TREATMENT


What is Soft Tissue Mobilization?

The primary focus at my facility is the soft tissue component of the injury. Soft tissue is everything other than bone. Soft tissue does include the organs, but my interest is the muscles, tendons, ligaments, bursae, fascia and nerves. The treatment of these structures is known as soft tissue mobilization. The basis for this method of treatment is several fold. When trauma occurs, whether it be major trauma, or repeated microtrauma, inflammation occurs. The inflammation leads to fibrous tissue formation (scar tissue) in muscle, between the muscles and between the layers of connective tissue. This fibrous tissue formation causes a decreased ability of the muscle to lengthen and contract as it normally does which in turn leads to a decreased range of motion. This effect can be very local within a muscle or can affect the muscle groups very broadly. The fibrous tissue can also cause pain and a predisposition to re-injury in the same injury. Additionally, pain can lead to muscle guarding, or splinting. The guarding protects the injured area. If the contraction of the muscle guarding is prolonged, the muscle can lose its normal length by the process of adaptive shortening.

There are other factors that have not been researched. These factors include a chemical effect such as histamines and endorphins to name a few. Also, the proprioceptive mechanism is not understood. This is often seen when injuries receive proper taping treatment and significant improvement occurs. The body’s feedback loops are not understood enough to know why we can provide light manual pressure treatment in some cases and produce significant results.

Soft tissue mobilization addresses the previously described complication of soft tissue injuries. The soft tissue is mobilized by the doctor’s hands as his/her hands/fingers move through the muscle. The patient has the involved joint moving as well. This motion is joint mobilization, which occurs simultaneously during the soft tissue mobilization. This motion may occur with the patient performing all the motion (active), or with help from the doctor (active-assisted), or entirely by the doctor (passive). All of the muscles surrounding the injured joint/region are treated (mobilized) and the joint is moved (mobilized) in all planes of motion and this makes the treatment time consuming. The treatment can be modified to be sport specific or task specific if needed or required. Joint manipulation is used as indicated.

Process of History and Diagnosis:

Treatment is of course, based on a diagnosis. The first step of a diagnosis is the history. It is often stated in health care that the history is eight percent of making the diagnosis. A significant amount of time is allocated for the history and physical examination at my office. After the examination is completed, a diagnosis is derived and treatment begins unless advanced testing is indicated prior to initiating treatment. Advanced testing may include: electrodiagnostic test, MRI, X-Ray, CT Scan, lab work, or other tests.

Appropriate referrals to other health care professionals are based upon the data gathered in the history, physical exams and tests. The referral may be to an orthopedic surgeon, neurosurgeon, neurologist, physiatrist (physical medicine), internist, rheumatologist, pain management specialist, vascular radiologist, dentist, psychologist, or physical therapist.