Trigger Point Therapy - Soft Tissue Release
Soft Tissue Release (STR) is a dynamic, highly effective technique that can have an immediate and powerful effect on muscle and connective tissue.
STR is a combination of Myofascial Release, Therapeutic Massage, and Active Assisted Stretching. The technique involves applying precise pressure during a specific stretch performed in multiple planes of movement. The goal is to appeal to the autonomic nervous system in a way that leads to spontaneous release of the injured muscle, thus regaining the original resting length of that muscle.
STR and Trigger Point Therapy
STR can be incorporated into any type of massage, therapist-assisted stretching or other manual therapy techniques, and is frequently used as an adjunct to trigger point therapy.
STR and Research
All tissue has conductive ability. When myofascial disruption occurs, a reduction in the electric potential is generated. Research suggests that dense collagen reduces or impedes electrical flow through the tissue, thus reducing the activity of the local fascial cells. The thixotropic quality of myofascia means that when it shortens or thickens, it dries out, and the ground substance turns from a watery solution which facilitates movement to a less flexible gel which limits movement.
Application of pressure brings about a change to a solution and rehydration, where the connective tissue becomes more solute and less sticky and dense. Removal of the pressure causes a re-gelling, but the tissues will have improved in both conductive ability and water content (Oschman, 1997). This boosts electrical activity and improves the neuromuscular relationship.
Movement is essential to the repair and maintenance of healthy tissue. It provides direction for deposition of collagen and encourages vascular regeneration. Movement also lubricates and hydrates connective tissue by improving the balance in the ground substance between the GAGs and the water. This will reduce the potential for adhesion formation (Lederman, 2005).
Research with tissue cultures highlights the importance of both stress and motion to healing. Lederman (2005) also states that ‘active techniques will stimulate muscle fibre regeneration, a normal ratio of muscle to connective tissue elements and the development of neuromuscular connections’.
Combination of Pressure and Movement
Treatment using a combination of pressure and movement, therefore, should have a significant positive effect on the quality of the myofascial tissue. Passive tissues, when worked on, present as relatively soft, and pressure is diffused by their softness; deep connective tissue restrictions may not get enough mechanical energy to cause thixotropic change (Juhan, 1987).
If pressure and movement are applied together with muscular contraction, tissue density is significantly increased. This in turn increases the pressure delivery through the myofascial tissue and will enhance the effectiveness of treatment (Lowe, 1999).
Combining concentric muscle contraction with a specific broadening pressure into the myofascial tissue facilitates a greater mobilisation of the connective tissues (Lowe, 1999). Longitudinal stress may also positively influence the pattern of myofascial tissue (Cantu and Grodin, 1992), and the application of longitudinal strokes while the tissue undergoes eccentric contraction effectively stretches and lengthens the connective tissues.
It would seem that treatment could be more rapid, and the pressures applied by the therapist reduced, when pressure and external movement of the tissues are combined.
Soft tissue release has a fast response in alleviating tissue restrictions and enhancing tissue health, which suggests a neurological involvement. An immediate reduction in tissue tone cannot be explained by mechanical properties alone, but also involves the autonomic nervous system (Schleip, 2012).
The only currently available research specifically into the technique of soft tissue release (STR) is a preliminary single case study on a hemiplegic stroke patient. Barnard (2000) found that the application of STR to the muscles controlling elbow flexion and supination increased elbow ROM and reduced elbow flexor spasticity; ten minutes of passive STR was performed on five consecutive days, and a 41% improvement in elbow ROM was observed eight weeks after intervention.
There is a lack of empirical evidence to prove that STR is effective, so there is huge scope for research into the technique. Palpation skills are difficult to measure, and therefore, as is often the case, research is lagging behind clinical experience and anecdotal evidence.
Learning and Implementing STR
STR techniques are generally simple and straightforward to learn and can be rapidly incorporated into any type of massage, therapist-assisted stretching or other manual therapy techniques.
The above information is presented in extracted form from the text Soft Tissue Release by Mary Sanderson. Mary has been a successful therapist for many years and is a member of the teaching staff at the London School of Sports Massage. She has worked with many elite athletes and treats several top players at the Wimbledon tennis championships.
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This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.