If the alarm status is prolonged or repetitive defensive adaptation processes commence, chronic changes are produced. In assessing and palpating the patient these neuro-musculo-skeletal changes represent a record of the attempts on the part of the body to adapt and adjust to the stresses imposed upon it as time passes.

The results of the repeated postural and traumatic insults of a lifetime, combined with the tensions of emotional and psychological origin, will often present a confusing pattern of tense, contracted, bunched, fatigued and ultimately fibrous tissue.⁵

The minutiae of the process are not for the moment at issue. What is important is the realisation that, due to prolonged stress of a postural, emotional or mechanical type, discrete areas of the body become so altered by the efforts to compensate and adapt, that structural and, eventually, pathological changes become apparent. Researchers have shown that the type of stress involved can be entirely physical in nature⁶ (e.g. a single injury or repetitive postural strain) or purely psychic in nature⁷ (e.g. chronically repressed anger). More often than not though a combination of emotional and physical stresses will so alter neuro-musculo-skeletal structures as to create a series of identifiable physical changes, which will themselves generate further stress, such as pain, joint restriction, general discomfort and fatigue. Predictable chain-reactions of compensating changes will evolve in the soft tissues in most instances of chronic adaptation to biomechanical and psychogenic stress⁸. Such adaptation will almost always be at the expense of optimum function as well as also being an on-going source of further physiological embarrassment.

It is on these patterns of dysfunction and the consequent chain reactions they involve that this series of articles will at first focus - how to ‘read’ the signs and symptoms of the body and how to begin to normalise what is dysfunctional.

If successful treatment is to be applied it is important to realise that quite different approaches are needed to release tense muscle which is under neurological control and tense tight muscle which has become fibrotic and which requires a more ‘mechanical’ approach to normalisation.These variables will be considered in a subsequent article.

Stress Response Sequence^{9,10,11,12,13,14,15}
When the musculoskeletal system is 'stressed' a sequence of events, starting with increased muscular tone, occurs as a result of:

• Congenital factors (for example short or long leg, small hemipelvis, fascial, cranial and other distortions)

• Overuse, misuse and abuse (and disuse) factors (such as injury or inappropriate patterns involved in work, sport or regular activities)

• Postural stresses

• Chronic negative emotional states (anxiety etc)

• Reflexive factors (trigger points, facilitated spinal regions - which will be discussed in more detail in a future article)

As a result of which -

• Chronically increased muscle tone develops which leads to a retention of metabolic wastes.

• Prolonged increased tone also leads to localised arterial embarrassment - (relative to the efforts being demanded of the tissues) - resulting in oxygen deficiency in the tissues - ischemia