20 Oct ACTIVE RELEASE TECHNIQUE…Train Better. Get what the PROS GET.
ACTIVE RELEASE TECHNIQUE
Active Release Techniques® (ART) is one of the fastest growing treatment methods in sports rehab and physical medicine practices today. With the ability to treat injuries quickly and effectively, athletes all over the world have incorporated ART into their training regimens.
“All Athletes and Weekend Warriors Have One Thing In Common… Soft Tissue Injuries to muscles, tendons, ligaments, and nerves”. –Dr. Matt Fontaine
“THE MOST COMMON PATTERN OF MOVEMENT DYSFUNCTION WE SEE IN RUNNERS AND ATHLETES IN GENERAL IS POOR MOVEMENT, A LACK OF STABILITY & MOBILITY AND MOTOR CONTROL, RESULTING IN REPETITIVE MOTION INJURIES AND JOINT PAIN SYNDROMES”
Sports and training have the potential to wear us down over time and lead to soft tissue injuries that result in muscle and joint pain syndromes. Soft tissue injuries that limit optimal sports performance are frustrating and can limit or shorten athletic careers or recreational sporting activities. Young athletes tend to ignore their minor injuries, aches and pains thinking that they recover quickly from their pain. Over time the repetitive motions we put our bodies through wear our tissues down until these small injuries finally push our tissues past their capacity threshold , usually manifesting with more severe injury to the muscles muscle and joints causing pain syndromes, limitations of activities, and especially sub-optimal sports performance.
How Do Our Bodies Move When We are Healthy? Fascia, when healthy forms a free gliding interface between and within muscles, allowing free movement to occur. When fascia, muscles, tendons, and ligaments get mechanically overloaded, injury can occur resulting in fibrosis and adhesions that disrupt the “sliding and gliding” of tissues. Simply said, the muscle and other soft tissues get “glued down and stuck together” which limits your ability to move correctly.
The picture above shows muscle and fascia. The fascia is the silk that allows the muscle layers to glide freely during movement. This fascia gets “glued down” after repetitive motion injury or after trauma. So Why Do I have pain? What happened to cause my injury? Hypoxic Fibrous Adhesion Production: Chemical Pathway and Clinical Importance This article written by Dr. William Brady, an ART provider and former ART instructor, details the importance and effects of soft tissue injuries and adhesion formation following such injuries. Because immature scar tissue is weaker than healthy tissue and cannot handle as much load as normal healthy muscle, the following typically occur over time with repetitive use of unhealthy “glued down” tissue:
- Muscles become shorter and weaker.
- Tension on tendons causes tendonitis.
- Nerves can become entrapped.
This can result in reduced ranges of motion, loss of strength, pain, and often numbness and tingling. Special thanks to Dr. Brady, a fellow ART provider, for letting us post this link. An awesome overview of just how important soft tissue adhesion formation is to pain and human performance.
Lets take a closer look at how the body responds to overuse or repetitive motion, like sitting all day at work, or running, cycling, strength training over time. The following is a bit lengthy but thorough explanation of how injuries can occur over time. The following is taken from Dr. Michael Leahy, developer of Active Release Techniques ® Leahy PM. Active Release Techniques Soft Tissue Management System, Manual®.
Special Thanks to Active Release Techniques for use of this picture.
For the mathematically inclined, the following formula can explain how repetitive injuries occur, resulting in the Cumulative Injury Cycle: I= NF/AR Where I = insult to injury, N= number of repetitions, F= force or tension applied, A= amplitude of force, R= relaxation time between repetitions. This easily expresses how low load forces applied over thousands of repetitions with little relaxation time can break down tissue. Simply stated, small movements of low force repeated thousands and thousands of times can breakdown muscle tissue. The body repairs this broken down tissue with inelastic scar tissue. Over time this “scar tissue” builds up and the fascia and muscle get glued down, resulting in restricted movement. We know this occurs to prime mover muscles that are adaptively placed under constant work load to try to stabilize joints for movement because of weak or inhibited deep small stabilizer muscles.
