Soft Tissue Manipulation for Fibrous Adhesions
By: Ryan M. Lawrence, D.C.
As advances are made in fields related to sports medicine, beneficial information concerning mechanisms of athletic injury are uncovered, as well as more efficient means of diagnosis and treatment of them. Proper usage of physiologically therapeutics such as ice, heat, ultrasound, etc., as well as other ancillary modalities, may contribute greatly to injury recovery. They do, however, overlook the vast importance of focusing on muscle, tendon, and fascia. More attention is being given to therapies that target the soft tissues more directly. These include various forms of soft tissue manipulation, such as myofascial release, manual neuromuscular therapy, Graston Technique, etc.
Understanding the basic mechanisms of soft tissue injury is paramount in order to ascertain a proper diagnosis and establish a treatment regimen. When an acute injury is sustained by muscle or fascia, the precipitating events are those of acute inflammation. The acute inflammatory process often leaves a residue of edematous exudates. From the exudates, a highly vascular mass of granulation tissue develops which leads to the infiltration of fibroblasts and endothelial cells. The fibroblasts gradually create a matrix of collagen fibers, which become fibrous, or scar, tissue adhesions. Reoccurring soft tissue injuries, such as chronic muscle strains, may also cause these adverse effects of adhesion deposition.
The deposition of scar tissue adhesions within a muscle may lead to a cascade of deleterious effects. For instance, a muscle may become tight and restricted, often causing the muscle to weaken. When a muscle weakens, it can further become tightened, which not only perpetuates the cycle, but also results in an increase in pressure and/or tension within the tissues. This increase in pressure may result in a decrease in circulation of the lymphatic vessels, resulting in further edema and exudates, while a decrease in blood circulation results in cellular hypoxia. In both instances, more tissue fibrosis and adhesions are produced which permits this cycle of soft tissue injury to continue.
The aforementioned sequellae highlight the importance of a treatment regimen designed specifically for soft tissue injuries. Properly performed soft tissue manipulation will separate and break down fibrotic tissue cross-links, while also beneficially stretching connective tissue and muscle fibers. The riddance of scar tissue will break the soft tissue injury cycle and help to initiate and sustain the healing cascade. Treatments that are specifically designed for muscle and other soft tissues will increase the speed and recovery of these injuries. Athletes are already noticing these results, and the various types of soft tissue manipulation therapies are becoming more in demand.