Soft tissue technique

Soft tissue technique, performed by osteopathic physicians, is a type of osteopathic manipulative treatment (OMT) directed towards muscles and fascia throughout the body. They involve a Doctor of Osteopathic Medicine (D.O.) using his/her hands to stretch or relax dysfunctional soft tissue structures. While these techniques can be applied almost anywhere, they are especially useful for the paraspinal musculature that surround each vertebra of the spine. The end goal of all soft tissue techniques is to relax hypertonic muscles and stretch tight fascial structures.

Pathophysiology of Soft Tissue Dysfunction

Trauma, accidents, local inflammation, immobilization and emotional tension all can lead to the local irritation that causes muscle tension. As muscle tension increases a number of problems occur: muscle fibers tighten, blood vessels become compressed, tissue metabolites are retained and local edema occurs. This process eventually leads to limited muscular elongation, restricted joint movement, tendon function restrictions, fascial shortening and a functional disability.

Mechanisms of Action for Soft Tissue Techniques

Soft tissue techniques work by affecting a variety of components within the soft tissue structure. These components include the musculature, fascia, vasculature and local nervous system, which will each be described below:

• By applying a direct force to tight muscles, the muscles can be stretched or kneaded until relaxation occurs.
• Similarly, as muscles are stretched, the fascia surrounding each muscle is also stretched until fascial relaxation occurs. Please note that fascia can be specifically treated by using myofascial release techniques if dysfunction is still present after soft tissue techniques have been used.
• In relation to vasculature, soft tissue techniques have been shown to increase the amount of circulation to the muscles and fascia. As more blood reaches the tight muscles, the amount of oxygen and nutritional components reaching the muscles increase, as well as increasing the rate of removal of local metabolites and waste products. All of which lead to more rapid healing rates.
• The somatosomatic and viscerosomatic neural reflexes can also be decreased through soft tissue techniques.

Indications/contraindications

Soft tissue techniques are used to resolve dysfunctions commonly described by the mnemonic device "TART" (Tissue texture change, Asymmetry, Restriction, and Tenderness). They are often well tolerated by most patients. Some contraindications include local infection, open wounds or lack of skin and soft tissue integrity. Caution should also be used on patients taking anticoagulants as bruising can occur.

Techniques

The choice of technique is based largely on treatment goals. There are three basic methods used when treating with soft tissue techniques:

• Traction techniques(or stretching techniques) engage the origin and insertion of the myofascial structures by longitudinally stretching the muscle fibers.
• Kneading techniques involve a rhythmic lateral stretching of the myofascial structure much like stretching a bowstring. In these techniques, the origin and insertion of the muscle remain stationary.
• Inhibition techniques use sustained deep pressure to promote soft tissue relaxation.

Most often soft tissue techniques are used in combination with other treatment modalities in order to maximize results. This combination applies the principle of synergy to make sure a patient's somatic dysfunction is as resolved as possible.

Sources

Updated by Western University of Health Science/COMP OMM Department

Ward, Robert C. et al.; Foundations for Osteopathic Medicine (2nd ed.). Philadelphia: Lippincot Williams and Wilkins. ISBN 0-7817-3497-5