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!!!!

Confessions of a Blogger in Wonderland

Well, today was an interesting day. I woke up at my normal 4:30am to do walk my dogs, get ready for work, etc. I made my way in and stopped to get a cup of bold coffee then made my way into the gym to teach a yoga class. Typically, I have about 30-45 minutes of prep time before I start my class and I usually either mess around for a bit with a few poses or go through a short yoga practice to start my day.

Well, today was a little different. As I was going through my mini-practice, I suddenly had a revelation. "What the heck am I do this for?" I realized that I had lost track of why I was practicing. Was I practicing just to practice yoga? Was I just "warming-up" for my class? At that moment, the answers that I was giving to myself really did not make sense other than going through the motions. My realization was that I had not set any intention for myself for that day. Just doing something just to do it. I think that's fine sometimes, but I think what gets me into trouble is when I am just doing things just to do them and then I get caught in a rut. This action then becomes a habit, and I find myself losing interest and then really getting myself into a rut of doing NOTHING.

Well, I thought as a Soft Tissue and Movement Therapist, I really should practice what I preach. When I go into a session with anyone, I make it a priority to set an intention. It usually helps that the client or group of athletes has a common goal. From there, we can develop some strategies and then movement sequences, whether it be a post-rehabilitation or performance enhancement. I find this extremely beneficial to me and the person I am working with as creates a framework, but like I stated before, when this does not happen, well, its a little more "higgledy-piggledly" as my grandmother used to say.

This morning, I realized that I was going about things in a higgledy-piggledly way. I have been "working out" just to work out and it was without a clear purpose. Initially, I find the novelty of an activity the most exciting part of the process and I still do think its exciting, but I would not go as far as to think it's the most exciting anymore. What's the most exciting to me now is taking that activity, say yoga, and really digging deep into it. "What is my body able to do? What is not able to do? Can I become even more flexible than I am now? Can I learn to control my breathing through yogic training? " This is all so important in the grand scheme of having some intentions for my actions. Here are some the answers to the above questions:

• I do not know what my body is fully able to do because I have never tested it to that point.
• I believe the things that I am CAN DO are far more in number than those that I cannot do because I haven't tried a lot or spent enough time focusing on it; therefore, what I cannot do is not a logical question.
• I can definitely become more flexible (mobility and stability-wise) as well as become stronger.
• My breathing can be much better and I believe yoga is a great system for learning that.

To me, identifying where I can improve is a starting point. It's a place where I can start to go to a goal. For me, I am aware of of where there are weaknesses and tightness in my body. If I want to truly become more flexible, I will "clear" those areas first then move onto improving those areas. There are MANY techniques how to find that flexiblity. As far as being stronger, I can always be a stronger but I do not think its going to necessarily have to be in the form of solely lfiting weights. There is a lot of wisdom behind bodyweight exercises and tweaking them. I also think there should be a reason for me getting stronger. For instance, I have never been able to do a press to handstand because lack of shoulder and core strength and stability. Well, that's a reason to go lift weights. Will my shoulders look more ripped? Yes more than likely, but I like to think of that as a byproduct of function and not a primary objective. However, to each his own. If you want ripped shoulders that look great and you are willing to work for that goal, I say more power to you.

At 3-D Optimal Performance, we stand for maximzing the areas of your life in mind/body/spirit. There is no difference. If we optimize one, we are going to be optimizing the other two. However, intentions based on principles do pave a road, and not necessarily to hell.  I like to use a passage from "Through the Mirror" by Lewis Carroll. It goes:

Alice: Which way should I go?
Cat: That depends on where you are going.
Alice: I don't know which way I'm going!
Cat: Then it doesn't matter which way you go!

Our intention based principles will lead the way for us. However, if we do not have those, then we may be chasing our tails. Again, sometimes, we need to chase our tails but KNOWING that we are chasing our tails is the key. When I chase my tail but do not realize it, I find myself in a rut.

I check in with myself daily, and more than once per day. I urge you to do the same. That way, we both know what we are doing, how we are doing it and most importantly, WHY we are doing it.

In Health,

Will

3-D Hip: Overview of Acute and Insidious Onset Injuries

A while back, I went over the 3-D hip and included a focus on the iliopsoas and the ligaments of the hip capsule. I also went through the Chain reaction biomechanics of the hip. If you dont find the hip interesting, I strongly urge you to reconsider that. The hips are truly the powerhouse of the body. Typically, I find that soft tissue in the hips are some of the most hypomobile of the body which can cause all kinds of issues in the body, especially the back.

