More than just a ‘massage’….

Explaining the many techniques of Soft Tissue Therapy

 

Grab yourself a cuppa, and your reading glasses…. this blog may take a while 😉

Sports massage is an increasingly searched for and known about treatment, not just for sports people, but for just about anyone with any level of activity. Also known as ‘soft tissue therapy’, the techniques used, taken from sports science research and practise, can help people prevent injury, improve joint condition, improve postural position, perform better and manage recovery from a soft tissue injury.

So how does it work?

There are five core techniques used by an advanced sports massage therapists.

‘Soft tissue release’ lengthens, improves and loosens tight muscles through bespoke resisted stretching carried out by the therapist, sometimes with the involvement of the patient. ‘Connective tissue therapy’ recognises that broad bands of connective tissue, known as fascia chains, have a huge impact on pain and flexibility so the therapist uses special methods to soothe, loosen and restore them to their optimum state. ‘Frictioning’ of impaired soft tissues breaks down what are commonly known as ‘knots’ but are actually combinations of miniature pieces of fibrous scar tissue, adhesions (sticking together of repairing tissues) and/ or a build-up of metabolic waste products that feel like tiny crystals when rubbed over. ‘Trigger pointing’ is a pressure technique to gently ease a tiny bundle of muscle fibres that are in spasm, back to relaxation. And finally ‘Muscle Energy Techniques’ alter motor nerve reactions which are holding a muscle in a tightened, rigid state.

There might be some situations where it’s not the right time for a sports massage. Being in the middle of a rheumatoid arthritis flare up for example. Or being in the acute stage immediately after an injury, surgery or fracture. Your practitioner might suspect a DVT or dangerous mole, so would refer you quickly to your GP. Or you may show some of the red flags for a damaged disc in your spine, if so your therapist would be well trained in helping you get further advice.

But generally speaking, the evidence shows that there are many benefits of soft tissue therapy, whether you are an active sports person, have a less competitive hobby or sport, enjoy everyday activities like walking or gardening or simply want to maintain comfort of movement in your back and joints.

Wellbeing and cellular healing

Sports massage (soft tissue therapy) can help keep your muscles, tendons, ligaments and fascia (connective tissue) flexible, elastic and unimpaired by congestion or tightness. It can aid wellbeing through pain relief, which is often achieved during a session. It can improve blood supply, white blood cell supply and lymphatic drainage at a damaged area, so allowing faster tissue repair and healing. It can take tight muscles out of spasm meaning that there is greater flexibility around a joint and therefore less discomfort and wear and tear of the cartilage. And it can release tight muscle groups to improve a nerve, vein or artery pathway.

Your practitioner will be trained in the rehabilitation phases too, so that when initial hands on treatment has started working, you can progress to appropriate strengthening exercises to combat atrophy, or strengthen the area around a weak joint.

In a normal, healthy and functioning joint or musculoskeletal body part the soft tissues are elastic, functioning well, moving freely and strong. The aim of sports massage and soft tissue therapy is to bring soft tissue – whether that be tendons, muscles, ligaments or fascia – into the best condition possible to reduce intrinsic restriction, for ease of movement, strength and pain free living.

So, here is some more detail about how you would experience the five main techniques. In all situations, your therapist will have taken a detailed history and carried out range of movement and special tests so that s/he knows which soft tissues to target. Your privacy will be respected, you can wear comfortable sports clothes, such as shorts, and towels will be used to cover you as much as possible.

To explain ‘Soft Tissue Release’ in more detail… Basically a muscle will be gently held and ‘locked’ in place near the attachment point, whilst in its shortened, relaxed state, then stretched out to its full length. Due to the nature of the manoeuvre, it is also known as ‘pin and stretch’. Sometimes the practitioner will carry out this action for you (making that a passive experience for you), and sometimes you will be asked to move so that the muscle is taken through the stretch (active STR). This technique creates a lengthening of muscle fibre bundles, increasing range of motion, and can help break down adhesions and stimulate blood supply.

In simple terms, STR can be seen as targeted, constructive in its specificity, and more beneficial than stretching you can do yourself. It has an unbinding effect on muscles fibre adhesions (intramuscular) and myofascial adhesions (muscle to fascia). It is very useful for hypertonic hip flexors and a piriformis muscle which is irritating the sciatic nerve, although it can be used on any muscle which is reachable by the practitioner.

