Active Release Technique (ART) is a soft tissue method that focuses on relieving tissue tension via the removal of fibrosis/adhesions which can develop in tissues as a result of overload due to repetitive use. These disorders may lead to muscular weakness, numbness, aching, tingling and burning sensations. This is done through the body’s own movement guided by a certified practitioner.
Purpose
ART is used to treat symptoms with muscles, tendons, ligaments, fascia and nerves. Its design is 3 fold:
- to restore free and unimpeded motion of all soft tissues
- to release entrapped nerves, vascular system and lymphatics
- to re-establish optimal texture, resilience, and function of soft tissues.
Technique
Tissues are prone to negative changes from trauma, such as swelling, fibrosis and adhesions. During treatment, the clinician uses manual therapy through movement to apply compressive, tensile and shear forces to address repetitive strain injuries, cumulative trauma injuries and constant pressure tension lesions. The clinician applies deep tension at the area of tenderness whilst the patient is instructed to actively move the injury site from a shortened to a lengthened position. The placing of a contact point near the lesion and causing the patient to move in a manner that produces a longitudinal sliding motion of soft tissues, e.g, nerves, ligaments and muscles beneath the contact point.
Post ART treatment exercises
Once the restrictive adhesions between tissues has been released, post treatment exercises become an essential part of the rehabilitation process to ensure the symptoms do not return.
There are 4 fundamental areas that should be addressed in any exercise program:
- Flexibility: Good flexibility enables muscles and joints to move through their full range of motion. Poor flexibility leads to a higher chance of injury to muscles, tendons, and ligaments. Flexibility is joint specific; a person may have excellent range of motion at one joint, yet be restricted in another. Stretching exercises are only effective if they are executed after the adhesions within the soft tissue have been released. Stretching exercises that are applied prior to the adhesions being released will only stretch the tissues above and below the restrictions. The actual restricted and adhered tissues are seldom stretched, leading to further biomechanical imbalances.
- Strength: Strengthening exercises are most effective after treatment. Attempts to strengthen shortened and contracted muscles may result in further contraction and restriction. This causes the formation of more adhesions and restrictions within the tissues, exacerbating the repetitive injury cycle. This is why the application of generic or non-specific strengthening exercises for RSI seldom works.
- Balance and proprioception: Proprioception describes the body’s ability to react appropriately (through balance and touch) to external forces. Proprioception exercises should begin early in the rehabilitation process. Effective proprioception exercises are designed to restore the kinesthetic awareness of the patient. These exercises form the basis for the agility, strength, and endurance required for complete rehabilitation.
- Cardiovascular: Cardiovascular or aerobic exercises are essential for restoring good circulation and for increasing oxygen delivery to soft tissues. Lack of oxygen and poor circulation is a primary accelerant of repetitive strain injuries.
ART and performance
ART is effective for active people of every level. It can provide patients with a means to enhance their sports performance by identifying and releasing restrictions that reduce their performance in their chosen activity. This typically occurs after the practitioner conducts a biomechanical analysis of the patient’s motion. During the biomechanical analysis and the subsequent treatment, the practitioner:
- Evaluates gait, motion, and posture.
- Identifies the biomechanical dysfunctions that are restricting the performance.
- Locates the soft tissue structures that are the primary cause of the biomechanical dysfunction as well as affected structures throughout the kinetic chain.
- Treats the soft tissue dysfunctions with ART to restore full function to the affected structures.
ART Performance Care is applied after trauma based injuries have resolved. ART Performance Care concentrates upon removing restrictions that inhibit full range of motion, and in restoring full function and performance to affected soft tissues. This process can result in significant increases in sports performance of power, strength, and flexibility.
The goal of Active Release Technique (ART) therapy is to restore normal soft tissue mobility by breaking down frictions and restrictions in the muscle that can result in painful and unnatural movement patterns. Tissue tension disorders can lead to altered muscle recruitment, nerve symptoms such as numbness or tingling, and overall muscle and joint pain.
During an ART session, a specially trained practitioner uses their hands to apply pressure, manipulation, and movement to damaged or abnormal tissue in muscle, fascia, ligament, tendon, and nerves.
Practitioners have successfully used ART therapy for decades to treat symptoms caused by soft tissue conditions, increase blood flow, ease discomfort, and promote faster healing of injuries. The therapy effectively treats both acute and chronic conditions and is often used to treat sports injuries.
Only certified practitioners should perform ART therapy. Trained practitioners are usually physical therapists, massage therapists, chiropractors, or doctors. Certification requires mastery of over 500 specific protocols used to treat affected areas of the body.
