Active Release Technique/Laser Therapy
Treatment for Musculoskeletal and Nerve Soft Tissue Injury
Soft tissue injuries come about in many ways, slips, falls, sports injury, automobile accidents, and repetitive motion to name a few.
A soft tissue injury occurs when a muscle, nerve, fascia, tendon, or ligament is damaged. Tissues may be damaged suddenly, as in a whiplash type injury from a rear end automobile collision (acute injury,) or over time from micro trauma to the tissues, as from the repetitive motion of keyboard entry causing carpal tunnel syndrome. Micro trauma eventually leads to a condition called Cumulative Trauma Disorder (CTD.) The term "trauma" is not really accurate when used with this description, but it is widely accepted. It would be more appropriately called Cumulative Injury Disorder (CID) as it is injured from over use, not trauma. If an acute injury is not treated properly a CID cycle may be initiated.
When soft tissue is damaged the process of inflammation occurs releasing chemicals in the area that cause swelling, heat, and pain. The fourth sign of inflammation, redness, may not visible if the tissues involved are deep to the skin.
The process of inflammation causes the formation of scar (fibrotic) tissue. Scar tissue is an important part of the normal healing process as it forms a crude patch to knit the damaged tissue together, and impedes the invasion of bacteria when the skin is broken. However, when scar tissue forms beneath the skin adhesions between tissue layers may form, and restrict normal motion of all tissues involved. This presents a particular problem as we need freedom of movement between the layers of tissues, and of the joints where tendons, ligaments, and muscles attach. Normally, the surface of the tissue layers are slippery and will slide against adjacent tissues when the body is bent, stretched, twisted, etc. As most soft tissue layers run their fibers in different directions, when scar tissue adheres them together (the fibrotic adhesion) contraction in one direction may cause a painful stretch in another, especially when a nerve is involved. Examples: 1. A whiplash injury initiating a fibrotic adhesion between a muscle of the upper cervical spine and the dura mater (the protective covering of the spinal cord,) is a major cause of chronic headaches. 2. Anyone who has had abdominal surgery will remember how painful it was when the nurses had them up and walking as soon as they could stand up. If they fail to move around enough, adhesions form between the muscles layers that cause great pain with movement and/or stretching the abdominal area.
Scar tissue shortens as it ages. In the case of a muscle strain (torn muscle fibers) scar tissue forms across the contractile tissue. Usually, due to pain, it is difficult to extend and stretch that muscle. After the repair phase of healing has occurred (up to six weeks after initial injury) the scar tissue continues to modify and reform itself (remodeling phase of healing) for up to a year or longer. It continues to shorten, and gets stronger, restricting movement and/or stretching of the tissues involved. A condition called "denervation supersensitivity" develops as the scar tissue begins its formation. Nerve endings grow into the developing fibrotic tissue making it "super sensitive" further restricting the motion of the affected tissue due to pain, and may be a contributing cause of fibromyalgia. Standard soft tissue treatments (ice, heat, rest, ultra sound, massage, etc.) offer limited success for the affected tissues.
Laser Therapy (Photobiomodulation)
Laser therapy has been around since the 1960's in Europe, but was not recognized by the United States Federal Drug Administration (FDA) until 2002 for the class III laser, and 2003 for the class IV lasers. The laser in use at Mid-Michigan Chiropractic Center is a (K-Laser) class IV laser and was approved for use by the FDA in June 2010.
Laser therapy is used to treat a variety of conditions such as the musculoskeletal pain of the head, neck, back, shoulders, arms, elbows, wrists, hands, fingers, legs, hips, knees, ankles, feet, etc., and neurological pain such that is found in, but not limited to headaches, diabetic neuropathy, radicular pain, plantar fascitis, carpal tunnel, sciatica, etc. There are over 2500 medical studies that show the physiological effects of laser treatment and why it works. Click here for more information on laser therapy.
Active Release Techniques®
Professional education for soft tissue injuries (muscle, tendon, fascia, ligaments, and nerve treatment) has been generally ignored in the healing arts. The standard of care for soft tissue injuries has been rest, drugs, massage, ultra-sound, exercise, cold, and/or heat with limited success. Knowledge of identifying how the tissues move in relation to one another was poor at best, until now.
Active Release Techniques® (ART®) is a highly specific method of dealing with fibrotic tissue adhesions that cause pain and restricts normal motion between soft tissue structures. Adhesions can develop between muscle group or muscle and nerve (example: Back pain, neck pain, carpal tunnel syndrome, arm pain or numbness, or sciatica to name a few symptoms) causing mild to severe pain. Active Release Techniques® releases the adhesion helping to restore normal movement between the soft tissue structures, thereby reducing or eliminating the symptoms in the vast majority of cases.
ART® is a type of manual hands-on therapy that corrects muscular and soft tissue problems that are caused by adhesions. Soft tissues are muscles, nerves, tendons, ligaments, blood vessels and the connective tissue that surrounds or contains those soft tissue.
