Specific Soft-Tissue Mobilization
SSTM uses graded and progressive applications of force in order to increase the tensile strength of the tissue and restore the functional biomechanical properties of the soft tissue. Soft-tissue dysfunction can occur when the load is excessive in relation to the mechanical properties of the tissue, or when the biomechanical properties of the tissue have decreased in relation to a “normal load.”3 A manual therapist must establish the etiology, identify the site, and apply specific treatment in order to appropriately treat soft-tissue dysfunction. Physiological, accessory, and combined SSTM are the three classifications that have been proposed to help identify and treat problems effectively.4 Although SSTM is specific, graded, and progressive, the mechanical properties of soft tissue are based on biophysical principles and strong supporting evidence is not available.5 If interested in the SSTM technique (along with all others mentioned below), physical therapists may obtain continuing education to enhance their skill of identification and treatment of soft-tissue dysfunction.
Myofascial Release
As described by Andrew Taylor Still, the father of osteopathic medicine, the MFR approach is a form of soft-tissue therapy used to treat somatic dysfunction that may be causing pain and restriction of motion. The idea of MFR is to relax contracted muscles, increase circulation and lymphatic drainage, and stimulate the stretch reflex of the muscles and overlying fascia. Current research has focused on the effects of MFR and fibromyalgia. Peripheral pain generators in fibromyalgia include: degenerative joint disease, myofascial trigger points, inflammatory joint disease, bursitis, tendinitis, hypermobility syndrome, neuropathic pain, injuries, traumas, repeated muscle pulls, visceral pain, disk herniation, spinal stenosis, and recurrent cephalalgia.6,7 A recent 2010 randomized controlled trial researched whether myofascial release therapy can improve pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia. Statistically significant findings revealed improved anxiety levels, quality of sleep, pain, and quality of life in the experimental group over the placebo group immediately after treatment and at the one-month mark.8
Muscle Energy Techniques
Muscle energy is classified as a direct technique in which the restrictive barrier is actively engaged to contract a muscle against a distinct counter force.9 It can be utilized to stretch tight muscles and fascia or assist in mobilization of a restricted joint. The physiological approach of MET is to act on the Golgi tendon organ’s reciprocal inhibition of the agonist and antagonist musculature, thus allowing for brief relaxation and engagement of the restrictive barrier.9 Soft-tissue irritation can be interpreted as pain, which, in return, reacts by increasing agonist muscle tension and weakening of the antagonist. Chronic myofascial dysfunction feeds this positive feedback cycle, thus contributing to the “toilet bowl” effect of chronic pain syndromes.
