Evidence-Based Neurological Approach to Multimodal Neurosummation: The Trigenics® Decade Review

:dropcap_open:I:dropcap_close:f you and I are the same, we both became health professionals because we had a deep desire to help people suffering with pain and dysfunction. We are consequently always seeking and learning new ways to do this. I feel blessed to have been able to discover and learn a way to help my patients in an incredibly dramatic and effective way and I would like to share it with you. 
neurosummationmultimodalIn January 2006, I had the great honour of being chosen to be featured on the cover of The American Chiropractor Magazine.  The associated article was about a superlatively effective treatment concept which I refer to as multimodal therapeutic “neurosummation®”. This is the fundamental basis of the treatment system, called “Trigenics”, which is designed to neurologically reprogram and correct muscle pull pattern imbalances through sensorimotor, neural re-regulation.  The originality of the Trigenics® method of treatment was that it incorporated the concept of simultaneous, instrument or manually applied, multiple source (multimodal) neural stimulation as an evidence-based / supportive clinical approach for enhanced therapeutic outcome. It was designed as a system of highly advanced neurogenic treatment for patients with musculoskeletal disorders and pain syndromes as well as a method of preventing injuries and augmenting athletic performance.
Historically, Trigenics® was the first, in the physical and manual medicine fields, to introduce the concept of simultaneously combining neuro-stimulative soft tissue treatment procedures with resisted exercise movement.   A focused, concentrative, breathing biofeedback component was also added to this bimodal approach to create the “trimodal” interactive treatment, and hence the name “Trigenics”®. 
BACKGROUND: Trigenics concepts originated in the early 80’s and were developed fully in the 1990’s. Trigenics, in its current form, was formerly introduced to the world of physical and manual medicine, by way of continuing education courses provided by the Trigenics Institute of Myoneural Medicine,  formed in 1998. Trigenics courses were evaluated for merit, accepted and co-sponsored by National University of Health Sciences in Chicago for CE credits in the early 2000’s as well as by the American Chiropractic Board of Sports Physicians (ACBSP). Trigenics courses are provided in North America by the Trigenics Institute in conjunction with Dr. Christian Guenette in the West, Dr. Stephen Chiu in the East and internationally by Trigenics Directors Dr. Michael Egan in Australia, Lindley Lethard, PT in New Zealand, Martin Toht, PT in Eastern Europe, Dr. Raul Cadagan in South America, Dr. Sashe Ellison in Central America  Dr. Valentin Maltsev, MD in Russia and Dr. Simon Billings in the UK.
In 2009, I was asked to teach a sports related manual medicine program to graduate trainers, coaches and physiotherapists in the EU for Tallinn University, Department of Health and Sports Sciences. As a result, in 2010 the Trigenics Institute expanded upon the teaching materials to create specialized Trigenics courses for strength coaches and personal trainers. Elite trainers Tyson Staples and Oliver Thompson are the regional directors for North America and Europe respectively. To date, Trigenics has been officially used by doctors or therapists in 4 Olympics and 3 World games as well as in many other elite and professional sports venues. There are over 2000 Registered Trigenics Practitioners in 25 countries worldwide.
TRIGENICS THEORY:  It has been widely accepted that proprioceptive, neurokinesthetic motor and muscle tone deficits with consequent muscle strength and length pull pattern imbalances are known to occur after certain types of stresses or injuries and that these neurogenic  muscle imbalances are the primary cause of neuromusculoskeletal pain and dysfunction conditions.6 In line with Trigenics are the concepts presented by Leon Chaitow, ND, DO, who stresses the importance of core function and motor control. Neuromuscular imbalanced pull patterns of “weak” vs “short” muscles causing global and local movement aberrations have been extensively documented over the last 2 decades by icons such as Vladimir Janda7 and more recent notables such as Karl Lewit and Craig Leibenson. The Trigenics myoneural assessment procedures focus on identifying and graphically mapping (on paper or with the “i3G” iPad program) muscle imbalances through specific strength and length testing procedures. 
