Jun 2014 14

Soft tissue release

By: Dave Wheeler

In an earlier guest blog, Mel Cash (the father of sports massage) described why he thought that highly trained “sports massage therapists” should drop that label and adopt the title “Remedial Soft Tissue Therapist”.

One of the reasons that Mel mentioned was that we use a range of techniques, only one of which is massage. Some of the techniques that we use are borrowed from the other “physical therapies” such as osteopathy and physio, whilst yet others are unique to the profession.

One of these techniques is called soft tissue release (STR).

 

What is soft tissue release?

Soft tissue release (or STR) is a technique of assisted stretching of muscle fibres, tendon and fascia.

STR involves repeatedly and quickly stretching small areas of the soft tissue.

Precise pressure is applied to part of the muscle which is then moved to achieve a very specific stretch.

 

soft tissue release of the hamstrings

 

The STR technique

The technique itself is very straightforward and is summed up in the 3 words:

  • shorten
  • lock
  • lengthen

 

  1.   Firstly, the muscle is shortened. Normally this would be to a neutral position - that is, where the muscle is neither contracted nor stretched.

For example if the hamstrings were being treated, then the client would be face down (prone), and their leg would be held bent up (flexed) at the knee at 90°.  This is passive shortening: passive because it’s the therapist that’s doing it; the client isn’t actively moving their limb into a particular position.

What’s important though, is that the muscle is shortened - in some cases a particular muscle can’t easily be placed in the neutral position. For example, the easiest way to perform STR on the thigh muscles of the quadriceps is to have the client seated with the leg fully extended forward at the knee - here the quadriceps aren’t in neutral, they’re fully shortened (contracted), but the STR is still extremely effective.

 

  1.   Secondly, the therapist applies a lock to the specific muscle area. The lock is usually applied close to the origin of the muscle (the origin of a muscle is the end attached to the bone which isn’t going to move).

The first time the STR stretch is done, this lock is applied proximal (close to) to the muscle origin along the direction of the fibres. Often, as the stretch is repeated, the lock is moved further away from the muscle origin.

For the therapist, the idea is to create a false insertion point for the muscle - in other words to artificially shorten the muscle. This has the effect  of the force of the stretch acting over a much shorter length of muscle than would otherwise be possible; as such the force of the stretch is much greater between the origin and the lock.

The lock can be applied in a number of different ways:

 

  • thumb

  • forearm

  • fist

  • elbow

  • fingers

 

  1.   Thirdly a stretch is applied between the origin and the lock by the movement of the limb.

The stretch is achieved by using the limb of the client as a lever to create the forceful stretch between the muscle origin and the false insertion of the lock.

The 2 main types of STR are:

a. Passive soft tissue release

Here, the therapist moves the client’s limb (that is, the client is passive).

Generally speaking, passive STR is useful when warming up large areas of muscle before more direct precise work. It can be gentler than having the client move the limb (not least because the therapist is applying the lock working one-handed)

Passive STR is also useful to educate the client on the movement required before moving into active STR.

b. Active soft tissue release

With active soft tissue release, the client actively moves the limb.

This is likely to produce a more forceful stretch, and so the general area is best warmed up first with passive STR.

Active STR also allows the therapist to apply a greater degree of precision by focussing on the lock, whilst the client focuses on the movement to generate the stretch.

 

soft tissue release of achilles tendon

 

When is soft tissue release used?

STR is a useful technique in a number of different circumstances:

  1. Treatment of pain

According to Deyo and Chawkins (1996), 95-98% of all chronic pain is of a soft tissue origin.

The advantage of using STR to treat chronic muscular pain is that it can target small areas of muscle precisely.

So, for example, carpal tunnel syndrome may respond well to precise, gently applied soft tissue release.

 

  1. Pre- & post-race

Broad-stroke passive STR can be a very effective pre-event warm-up treatment. It’s important that the technique isn’t applied too aggressively, though - the aim is to warm the muscles up here, not to increase range of movement.

One semi-professional runner that I treated used passive STR as his pre-race warm up. It wasn’t part of his warm-up routine, it WAS his warm-up routine.

STR can really come into own post-event, to help stretch out the muscles, especially after long races. The focus here, is usually on the major muscle groups, such as quadriceps or hamstrings.

 

  1. Mobility

Using soft tissue release, chronically hypertonic (tight) bundles of muscle fibres can be stretched whilst the surrounding normally pliable muscle fibres can be left untouched.

It’s this specificity which gives STR it’s real power as a therapeutic technique in the clinical setting

 

How does soft tissue release work?

The honest answer is, nobody really knows. I can rationalise it, but that’s not the same as there being any real research or proof.

The first thing to say is that STR is counter-intuitive.

I’ve written before about the stretch reflex - a natural reflex that the body has against stretching. The message between muscle and central nervous system takes 1-2 milliseconds, which means that the muscle could start to resist the stretch pretty much instantaneously.

It could, but it would seem that it doesn’t. It seems as though, providing the stretch is only for around a second, the stretch reflex is held in abeyance when STR is performed.

For reasons that aren’t entirely clear, these very short stretches which last less than a second seem to bypass the stretch reflex. It might have something to do with the brain overriding the reflex of the central nervous system in the clinical setting, or there might be a more mechanical explanation. Whatever the reason, the 1-second stretches of STR seem to have the effect of stretching the soft tissue, even though the stretch-reflex theory suggests that they shouldn’t.

In any event, it seems to work.

Soft tissue release is a really useful technique. It should be pretty clear, though that whilst the technique is easy to describe, it works best when your therapist really understands muscle & tendon anatomy and the precise actions of each of the areas of muscle that he or she is dealing with.

As ever, if you think I can help, give me a call.