I have been steadily changing the way I use instrument assisted soft tissue mobilization and functional release during the past two years. As a result, not only have my outcomes improved, but my patients have little to no soreness between physical therapy treatments. That is a big change.
Ten years ago, I used to teach being "appropriate aggressive." Based on a mechanical fascial deformation model, I learned from Paris to the Institute of Physical Art that the forces we used to make rapid changes during tissue work were due to mechanical changes. I also taught the stress-strain curve, pushing the tissues until you hit the plastic range so changes could be made.
Don't get me wrong, I still helped patients, but I routinely bruised them. They still got better, and I always explained from day one that it was not uncommon to be sore and discolored. Tim Flynn told me a few years ago that I was being too rough in my videos, so I started going lighter and lighter and to my surprise, patients' range of motion (ROM), pain, and function still improved. In many cases, they were just as well or even better.
Myth 1 – Soft Tissue Mobilization Deforms Fasci
The way I look at it now, I don't know what I was thinking when I included this as part of my informed consent. This article by Chaudry, et.al. basically shows it takes an extreme amount of force (more than 100 pounds) to even produce 1 percent deformation. This is hardly the amount of deformation that would be required to see the rapid changes in ROM we often see when doing manual tissue work.
Myth 2 - Creep or Fascial Deformation is Desirable with Manual Therapy
Even an early research from 1992 showed that much longer duration was needed for fascial deformation. Longer than what we would be able to offer physical therapy treatment, or that a patient would be willing to endure. So how do we explain these changes that we can feel through our hands or our tools? The changes are tone reduction through activation of receptors like Pacini and Ruffini corpuscles. They communicate pressure to the CNS which in turn reduces tone in the area (and adjacent areas) you are working on. These concepts are covered much further here. If you stop and think about it, do you really want to cause trauma to something like an ITB just to have a patient's knee or hip feel "better?"
A simple study also showed that massage of the peroneals affected the tensor fascia lata and the brachioradialis affected the anterior deltoid. This also explains how when we work on patterns or what others call lines, we are able to make global changes.
These articles are from researchers that are very well known in the body worker and massage circles, but not the peer reviewed manual physical therapy or PT circles. I am glad I was exposed to them, and I'm sure all of my patients are as well.
In the end, you can still make rapid changes in your physical therapy treatment with either soft tissue mobilization or instrument assisted soft tissue mobilization and there are still advantages to using tools over your hands.
Click here for more information on Dr. Erson Religioso III.