What exactly are soft tissues? Soft tissues surround and support your organs and skeletal system to include muscles, tendons, ligaments, nerves, joints, cartilage, spinal discs, and fascia. Fascia is connective tissue that surrounds, connects, and supports everything in your body.
Soft tissue injury occurs when there is any injury to the connective tissue. Think of your shirt sleeve as fascia. When you move your arm overhead, the shirt sleeve slides up. If the sleeve is too tight, it won’t slide. This is what happens in soft tissue injury. The fascia cannot properly slide over the muscle which causes the muscle to become abnormally tense/contracted. If the muscle is less flexible, or elastic, it is unable to do its job of relaxing after contraction if it is constantly tense. This can lead into trigger points.
When a muscle is stress or injured, it often forms hyperirritable contracted knots, or trigger points, within a tight band of muscle fibers that cause local and/or referred pain elsewhere in the body when stimulated. Think of healthy tissue as cooked spaghetti: long, thin and flexible. However, if you stick a fork in the spaghetti and spin it around, the spaghetti remains the same length, but it is wrapped around itself and seems shorter when really, it’s not. In this analogy, think of the fork as the injury which caused the spaghetti to transform into a contracted knot creating a trigger point.
Once trigger points form, they are divided into two categories: active and latent. Active trigger points produce symptoms at rest while latent may become painful when you press on it.
Soft tissue techniques are a form of manual therapy used to relax injured muscles, break up adhesions and trigger points, reduce scar tissue, decrease fluid buildup, and stretch/lengthen fascia. These techniques include self-myofascial release, cross friction massage, Active Release Techniques (ART)/pin and strip, instrument assisted soft tissue mobilization (IASTM), and trigger point therapy.
Self-myofascial release is commonly performed with a foam roller, lacrosse ball, or softball. The foam roller is pressed into the muscle being treated and then the body is moved back and forth over it. Rolling can be used immediately before exercise to increase tissue or fascia flexibility or after exercise to reduce muscle soreness. This is the one exercise where no pain no gain actually applies. The goal with rolling is to search and destroy all the hyperirritable or tight areas in your muscle so the fascia can easily slide along the muscle during contraction.
Cross Friction Massage
Cross friction massage is used to gain mobility of soft tissue structures (ligaments, tendons, muscles) to breakdown scar tissue and remodel it to become more flexible, pliable, and functional. After a surgery, cross friction massage can be extremely beneficial in order to break up fibrous scar tissue that has formed under the incision. This type of technique is applied transversely over the site of injury, unlike a traditional massage which is given longitudinally, and leads to short-term analgesic pain relief due to the friction.
Active Release Techniques
Active Release Techniques are a soft tissue method that focuses on relieving tissue tension through removal of adhesions developed as a result of repetitive use and tissue overload. A clinician applies a compressive force at area of tenderness while the patient is instructed to actively move the muscle from a shortened to a lengthened position. This produces a longitudinal sliding motion of soft tissues beneath the contact point, thus breaking up the fascial adhesions. Another term you may hear is pin and strip.
Instrument Assisted Soft Tissue Mobilization
Instrument Assisted Soft Tissue Mobilization are a range of ergonomically designed tools which enables clinicians to effectively locate and treat soft tissue dysfunctions. These tools break down fascial restrictions and scar tissue, but with appropriate amounts of pressure, to stimulate a local inflammatory response. This “micro trauma” facilitates a cascade of healing activities resulting in remodeling of the affect soft tissue structures to increase range of motion and decrease pain.
Trigger point therapy can be performed multiple ways, but dry needling is a unique feature that we offer. Dry needling is a skilled intervention performed by licensed physical therapists (where allowed by state) to treat dysfunctions in muscle, fascia, and connective tissues to diminish pain and improve function. This intervention uses a thin solid needle to stimulate underlying myofascial trigger points. The needle is guided towards the trigger point until resistance is felt and a local twitch response is elicited. It is essential to elicit these twitch responses because this is the first step in breaking the pain cycle to get the muscles to relax.
Unlike acupuncture, “dry” needling indicates that the needle is used without medication and is inserted through the skin into muscle. Other terms you may hear are trigger point dry needling or intramuscular manual therapy.
Dry needling is safe for nearly anyone and with little side effects. Studies have shown that dry needling improves pain, reduces muscle tension, and normalizes function in which nerve impulses are transmitted to muscles.
After a dry needling session, you may experience needle insertion pain, muscle soreness, fatigue, and bruising. Aggravation of symptoms is not likely.
Dry needling is rarely a stand-alone procedure and should be part of a broader treatment approach that includes incorporating soft tissue techniques, therapeutic exercise, and functional re-training.
As you can see, there are numerous techniques to treat soft tissue injuries. No one way may work for you. I encourage you to check out our YouTube channel and explore the links for ways you can perform self-myofascial release at home through foam rolling or the pin and strip technique using lacrosse and softball.
DPT student, Clarkson University