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.
Patients 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.
Simply noted, soft tissue is everything other than bone. Soft tissue does include the organs, but our interest is: muscles, tendons, ligaments, bursae, fascia and nerves. The treatment of these structures is known as soft tissue mobilization. The basis for this method of treatment is several fold. When trauma occurs, whether it be major trauma, or repeated microtrauma, inflammation occurs. The inflammation leads to fibrous tissue formation (scar tissue) in the muscle, between the muscles and between the layers of connective tissue. This fibrous tissue formation causes a decreased ability of the muscle to lengthen and contract as it normally does which in turn leads to a decreased range of motion. This effect can be very local within a muscle or can affect the muscle groups very broadly. The fibrous tissue can also cause pain and a predisposition to re-injury in the same injury. Additionally, pain can lead to muscle guarding, or splinting. The guarding protects the injured area. If the contraction of the muscle guarding is prolonged, the muscle can lose its normal length by the process of adaptive shortening.
Soft tissue mobilization addresses the previously described complication of soft tissue injuries. There are really two components to soft tissue mobilization. By definition, manipulation implies high velocity, high amplitude thrust or motion. Mobilization implies low velocity, low amplitude thrust or motion. The soft tissue is mobilized by the doctor’s hands as his/her hands/fingers move through the muscle. The patient has the involved joint moving as well. This motion is joint mobilization which occurs simultaneously during the soft tissue mobilization. This motion may occur with the patient performing all the motion (active), or with help from the doctor (active-assisted), or entirely by the doctor (passive). All of the muscles surrounding the injured joint/region are treated (mobilized) and the joint is moved (mobilized) in all planes of motion and this makes the treatment time consuming. The treatment can be modified to be sport specific or task specific if needed or required. Joint manipulation is used as indicated.
As an integral part of treating most musculoskeletal injuries; we feel that is essential to use manual techniques of the soft tissue related to the injury, related body regions and kinetic chain. Soft tissue such as muscles, tendons, ligaments and fascia need to be assessed for integrity and function. Some techniques not only reverse the outcome of conditions once thought to be permanent but will help acute injuries from becoming chronic. This comprehensive treatment approach has greatly improved our outcomes and necessary treatments for patients.