When we look at the hip, we can see a very complex structure but this complexity also has a simple side as well. Because of the complexity, we unfortunately see quite a bit of injuries. Unfortunately, this year, I've seen my fair share of hip injuries. Within the first 6 weeks of the fall season, I have seen: sports hernia, osteitis pubis, internal snapping hip syndrome, adductor strain, ASIS apophysitis, gluteal medius strain and various other back problems that I think stem from the hip issues. Unfortunately, I did not see any of these atheletes in our athletic development/injury prevention program with the exception of one and he insisted on playing about 30 games of lacrosse while going through his rehab program for an adductor strain from the previous sports season. What I have become very good at is understanding the hip and many of the issues that affect it, so I will go through a little overview of some of the injuries commonly seen as well as the though process that I use in post rehab and injury prevention situations involving the hip.

Introduction to "I am Will's Body" muscle function series

Many, many years ago, Reader's Digest published an amazing set of articles by J.D Radcliffe. These articles were originally entitled "The body and how it works." This series of articles took a very different look at the body as the author would become the body part, like the heart or liver, and speak in the first person, as the organ. Wonderful. It was such a new way at looking at the body. Instead of memorizing facts about the heart, it was if the heart was talking to the reader in a an autobiographical way. These articles were published later as "I am Joe's body". Here's the first paragraph of the Liver article:

"Joe frets about his teeth, hair, lungs, heart; he is hardly aware of my existence. I am Joe’s liver.* When he thinks of me at all, he has no trouble visualizing me. I look like what I am supposed to look like-liver. The largest organ in his body, I weigh three pounds. Protected by ribs, I pretty well fill the upper right part of Joe’s abdomen"

Introduction to 3-D Soft Tissue Therapy - Part 2

In yesterdays post, I touched on the healing process of soft tissue in the body. It's an amazing process that I believe that we take for granted a lot of the time. We just expect the body to "do its thing" without an appreciation for the process; however, maybe a lack of appreciation of the process stems from a lack of understanding. Functionally, speaking, we must allow the body to heal so creating an environment of optimal healing is of the utmost importance.

A DEEPER LOOK AT THE HEALING PROCESS

There is definitely a simple complexity in the soft tissue healing process. Let's take an injury that unfortunately, I have had more than my share of experience with. This year, my football players have been afflicted with Acromioclavicular Joint (AC joint) sprains. They have mostly been Grade 1's but there was one pretty nasty Grade 2 that required that we take the athlete to the hospital to make sure it was nothing more than an AC joint sprain. The area of injury was the ligament soft tissue that connects the acromion to the clavicle. Sometimes we will see a superior displacement of the clavicle and you can see the discontinuity in the form of a little ridge. I tell my boys that their days of modeling tank tops is over. (Lame, I know)

Introduction to 3-D Soft Tissue Therapy - Part 1

(Technical level: Beginnger-Intermediate)

When I went through massage school a few years ago, I can say that I loved learning about the soft tissues of the body more than anything else, and what got me was that my teachers said "This is just the beginning." Three years later, I look back and I'm still learning about the soft tissues of the body. What's amazing is that we are just starting to tap into the knowledge about and wisdom of the soft tissues of the human body.

As I learned more and more about the soft tissues, I also learned that there were literally hundreds of different methods to facilitate healing of the soft tissue like Swedish Massage, Deep Tissue Massage, Active Release Technique, Graston Technique, Bowen Therapy, Lomi Lomi, etc. The list really does go on and on. The interesting thing is that all of these modalities have a place in soft tissue therapy. However, many people get wrapped up in the TECHNIQUE and forget the PRINCIPLES OF FUNCTION. If we do not anchor ourselves and techniques to the Principles of Function, then we are doing something just to do it. The technique should be applied to the individual if appropriate, not applying the individual to the technique (if that makes any sense).  The interesting thing is that when we start to anchor ourselves to Principles of Function, our "toolbox" is only limited by our imagination (and scope of practice). Let's take a look at the soft tissue of the body, our Principles of Function and then see what we can come up with as far as appropriate techniques.

WHAT IS THE SOFT TISSUE SYSTEM?

The soft tissue system consists of the muscles, fascia, ligaments, tendons, nerves, joint capsules, circulatory and lymphatic structures. Unfortuately, many the soft tissue system has been largely ignored even though it causes more pain and dysfunction than any of the other organ systems.

3-D Movement Focus: Power Yoga (Strength and Flexibility)

In 1996, my amazingly cool aunt, Tracy, introduced me to Yoga. I was in high school and thought I knew it all. Well, stepping onto the yoga path, I came to realize that I still know very little over 10 years later, but it has been a great journey.

Yoga to me is an amazing movement practice. One of my first teachers and colleagues, Paula D. Atkinson, said that "Yoga is MAGIC" and I believe her. The great thing about yoga is that can be anything you want it to be. It can primarily be a physical, mental or spiritual practice OR all three. It just depends on the yogi or yogini.