Do You Have Issues in Your Soft Tissues?
What is Soft Tissue Therapy?
What is Soft Tissue Mobilization?
Soft tissue therapy or soft tissue mobilization techniques have long been a part of physical therapy practice. While massage is a broad term that encapsulates the practice of kneading or rubbing of muscles and joints with the purpose of relieving tension and can be performed by many different types of practitioners, soft tissue mobilization (STM) is a more specialized technique that requires a deep understanding of the anatomy and physiology of deep tissue layers. STM requires the assessment of these tissues and an understanding of how manipulating them impacts function. In this article we will take a look at the layers of soft tissue in the body, examine the stages of healing that these tissues undergo after injury, and explore how soft tissue mobilization techniques can help treat pain, impaired posture, inflammation, and range of motion and mobility restrictions.
What is STM?
Soft tissue mobilization is a low load manual technique that employs long duration forces applied in various directions to improve mobility between underlying and adjacent layers of connective tissue. (Deshmukh, et al., 2014). STM is a general term and over the years different styles and approaches to STM have been discovered. Some examples of STM in physical therapy include:
Cross Friction or Transverse Friction Massage
Strain Counterstrain
Myofascial Decompression (Cupping)
Trigger Point Therapy
Manual Lymphatic Drainage
Foam rolling
Some of these techniques are performed using only the therapist’s hands while others require special tools to help facilitate the treatment.
LAYERS OF TISSUE
Between the visible top layer of skin and the underlying bones lie several layers of tissue that are important in soft tissue therapy. Most superficially we have the epidermis or the outer layer of skin. Beneath that lies the dermis which houses nerves, hair follicles, sweat glands, blood vessels, connective tissue and other structures. Underneath the dermis is the superficial fascial layer then the layer of subcutaneous fat, more blood vessels, and nerves, followed by the deep fascia and then the muscle.
When layers of soft tissue are not sliding and gliding like they should be it can result in pain, reduced joint mobility, scar tissue formation, and flexibility issues. Tissue dysfunction, pain, inflammation, and injury can happen at any of these levels and soft tissue therapy may play a role in treating the symptoms.
WHO CAN BENEFIT FROM SOFT TISSUE MOBILIZATION?
STM is indicated to help treat a variety of conditions. These conditions include tendinopathies, muscle strains and tears, subluxations or dislocations, overuse injuries, contusions, edema, inflammation, post-surgery, and scarring. It may also be used to address a range of motion restriction, pain, impaired posture, muscle guarding, and poor tissue mobility.
WHY DOES SOFT TISSUE MOBILIZATION WORK?
While research shows us that STM is effective in promoting tissue healing, reducing pain, and improving range of motion in many cases, the exact physiological mechanisms underlying these changes are still being examined (Hawkins, Williams and Galloway, Kaytlin, 2020). When you sustain a tissue injury it follows a predictable pattern of healing consisting of inflammation, proliferation, then remodeling. During the inflammation phase, blood flow to the injured tissue increases so that damaged tissue can be broken down and carried away, allowing for transition into the second phase. During the second phase, the proliferation phase, cells called fibroblasts increase in number around the injured area in order to synthesize collagen fibers that form the scaffolding that will eventually become fully-healed tissue in the remodeling phase.
It is thought that the compression of tissues during soft tissue mobilization can facilitate tissue healing by stimulating fibroblast activity during this proliferation phase and by helping to realign and reorganize the new collagen. It is also used to break up scar tissue and increase blood flow to the area to promote the formation of new and better-organized collagen fibers. Additionally, STM is thought to have an effect, at least temporarily, on pain receptors and mechanoreceptors which may account for reductions in sensitivity to pain and improvements in range of motion that occur after STM.
IS SOFT TISSUE MOBILIZATION SAFE?
When performed by a licensed physical therapist, soft tissue mobilization is generally considered safe but there are contraindications to using these techniques including, but not limited to, over areas of unhealed wounds, over a fracture, in an area of cancer, certain types of kidney and heart failure, and others. Talk with your physical therapist about your medical history so they can decide if these techniques are safe for you.
If you have been going to physical therapy or have been thinking about scheduling an appointment, talk with your therapist about whether soft tissue mobilization may be right for you. While soft tissue mobilization is only one part of a complete rehab program, it can be a great tool to help reduce and manage your symptoms now and in the future.
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