Category: Techniques

Not all pain is caused by obvious injuries like broken bones or cuts. Some pain may stem from the myofascial tissues. These tough membranes are wrapped around your muscles to provide support and connect them to other parts of the body.

When myofascial tissue becomes stiff, it may restrict movement in both the muscles and joints. This can lead to joint and muscle pain. During myofascial release, your chiropractor will locate and release areas of myofascial tissue that are stiff and tight.

Myofascial Pain Symptoms

Myofascial pain can be caused by trauma — such as a car accident — repetitive motions or muscle tension due to stress. In fact, people who are often stressed or anxious may be more likely to develop myofascial pain. This could be due to frequent clenching of the muscles.

The symptoms of myofascial pain include a deep ache or pain in the muscle, pain that continues or worsens, or a sensitive knot in the muscle. The source of the pain is stiffness in specific areas of myofascial tissue — known as “trigger points.” Normally, myofascial tissue is elastic and moves when light pressure is applied. Trigger points, though, feel tight and rigid.

Unlike pain caused by broken bones or cuts, myofascial pain can occur over a wider area of your body. Also, the trigger points may not be located near the area where you are experiencing the pain. This is called referred pain.

Diagnosis of Trigger Points

During a physical exam, your chiropractor will identify areas of myofascial tissue that are stiff and rigid. This is done by applying light finger pressure to the body, looking for tissue that does not feel elastic or move easily. Again, the trigger points may not be located near the source of your pain.

Myofascial Release Treatment

After identifying the trigger points, chiropractors can use myofascial release therapy to reduce the stiffness in the myofascial tissue. This technique involves stretching and applying manual pressure to areas of the myofascial tissue that are tight.

During the treatment, your chiropractor will carefully observe your body’s response in order to know how much and where to apply the pressure. Loosening up the myofascial tissue can allow the muscles to move more freely. This may reduce your pain symptoms.

Muscle pain can result from many different causes. If are experiencing pain, consult your chiropractor to help you determine your best treatment options.

Manual therapy, also known as manipulative therapy, is a physical treatment primarily used by chiropractors to treat musculoskeletal pain and debility.

How Does Manual Therapy Work?

This form of physical therapy takes a hands-on approach rather than using devices or machines. When a chiropractor uses their hands during manual therapy, they apply pressure on the muscle tissue and maneuver the joints in an effort to reduce pain associated with muscle tension, muscle spasm and joint dysfunction.

How Does Manual Therapy Help?

When a person has insufficient movement and range of motion in their joints, it can lead to pain, discomfort and an interruption in function, movement and posture.

By implementing manual therapy, the following can occur:

• An increase in range of motion
• A decrease or elimination of soft tissue inflammation
• Pain regulation
• Relaxation
• Healing, stability and/or extension of contractile and non-contractile tissue
• Ease in movement and restoration of function

Types of Manual Therapy Movement

There are many manual therapy techniques, and, as a group, they aim to relax tense muscles and ease restricted joints. Overall, however, these procedures exercise three main types of movement:

• Manipulation. Sheer, rotational or agitated force that is rapid and results in an audible popping sound caused by the sudden breakdown of gas bubbles that develop during joint cavitation
• Massage. Recurring stripping, kneading or rubbing of the soft tissues for the purpose of redistributing fluid, relaxing muscles, increasing circulation, easing muscle tension, breaking up scar tissue and reducing pain
• Mobilization. Stretching the soft tissues in a slower, more regulated process in order to improve flexibility

Mobilization and manipulation are often talked about together. They use calculated movements of various speeds (slow to fast), force (moderate to strong) and distances to pull, rotate or thrust joints and bones into position to help release stiff tissues around the joint, minimize joint pain, reestablish alignment and assist with flexibility.

Types of Manual Therapy Techniques

Prior to executing manual therapy, the chiropractor will typically do an assessment of the nerve and blood supply in the treatment area, as well as look at the bone and muscles themselves. This helps him or her determine whether this physical therapy is appropriate for the patient’s needs. Contingent on the assessment, the chiropractor may perform one or more of the following manual therapy techniques:

• Soft tissue mobilization. Breaks up hard or rubbery muscle tissue (e.g., scar tissue), circulates tissue fluids, restores normal texture to tissue, reduces pain and lessens muscle tension through rhythmic stretching and deep pressure
• Strain and counter-strain. Focuses on fixing irregular neuromuscular reflexes that trigger structural and postural problems. Here, the chiropractor first determines where the patient’s tender points are. The patient is then asked at what point the soreness diminishes. The patient is next held in position (at a point where they are comfortable) for up to two minutes. During this time, the muscle is stretched mildly and then slowly taken out of this position, which lets the body reset its muscles to a natural level of tension so that healing can occur.
• Joint mobilization. Loosens the constrained joint and boosts range of motion by delivering slow speed and amped up distance of movement.
• Muscle energy technique. Designed to activate restricted joints and lengthen shortened muscles by using voluntary contractions of the patient’s muscles against a defined counter force implemented by the chiropractor, who helps by taking the muscle to a specific position and placing it in a precise direction
• High velocity, low amplitude thrusting. Restores the sliding motion of joints and allows them to open and close efficiently. This more aggressive technique involves taking a joint to, but not beyond, its restrictive barrier

Please contact your chiropractor with any questions.

