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Soft tissue techniques (STT) are an umbrella term used for treatments to the body that involve muscles, ligaments and fascia. This can be massage, stretching, dry needling to name a few. This discussion will talk about the science and neuroscience of different techniques. It may be a bit science heavy but we will break down the biology and neurology of it all.
The science behind STTs is based on several physiological and biomechanical principles:
1. Neuromuscular Effects
Muscle Relaxation: STTs stimulate mechanoreceptors in our tissues which help modulate muscle tone, reduce hyperactivity and tension. We have mechanoreceptors everywhere in our bodies. Mechanoreceptors tell us about mechanical changes in the body - temperature, chemical changes, stretch and tightness.
Pain Modulation: Techniques like massage stimulate sensory receptors, activating the gate control theory of pain, where non-painful stimuli inhibit the perception of pain by blocking nociceptive (pain) signals to the brain.
A great example of the gate theory is when you hurt yourself walking into a corner of a table - this sensation is sharp and painful. As a result of this, you reflexively “rub” the spot. This rubbing action counteracts the sharp/painful stimulus your brain interprets from hitting against the table. The brain thinks the sharp/painful stimulus is a disaster and danger for you, which of course, it isn't, it's just a table, not a tiger! Following this rubbing sensation, at the brain level, the brain has a “gate” that opens up to all sensations. At the “gate” the brain is then confused between sharp signals and rubbing signals, so consequently, the brain “turns off” the pain pathway - as it realises that the table isn't going to kill you. So your pain sensations are modified and reasonable to the response.
Proprioception Improvement: Proprioception is the body’s way of understanding where it is in space. We know the position of our limbs without actively thinking about it, due to these receptors. For example, our brain knows exactly where your little toe is so that if you move your leg you wont hit it against the leg of the table.
Stretching and mobilisation techniques enhance the feedback from muscle spindles and joint receptors, improving movement coordination and stability.
2. Circulatory and Metabolic Effects
Increased Blood Flow: Soft tissue techniques enhance local circulation, improving oxygen delivery and nutrient supply to tissues, which accelerates healing and reduces muscle fatigue.
Oxygen delivery is how we keep our muscles ligaments and tendons limber. When we have an injury, for example a low back spasm, we want to gently and effectively reduce the spasming muscles and increase blood back to the area to enhance healing. For chronic pain, using the same example of the low back, the tissues are slightly different in chronic pain situations, as the muscles might have “less” blood supply due to the nature of how long your body has been injured. For some people this may be years or decades of pain. So the tissues here might have less oxygen in it, so soft tissue techniques are trying to promote blood flow back to the muscles to enhance healing mechanisms.
Lymphatic Drainage: Techniques like manual lymphatic drainage promote the movement of interstitial fluids, reducing swelling and inflammation.
An example of this is if you have a swollen ankle, you don't want to do a deep tissue massage as this can make things worse. However we can do light lymphatic drainage also called effleurage techniques to help get rid of the chemical waste products of inflammation so the heart can re-circulate and bring new blood to the injured ankle.
Removal of Metabolic Waste: As above, enhancing circulation helps flush out metabolic byproducts like lactic acid, reducing post-exercise soreness and fatigue, as well as the chemical mediators of inflammation in an acute injury.
3. Fascia and Connective Tissue Effects
Fascia is a continuous, web-like connective tissue that surrounds and supports muscles, bones, organs, nerves, and blood vessels throughout the body. It plays a crucial role in movement, stability, force transmission, and proprioception.
Myofascial Release: Techniques like deep tissue massage and myofascial release stretching target fascial restrictions, improving tissue pliability and reducing adhesions. When we stretch the body, we are stretching the fascia too as it's so interconnected with the muscles. You can feel this if you stretch one part of the body but you may feel the stretch a little further/higher than the area you are stretching. For example, stretching the hip flexors you may feel tightness into the obliques and low back as well due to these fascial connections.
4. Biomechanical Effects
This is the main aim with osteopathy treatment and soft tissue techniques. We are trying to reduce pain, stiffness and increase range of motion, to correct dysfunctions and prevent them from recurring. This is part of our tenets of Osteopathy - that the body is a unit, and everything works together to heal itself, and structure and function are reciprocally related. The function of the muscle/joint is related to how the joint works. For example, a sore hip - you might be limping and then subsequently affecting the knee. Let's fix the problem at the hip first, so you are moving the hip optimally and reducing the limp so that the knee isn't taking all the load.
Improved Range of Motion (ROM): Soft tissue techniques break down adhesions, release fascial tightness, and enhance joint mobility, and thus increasing the range available for a body region.
Reduced Tissue Stiffness: By reducing excessive muscle tension and improving hydration of connective tissues, STTs enhance tissue elasticity.
Postural Correction: Targeted osteopathic manual therapy can address muscular imbalances and realign fascial structures to support better posture.
5. Psychological Effects
Reduction of Stress and Anxiety: Soft tissue manipulation stimulates the parasympathetic nervous system (PNS), reducing cortisol levels and promoting relaxation.
When you injure yourself for example your neck - it can be quite scary, very distressing and painful as every movement hurts including looking around, and swallowing! The calming side of soft tissue technique calms down your nervous system so that the brain switches from “Freak out mode” to “healing mode” as it can start to trust that some pain is necessary in an acute situation, but the brain may be “overreacting” and needs to settle to help the body’s own natural healing responses.
Enhanced Mood and Well-being: Techniques can stimulate the release of endorphins, serotonin, and oxytocin, contributing to an improved sense of well-being, again, in an acute neck injury, this is very important to help you move forward with your injury.
Types of Soft Tissue Techniques
Massage: The most common form, pressure applied to the body to enhance blood flow and to de-stimulate sensory receptors whilst decreasing pain, activating the PNS for anxiety towards an injury and improving range of motion.
Effleurage: Gentle stroking to promote circulation, and decrease inflammation and swelling in an acute injury.
Friction Massage: Deep pressure applied to break down scar tissue and improve collagen fiber alignment.
Trigger Point Therapy: Focused pressure on myofascial trigger points to relieve referred pain.
Myofascial Release (MFR): Sustained pressure to stretch and mobilize fascial restrictions.
Stretching: stretching the tissues, affecting the mechanoreceptors to help decrease tension and increase length of muscular structures
Muscle Energy Technique (MET): Used in osteopathic manual therapy where stretching and contraction exercises help to de-stimulate pain sensations to increase flexibility and mobility
Counterstrain: a gentle osteopathic technique putting the tissue into “ease”. It's a technique that uses a similar principle to trigger point therapy, but instead of pressing on a painful trigger point, the aim is to contract into “Ease” so it is a much gentler and pleasant technique for a patient.
Joint mobilisation: moving the joints within their available range of motion (stiffness, restriction) and rhythmically reducing pain sensations in a safe and controlled manner. Joint mobilisation can be gentle, progressing to firmer like a joint manipulation/cavitation. Any joint cavitations will be discussed with the patient prior to assessing if you and your injury is safe for this method of treatment before proceeding.
Soft tissue techniques work through a combination of neurological, circulatory, fascial, biomechanical, and psychological mechanisms. Their effectiveness is backed by research in physiology and rehabilitation sciences, making them valuable for pain relief, recovery, and performance enhancement.
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