Progressive Inhibition of Neuromuscular Structure and Neural Tissue Mobilization.

The index fingers of both hands were used to palpate two connected locations, referred to as main and endpoints. The locations were located along a neuromuscular structure and were the most and least sensitive sections, respectively. Once an endpoint (region of least sensitivity) was identified, the index finger of one hand was used to provide a moderate ischemia compression; the pressure was kept constant until the course of therapy was finished. After identifying the primary point-the area of greatest sensitivity-a moderate ischemic compression was also applied for 30 seconds using the index finger of the other hand.

The patient sat well back on the end of a plinth with thighs fully supported. The patient was asked to slump. Overpressure was applied to the lumbar and thoracic flexion in attempt to bow the spine rather than the hips. With spinal flexion position maintained, the patient was asked to bend his chin to chest and then overpressure in the same direction was added. The patient was asked to extend his knee actively. The patient was asked to dorsiflex his ankle. The therapist was maintaining the ankle dorsiflexion as a progression for technique. The number of these sequences was repeated several times,through which the amplitude of the technique was increased according to the patient response. The technique was progressed to a point where symptoms reproduced, or it was taken to a point where resistance of the movement was encountered.