“THE MOST COMMON PATTERN OF MOVEMENT DYSFUNCTION WE SEE IN RUNNERS AND ATHLETES IN GENERAL IS POOR MOVEMENT, A LACK OF STABILITY & MOBILITY AND MOTOR CONTROL, RESULTING IN REPETITIVE MOTION INJURIES AND JOINT PAIN SYNDROMES”
-DR. MATT FONTAINE
The nervous system will learn movements and tasks as we teach them, whether those tasks are functionally correct or incorrect. Faulty movement occurs due to poor motor control which often occurs following overuse and may be initiated in the presence of pain and/or tissue injury. These faulty patterns become learned by the central nervous system and are often sustained beyond the acute pain phase and contribute to the chronicity of muscle and joint pain syndromes. Many athletes try to base a normal and regular workout session on top of this faulty system. This is very frequently why injuries occur while working out. Over time the body exhausts its capacity to compensate and prevent the tissue injury or inflammation and the symptoms finally surface on a more dramatic note.
In his book, Anatomy Trains , Thomas Myers shows us that muscles are only separate in photos in anatomy books. In real life they are connected by spiraling fascial tissue. Movement becomes habit, which becomes posture, which becomes structure”. So what does all this mean? The resulting Cumulative Injury Cycle causes the body to produce tough, dense scar tissue in the affected area as part of the healing process. Simply stated, as we make repetitive movements our muscles will tighten. Tight muscles rub together during movement, which creates friction. This friction creates local irritation. The tightness also restricts blood flow, which reduces the amount of oxygen that goes into the tissues. The body only has one default to repair soft tissue or infection. That is inflammation, which should last only 2-7 days. After which time, the tissues should begin to repair and remodel. But that requires adequate blood flow. As we just stated, tight, restricted areas do not get enough blood flow to flush out inflammatory cells (garbage out) and fresh nutrients in ( groceries to rebuild healthy tissue). As a result, inflammation persists longer than it should and the body forms scar tissue in the area which builds binds up and ties down tissues that need to move freely. As scar tissue builds up muscles become shorter and weaker, tension on tendons causes tendonitis/ tendinosis, and nerves can become entrapped. This can result in reduced ranges of motion, loss of strength, pain, and often numbness and tingling.
The Phases of Healing and Scar Tissue Formation: Overused muscles (and other traumatized soft tissues) can cause changes to your body in three important ways.
- They can cause acute injuries (pulls, tears, collisions, etc.)
- The fascia and muscles can accumulate small tears(micro-trauma)
- The fascia, muscle and surrounding soft tissues become tight which reduces blood flow to cells (hypoxia).
Adhesions or scar tissue can be described as fibrous(inelastic) tissue that is formed over damaged tissue in the natural process of the body’s attempt to heal or fix damaged areas from injury. It is the glue your body uses to repair soft tissue damage. After injury, whether from microtrauma, compressions, strain/sprain, or an acute tear the body will:
1. Develop new capillaries around the injury to establish blood flow.
2. Cause migration and formation of fibroblasts
3. Fibroblasts will lay down extracellular matrix ground substance (glue) which acts like scaffolding to support newly formed tissue repair.
4. Finally, the maturation and reorganization of the scar tissue. Scar tissue gets laid down in a criss-cross latticed pattern, while normal healthy soft tissue has it’s fibers running in parallel. Thus, the scar tissue must be realigned for it to become truly mature and function like normal pre-injured state soft tissue.
Figure C: shows microscopic view of healthy tissue, fibers running in parallel. Figures F and I: Unhealthy tissue with adhesions
Immature scar tissue cannot be loaded in a normal manner without further injury. Currently there are no reliable imaging protocols to identify scar tissue. It must be done via hands on palpation of a skilled practitioner who can detect biomechanical dysfunction. Recent research concludes that hypoxia can lead to cell death, fibroblast proliferation and free radical formation. Free radical production leads to more fibrous adhesion formation.
What can I do to treat and resolve these injuries? There are non invasive treatments for soft tissue injuries…
As stated earlier, the fascia, when healthy forms a free gliding interface between and within muscles, allowing free movement to occur.
When fascia, muscles, tendons, and ligaments get mechanically overloaded, injury can occur resulting in fibrosis and adhesions that disrupt the “sliding and gliding” of tissues. Simply said, the muscle and other soft tissues get “glued down and stuck together” which limits your ability to move correctly.