Forceful spinal manipulation is not always necessary to treat conditions of the lower back, mid-back and neck. Gentle chiropractic treatment, such as drop table techniques, involves less powerful spinal maneuvering and slower, low-velocity movements that allow the affected joint to stay within its passive range of motion.

How Does the Drop Table Technique Work?

Also known as the Thompson technique, the “drop” approach uses a special chiropractic table. The table used has segments that can be lifted up and then dropped when a thrust is applied by the chiropractor. The drop allows gravity to assist and work in combination with the manual adjustment, and all of this provides a lighter adjustment than that which comes with some other chiropractic techniques, such as those that involve twisting positions.

To further clarify, the table has various sections that are raised between 1 to 2 inches relative to the rest of the patient’s body. Once the section of the table is lifted, it is fastened in place and the stiffness of the table is altered based on the patient’s body weight. When the chiropractor applies a gentle thrust to the area needing adjustment, the table releases and drops down, causing that segment of the body to fall too. The drop table comes to a rest, but the patient’s body momentum continues for a short period. This momentum is equally as critical to the drop table technique as the thrust and dropping of the table are, because it aids in alignment.

What to Expect After a Drop Table Technique

The number of sessions needed depends on the type of condition the patient has and its severity. However, in general, the patient should have better range of motion and less pain with each treatment.

To learn more about the drop table technique and how it can help, contact your chiropractor.

When there is damage to muscles and other soft tissues including pulls, tears, or not being able to get enough oxygen (hypoxia), it can result in the body producing rough, thick scar tissue in the affected area.

Scar tissue restricts the tissues from moving freely because they bind them and tie them down, and as scar tissue builds up, muscles shorten and become weaker, nerves become ensnared and tendinitis can develop due to tension on the tendons. This can lead to reduced range of motion, pain and loss of muscle strength. Should a nerve become trapped, the person may additionally experience numbness, tingling and weakness.

What Do Active Release Techniques Aim to Do?

Active release techniques (ART) attempt to address problems in individual tissues, since one tissue or structure can affect another structure both directly and biomechanically. With this method, the chiropractor identifies problems with movement, pressure and stiffness between the nearby tissues, and then addresses them.

While scar tissue and muscle tension can be addressed with massage, electrical modalities and applying pressure to trigger points, ART seek to take a different approach. It is not just about treatment; it’s also about understanding the muscles and how they have been affected.

After the chiropractor has gotten a feel of the tissues and their texture, motion and tension, he is able to understand and assess the motion of each tissue relative to the one adjacent to it. Now equipped with this knowledge, he can determine whether to:

• Apply a contact tension
• Shorten the tissue
• Make the tissue glide relative to the tissue nearby
• Lengthen the tissue

By doing one or more these, movement can be restored; fibrous adhesions can be broken down; trapped nerves or blood vessels can be released; pain can be reduced; and oxygen and blood can be efficiently delivered to the muscles and tissues.

How Are ART Different From Other Techniques?

There are more than 500 specific moves associated with ART, and each allows the chiropractor to recognize and rectify problems that affect each individual patient. For this, ART do not take a cookie-cutter approach, nor do they only treat problems with muscles. In addition, these “soft tissue system/movement-based massage techniques” treat tendons, ligaments, fascia and nerves.

However, unlike massage, the patient does not lie motionless, and neither pressure nor movement is lateral to the muscles, nerves, ligaments and tendons. Instead, ART use longitudinal movements, and they require the patient to be both a participant and non-participant in their care. In some levels of treatment, movement of the patient’s tissue is done by the chiropractor. In other levels, the patient must actively move the affected tissue in a specific way while the chiropractor employs tension. So, in many ways ART are not strictly a massage; instead, they are a form of manipulation.

What Conditions Do ART Treat?

Because the muscles and other soft tissues can be manipulated, a variety of conditions — all of which are typically the result of overused or overworked muscles — can be resolved with this technique:

• Headaches
• Carpal tunnel
• Back and shoulder pain
• Sciatica
• Tennis elbow
• Shin splints
• Plantar fasciitis
• Knee problems
• Tendinitis

Please contact your chiropractor if you have any questions about ART.