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Factors to consider for Soft Tissue Release (STR) treatments

This is an excerpt from Soft Tissue Release, 4th Edition by Mary Sanderson.

1. Types of STR

There are basically three types of STR: passive, active and weight-bearing. All three involve movement, but in active and weight-bearing STR it is the subject who produces the movement, whereas in passive STR it is the therapist. Passive work provides a good release and can be very relaxing (fig. 2.1).

Active STR is more powerful and should be preceded by passive work or other massage to warm up the area (fig. 2.2). Progression to active work is more energy efficient for the therapist, allowing concentration to be centred on the application of the pressure. Many subjects prefer to become actively involved with a particular release, especially when areas are painful to work with, because it gives them more personal control.

Applying resistance during active STR may enhance the release in some cases. As the subject attempts to produce a stretch, but is resisted by the therapist while doing so, isometric muscle contraction takes place in the antagonist muscles; because of this, there is an enhanced relaxation in the muscle undergoing treatment (fig. 2.3). This effect is known as ‘reciprocal inhibition’ (RI).

Weight-bearing STR is highly effective in returning an area to full function (fig. 2.4). The muscles are under tension, and a degree of eccentric contraction will be occurring to control the required movement. Manipulation under this tension may be very severe, and should therefore be the last stage in any treatment programme.

2. Application of Pressure or ‘Lock’

How the lock is applied, including its direction and angle of pressure, is important for effective results. The lock can be used to lengthen or traverse the target fibres. It can also be used to delve between muscle groups, to isolate tendons or to separate bellies within a muscle (fig. 2.5, 2.6 and 2.7). A form of friction is being created where pressure is attained, and the movement is made by the subject either passively or actively. Friction breaks the fibrous tissue binding the fibres and the movement enables this to happen in the correct direction to re-align them.

Specific Attention to the Fascia

A myofascial release (MFR) lock (fig. 2.8) is designed to work specifically on the fascia, by providing a load on the fascia prior to moving the muscle fibres. Depth should be attained before slowly gliding the fascia; when there is resistance, the lock should be moved 2–3 cm further. Once this is achieved, it is maintained while movement of the muscle fibres occurs.

3. Maintenance of Pressure

Pressure is maintained during the stretch, whatever the type of lock. The release occurs with the movement made by the subject. The lock is maintained while the fibres around are moving; this may cause the lock to jump or flicker, but the movement is still being produced functionally by the subject, not by moving the lock.

4. The Stretch

Maximal stretching is not the best way to release specific problem areas; the stretch should be localised. The basic principle behind STR is that congested fibres can be targeted more accurately. In some instances, the stretch may involve only the smallest of movements. On occasion it is also necessary to shorten a muscle prior to locking in, to relax the fibres so that an effective lock can be applied.

There may be many different ways to produce a stretch, particularly where muscles have more than one action. In some cases, the therapist may even choose to combine movements; for example, when treating the biceps brachii, the elbow can be extended and pronated as the pressure is applied. Where a more extreme stretch is being attained, the therapist should guide the subject into one movement and follow it with a further stretch. For example, in the case of the hamstrings, the hip may be flexed first as the pressure is applied, and then a further stretch applied with the extension of the knee.

5. Flexibility

STR is a very useful technique for subjects who require flexibility for whatever reason. It may be that the muscle or tendon fibres are shortened because of overuse or imbalance, or perhaps the nature of the relevant activity necessitates a high level of flexibility, such as that demanded in gymnastics or martial arts. In these cases, full stretching should be incorporated within STR only after the tissues have been worked on thoroughly. It is also important to note that range of movement must be tested prior to instructing a subject to move into an extreme stretch.

6. In Conjunction with Muscle Energy Techniques (METs)

METs can be used to great effect alongside STR (fig. 2.9). MET refers to stretching techniques which involve using the subject’s own muscular energy to help release holding tension. For example, following an isometric muscle contraction there is a period of relaxation called ‘post-isometric relaxation’ (PIR). A therapist experienced in this can use the PIR principle to enhance muscle relaxation, reduce tension and enhance its stretching capability. The use of RI has already been mentioned with reference to ‘resisted STR’.

7. Discomfort during Application

Where tissues are so severely adhered and fibrous that it may be painful to separate them, STR has two advantages over other techniques. Firstly, there is a pleasant, momentary relief when the pressure is released, even if a new lock is being sought. Secondly, subjects feel in control of their own discomfort. This may be particularly the case with high-performance sports people, who willingly put themselves through painful training sessions for success in their events!

More Excerpts From Soft Tissue Release, 4th Edition

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