Active Release Techniques ® is a patented, state of the ART soft tissue movement based treatment that is used to locate and break down scar tissue that results from soft tissue injuries to muscles, tendons, ligaments, fascia, and nerves. Active Release Techniques® are done using a hands-on method of locating and correcting problem areas in and between soft tissues such as muscles, nerves and tendons. The primary principles are; active patient motion, specific contact method and internal gliding of tissues. The main concept is to reestablish proper motion between fascial structures thus reducing fibrous adhesions and reestablishing neural and myofascial glide between tissues. Simply put, the tissue is placed in a shortened position; the contact is taken with emphasis on tension of the tissue rather than compression. The tissue is placed in motion to lengthen it while the lesion is palpated, held and allowed to release.
- Tension is applied with the hands into the scar tissue or restricted fascia.
- The muscle is shortened, then lengthened under tension to release tissue.
- This is repeated several times to release the tissue, stretching the adhesion, restoring blood flow, improving
ART Treatment on the Neck
Active Release Techniques, ART® specifically locates and treats the problem areas in the soft tissues. There are some 500 protocols for ART® and they are unique and the technique is patented. They allow providers to identify and correct the specific problems that are affecting each area.
But my doctor told me I had arthritis. What can I do? Is my problem a tight muscle? Do I need to strengthen muscles? Do I have a joint problem? What can I do about my pain?
These are all common questions we hear in clinic everyday from patients. The simple answer is that you need a specific diagnosis and a specific treatment to allow for effective resolution of your pain. All too often athletes with chronic pain continue to suffer even after having physical therapy, joint injections, or surgery because the soft tissue adhesions in the muscles were not detected and treated.
The right tool for the job makes all the difference. A comprehensive approach should include a Functional Movement Screen™, followed by appropriate treatment if needed to address soft tissue adhesions and joint dysfunction. These treatments should be accompanied by mobility work (foam roller, LAX ball, band assisted stretches). Properly prescribed exercises to address both mobility and stability and motor control for movement patterns are essential to optimizing sports performance. Proper movement screening is important to detect poor movement patterns. This can give the trained sports medicine professional tremendous insight as to which soft tissue may be involved. Once soft tissue restrictions are identified, they must be addressed and properly treated to allow for corrective mobility/ stability exercises to be optimally effective. In cases where soft tissue adhesions are present you must free up tissue gliding between muscle planes to allow stretching to be effective. ART® releases the scar tissue and restores normal internal gliding of muscle layers, making the foam roller and stretching exercises much more effective at improving mobility and preventing future injury.
A comprehensive sports medicine approach should include
1) A team coach for the sport
2) A strength coach and/or Athletic Trainer
3) A Chiropractor/ Physical Therapist who is a certified ART® and
4) A medical doctor who specializes in sports medicine and
Get the best care you can by incorporating all these people into your team of Human Performance specialists.
A Quick Note on Surgery There are times when surgery is necessary. ART® is essential to the overall success of the surgical procedure. Pre-surgical treatments can begin to clear up soft tissue areas that are not functioning properly and may have contributed to the injury in the first place. Post surgically ART® is vital to aiding release of scar tissue and quick recovery of normal muscle function. This aids in the rehabilitation process. If an athlete has had surgery, physical therapy and has not made a complete recovery, it may be time to try ART®.
Find a local Active Release Techniques Ironman Provider here
Special thanks to Dr. Michael Leahy for all his great work in developing and advancing the Active Release Techniques Soft Tissue Management System. His work has provider us providers with an amazing tool to detect and resolve soft tissue lesions in a way that is fast, efficient, and unsurpassed.
References
- Kumar V & Ramzi Cotran. Robbins Basic Pathology 7th ed. Elsevier; pp 69-77.
- Falanga V, & Kirsner RS. Low oxygen stimulates proliferation of fibroblasts seeded as single cells. J of Cellular Physiology. 1993 Mar; 154(3):506-10.
- Leahy PM, Active Release Techniques: Soft Tissue Management System. 2nd Ed. 2008; pp 8-16.
- www.activerelease.com
- Hinz, B. The myofibroblast: paradigm for a mechanically active cell. J of Biomechanics 2010 Jan 5;43(1):146-55.
- 6. The First International Fascia Research Congress. 2007 Harvard Medical School www.fascia2007.com
- 3. The Second International Fascia Research Congress. 2009 Vrije Universiteit http://www.fasciacongress.org/2009/