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Manual Therapy

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Manual therapy

Manual Therapy is a skilled hands-on treatment technique used by physical therapists to treat musculoskeletal pain and dysfunction from injury/overuse, immobilization, disease, and the aging process. Hands-on techniques can increase range of motion, treat joint structures, reduce pain, relax tissue, reduce inflammation/swelling, and enhance healing. There are many different styles of manual therapy used by physical therapists.

Sports massage helps to alleviate the stress and tension which builds up in the body during and after physically intense activity. Massage can quickly and effectively resolve minor aches and pain called "niggles" caused by overexertion and/or overuse from becoming full-blown injuries. Sports massage is often focused and systematic, targeting muscles that are used in a specific sport. For example, a runner has different needs than a baseball player. It uses various techniques to decrease muscle pain and improve recovery, as well as improve overall range of motion and flexibility. Some individuals prefer pre-event massage while other prefer post-event work. Massage can also help to decrease delayed onset muscle soreness.

Medical massage can work on a number of medical issues that are chronic in nature such as arthritis, degenerative disc disease, low back pain, tendonitis, or an area recovering from a previous injury. Acute condtions can also benefit from massage to decrease pain and restore function ina quicker time frame. It is important to communicate with your physical therapist your pain location(s) and behaviors as this can help to direct treatment techniques and improve outcomes. Often pain can radiate or travel to a different location and your therapist may need to address another site other than where you are feeling the pain. Medical massage tends to be deeper in pressure than a relaxation massage and tenderness is common. Your therapist may also recommend gentle stretching exercises after your massage to maintain its benefits.

Instrument assisted soft tissue mobilization (IASTM) is a popular treatment for myofascial restriction, tendonits, scar tissue and muscle tightness. IASTM uses specially designed instruments to provide a mobilizing effect to tissue and myofascial adhesions. Several IASTM tools and techniques are available such as the Astym or Graston. Many techniques require advanced certification. Several studies have shown IASTM can improve soft tissue function and ROM in acute or chronic sports injuries while also reducing pain.

The instruments can be made of stainless steel or plastic with beveled edges and contours that can conform to different body anatomical locations and allows for deeper penetration. It can also be used for the detection and treatment of soft tissue disorders. The instruments help tp effectively break down the underlaying soft tissue restrictions and scar tissue. This process leads initiates controlled microtrauma to affected area and causes the stimulation of local inflammatory response. This microtrauma initiates reabsorption of inappropriate fibrosis or excessive scar tissue and facilitates a cascade of healing activities resulting in remodeling of tissue. Combined with targeted stretching and strengthening, IASTM is an excellent treatment option for those with musculoskeletal conditions or injury.

Manual Therapy Techniques

Soft tissue mobilization is used to break up fibrous muscle tissue/adhesions and is often applied to muscles, tendons, ligaments, and scars. This method of manual therapy uses light to deep pressure with rhythmic stretching. The physical therapist localizes techniques to the area of the greatest tissue restriction and works the tissue surrounding that area. The therapist may use specific tools to enhance the process.

Muscle Energy Techniques (METs) are procedures used to lengthen shortened muscles, mobilize restricted joints and mechanical faults. The patient actively contracts uses his/her muscles against a controlled counterforce applied by the physical therapist from in a specific direction. After the muscle contraction, the joint is taken to its new range of motion.

Joint Mobilization/Manipulation which uses measured movements of varying speed (slow to fast), force (gentle to forceful), and distances (called 'amplitude') to twist, pull, or push bones and joints into position. This can help loosen tight tissues around a joint, reduce pain in a joint, and surrounding soft tissue, and help with flexibility, posture, and alignment.

Myofascial Release is a focused elongation technique that engages tight and restricted tissues through superficial and deep pressure to help restore muscle balance.

Understanding Fibrous Adhesions: Causes, Risk Factors, and Prevention

Fibrous adhesions are bands of scar-like tissue that form between muscles, joints, or organs, restricting movement and sometimes causing discomfort or pain. They can arise due to several factors, including:

Causes and Risk Factors

Overuse and Repetitive Strain
Repeated movements and excessive strain on muscles and joints can cause microtrauma to tissues. Over time, this can lead to adhesion formation, restricting movement and flexibility. Athletes, manual laborers, and individuals who engage in repetitive activities are particularly prone to this issue.
Poor Posture
Incorrect posture places uneven stress on certain muscle groups, causing them to tighten and become restricted. Over time, this chronic tension can lead to adhesion formation, reducing mobility and increasing the risk of musculoskeletal pain.
Aging and Tissue Degeneration
As we age, collagen production decreases, leading to reduced tissue flexibility and slower healing. Older adults are more prone to adhesions due to decreased circulation, reduced elasticity, and accumulated wear and tear on tissues.
Previous Injury and Scar Tissue Formation
When the body heals from injuries such as muscle strains, ligament sprains, or fractures, it produces collagen to repair damaged tissues. However, excessive or misaligned scar tissue can lead to adhesions, limiting the natural movement of muscles and joints.
Surgical Procedures
Surgery is a significant contributor to adhesion formation, particularly in areas such as the abdomen, joints, and tendons. Post-surgical adhesions can lead to complications, including restricted mobility and chronic pain/dysfunction.
Inflammation and Chronic Conditions
Chronic inflammation from conditions like arthritis, tendinitis, or autoimmune diseases can lead to excessive tissue repair; resulting in adhesion formation. Inflammatory responses can also alter tissue structure, increasing the likelihood of adhesions.
Poor Recovery Nutrition
Nutrition plays a crucial role in the healing process. A deficiency in key nutrients—such as protein, vitamin C, and omega-3 fatty acids—can slow tissue repair and increase the likelihood of fibrous adhesions forming. Proper hydration is also essential for maintaining tissue elasticity.

Prevention and Treatment Strategies

While fibrous adhesions can be challenging to manage, several strategies can help prevent or minimize their effects:

Manual Techniques
Manual techniques such as myofascial release, massage therapy, and deep tissue mobilization as described above can help to break down adhesions and restore movement. Soft tissue manipulation can be particularly beneficial for post-surgical patients. It is important to follow this up with the below recommendations to achieve the best outcomes.
Regular Mobility and Stretching Exercises
Engaging in stretching and mobility exercises can help maintain tissue flexibility and prevent adhesions from restricting movement. Yoga, dynamic stretching, and foam rolling are effective ways to keep tissues supple.
Proper Posture and Ergonomics
Maintaining good posture and using ergonomic adjustments in daily activities can reduce strain on muscles and prevent the formation of adhesions over time.
Optimal Nutrition and Hydration
Consuming a balanced diet rich in collagen-boosting nutrients (such as vitamin C, zinc, and protein) can support tissue repair. Staying hydrated is also critical to maintaining tissue elasticity and preventing excessive scar tissue formation.
Gradual Strength Training and Conditioning
Strengthening muscles and improving overall body mechanics can help prevent repetitive strain injuries, reducing the likelihood of adhesions forming. Gradual and controlled strength training is recommended, especially during recovery from injury.
Anti-Inflammatory Strategies
Reducing chronic inflammation through diet (anti-inflammatory foods like turmeric, ginger, and omega-3s), proper rest, and medical interventions can help limit adhesion formation in individuals prone to inflammation-related condition