Programs » Soft Tissue Mobilization

Soft Tissue Mobilization

Soft tissue mobilization has been performed in increasing frequency over the last twenty years due to its’ efficacy in treating various musculoskeletal pathologies. The increase in use is indicated by the new CPT codes of myofasical release, and then by the soft tissue mobilization code over the last ten years.

Soft tissue healing research has increased dramatically since the mid 1980’s and it is this information that verified the previous theories. Soft tissue injuries heal via fibrous healing. That is to say, fibrous tissue or scar tissue forms at the injury site. This begins a few days after injury and continues to proliferate. The scar becomes more dense and stronger as time passes. This scar tissue produces pain, loss of range of motion, loss of muscle and tendon contractility and extensibility thus leading to decreased function, and it also leads to a predisposition to reinjury in the same site at a time of future tensile loads.

The goals of soft tissue mobilization are to break down, or reduce, fibrous or scar tissue; improve range of motion; decrease pain; disperse inflammation, effusion and edema; and to increase function. The full effect of soft tissue mobilization on the proprioceptive pathways, or upon the chemical state of the injured tissue has not yet been fully investigated, but the positive empirical results have been noted.

Various forms of soft tissue mobilization have existed previously. One common form dates back to the 1940’s. Today, the most common method of soft tissue mobilization requires the primary use of the thumb to apply manual pressure to the soft tissue structures (muscle, tendon, ligaments, fascia, and bursa). The load is applied down the long axis of the thumb to the targeted tissues. The doctor applies the load (force) through the length of the muscle and fascia. This is performed while the patient is performing active, active-assisted, or passive range of motion in the injured joint. So, it is easy to understand that the patient is actively involved in the treatment. The muscle is moved from a shortened to a lengthened state. The load being applied by the doctor allows the restricted, fibrotic tissue to be broken down, thus restoring normal range of motion and decreasing pain. This is repeated in all of the muscles that surround the involved or injured joint. All of the muscles work together to form an action about a joint. Injuries occur by function and not by anatomy. This means that all the muscles that perform a similar function were injured at the same time, but there was a point of greatest damage. Other muscles that stabilized the joint may also have been strained to a more mild degree. Once all of the muscles around the site of injury are treated, better outcomes occur at a more rapid rate.

The manual pressure that is used varies upon the diagnosis and status of the injury (i.e. acute or immediate post-operative cases require less force). However, the force down the long axis of the thumb is continuous and is the keystone to the treatment. Soft tissue mobilization cannot be performed to an acceptable level of performance without the use of the thumb.

Soft tissue mobilization has several variables such as the amount of pressure that is exerted, the volume of work, and the specific positions of limitation (especially important in sports). The treatment is based on five main criteria:

the diagnosis;
the age of the patient;
the overall health condition of the patient;
the patient’s goals;
the doctor’s goals.

The ability to determine the appropriate application of soft tissue mobilization has allowed various types of injuries to be treated with good outcomes. Soft tissue mobilization has proved successful in treating very acute as well as chronic injuries. Many patients are referred to this facility after surgery of the spine, shoulder, elbow, knee, foot, and ankle to regain the range of motion and reduce soft tissue pain.

Exercises are frequently prescribed for patients to assist in regaining strength lost after injury. This level of exercise can be for the lay person or the professional athlete. Many doctors at this facility are Certified Strength and Conditioning Specialists and they can tailor the level of exercise for the needs and compliance of the patient.

Strength and Conditioning
Strength and conditioning has always been part of our practice, but its role has increased over the years. Strength and conditioning, and rehabilitation can be viewed as extensions of each other. Low-level strength and conditioning can be considered rehabilitation. There is no clear cut point where one ends and the other begins. We do know we are clearly in the realm of strength and conditioning and coaching when the athletes are at the highest level of sports performance.
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Our Role
The staff at the Soft Tissue Center serves many roles in spine care. We often serve as the first stop for the patient, so the entire diagnostic work-up is completed. The patient has either conservative care recommended, or is referred for a combination of pain management and conservative care, or is referred for a neurosurgical consultation. We are also sought for second and third opinions because our reputation is one for allowing enough time to hear the entire history and perform a thorough clinical examination. We can then review the previously performed tests and make our recommendations.
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