3-D Soft Tissue Therapy: A deeper understanding of the healing process

In my last two posts on soft tissue therapy, I went into the scarring process in relation to an injury. If you have not already, please take the time to read those two posts, as this post is really the last part of the series.

In the first two posts, I described the healing process from a traumatic injury of sorts and left off starting to describe the FIBROTIC PROCESS.

When an acute injury begins on the linear process of healing, the body responds to that area only. However, with the fibrotic process is cyclical and affects the entire fabric of the connective tissue. Unlike the scarring process which ends, the fibrotic process will continue until the main cause of the irritation is discovered.

The irritant in the fibrotic process, such as repetitive stress, excessive pressure-tension (i.e sitting for long periods of time), postural stress starts a chain reaction in the tissues as follows:

1. Activation of microphages
2. Increase in tissue vascularity
3. Increase in fibroblastic activity
4. Increase in connective tissue
5. Increase in myofibroblastic activity
6. Shrinkage of connective tissue
7. Abnormal motion

Again, this cycle will continue until the irritant is found.

With the scar tissue, we see that lack of ROM is due to the elasticity of the scar as well as the surrounding adhesions; however, the fibrotic process is a change in entire soft tissue region.

A case study would be the difference between a rotator cuff tendinitis caused by too much overhead throwing activities that is caught early, R.I.C.E'd, and taken through the proper therapy as opposed to the 'idiopathic' frozen shoulder or adhesive capsulitis where the fibrotic process has taken over and changed the texture of the entire shoulder capsule where there is little ROM, pain and chronic inflammation. For more info on this, click here. Its a good article by the American Family Physician Newsletter.

Working with clients or patients, its so important to take a detailed medical history in regards to injuries. One of my lacrosse players who trained with me this summer was having some knee issues so we did a little soft tissue work on him to see if we could get a little more ROM in his ankle. I asked him on multiple occasions if he had injured his ankle to which his reply was "I don't think so"; however, I knew something was wrong. The difference of ankle motion in his right foot to his left foot was pretty big. Well, my athlete returned back to college and unfortunately sprained his ankle a few days ago. It was severe enough that they took him to the doctor for x-rays. The x-rays revealed that he had a break in his right ankle from a while ago that had healed but the injury had calcified. WELL THERE GOES MY ASSESMENT OF HIS ANKLE. The feeling was a definite osseous end feel; however, the soft tissue surrounding it was a bit like working on a rope that has several knots in it that prevent it from really stretching out. It's a hard feeling to explain but I confirmed the unusual lack of ROM in the right ankle by checking it against the left ankle. Definitely not the same.

These palpation skills are something that I will go into a little more in depth. I believe that it is an experience that you need to have. The feeling of healthy tissue and dysfunctional tissue is VERY different. As a soft tissue therapist, you learn, through tactiile "observations" what it feels like.

I hope this look into the soft tissue healing process helps. As a soft tissue therapist or really anyone who works the body, we need to understand the process that many of our clients and patients are experiencing. As our knowledge deepends, we are able to tap into that knowledge base so that we can apply the Principles-Strategies-Techniques to our individual clients.

I will continue on this soft tissue journey soon by discussing some strategies and techniques for assessing soft tissue.

In Health,

Will

Again, I would like to thank Lenny Parracino CMT, FAFS for his guidance, knowledge and wisdom in regards to the soft tissue system. Thank you, Lenny!!!!