Soft Tissue Release Course
SOFT TISSUE TECHNIQUES – ACTIVE – PASSIVE – RESISTED & TRANSVERSE
Soft tissue release (STR) is a technique that is used to stretch a muscle or connective tissue using a variety of methods; active, assisted active, passive, resisted and transverse (NLSSM, 2014).
STR has a number of effects on the function of muscle tissue. Firstly, STR is effective at elongating tissue which can help improve the flexibility of a muscle. Secondly, it is able to break down adhesion and reduce chronic tissue congestion. Thirdly, scar tissue can be mobilized and re aligned, which has the effect of improving elasticity of the tissue. Fourthly, according to Dalton (2011) soft tissue techniques which involve activating movements like STR affect the different types of sensory receptor within the tissue, which can result in reduced pain. Fifthly, STR has the usual benefits of traditional massage, for instance increased circulation, better nutrition and the removal of waste products. Sixthly, STR is also very effective at stretching the fascia due to the locking and then stretching; this helps slide the layers of fascia apart. Finally, STR can be applied to specific areas of a muscle and reduce hypertonicity without changing the length of normal tissue elsewhere in the muscle.
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STR is contraindicated on acute and in some cases sub-acute stages of rehabilitation. It is also contraindicated if the client’s pain is excessive or if a pulse is felt. For example, when working on the psoas, you must be careful around the femoral artery. As with all massage techniques, you must be cautious with diabetics because in some cases they cannot judge their pain threshold accurately (NLSSM, 2014).
The basic technique involves warming the tissue up via normal massage techniques, this also gives a chance to palpate for adhesions and tension. Once an area is discovered, you create a false origin by locking the tissue at roughly 45 degrees to the skin surface. This is achieved by sinking through the tissue to reach the target tissue and then sliding along a microscopic distance to take up the slack in the tissue. It is important to note, that greater success will be achieved by allowing the tissue to respond to your touch rather than forcing things. Some therapists refer to this as “the dance” or having a conversation with the tissue. You should use a large surface area first, for example the heal of your hand and then move to thumbs to increase pressure and accuracy. The therapist should maintain the lock at all times, then stretch the tissue in the opposite direction, slowly, for best results. This technique can be performed through a towel for better grip.
There are five different methods of STR; active, assisted active, passive, resisted & transverse. Active soft tissue release is performed by the client on themselves. This can be done in either a longitudinal or transverse direction. The client locks or pins the tissue at roughly forty five degrees and then moves the tissue in the opposite direction to the lock. If the lock is towards the origin, then they move the insertion. The therapist takes no active part except in explaining how it works. This technique can be used for home care to promote the therapist’s work and help stretch tight tissue. With any home care is it important that the client actually performs the activity on a regular basis. In the case of STR, the client is more likely to perform it because it will give pain relief.
In order to perform active assisted STR, the client and the therapist must work together. The therapist applies the lock in the normal manner, but the client performs the movement. It is very important that the therapist gives clear instruction, in layman’s terms, about the type of movement required. The therapist must make sure that the timing of the technique is correct. Sometimes when using this technique, the therapist has to go in time with the client because the client cannot follow the instruction or does not understand the timing of the actions. An advantage of active assisted STR is that the therapist can use both hands to lock the tissue. This means that deeper pressure can be applied if necessary, or that the locking hand can be reinforced, preventing damage to the therapist’s hands. This is also beneficial when working on big muscles, or if the tissue is difficult to lock. One of the negatives of the active assisted technique is that it requires small amounts of eccentric muscle contraction of the agonist and this can make it difficult to maintain the lock.
Active assisted STR is useful during the remodeling phase because it helps to re-align scar tissue. It is very effective for treating chronic injuries as it breaks down adhesions and reduces hypertonicity. One of the reasons why this reduction in hypertonicity occurs is because the client is performing the stretch and thus has control of the level of pain. If too much pain is created or the movement is performed too fast, the muscle spindles and other sensory receptors can be triggered causing more tension. However, when the resistance of the tissue is at its highest the client normally slows the movement, because it is painful. This achieves a better effect on the muscle spindles, because the rate of stretch is slowed, resulting in more tension being released (Dalton, 2011). This technique also has the advantage of being able to be used successfully anywhere, even on the sports field and it can help the client learn the technique for home care.
Passive STR is different from active STR because the therapist performs all the actions. The therapist applies the lock to the tissue and then passively moves the joint to create the stretch. This allows the muscle to be relaxed, which means the therapist can be more accurate and target small areas of scar tissue or adhesion. Passive STR is normally a shallower technique because you can only use one hand. This can make it difficult to lock deep tissue securely. It also means that this technique can be used as a lighter version to take the tissue from the warm up strokes to the deeper forms of STR. It is useful if the client is unable to perform the movement for some reason. Maybe they are unable to time the movement or cannot understand the instructions. Passive STR can be used with caution in late sub- acute phase, not directly on the damaged tissue, but around the site to reduce tension in the whole muscle.
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In resisted STR the therapist applies the lock to the tissue as per normal, but the client is responsible for the joint movement and the stretch. However, the therapist uses a small amount of counter resistance to the joint movement, in the same manner as in a reciprocal inhibition (RI) muscle energy technique. In the case of the hamstrings prone, the therapist locks the tissue, while the knee is flexed. The therapist’s second hand is placed on the ankle, and the client is cued to perform knee extension. As the extension takes place, the therapist applies a little resistance to the quadriceps muscles. The added resistance to the antagonist causes a reciprocal inhibition to the agonist. This means that the target tissue is stretched via the STR component, but also the agonist is inhibited neurologically by the antagonist. This causes a local stretch effect on hypertonic tissue and a whole muscle effect on the tension of the muscle. This makes this technique produce a more effective overall stretch. It can become difficult to perform resisted STR because of the number of actions and you only have one pair of hands. The therapist may also find it hard to maintain strong pressure on the lock.
When using transverse STR the lock is applied across the direction of the tissue fibres. This makes a bow like shape in the tissue. The movement is then performed in the opposite direction to the lock, making sure that the lock holds. This transverse technique can be performed as either an assisted active or a passive movement. Transverse STR is very effective for clients with hypermobility, as you can isolate the tight tissue without affecting the joints. For example, this could be used on a pregnant women without concern for her joints. Transverse STR also helps breaks down cross fibres and thus releases tension without elongating the tissue. There is no need for overstretching as it is transverse. This technique can also be used on shallow / delicate areas of the body, for example the abdomen because you don’t necessarily need deep pressure to create a lock. By adding a slight twisting motion to the tissue you can increase the strength of the lock.