The ART® soft tissue management system is based on scientific evidence that muscles, nerves, blood vessels, and connective tissues develop adhesions within, around and/or between them after acute or repetitive motion injuries.
Our bodies contain a special tissue known as fascia. This tissue connects each part of our internal structure to other parts of our body very much like a flexible skeleton, holding the parts together yet allowing motion. When this tissue is healthy, it is smooth and slippery, allowing muscles, nerves, and blood vessels to move freely against the body part next to it. Imagine a piece of scotch tape, where the smooth side is healthy fascia, and the sticky side is scar tissue or unhealthy fascia. Rub both sides of the tape along your skin to “feel” how it can either slide freely, or stick to your skin as an adhesion would “gluing” tissues together within your body. That pulling sensation from the sticky side is similar to what an adhesion would be. If the adhesion is between muscles there will be a loss function of a joint, stiffness, and/or pain upon movement. If the adhesion is to a nerve and another structure, you may experience numbness, tingling, weakness, and/or pain with or without movement.
Adhesions cause altered function of muscles and joints resulting in a wide variety of symptoms that characterize the cumulative injury cycle. Cumulative injury is a series of injuries to the soft tissues of the body. It is helpful to understand that cumulative injury results from acute injury, repetitive motion injury, or a constant pressure or tension injury, all of which lead to what we term as the cumulative injury cycle. It is the existence of the cumulative injury cycle that separates this disorder from other injuries of the neuromusculoskeletal system.
The cumulative injury cycle is self-perpetuating, and as this downward spiral continues, the symptoms and syndromes typically worsen. These may include tendonitis, muscle pulls or strains, myofascitis, fibromyalgia, bursitis, trigger points, peripheral nerve entrapments, thoracic outlet syndrome, strength imbalances, poor flexibility, chronic muscle or joint pain and stiffness, chronic fatigue, carpal tunnel, and other conditions or symptoms.
The cumulative injury cycle can be started in three ways: Acute injury, repetitive motion injury, and/or constant pressure or tension injury. Left uncorrected the injuries can lead to chronic inflammation, adhesion/fibrosis, weak and tense tissues, and decreased circulation to the tissues involved.
Our bodies are very adaptable; they have to be to survive. Our bodies warn us of damage with pain signals, and repair damaged areas. Very often, we think we are “better” after several days to several weeks and the pain has gone away. What has happened is that the body has healed the damaged area with scar tissue. You may not be aware of your “new” problem for weeks to years from the onset of the original injury depending on how much the area is stressed. You may recognize adhesions as a loss of function: Decreased ranges of motion of a joint, weakness of an area, stiffness, soreness, pain upon exertion, or many of the symptoms that are associated with “getting older.”
The goal of ART® treatment is to release adhesions from the layers of soft tissue and improve your condition. Typically treatments may be uncomfortable at first as tissues are stretched. You may even feel a slight burning sensation as adhesions are released. These are all normal responses, however all procedures are performed within your tolerance for discomfort. There is rarely residual discomfort following treatment. Unfortunately there is no painless way to free adhesions, but everything is done within your comfort zone. On rare occasions bruising of the skin may occur. You may also be “sore” for up to 36 hours after treatment as if you had exercised hard. Most people immediately notice a “loose” feeling with better mobility of the affected area and a reduction of their symptoms.
ART® is not like a massage. Massage generally promotes relaxation and circulation. Neuro-muscular massage gets more specific, but it does not fix soft tissue adhesion or restore improper function as does ART®. ART® protocol is very specific for the correction of soft tissue adhesions. Anyone who has experienced it will tell you it is NOT massage!
The ART® practitioner must have a detailed knowledge of anatomy and a sensitive touch to locate the involved tissues. Most cases presented are chronic. Old sports injuries, chronic back and neck pain, repetitive motion injuries, failed back and neck surgeries, and carpal tunnel syndrome are but a few examples that are treated with reasonable success. Most acute injuries can be treated as well. The following is an example of how a fibrotic condition (adhesion) can occur from a repetitive motion injury. A simple "muscle knot" or a sustained muscle contraction will deprive an area of blood, oxygen, nutrients, and a thyroid hormone called T3. When a muscle has been deprived of T3 for even a few minutes it will lose the ability to relax, setting the stage for inflammation, fibrosis, denervation super sensitivity, etc. A reduction in the partial pressure of oxygen (to 55 mm of Hg) due to the restriction of blood to an area in that muscle will start the inflammatory process that causes the fibrotic condition (adhesion) to proliferate. ART® works directly with the fibrotic area. In the hands of a skilled ART® practitioner the fibrotic lesion is located and removed or reduced. With the restoration of normal tissue motion, pain is decreased or eliminated, joint motion improves, and normal or near normal activities can be resumed. See the above reference on Musculoskeletal Soft Tissue Injury.
A written examination and an intense hands-on training is required to be certified as an Active Release Techniques® practitioner.
Dr. Charles Graham is a certified instructor for ART®. Click here for more information on Active Release Techniques® and to find a qualified provider near you.
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St. Johns, Michigan 48879