TMR Tots was developed by Susan Blum in 2008 as a pediatric application of Total Motion Release. Total Motion Release (TMR) is a physical therapy system developed in 2002 by Tom Dalonzo-Baker for the assessment and treatment of pain. (1-12)
The Science:
TMR techniques were developed in the clinical setting and are based on sound anatomical and scientific principles. Range of motion is increased and pain relieved utilizing a modified Counterstrain method based on the original work of Lawrence Jones, DO.in the 1950’s, (13)
An excellent reference describing this technique is the manual used in training osteopathic physicians (14). A key contributor to this work was William Devine DO, Director of Osteopathic Medicine and the Director of Postgraduate Osteopathic Manipulative Medicine for the AZCOM Osteopathic Postdoctoral Training Institute (OPTI). Dr. Devine has mentored Susan. Blum the developer and instructor of TMR Tots.
A recently published, peer reviewed manuscript, written by a team of world renown pain researchers, describes the formation and maintenance of inflammatory, interstitial stasis (trapped inflammation between our cells.) This form of persistent inflammation is specifically targeted or “released” by the counterstrain techniques. The paper offers insight into the complex world of fascia, inflammation and pain receptors and describes the hypothesis why TMR has become an ideal treatment choice for multiple difficult to treat medical conditions (15).
Significance In Therapy
Restrictions in range of motion create imbalances in postural alignment and mobility. TMR Tots utilizes the same fascial release techniques to identify and treat restrictions creating limitations in motor development.
The primary impairment in children with hypotonia and other neurological challenges is a deficit in postural control (stability) limiting ability to sustain vertical alignment against gravity. The pull of gravity produces a flexed posture resulting in restrictions from prolonged immobilization creating blocks in mobility. Poor alignment results in fatigue, challenges to attend, and substitution for lack of range of motion inefficient compensations in struggle to move. The result places a ceiling on potential skill development.
Why TMR Tots?
Restrictions resolve with TMR treatment to clear the stasis and allow skeletal. muscles to be aligned with their correct length/tension relationships. Removing the blocks is the preparatory work in creating a foundation for optimal benefit from traditional physical therapy strategies. Once the child’s posture is vertical it is possible to more successfully and begin to build on strengths in the new available – previously inaccessible ranges of mobility.
TMR Tots identifies and builds on a child’s strengths to develop eccentric motor control in expanding ranges from vertical alignment utilizing Kleim’s principles of neural plasticity. (16, 17)
Activities follow the sequence of typical cephalocaudal and proximodistal development and are structured to focus on graded emerging control. The program is structured to minimize the error in trial and error and maximize success to accelerate skill development
The 4 components of the TMR Tots System are: Assess Function, Release, Organize, Activate. • Functional assessment identifies both limitations in function and the associated restrictions in range of motion and a child’s emerging strengths to build upon. • Release utilizes the TMR pain free Counterstrain methods to gain the prerequisites of mobility and alignment to develop control and strength • Organization is sensory input to orient the child to improved posture and body awareness (Supplementation of sensory input is a component of Tots
a) Children with CP which impacts sensory pathways (18)
b) Limited mobility deprives a child of the sensory experiences needed to . integrate somatosensory mapping for the development of motor control • Activation provides targeted facilitation to develop graded control in the newly accessed areas (the discovery zone). building on a child’s strengths and successes moving into expanding ranges.
Accelerated development of motor control has been consistently reported by the over 2,000 therapists are utilizing the Tots concept world-wide. Some of the most dramatic results in postural control and function have been reported with children presenting, with GMFCS 1V & V challenges in India far surpassing any previous clinical experience (19)
The importance of a vertical foundation:
The energy drain from the struggle to function with an asymmetrical posture, can limit a child’s ability to attend and discover their full intellectual potential.
