Instrument-Assisted Soft-Tissue Mobilization: A Multilayered Approach

Soft tissue dysfunction can be a frustrating problem that keeps athletes from playing their chosen sport or maintaining their training regimens.

It can also increase injury risk. Soft tissue dysfunction typically begins as an acute injury, but when athletes attempt to return to play too soon, it can lead to improper healing, decreased performance and chronic dysfunction. But by using a multilayered approach, athletic trainers, chiropractors and therapists can apply instrument-assisted soft tissue massage techniques to address adhesions in the superficial and deep fascial layers and improve outcomes for athletic injuries.

What Happens in Chronic Soft Tissue Dysfunction?

Chronic soft tissue dysfunction starts when shortened tissue occurs at the injury site due to increasing scar tissue. The coagulation of the tissue and fascial layers cause dysfunctional muscle firing patterns from weakness and compensation. Compensation in this weakened area then leads to a decrease in intrinsic muscle control in the core and segmental stabilizing muscles, increasing stress on joints and leading to increased injury risk.

A Global Approach to Instrument-Assisted Soft-Tissue Massage

Consider this: A patient presents with chronic headaches and worsening lower back pain that interferes with her position as a nurse. She has suffered from weekly headaches for more than 10 years, along with intermittent lower back pain. She has received treatment and massage weekly to bimonthly for the last six-plus years and has relief following these treatments, but the results are short term. Overall, she has been using ibuprofen to cope with the pain and has reduced her shifts at work to better accommodate her pain.

Most practitioners are used to treating a patients with this presentation from an injury-focused viewpoint, but sometimes a global viewpoint is needed. In our patient described above, an evaluation found that soft tissues from her neck to her pelvis and her shoulders were causing her tightness and feeling of pain. Along with her pain generating soft tissue, she was compensating for faulty mechanics in the hip and pelvic region. Treatment using Fluid Motion Tools along fascial lines helped to break up the thickening in the fascia, improving proper movement patterns and allowing intrinsic muscles to properly stabilize the patient. We were able to manage her pain much better and release her to a full work schedule in just a few short weeks.

The same process can be seen in athletes. When a 17-year-old high school pitcher recently complained of constant severe headaches and shoulder pain, he was originally evaluated and treated with physical therapy and pain management, including cortisone injections in his neck and shoulder. After months of treatment (and time off from baseball), his pain was reduced but was still persistent.

When he contacted our office, a functional and orthopedic evaluation of his cervical spine and shoulder was unremarkable. He had excellent range of motion and laxity in his upper neck, no signs of impingement or tears in his shoulder. But upon evaluation of his gait and a functional wall squat, it was revealed that his right ankle was dysfunctional, causing excessive calf tension and Achilles restriction, external rotation in his right hip, and excessive upper thoracic and thoraco-lumbar restrictions—which led to soft tissue adhesion and dysfunction in his mid-back and left shoulder region.

Our approach was to break up the soft tissue adhesions in his calf, leg and hamstring, improve range of motion in his ankle and stability in his hip, and address myofascial adhesions in his thoracic and upper cervical regions using Fluid Motion Tools and fascial line techniques. In four visits, his headaches were improved, and he was back to pitching within three weeks of his initial evaluation.

By addressing all layers of tissue and looking at patients’ dysfunctional patterns, we can identify decreases in athletic performance. Even further, if we are adamant about addressing the entire patient, we can improve soft tissue dysfunction in all areas of the body, not just the injury site.