Gain knowledge to ensure you select the soft-tissue solution that meets YOUR needs
By Jasper Sidhu, DC
Although addressing soft-tissue dysfunction is an important part of chiropractic, there can be some confusion on what tools or techniques are best to use in your practice.
There is no single technique that is superior — it always comes down to your experience, and understanding exactly what you are addressing. Using the right tool in the wrong way won’t get results.
In addition, by not addressing soft-tissue dysfunctions, you are limiting the full benefit of the chiropractic adjustment.
This article presents several soft-tissue solutions that can be incorporated into your practice, with focus on the role of each soft-tissue technique.
Source of soft-tissue dysfunction
Soft-tissue therapy can be broken into several categories: hands-on treatments, instrument-assisted therapy, and self-administered techniques the patient can do between office visits.
Before discussing the various techniques available, you need to know the purpose of applying soft-tissue techniques into your practice. Any sort of trauma, such as a strain or sprain on a muscle, tendon, or ligament, produces micro trauma in the area afflicted.
Once this happens, the body will attempt to heal itself. If this trauma — which can be a single event from an injury or cumulative through repetitive activities — is not addressed, the injured tissue heals in an irregular pattern. Instead of a smooth tissue that is aligned in the proper direction, you end up producing a “scar tissue” or “adhesion.”
These scar tissues can result in altered muscle movement patterns, resulting in restricted movement, formation of trigger points, and creation of a pain cycle.
These adhesions also prevent an adjustment from holding, since the muscles around the joint are still in a state of dysfunction.
The best visual example of this was provided by Dr. Warren Hammer, who compared this to two papers slliding on top of each other. If the papers are flat and not crumpled, they slide smoothly.
Now, if you fold the papers and open them up again, it’s much harder to slide them on top of each other. This is what happens when you have adhesions and scar tissue.
In addition, formation of trigger points can also occur, which are hyperirritable spots in skeletal muscle associated with palpable nodules in taut bands of muscle fibers. Pressing on these points can elicit local tenderness, referred pain, or a local twitch response.
Hands-on treatment
Active release technique (ART): Active release is a patented, soft-tissue technique that is a combination of both assessment and treatment.
The technique focuses on localizing adhesions and then using the clinician’s hands to break up the scar tissue, while providing directed tension with very specific patient movements.
The technique has more than 500 specific moves associated with its protocols.
Trigger point therapy: Trigger point therapy is the process of applying ischemic compression of a trigger point, thereby deactivating these points.
Trigger points are primarily in muscles, while adhesions and scar tissues can form in ligaments, muscles, and tendons. Therefore, only addressing trigger points without relieving the adhesions around the trigger point will often result in reactivating the trigger points you have previously addressed.
When it comes to hands-on, soft-tissue solutions, studies have shown there can be reliability and validity between practitioners in using their hands to assess and treat areas of dysfunction. However, this can only be accomplished through clinical, hands-on training.
Similar to learning palpation skills in school, hands-on, soft-tissue techniques also require practice. When looking at different treatment approaches, consider the support and training that goes with that technique. With ART, there is an extensive education program that consists of seminars, videos, and online training. The education is critical in accelerating not only your knowledge, but also skills in achieving optimal outcomes.
Instrument assisted techniques
Instrument assisted techniques utilize fabricated tools designed to reduce the stresses placed on the hands through the various surfaces offered by the tools. The tools can easily glide over the suspected muscles. Adhesions can be felt as “bumps” or “sandpaper” underneath the instruments, thereby helping a clinician localize the area to be treated.
The unique properties of the stainless steel instruments somehow amplify the sensation through the instruments to the hands. This could be compared to putting your hands on a railway track and feeling the vibrations of the train coming from miles away.
Each tool offers its own unique advantages and the right choice for one clinician is not necessarily the same for another.
The question on whether instruments or hands are better is common. This is strictly a decision made on each clinician’s unique perspective in their treatment approach. Some clinicians utilizing the instruments say they are better able to “feel” and localize the adhesions.
However, as you continue becoming proficient with a hands-on approach technique, your skills will greatly improve to this level.
Some clinicians who utilize ART technique find they can be more exact in the areas they want addressed. It’s similar to the reasons a clinician prefers their hands or instruments for adjusting. Explore all your options and you will be able to see which ones are right for you.
Self-care
Apart from clinician-directed therapy, there are several strategies for allowing a patient to continue with their self-care between treatments.
In the past, foam rollers were used to address trigger points by having the patient roll over the affected areas. The limitation with this was that the roller had one density to it and didn’t allow any give.
Trigger points are not meant to be pressed with one steady pressure, but with gradual pressure changes, depending on the release of the trigger point. This issue has been overcome with trigger point performance therapy.
The patented material comes in various shapes and changes shape after five to seven seconds, thereby aiding in penetrating the belly of the muscle safely and effectively when ample pressure is applied. This type of material is available in various shapes so that various muscle groups can benefit.
Whatever technique or product you go with, you can be assured that soft-tissue therapy is an integral part of a patient’s total treatment approach.
Jasper Sidhu, DC, graduated from Canadian Memorial Chiropractic College (CMCC) in 1994. Sidhu is vice-president of clinical services at WAVE Manufacturing Inc. He can be contacted at jsidhu@wavexercise.com.
