Interview with Dr. Lisa Papenbrock - NIMMO/trigger point therapy

I interviewed Dr. Lisa Papenbrock once again and this time it was about NIMMO technique or Trigger Point Therapy. However, we did not only focus on such therapy as we also discussed the different techniques and experiences that we jive together to give the best care for our patients.

Just an introduction, Dr. Papenbrock is my old roommate in chiropractic school and we graduated in 2007. Both of us have worked continuously to improve our tool boxes for different types of technique. There has been a shift in how we practice now compared to when we graduate from school. We try to look more at the whole body than just the adjustment and cracking part of chiropractic because we feel like there is more a lot to it. As we get even further, we also incorporate the mind and body connection in our respective practices to help you get the most optimal health for yourself.

Dr. Lisa Papenbrock on NIMMO Technique or Trigger Point Therapy

Dr. Papen brock shared that the NIMMO Technique or Trigger Point Therapy is officially called as Receptor-tonus Technique. It was developed by chiropractor Raymond Nimmo in the 1950s. During that time it was unheard of to do any type of myofascial or muscle work and it was all about adjustments of the nerves. Nimmo said it was weird because there was a division in doing only upper cervical stuff and the other sacral stuff, and the patient was doing better. So he started looking more into the central nervous system as the key component of dysfunction and pain. He developed the NIMMO technique from there and he taught Dr. Papenbrock’s chiropractic mentor Jeffrey Cohen. Eventually, Dr. Papenbrock also got to teach the NIMMO technique to many students in the past ten years.

The NIMMO technique is a phenomenal and incredibly easy therapy. Dr. Papenbrock noted that sometimes the easiest stuff is the best. From the NIMMO technique, more people came up with new techniques so Dr. Papenbrock refers to it as the grandfather technique.

Dr. Papenbrock added that with Trigger Point Therapy, she finds trigger points, knots, or a source of an area where there is inflammation of the muscle. She holds it for five to seven seconds and that is it. The art of the Trigger Point Therapy is knowing where all to treat. So if there is someone who has wrist pain, she will not only treat their wrist as she will also treat their neck, the inside of their shoulder blades, and rotator cuffs. It also won’t matter which one came first, because the goal is to treat it all. The Trigger Point Therapy is also about treating the body as an entire unit, because everything affects our central nervous system and it changes our sensory input and therefore changes our motor output. 

For my practice, I want to use as an example when a patient comes in for plantar fasciitis. I don’t just treat the sole of the foot because it could also be caused by the forward head posture since this would cause someone to shift their weight forward so I look at their neck, too when they come in for such pain. I want to tell my patients that they should not look at us like we are crazy when we try to look at all the possible causes of the pain. I think that having the whole approach like Nimmo was revolutionary despite the lack of research. In relation to this, with yoga and meditation, they knew that breathing was affecting our nervous system in a profound way, and as we dissected and learned more about the nervous system, we realized that it does physiologically work in a specific way to down regulate our nervous system. It’s really impressive.

Dr. Papenbrock also talked about repeated first-hand experience because in our practice, there are many times when we do not know why we are doing the things that we are doing. Our body has an innate ability to want to take care of itself and so for thousands of years, people have been controlling their heart rate, body temperature, and anxiety with breathing. Now that we have the technology and data to back it up, it shows what our first-hand experience has been showing us for many years. Dr. Papenbrock finds it entertaining that we are reliant on what technology and research can prove, but our first-hand experiences already show us that what we are doing works and we should just keep doing it.

Using The Techniques And Incorporating Our Experiences For Better Results

I took the active release technique with Dr. Papenbrock while in chiropractic school. It’s actually fine because when you get out of school with a technique and you put it into practice, you do it textbook. Later, you add more things to the technique you learned based on your experiences to make what works best for you or for the specific patient. Dr. Papenbrock chimed in saying that is the beauty of chiropractic because we learn the techniques and we use them as tools to turn them into other beautiful techniques that changed our lives and our patients’ lives, and I strongly agree with that. 

When we were in school, we also took the Graston Technique, which incorporates a patented form of instrument-assisted soft tissue mobilization that enables clinicians to effectively detect and treat scar tissue and restrictions that affect normal function. When we were taking up the different techniques and courses at chiropractic school, we were kind of taught that the harder it is, the better. However, Dr. Papenbrock and I took up another technique and we found something that’s easier and ties perfectly with chiropractic. With this realization, we had to reign ourselves in that more is not always better, and harder is not always better.

Further, Dr. Papenbrock said that a lot of the modern techniques now are embracing the fact that we are working with the nervous system and it’s basically what Nimmo said in the 1950s. She noted that it’s nice to see newer techniques adapting to this and changing how we are catering to patients although when we first make changes to the techniques and practice, we do not have research to back it up yet. So it’s all kind of hypothetical, but there will be technology later that will show why what we are doing works. From there, we can adapt our language to make it more appropriate to explain what we are doing.

I want to say that our experiences in treating people have drastically changed. If you came to see either one of us ten years ago, just know that if you come back in and it won’t be the same experience ten years ago. You might be disappointed at first, but you have to understand and be open to the fact that we are constantly tweaking things as we learn more. We incorporate everything we learned from our patients and our continuing education.

