Reciprocal Inhibition + STM | Modern Manual Therapy Blog

Reciprocal Inhibition + STM

Those of you following my facebook page know that I have been dabbling in Neurokinetic Therapy a bit after seeing some cases posted in Stop Chasing Pain's page.

Since I have only the textbook to go on, and have not taken the courses, I have only rudimentary explanations for the results I have been seeing. However, I decided to take those principles and apply them to what I am already using in the clinic. Those of you doing any STM, functional release or IASTM can try this too!

Here is an example, the patient you are working on has unilateral cervical and shoulder pain, with restrictions in cervical ROM, and grade 1 restrictions in the left first rib. My manual therapy triad starts with STM/IASTM to the superficial tissues around the first rib. YMMV depending on two things 1) How well the patient tolerates the STM 2) Tone vs. restrictions

Let's take a look at #2

Treating tone normally requires slower strokes starting superficially to decrease it and "peel back" the layers. This is opposed to the rapid "stripping" strokes often used with instruments to reduce adhesions. A few of my patients recently have presented with tone that was not responding to normal STM/IASTM techniques. I had the patient resist scapula depression, which immediately reduced the tone in the upper traps, which in turn responded much faster to the STM, now that I could concentrate on the deeper adhesions.

For the cervical extensors, I resisted cervical flexion, which reduced tone in the extensors, then worked on them with the EDGE, and was also able to get deeper, much faster. I estimate using reciprocal inhibition will reduce the overall treatment time of most areas by 3-5 minutes.

Try it and let me know what you find!


  1. Great post Erson. I really like using a lot of RC (reciprocal inhibition) with my manual work, not only STM. I feel that it provides interaction as opposed to passiveness. With the c-spine I use resisted capital flexion as opposed to resisted cervical flexion. I have found that the cervical extensors and in particular the multi joint muslces (i.e. upper trap, splenius, and cervical e-spinae) can contract to stabilize the neck in a forward head position, which is the method people will try to produce if they are not cued to only do capital flexion.

    Resisted scapular depression I too use a ton for any muscular tightness of the upper trap. It shuts it off faster than anything else I do.

    Glad to see someone else finding these same results.

    Eric Kruger DPT

  2. Thanks Eric! Tried resisted cap flexion today, and of course worked better than cervical flexion for the posterior upper C spine.

  3. Hi Erson,
    Great info as allows! Integrating thr neuorological sysytem into treatment techniques is a great added tool. The next step would be to re-teach the neurological system , (via the motor learning center ), the correct pattern of movement. This is done by stretching first (STM/LASTM etx.) directly followed by strengthening of its antagonist. This needs to be repeated at last 2x per day for approx one week in order for the body to "learn the new pattren." This is a great way to integrate your system with Neurokinetic Therapy (NKT).

    All the best

    Robert Shapiro MA PT COMT

  4. Any chance you could post a video of resisted scapula depression? What are your cues to the patient?

  5. I'll try and film a quick one today if I get the chance. Basically, I use my webspace on the inferior angle of the scapula with the patient's involved side up in sidelying. I tell them to meet my resistance and lightly push the inferior angle superiorly to get them to fire their lower trap. This inhibits the upper trap after 3-5 seconds, then I get to work!