Soft Tissue Therapy for injuries

Soft tissue therapy (STT) can be an effective and sufficient way to treat most minor and chronic musculoskeletal injuries. The outcomes, however, depend greatly on the appropriate selection of interventions and the practitioner’s ability to apply them. 

Definition
 
STT is an umbrella term for a variety of interventions aiming to assess, treat and manage the causes and symptoms of an injury or an abnormality in a person’s soft tissue(s). STT is appropriate after the acute phase of an injury had passed and inflammation has subsided significantly.
 
Usually, the natural progression is from initial assessment/testing, through treatment, to re-assessment/testing in order to observe and measure progress.
 
Functional and postural assessment
 
Postural and functional assessment can be an integral part of designing a treatment approach for the client. The therapist may ask the client to stand in their natural posture and observe the alignment of the body. This initial step can reveal potential imbalances and offer insights as to the likely causes of the pain or injury.
 
Additionally, a variety of functional tests can be performed on various joints or individual muscles. These are helpful in determining abnormalities in muscle tone or joint range of motion. Various tests can also be performed to assess the strength, speed, and precision of communication between the nervous and the muscular system.
 
“Hands on” techniques

• Massage in its various forms may be used as part of the treatment approach. It is effective at promoting a better circulation, reducing swelling and inflammation and promoting relaxation, essential for recovery.
• Myofascial release / Soft tissue release (STR) affects the fascia and the muscles it wraps. These techniques are helpful in reducing scarring post-injury or post-surgery. Additionally, they improve the mobility and flexibility of the treated soft tissues. The application involves applying and holding pressure to a particular area while stretching the relevant fasciomuscular structure.
• Sustained pressure / Trigger point techniques / Neuromuscular techniques (NMTs) involves the application of an ischemic compression to an identified area of tightness or radiating pain. Areas of hypertonicity or discomfort can be eliminated relatively quickly through a holistic action involving the muscle, the nervous system and local circulation. Deep ischemic compression is applied to an area with intensity causing significant discomfort. The neuromuscular response is reset by inviting the patient to relax into the tension as the body takes its time to adapt. After a reduction in the subjective intensity experienced by the client, the pressure is increased once again. The process is repeated several times until there is no pain in the area other than the physical discomfort from the weight of the pressure.
• Cross-fibre friction (CFF) is an effective way of alleviating scarring and adhesions within and between soft tissues. The repetitive transverse stroking of the patient’s tissues by the therapist is perceived by the body as a microtrauma. This, in turn, activates innate healing abilities and thus accelerates recovery. The main purpose of the technique is to realign muscle/tissue fibres, which can increase muscle length and improve circulation.
• Contract-relax / Muscle energy techniques (METs) involve a submaximal contraction of a muscle for a brief period by the client followed by relaxation accompanied by lengthening/stretching of the muscle by the therapist. In the period after the contraction, the muscle relaxes more deeply and can be lengthened without discomfort to beyond its initial range. The two most common techniques either contract the same muscle that will subsequently be relaxed and lengthened (autogenic inhibition) or the opposing one (reciprocal inhibition).

 
Electrical and thermal therapy

• Electrotherapy can involve the use of various devices such as ultrasound, NMES (Neuromuscular Electrical Stimulation), interferential stimulation, PSWD (Pulsed Short -Wave Diathermy), and TENS (Transcutaneous Electrical Nerve Stimulation). The purpose is to improve tissue function and speed up recovery.
• Heat therapy can be used for chronic injuries to promote blood flow in the area and enhance waste removal and healing. Wraps, jells, towels, packs, pillows or blankets can be used to apply heat to the treated area.
• Cryotherapy (cold therapy) can be used during the acute phase to reduce swelling and inflammation. Additionally, some athletes speak to its high value as an enhancer of workout recovery. Conversely to heat, cold reduces circulation to the area and can thus reduce swelling. The application of ice packs, sprays, wraps, jells also has a pain-reducing effect by restricting or diminishing the nerve pathways.

 
Other interventions

• Mobilisation of the injured area is essential for recovering/improving range of motion and preventing atrophy. A natural progression may look like this: actively contracting the structure on the opposite side of the injury > passively contracting the injured structures > actively contracting the injured structures.
• Stretching is essential both for prevention and recovery from soft tissue injuries. It helps to maintain a full range of motion in a healthy joint and improve flexibility following trauma. Caution is needed when stretching a recently torn muscle to avoid re-injury. Static stretches must ideally be held for at least 30 seconds to exert their beneficial influence on the area.
• Strengthening is a natural next step in the recovery process aimed at restoring or improving function. Developing strength is beneficial as it has an effect on a number of other parameters such as power and endurance. It is possible to have too much strength, though. When a neuro-muscular structure is strengthened beyond a certain point, this can put adjacent structures such as bones, ligaments and tendons at a higher risk of injury due to the increased forces they can experience.
• Kinesiology taping can be used during the acute phase to relieve swelling and inflammation, during the recovery phase to stabilise and support the injured structure and in the chronic phase as a corrective intervention. The application of tape with a specific stretch and in a specific direction in and around the trauma can promote healing by improving lymphatic circulation and balancing muscle tone.

 
Evidence
 
Empirical evidence points unequivocally to the value of STT for treatment and recovery from soft tissue injuries. The case studies of practitioners and testimonials of clients offer countless accounts of successful recoveries.
 
The literature, however, is more conservative in its judgment. Most systemic reviews do find some value for some interventions (Ther et al 2016; Ajimsha et al 2015) but conclude that more high-quality research is needed for solid proof.