There are various modalities of soft tissue augmentation and some are effective for specific things as evidenced by research, and others fail to have sufficient evidence to support the use of the technique. The topics discussed here will include Deep Frictional Massage (DFM), Graston Technique, Myofascial Release, and Soft Tissue Massage.
Deep Frictional Massage:
Deep frictional massage (DFM) is a technique utilizing friction directed transversely across the tissue to break up adhesions, potentially help with collagen alignment to increase range of motion, reduce edema, and essentially function as a healing mechanism, particularly for tendonopathy conditions. There is some evidence to support the efficacy of DFM when used in conjunction with other treatments, but insufficient evidence to support it as a treatment on its own (Joseph et al., 2012).
Bottom Line: The current research combined with anecdotal evidence from practitioners who have experienced positive outcomes is sufficient to support the use of DFM in practice, but the treatment may be most effective when used as an adjunct to other modalities.
Graston Technique:
The Graston technique incorporates the use of six stainless steel instruments to treat various symptoms such as ligament healing after injury. Evidence has shown Graston technique can accelerate ligament healing in the initial stages allowing for earlier rehabilitation and recovery, but that there is no change from controls when looking 12 weeks post treatment. The only major change was an increase in stiffness from Graston treatment, which physiologically is a beneficial thing to improve (Loghmani & Warden, 2009). Graston can also be used as a form of deep frictional massage to ease strain and fatigue on the part of the clinician applying the treatment. The following slide shows some other research findings with regard to the Graston technique. Most of the following research results on the slide were case studies, which are not the best research design when trying to demonstrate effectiveness of a treatment, so the evidence may not be compelling unless reinforced by randomized control trials or similar studies.
Graston technique has also been indicated for treating chronic conditions such as tendinopathies, entrapment syndromes such as carpal tunnel, for breaking up adhesions and scar tissue, for treating ligament pain from MCL/LCL type sprains, and fascial syndromes such as plantar fasciitis, ITB syndrome and chronic compartment syndromes. Graston can also be used for acute conditions in the control of edema, but the technique needs to change to reduce pressure in acute situations.
Bottom Line: The Graston technique is a well-respected technique among practitioners and there is some evidence to show that it can produce desired physiological changes in tissue with the added benefit of less strain on the practitioner to perform the technique.
Myofascial release:
First let’s define what fascia is since people often don’t know. Fascia is the soft tissue component of connective tissue that spans the entire body and provides some structural support. If you were to take out all of the organs, skeleton, muscles, and remove the skin, you would have a whole body outline from head to toe of fascia. This demonstrates the interconnectedness of the whole body and can help us visualize how an injury in the hip could influence mechanics in other parts of the body or how fascia pulling on one side of the body, could affect the other side. Myofascial release has two approaches: one is direct and one is indirect. For the direct technique, the practitioner will use a low force, constant load to the tissues until they feel the tissue release. The release sensation is obvious to a well-practiced clinician and can provide real time feedback to them. The technique is typically held for a short time after the release and then slowly eased off. The picture below is an example of a direct technique.
For the indirect technique, a gentle stretch is added for traction and the force is applied until a barrier is discovered and from there, the pressure allows the tissue to go where it wants to go. The picture below is an example of an indirect technique.
Bottom Line: There is very little research on myofascial release due to the great amount of variability in technique and application, but the treatment makes sense in terms of how it works theoretically and the patient satisfaction is very high, which always counts for something in therapy.
Soft Tissue Massage:
Soft tissue massage is what you most think of as a typical massage. There are many different modalities of massage, but the focus here will be primarily the Swedish type of massage that is seen commonly in sports clinics. Despite how long soft tissue massage has been around, scientists are still not sure what effects, if any, occur physiologically with soft tissue massage. The research that has been done on this therapy does not definitively support the claims that massage can produce physiologically changes at the cellular level. Additionally, the evidence does not support the popular claim that massage can reduce delayed onset muscle soreness. Soft tissue massage for performance recovery is another area that has been heavily investigated by researchers. However, there is insufficient evidence for soft tissue massage benefiting recovery or performance (Best et al., 2008). Part of the problem is the difficulty comparing techniques across practitioners/research when pressure, duration, and technique tend to vary from one therapist to another.
Bottom Line: The use of massage as a therapeutic modality has been around for a very long time so there is ample evidence demonstrating massage as a valuable therapy for patients at least psychologically despite the lack of evidence regarding physiological effects.
References:
1. Best, T. M., Hunter, R., Wilcox, A., & Haq, F. (2008). Effectiveness Of Sports Massage For Recovery Of Skeletal Muscle From Strenuous Exercise. Clinical Journal of Sport Medicine, 18(5), 446-460.
2. Loghmani, M. T., & Warden, J. S. (2009). Instrument-Assisted Cross-Fiber Massage Accelerates Knee Ligament Healing. Journal of Orthopaedic and Sports Physical Therapy, 39(7), 506-514.
3. Joseph, M.F., Taft, K., Moskwa, M., Denegar, C.R. (2012). Deep friction massage to treat tendinopathy: a systematic review of a classic treatment in the face of a new paradigm of understanding. Journal of Sport Rehabilitation, (21), 343-353.
4. http://www.grastontechnique.com/Research_Reports.html