Soft Tissue Therapy
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Soft tissue therapy (STT) is the assessment, treatment and management of soft tissue injury, pain and dysfunction primarily of the neuromusculoskeletal system. Licensed health care professionals who typically provide soft tissue manual therapy include chiropractors, massage therapists, physical therapists and some osteopathic and naturopathic doctors and other providers of manual therapy. Repetitive strain injuries (RSIs) also known as cumulative trauma disorders (CTDs) of the soft tissues are becoming increasingly prevalent and account for the majority of disability and impairment cists.[citation needed]
Typically, regulated healthcare professionals who provide soft tissue therapy have a background in anatomy, physiology, pathology, pathophysiology, biomechanics, functional anatomy, as well as tactile/palpatory and functional movement assessments.
Postural and functional assessments
Clients presenting with a specific complaint/s will generally undergo a number of assessments that will each provide information about the client's soft tissue status. These assessments are conducted according to the client's presenting signs and symptoms. The purpose of this process is to help identify the most likely cause of the pain or injury. They may include assessments of posture, biomechanics, range of movement, nervous system, among others.
When the findings of an assessment suggest that the client may have a condition or signs and symptoms that are beyond the scope of a practitioners skill-set, training, and/or specialisation, they will refer that client to the most appropriate healthcare professional.
Treatment strategies
The specific treatment application of an ache, pain, or injury will be solely reliant on the conclusions reached by the assessments. Any number of treatment techniques may be used to achieve optimal treatment results.
As with most professions, the more refined the practitioner's skills, coupled with their understanding of anatomy, physiology, and dysfunction the more intricate may be the treatment applications.
Manual techniques
- Trigger Point techniques provide relief from Myofascial Trigger Points.
- Myofascial Therapy, that targets the muscle and fascial systems, promotes flexibility and mobility of the body's connective tissues. Likewise, it mobilises fibrous adhesions and reduces the severity and sensitivity of scarring caused by injury or surgery.
- Massage techniques, traditionally known as Swedish Massage, may be used as part of a treatment application. Referred to, in Soft Tissue Therapy, as broad-handed techniques, this mode of treatment aims to reduce swelling and / or inflammation.
- Cross friction create heat, which in turn provides the impetus for the mobilisation of adhesions between fascial layers, muscles, compartments and other soft tissues. Frictions are also thought to create an inflammatory response that instigates a focus to an injured area, thereby, promoting healing, especially in tendon pathologies.
- Sustained Pressure (ischaemic / digital pressure) alleviates hypertonic (tight) areas within muscle and fascia.
- Other Techniques such as Active Release Therapy, Myofascial Release and / or Deep Tissue Massage are all combinations of the techniques listed above.
Generally, any one of these techniques alone, or in combination, may provide the solution to an ache, pain, or an injury. However, claims that any particular soft tissue technique will alleviate a specific condition, predictably, every time, are deceptive.
Stretching
- Static stretches attempt to alleviate excessively hypertonic (tight) muscles.
- PNF stretches (proprioceptive neuromuscular facilitation) are used in an attempt decrease the tone in a muscle or muscle group that is assessed as being hypertonic (tight).
- To treat DOMS (delayed onset muscle soreness), Proprioreceptive Neuromuscular Facilitation (PNF) is typically used.
- The use of very light muscular contractions, in very specific directions is Muscle Energy Technique (M.E.T.). Refined more than 100 years ago in the field of osteopathy, this technique, alters joint restriction and joint range of motion, through altering the length of local musculature.
Exercise prescription
Dysfunctional soft tissues are either too short and tight or too long and weak. Dependent upon on assessment findings, some clients may be required to undertake a series of exercises, to strengthen, or simply to "switch-on" particular muscles or muscle groups.
Tapping
Soft tissue practitioners and muscular skeletal specialists often use therapeutic tapping or strapping techniques with success to relieve pressure on swollen injured soft tissue or to alter muscle firing patterns or to provide support during healing. These techniques are designed to enhance lymphatic fluid exchange and allow the body to return to its natural healing process.
After an injury to the soft tissue, muscles or tendons due to sports activities, over exertion or Repetitive strain injury such as Carpal tunnel syndrome, swelling often impedes blood flood to the injured area slowing down the healing process. Trained musculoskeletal specialists are effective in relieving pressure caused by swollen tissue and enhancing blood circulation to the injured fascia tissue and muscle mass using elastic tapping.
Advice
As part of an overall treatment strategy, clients will often be required to contribute to their treatment outcomes for optimal benefit. This may be as simple as keeping a series of appointments, to home exercises, to a dietary review, or to some self-massage.
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