To explain ‘Connective Tissue Therapy’ in more detail… Although the bands and chains of connective tissue fascia found in the body do have their own nerve supply, this therapy works in reshaping and remodelling connective tissue collagen structures. Fascia is a complex soft tissue, like a biological fabric, amazing when viewed under a microscope, with web like sheets that constantly adapt between viscous and fibrous. Fascia is’ visco-elastic’, and its sheet formation is sometimes extremely thin (such as around muscles) and sometimes multi-layered (such as plantar fascia in the foot) around and between muscles, bones and organs. As it becomes increasingly recognised in medicine as having stabilising, force transmission, balance (proprioception) protective and organisational functions, sports massage therapists know that stiffness and damage to fascia can also be a source of your pain or lack of mobility.

So there are several techniques your practitioner can carry out to check for impaired fascia function, based on the principle that this wonderful structure remodels according to pressure. One is to slowly glide a band of pressure using the palm or forearm along part or all of a long fascia chain (eg the superficial back line) which releases areas of bound tissue. Another is to work on one area of fascia in order to release other areas in the chain. For example deep tissue work to the plantar fascia can help with flexibility of the entire leg. Advice on hydration and regular self-stretching is also given by the practitioner to keep the high-water-content structures in their optimum state and avoid build-up of overnight regrowth stiff/adhesive layers.

 

 

Fibre repair

The next technique is the administering of ‘corrective frictions’ transverse to the direction of the muscle fibres.

The therapist uses her fingers or a special tool to cross fibre friction deeply where there is a build-up of metabolic waste products that feel like a hard knot, or intramuscular adhesions (repairing fibres sticking together in a non-optimum patterns) or intermuscular adhesions (muscle to muscle stickiness or muscle to fascia). The process can also be used on scar tissue which can be on the surface after an injury or surgery, or intramuscular where an area of micro tears of soft tissue is subject to repair with sub-optimal laying down of collagen.

Sometimes in ligaments or tendons (soft tissue to bone), there can be small calcium deposits or ossification around the repair site but this is not suitable for friction massage.

The process will feel comfortable, the tissue will be actively moved and the muscle will have been tested for weakness during the assessment process. And then palpated to confirm. Effectively the therapist is causing some micro damage encouraging correct regrowth of fibres. She is separating sticky fibres, she is encouraging increased blood supply and she is encouraging reorientation of any collagen regrowth.

To explain the next process used by sports massage therapists, it’s useful to briefly explain that sometimes muscle fibre bundles can go into protective spasm to immobilise an area of the body that is problematic due to injury or overuse. This is a natural sympathetic nervous response.  The fibrous, painful areas of soft tissue in spasm are called ‘Trigger Points’. They invoke a referred pain response somewhere else in the body and many typical patterns are recognised. Trigger points can cause pain, referred pain elsewhere and can shorten a muscle affecting range of motion or weaken the muscle.

Once a trigger point is located, pressure will be applied and the therapist will ask for a pain scale feedback, which should be tolerable (no more than 8 out of 10). The client then breathes deeply and relaxes. After a few breaths, the therapist asks for a pain scale feedback again, which should be lower (or sometimes even 0). This is carried out three times. Effectively the therapist is creating a neuromuscular relaxation response.

Interestingly, experiments have been carried out recording the flooding of white blood cells to an area after moderate pressure is applied.

Neuromuscular processes

Finally, the soft tissue therapist has a range of ‘Muscle Energy Techniques’ in her toolkit. These techniques are also neuromuscular and work on the motor neurones. When effective they can both increase range of movement and strength by making the recruitment of more muscle fibre possible and releasing a muscle from being overly shortened.

Post Isometric Relaxation (PIR) is a commonly used technique where the therapist asks the patient to tense or push against her resistance for 10 seconds using the affected muscle (called an isometric contraction). When the tensed muscle then rests after the effort – a stimulation cessation process involving the inhibition of the motor end plate – a relaxation is achieved which allows the therapist to stretch it further.

Alternatively, the antagonist muscle to the affected muscle is used to tense against the therapist’s resistance. This will intrinsically ‘switch off’ the affected muscle so that the therapist can then stretch it further. This is known as reciprocal inhibition.

And sometimes it is as simple as a technique called positional release. An injured, tense muscle is placed in a position of complete relaxation and a pain free state and rest as part of the healing process. This allows for more optimal repair to take place and can switch off the protective spasm.

 

So, there you have it…. the science behind advanced soft tissue therapy…. more than ‘just a massage!’.