From a therapeutic corrective perspective, the Trigenics approach has always been to specifically address all muscle imbalances first with neurologically summative lengthening (TL) or strengthening (TS) procedures. If any pain remains following treatment, TL procedures are applied to the muscles which are stressed in the position(s) of pain with distortional pressure applied in the area of pain during contraction for further resolution.What was notably different and unique about the Trigenics neurosummation procedures is that, although various existing and proven neuromuscular and PNF techniques are clearly incorporated which internally generate a neurological response (PIR-Lewit, PFS-Janda, Contract-Hold-Relax, Reciprocal Inhibition, the Inverse Myotatic Reflex etc), these techniques were never before simultaneously combined with additional, externally applied, simulative forces to further magnify their effect to cause a new cumulative combined “super” effect. 
This is the real cornerstone of Trigenics, and this is why so many practitioners will watch Trigenics being applied and exclaim that it “looks like” PNF or PIR, etc. Trigenics openly incorporates some well-known therapeutic neuromuscular techniques in its treatment procedures. The difference is that it just makes these techniques far more effective with the simultaneous addition of other new therapeutic procedures which cumulatively stimulate mechanoreceptors and afferent pathways to create a summative effect neurologically and therapeutically. Although some other techniques now claim to create the same effect, it was Trigenics® that first introduced the hypothetical concept of creating an “afferent barrage” to essentially “short-circuit” the brain into resetting and normalizing it’s efferent motor transmission much in the same way that a computer is reset by sending a barrage of electrical impulses to the CPU. Hence the Trigenics phrase “therapeutic neurosummation®” which globally relates to the known neurological term “amplitude summation”. 
I believe that one of the main contributions Trigenics has made to the world of manual medicine was, therefore, in simultaneously adding the resistive load exercise component to muscle movement for increased neural firing to the treatmeprotocol.  Another contribution was in changing the soft tissue treatment pressure direction and load for a dynamic neural transduction effect so as to maximally deform muscle fibre length-tension relationship for further neurological amplification of mechanoreceptor activity .
In 2003, Dr. Kevin Hooper, a Canadian sports physician and Olympic chiropractor for Team Canada, wrote about the Trigenics phenomenon and published an article on Sports Trigenics in “Dynamic Chiropractic” entitled “Advanced Neuromuscular Medicine for Soft-Tissue Conditions and Athletic Enhancement”. He then collaborated with me that year in using the Trigenics concepts to write a book on Trigenics exercises for the back. In this book, and in the advanced Trigenics courses, resistance tubing, gym balls, weights and various exercise equipment are used to provide the resistance component of the muscle contraction exercise while externally applied soft tissue neuro-stimulation procedures are applied. Trigenics is not only applied using manual methods. Many Trigenics practitioners have also learned to use adjunctive equipment including excellent proprioceptive stimulatory devices such as the arthrostim and vibrocussor, with specialized Trigenics heads, to further stimulate mechanoreceptor activity during Trigenics procedures.  
neurosummationmultimodal2Initially, Trigenics® was, considered to be either leading edge or abstract in that it put the initial primary focus of therapy on augmentative correction of aberrant sensorimotor control neurology rather than the aberrant biomechanics found in interosseous dyskinesia and/or soft tissue adhesions with myofascial glide/tightness dysfunction.I can well remember traveling avidly on the lecture circuit for years in the early 2000’s providing presentations for schools and organizations like the OCA, ACA, FCA, American Sports Council, the ACBSP and even Parker Seminar throughout North America, vigorously espousing the need to first address aberrant muscle neurology when the big buzz was then still all about excellent soft tissue myofascial adhesion release techniques like “active release technique” (ART) or “myobrasion”® techniques like “Graston”.
