts in an already stretched position, the tendon organs are stimulated, the muscle relaxes and the movement can be taken further.
Nerve mobilisation is used to mobilise the different parts of the nervous system. The aim is for nerve plexuses, nerve roots and peripheral nerves to move normally in relation to surrounding structures such as ligaments, muscles and bone, so that nerves, muscles and connective tissue can work together.
A form of nerve mobilisation was used early on in naprapathy for conditions in which the nerve root was thought to have adhered to the nerve root sheath, for example after a disc injury. The technique can partly be compared with today's so-called tensioner techniques. Today, nerve mobilisation is used by several professions within manual medicine.
A myofascial trigger point is a hypersensitive spot in a taut band of muscle fibres. It causes local pain, but also a characteristic referral of pain to another part of the body.
Treatment aims to make the taut band relax, using stretching and relaxation techniques and the reflex effects that pressure and touch have on pain. Why the band develops is not fully understood. One theory is that it is caused by a vicious circle in which a lack of energy prevents the muscle fibres from releasing their contraction; another is that damage at cellular level lets calcium leak out and keeps the muscle cell activated. In both cases, the naprapath stretches the muscle fibres to break the vicious circle.
Common techniques are sustained pressure on the muscle, stretching using PNF, INF and PIR, massage and so-called dry needling. Depending on what caused the trigger points, they can also be treated indirectly, and sometimes directly, with manipulation, mobilisation and nerve mobilisation.
Stretching is used to influence the function, tension and elasticity of connective tissue and muscles, and thereby indirectly joint mobility. The aim is to increase or maintain mobility, reduce muscle tension and increase circulation.
The most common method in naprapathy is PNF (proprioceptive neuromuscular facilitation). The muscle is stretched to a pain-free end position, the joint is fixed and the patient contracts the muscle isometrically for 6–10 seconds. The muscle then relaxes and is stretched to a new end position, usually three to five times. The relaxation is usually explained by the Golgi tendon organs, which inhibit muscle tension.
In INF (inhibitory neuromuscular facilitation), the patient instead works isometrically with the opposing muscle, the antagonist, producing reflex relaxation through what is known as reciprocal inhibition. Active PNF combines PNF and INF. The overall effect of stretching has not yet been scientifically established, as research is limited.
Massage is the basic form of treatment of connective and supporting tissue in naprapathy. Pressure and stretching are used to work the tissue in order to increase circulation and reduce pain and tension.
Naprapaths mainly use classic massage with stroking (effleurage), kneading (petrissage) and friction, as well as edging and scissor strokes. Pain relief is explained in part by the so-called gate control theory: massage stimulates pressure and touch receptors, whose signals dampen pain signals in the spinal cord on their way to the brain. There are also theories that the body's own hormone oxytocin contributes to an increased sense of well-being.
Naprapaths also use deep transverse friction (DTF), which is thought to be able to affect adhesions and scar tissue in connective and supporting tissue. The aim is to start a new healing process that prevents new scar tissue from impairing function. The treatment should be combined with rehabilitation.