Sometimes, we even incorporate Dr. Papenbrock’s meditation and my yoga practice and you might not even know we are infusing it to what we are asking you to do. All these different facets of life are going to affect your health and if we do not ask you to do it, it will have a domino effect. For example, if you let your wrist pain continue, you will alter how your arm moves and hold your upper back in a different way then maybe end up with headaches. Dr. Papenbrock added that this might also affect your breathing and you will start getting anxiety. If this happens, there will be a huge mental component that gets affected just because you let your wrist pain go on. You will later realize that if you do not take care of the pain immediately, it will snowball into the different facets of your life such as your relationships and your work. So, with all these information that we have based on techniques we learned and the experiences with our patients, the way we treat you will also evolve. We do not want to treat patients the exact same way like they were treated ten years ago, and with this, we get a deeper sense regarding healing than just being phenomenal technicians.

Newer Is Not Always Better

Like what Dr. Papenbrock was saying about NIMMO, which is older than the newer techniques, I like to let my patients and readers know that newer is not always better. I learned about this skin rolling from a chiropractor I worked with when I was first out of school. I asked him why he does such, and he just told me he doesn’t know but he keeps doing it because it works. I went away from it, but recently came back to it, and I randomly saw a post about it and the post explained the batson’s plexus and the vasculature around that area helps vascularize around the spine and the disk. So I thought about the chiropractor I was talking about earlier not knowing the physiology behind it, but he knows it works. So for my patients, when I start rolling along your spinous processes and your back, know that there is physiologic reason behind it.

Dr. Papenbrock added that just because someone cannot always explain why they are doing it and why it works because it hasn’t been figured out yet, that does not mean it does not work. So we leave the question, “Do you always need a reason to have as to why things work?”

Dr. Papenbrock continued to note that everything is a trend and you can learn new techniques to evolve your practice, but just because something is on trend, it does not mean it’s the only thing that works. There are so many things that are tried and true and they are very sustainable and relevant in today’s chiropractic community. We do not want to forget about these older techniques that are still clearly very appropriate in a lot of ways.

Having Different Techniques For Different Patients

Every person is super individual that is why Dr. Papenbrock and I want to have a lot of different options or ways to introduce the same techniques to our patients. For example, when a 45-year-old patient who has fibromyalgia comes in, the patient will respond differently compared to an 18-year-old. It takes trial and error at first as well as research to know what works for specific patients.

Dr. Papenbrock was actually involved with a research on NIMMO at the New York Chiropractic College. They measured tissue tension pre and post NIMMO therapy. They first treated the tissue tension in a tight muscle then later treated the full body. So, the research proved that there is scientific evidence that NIMMO does work. In line with this, from the patient perspective, they might say that when we try to treat them and their pain and we look at other parts of their body aside from where the pain is, they might say that’s not where it hurts. However, they have to let us treat the parts that do not hurt, because tissue tension in other parts of the body that does not have symptoms is still important to treat. Dr. Papenbrock adds that it creates biomechanical changes in your body that aren’t efficient, which ends up leading to more tissue tension in other areas, which could have been prevented if the whole body was treated from the very beginning.

The Differences And Similarities In My Practice And Dr. Lisa Papenbrock’s

Dr. Papenbrock’s practice is different from mine because my practice is insurance-based. Insurance does not, however, cover maintenance care. Dr. Papenbrock treat people in that realm and she actively prevents problems. I will give you exercises to do at home so you do not have to come back since insurance will not pay for it, but Dr. Papenbrock treats people and prevents their injuries because she works with people who have a lot of hobbies and do not want to end it.

Dr. Papenbrock went ahead and talked about what her appointments look like. She noted that she sees two patients in an hour and works hands-on with them for 25 minutes each. Most of her patients also come in every two weeks or once a month depending on their activity level.

As for treatment, she said that when someone comes in for neck pain, she will still treat them from their hips upwards. She will primarily focus on the shoulders, neck, and jaw areas, but she will work all the way into the hips. When someone comes in and the pain they were feeling goes away, they would also start to notice the other pains in their body. She noted that people will likely feel the most intense pain first, and will only notice the other pains in their body when the acute pain subsides.

For example, when a person feels lower back pain and then a neck pain, the lower back pain will not vanish, but the brain focuses more on the neck pain. Once the neck pain is under control, the lower back pain will not just reappear as it never vanished in the first place and has been there the whole time. So, Dr. Papenbrock said she really treats the whole body of a patient so that the patient will adapt more and more to what they are experiencing.

To add to Dr. Papenbrock’s practice, it’s a good way to keep doing the things you love and not have an injury because once you have an injury, you usually have to step back from the things you love doing and take time to rehabilitate. Prevention feels good and it’s a lot more affordable when you are not getting hurt in the first place.

More on insurance, people cannot get different parts of their body treated in the same appointment. So they might go to physical therapy many times to treat the different parts of their body but with Dr. Papenbrock and I, we get to treat the whole body in one visit. She noted that we are not limited with what to treat because many of the body parts are related to one another and tied with one another.  We share the same sentiment that we went to school to do what we feel as doctors are best for our patients.

To end this, what we can promise is we will keep evolving our practice so you can have better care.

You can check out Dr. Lisa Papenbrock and her courses here. You can also reach out to her if you have any questions through her website’s contact page.

If you have any questions, you can drop it in the comment section or you send me a message through Facebook or Instagram. I’d be happy to do another podcast about your questions. Also, if you want me to talk about something specific, let me know!

You can also check my TikTok account as I use the platform to educate viewers about movement, chiropractic education, yoga, pregnancy, and more! 

Thank you for listening and see you next week!