The development of inefficient compensations can limit acquisition of fine motor skills. Improved alignment corrects imbalances in the viscera which can impact all. other systems (pulmonary, gastrointestinal, cardiovascular, etc.) with beneficial results often reported in the child’s overall physiology and well-being. (20)
1. Miley, E.N.; Reeves, A.J.; Casanova, M.P.; Marionick, J.P.; Baker, J; Baker, R.T.; Test– retest reliability of the Total Motion Release® scale, Journal of Sport, 2021,30, 961-964
2. Baker TD. Total motion physical therapy. TMR history. 2021.
http://www.totalmotionpt.com/what-is-tmr/tmr-history/. Accessed February 6, 2020.
3. Wainner, R.S.; Whitman, J.M.; Cleland, J.A.; Flynn, T.W.; Regional interdependence: a musculoskeletal examination model whose time has come. J Orthop Sports Phys Ther. 2007;37(11):658–660.
4. Gamma, S.C.; Baker, R.T.; Iorio, S.; Nasypany, A.; Seegmiller, J.G.; A Total Motion Release warm-up improves dominant arm shoulder internal and external rotation in baseball players. Int J Sports Phys Ther. 2014;9(4):509–517
5. Fyock, M.B.; An analysis of patient outcomes when applying the Total Motion Release® technique to treat patients with patellofemoral pain syndrome: a dissertation of clinical practice improvement. ProQuest Dissertations Publishing: Univ of Idaho; 2016.
6. Walker, J.A.; Physical therapy rehabilitation following total shoulder replacement using Total Motion Release techniques in combination with traditional intervention. MOJ Sports Med. 2018;2(3):96–101.
7. Saira, K.; Mustafa, K.; Kinjol, K.; Effect of Total Motion Release on pain and function in subjects with acute low back pain: a pilot study. Indian J Physiother Occup Ther. 2019;13(3):152–156.
8. Tyree, K.A.; May, J. ;A novel approach to treatment utilizing breathing and a Total Motion Release® exercise program in a high school cheerleader with a diagnosis of frozen shoulder: a case report. Int J Sports Phys Ther. 2018;13(5):905–919
9. Drake, R.; Rhinehart, A.J. Smith-Goodwin, E.; Tecklenburg, L.; Can Total Motion Release increase shoulder range of motion in collegiate swimmers? J Sports Med Allied Health Sci. 2016;2(1):19
10. Dexter RR, Loftis TK, Pettaway AN, Baker RT, May J. The immediate effects of a Total Motion Release® warm-up on active rotational hip range of motion in overhead athletes. Int J Sports Phys Ther. 2019;14(6):898–910
11. Gamma S.C.; Baker, R.; May, J.; Seegmiller, J.G.; Nasypany, A.; Iorio, S.M. ;Comparing the immediate effects of a Total Motion Release warm-up and a dynamic warm-up protocol on the dominant shoulder in baseball athletes. J Strength Cond Res. 2020;34(5):1362– 1368
12. Strauss, A.T.; Parr, A.J.; Desmond, D.J.; Vargas, A.T.; Baker, R.T.; The effect of Total Motion Release on functional movement screen composite scores: a randomized controlled trial. J Sport Rehabil. 2020;29(8):1106–1114.
13. Jones, L.H.; Strain and Counterstrain, American Academy Of Osteopathy, 1981
14. Myers, H.L. ed., Compendium Edition: Clinical Application of Counterstrain, tomf.org.
15. Tuckey B., Srbely J., Rigney G., Vythilingam M., Shah J., “Impaired Lymphatic Drainage
and Interstitial Inflammatory Stasis in Chronic Musculoskeletal and Idiopathic Pain Syndromes: Exploring a Novel Mechanism,” Front. Pain Res., 23 August 2021 |
16. Massery, M,; Braking Bad: Eccentric control from talking to walking 2021, masserypt.com
17. Kleim, J.A.; Jones, T.A.; Principles of experience dependent neural plasticity: implications for rehabilitation after brain damage; J Speech Lang Hear Res 2008;51(1):223-39 18. Schenk, S.M.; Boyd, R.N.; Rose, S.E.; New insights into the pathology of white matter tracts in cerebral palsy for diffusion magnetic resonance imaging: a systematic review Dev Med Child Neurol 2012 54(9) 684-96
19. Blum SM, What is the TMR system?; tmrtots.com 2022
20. Blum SM, Why TMR Tots?; tmrtots.com 2022