Soft tissue therapy

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 bodywork practitioners (such as massage therapists), occupational therapists, physical therapists and some chiropractic, osteopathic and naturopathic doctors.^[1]

Typically, regulated healthcare professionals who provide soft tissue therapy have a background in anatomy, physiology, pathology, pathophysiology, biomechanics, and functional anatomy, as well as tactile/palpatory and functional movement assessments.

Postural and functional assessments

Assessments are conducted according to presenting signs and symptoms, with the purpose helping to identify the most likely cause(s) of the pain or injury. They may include assessments of posture, biomechanics, range of motion, and the 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 specialization, 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.

Manual techniques

• Myofascial Therapy targets the muscle and fascial systems, promotes flexibility and mobility of the body's connective tissues. Likewise, it mobilizes fibrous adhesions and reduces the severity and sensitivity of scarring caused by injury or surgery.^[2]
• 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 mobilization 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.
• Soft Tissue Technique where the practitioner applies firm, direct pressure to relax hypertonic muscles and stretch tight fascial structures.
• Sustained Pressure (ischaemic / digital pressure) alleviates hypertonic (tight) areas within muscle and fascia.
• Trigger Point techniques claim to address Myofascial Trigger points, though the explanation of how this works is controversial.

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 stretching attempts to alleviate excessively hypertonic (tight) muscles.
• PNF stretching (proprioceptive neuromuscular facilitation) is 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 on assessment findings, some clients may be assigned a series of exercises, to strengthen particular muscles or muscle groups. In some cases the muscles may be having trouble firing, which is addressed with a combination of manual therapy and exercises. Exercises may also be used to retrain correct joint movement.

Taping

Soft tissue practitioners and muscular skeletal specialists often use therapeutic taping techniques to relieve pressure on swollen injured soft tissue or to alter muscle firing patterns or to prevent re-injury during healing. Some of these techniques are designed to enhance lymphatic fluid exchange.

After an injury to the soft tissue, muscles or tendons due to sports activities, over exertion or repetitive strain injury, swelling often impedes blood flood to the injured area, which slows the healing process. Elastic taping methods may be used to relieve pressure caused by swollen tissue and enhancing blood circulation to the injured fascia tissue and muscle.

References

1. "Soft Tissue Sports Massage". The Treatment Table. The Treatment Table. Retrieved 2016-06-07.
2. Paul van den Dolder, Paulo Ferreira, and Kathryn Refshauge. "Is soft tissue massage an effective treatment for mechanical shoulder pain? A study protocol". National Institutes of Health. US National Library of Medicine. Retrieved 2016-06-07.