Times have changed as many current manual and physical medicine practitioners have become more aware of the critically important neurological connection. As such, Trigenics was formally presented to attendees of the World Federation of Chiropractic symposium in 2011. My colleague and chiropractic college classmate, Dr. Frederick Carrick also played an enormous role in bringing abberant neurology to the forefront for Chiropractors and physical therapists. (One of my favorite quotes is from Dr. Carrick describing Trigenics: “Trigenics is consistent with the principles of neuroplasticity and corticoneural re-organization of the somato-sensory and sensorimotor systems.”) It is plainly apparent that there is a lot more focus today on aberrant neurology and related muscle tone and pull imbalances as the primary cause of musculoskeletal dysfunction. Several studies in the last decade have shown a relation between muscle tightness, injury and muscle strength imbalance6 (Murphy et al., 2003). Certainly many have come before Trigenics and continue to do compelling research in the field of neural information processing with information on such bio-mechanisms as local axon synaptic temporal and spatial neural summation (Coolen, Kuhn, Sollich et al., 2005) and sensorimotor neuronal synaptic “plasticity” as it relates to facilitative or depressive post-synaptic amplitude summation (Ni e, Graen-Nielson et al, 2009). Prior to Trigenics, however, no one had introduced stimulative, mechanically induced, somato-afferent neural summation concepts on a more global musculo-neural (PNS) and afferent converging brain-based (CNS) level for therapeutic outcome relating to pain reduction and gross functional increases in strength and functional mobility. This was most definitely a new and “evolutionary” concept which did, indeed, gain “unprecedented results”!  
In the last few years many distinguished notables like Dr. Tom Hyde, and others, who had previously been using and teaching soft tissue techniques, have, much to their credit, now incorporated strikingly similar “afferent barrage” therapeutic neurosummation concepts into their more recent treatment systems like FKTR-PM where ART or Graston are combined with resisted exercise. Even kinesiotaping espouses such “theories”. Of course, as I stated in my book on theoretical Trigenics in 1999, it was only a matter of time before the rest of the therapeutic world would pick up on utilizing the more sensible approach of using the body’s own hardwired neural pathways to enhance treatment outcome. It is nice to see that this is now finally being recognized by so many notables as the new, leading-edge frontier and gold standard in physical therapy and manual medicine. 
RESEARCH AND PUBLICATIONS: A groundbreaking peer-reviewed, evidence-based study was published on Trigenics by a group of physiotherapists,  medical doctors and PhDs at Tartu University.5 It was commissioned by the Estonian Olympic Committee and initiated by Trigenics Practitioner and sports physiotherapist, Martin Vahimets, PT, MSc, RTP. The study was ordered after the EOC became aware of the huge value Trigenics was providing to their athletes. The study suggested that Trigenics beneficially alters muscle “tone” as well as creating a state of enhanced tonus and contractibility for injury prevention, rehabilitation, training and performance enhancement. A profound pilot study using sEMG on the soleus muscle was done by Lauri Rannama, MSc, PT at Tartu University, Department of Exercise Biology and Physiology and Institute of Neuroanatomy. In the study entitled “Neurological changes following application of Trigenics Sensorimotor Treatment Protocols”, Rannama proposed that muscular contractile power, strength, speed of movement and structural support all increased while risk of injury decreased following Trigenics.4  In 2011, the Samara Medical Journal in Russia published an informative article on Trigenics® entitled “Trigenics: A new Era in Rehabilitation and Sports Medicine.”3 Further studies are now underway or planned at National Universities in Estonia, Russia and Usbekistan. In the area of rehabilitation, Dr. Ted Forcum published an excellent article in the Sept. 2011 edition of The American Chiropractor entitled “Post Disc Herniation Surgery Rehab: A Case Study using Trigenics ®”.  