What is an Adhesion?
Adhesions are scar tissue inside your body. They are dense, fibrous bands of inflexible scar tissue that stick two surfaces or organs together which impede normal function. Adhesions can form anywhere in the body.
While scar tissue is a natural part of your body’s healing process, it is not normal tissue. It may cause muscles to shorten and weaken, entrapment of nerves, post-surgical complications, bowel obstructions, infertility, chronic pelvic pain, and other health issues.
Breaking up scar tissue and adhesions through ART relieves pain and brings function back to the affected part of the body.
What Causes Soft Tissue Damage?
Acute, chronic, or cumulative injuries can cause scar tissue to form inside or between muscles, nerves, blood vessels, and connective tissue. Trauma, tears, sprains, or strains from overuse of certain muscles, inflammation of the connective tissue that protects and supports muscles and organs, injury to tendons and ligaments, and post-operative conditions all may cause the accumulation of adhesions and tissue damage.
These adhesions restrict and alter movement in the joints or muscles, causing pain, fatigue, and other symptoms.
Pressure caused by poor posture can also cause muscle and tissue adhesions.
What Conditions Does ART Treat?
ART effectively treats a wide range of conditions, including tears, sprains, repetitive strain injuries, and other cumulative or overuse injuries.
Conditions commonly treated with ART include:
- Lower back pain
- Sciatic nerve pain
- Chronic neck pain
- Tension headaches and migraines
- Shoulder sprains, pain, or frozen shoulder
- Repetitive use injuries like tendonitis, which often cause pain in the shoulders, elbows, wrists, knees, legs, or heels
- Carpal tunnel syndrome
- Plantar fasciitis
- Post-operative scarring and adhesions (especially common in those who have had abdominal surgery or gynecological procedures)
Signs of Scar Tissue
A buildup of scar tissue can cause pain, weakness, and restricted movement. One or more of the following may be a signal that scar tissue is causing dysfunction or pain in the body.
- Muscle stiffness in the neck, back, or extremities
- Sharp pain in the heel of the foot
- Decreased range of motion
- Increased weakness
- Lack of flexibility
- Joint inflammation
- Tingling, numbness, or pain in the fingers or other body parts
What to Expect During an ART Session
The goal of ART therapy is to break up scar tissue to restore free movement, resilience, and function of soft tissue, to improve circulation, and to reduce or eliminate pain and stiffness.
MOTION physical therapists are certified ART practitioners and experts in treating soft tissue injuries. After a thorough assessment of your situation, your physical therapy team will design a treatment plan to fit your individual needs.
Your First ART Therapy Session
The more we know about your specific health condition, the better able we can provide you with the relief you need and deserve. You can help by preparing for your first visit. Jot down detailed notes about your symptoms and anything that worsens or relieves the pain and bring those notes to the session.
During your first visit, your physical therapist will conduct a thorough physical examination and functional assessment to determine your starting point. We will ask you to move certain body parts in order to assess their function, so please dress comfortably. Throughout this and every visit, we encourage you to ask questions and provide feedback.
By carefully examining the data we collect, including your medical history, results of the physical exam, findings from the functional assessment, and information provided by you and your physician, we will develop a treatment plan that addresses your specific goals.
Subsequent ART Sessions
During every ART session, your physical therapist will evaluate the texture, tightness, and movement of your soft tissue to determine which areas need treatment. They will then conduct the treatment, answer your questions, and chart your progress.
How is ART Performed?
By applying their hands to your skin, your physical therapist locates the area to be worked on, then applies pressure as you actively move a certain body part, or your PT moves the body part for you. Your PT continues to apply a combination of tension and motion as you or they position your body part to shorten the muscle, then position it to lengthen the muscle. This continues until you feel a release.
Does ART Hurt?
Areas targeted by ART therapy are sensitive, to begin with, so there can be some discomfort during treatment. However, your PT will ask for your feedback throughout the session to ensure the therapy never becomes too painful. Patients often comment that the experience is like a therapeutic massage in that it “hurts so good.” You may experience soreness after the session, which usually resolves within a few days.
How Many Sessions Will I Need?
Some patients experience an improvement of symptoms after the first session. However, it may take up to six visits, depending on the severity of your condition, to achieve full benefits. Sessions usually last about 15 minutes.
Individuals who actively take part in their treatment and recovery program by performing home exercises recommended by their PT often need fewer sessions and help reduce the chances of reoccurrence of symptoms.