The principles of Trigenics® were also used to develop the world’s first interactive non-surgical manipulative procedure called “OAT” which has safely restored complete or near-full range of motion in one visit to hundreds of adhesive capsulitis (frozen shoulder)  patients over the last 10 years. A 10 case pilot study was conducted which was published by the author and Dr. Maxim Bakhtadze, MD, PhD in the Russian Journal of Manual Therapy in 20121. Currently an evidence-based peer-reviewed medical research study is being conducted in Canada by Dr. Barham Jam D.P.T. on the OAT which is approved by the Canadian Medical Board’s ethics committee. Publication of this study in a medical journal is expected in 2013. 
CONCLUSION:  Although the overwhelming clinical evidence for the tremendously beneficial effects of multimodal therapeutic neurosummation® is strong, much more peer-reviewed medical research would be helpful for unquestionable scientific validation of the outstanding results and to discover what other myoneural and biomechanical changes take place following various applications of Trigenics. 2,3 

  1. “The Oolo-Austin Trigenics Dissection Procedure (OAT) for treatment of adhesive capsulitis using local anesthetic.”  Bakhtadze M., Austin AO,  Journal of Manual Therapy  (Russia) 2012;(1):81-86.
  2. “Effective method of treatment of shoulder adhesive capsulitis (frozen shoulder  syndrome)” Austin AO, . Samara Medical Journal 2012;1-2(65-66):53-58.
  3. “Trigenics: A new era in rehabilitation and sports medicine.” Austin AO.,  Samara Medical Journal 2011; 5-6(63-64):51-53.44.
  4. “Neurological changes following application of Trigenics sensorimotor treatment  protocols.” .  Rannama L. ,  Canadian Chiropractor 2009;Jul. (on-line)
  5. “Influence of Trigenics Myoneural Medicine on lower extremity muscle tone and viscous-elastic properties in young basketball players.” Gapeyeva H, Kaasik P, Ereline J, Paasuke M, Vain A, Vahimets M, Acta Academiae Olympicae Estoniae 2005;14(1-2):49-68. (Indexed in International Databases of sportdata and EBSCO Publishing SPORTDiscus with Fulltext).
  6. “Assessment and treatment of muscle imbalance: The Janda Approach.” Page P, Frank C, Lardner R. Human Kinetics 2010.
  7. “Muscle strength in relation to muscle length, pain and muscle imbalance.”. Janda V, In Harms– Rindahl K, editors.  New York: Churchill Livingston; 1993.
  8. “Theory of Neural Information Processing Systems’, A.C.C. Coolen, R. Kuhn and P. Sollich,(Oxford University Press, 2005).
  9. “Spatial and temporal summation of pain evoked by mechanical pressure stimulation”  Graven-Nielsen PhD,  Lars Arendt-Nielsen PhD.   Journal of Pain, 13 (6): 592–599. July, 2009.
  10. “ A Prospective Study of Overuse Knee Injuries Among Female Athletes With Muscle Imbalances and Structural Abnormalities”, Devan, Pescatello,  Anderson,  J Athl Train. 2004 Jul-Sep; 39(3): 263–267.
  11. “Trigenics Functional Neurology & Myoneural Medicine, Theory”, Oolo-Austin, 1999, (privately published).
Dr. Allan Oolo Austin is a chiropractor and osteopath who, over the last 33 years, attained additional designations in sports medicine, rehabilitation, acupuncture and natural medicine. The developer of Trigenics, Dr. Oolo Austin has been teaching doctors and therapists worldwide for 15 years. As a visiting professor, he developed and taught a manual medicine program at Tallinn University’s Department of Health and Sports Sciences. Dr. Oolo Austin is the founder of Chiropractic in Estonia and the president of the Estonian Manual Medicine and Chiropractic Association. He has worked officially as a sports doctor at many Olympics and World Games. Dr. Oolo Autin is a Rotarian and feels fortunate to be able to still learn from those he teaches, who often share their valuable knowledge with him. He can be reached at +1 416 481 1936 or institute[at]trigenics.com

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