The Ins and Outs of Soft Tissue Treatment
This is something you need to know about.
Not just because it’s awesome on its own, but because it helps make everything else more awesome. Learning about this will have carry over to strength training, fat loss, conditioning and overall health and well-being.
Soft tissue work.
So what am I talking about? Soft tissue work is a term that can be difficult to break down—so I’ll do it for you. What can I say, I’m a nice guy.
Essentially, soft tissue is exactly what it sounds like—any tissue in your body that is soft. This includes muscles, fascia, ligaments, tendons and joint capsules.
The overarching term for any modality that is intended to treat and/or improve the quality of soft tissue. These modalities can include self-myofascial release (SMR), Active Release Therapy (ART), Graston Therapy and Massage Therapy.
The condition of the soft tissue to do what it do! That is, soft tissue quality basically means the ability of the tissue to perform optimally and without pain.
If you’re unfamiliar with soft tissue work, you may be wondering, “Why do I have to work on it at all?” That’s a fair question.
Let’s talk about how soft tissue damage occurs, and why it’s bad.
When you do any sort of challenging movement—whether it’s resistance training, intense cardio or even vigorous sex—it usually creates small tears in the muscle, called “microtrauma.”
This is not only part of training but it’s the entire point of training: The microtrauma results in the tissue healing, growing and getting stronger.
That’s the good. Now onto the bad.
Creating said microtrauma can, and eventually will lead to adhesions. This essentially occurs when tears don’t heal completely or properly, and muscle tissue begins to “stick” to other tissue, creating tension from those tissues pulling on each other. These types of soft tissue damages impede function and performance.
To give you a basic definition, knots can form and the soft tissue can’t perform as smoothly and efficiently as it would without these obstructions.
So when we talk about soft tissue work, we’re really talking about treatments that will work those knots out, restore blood flow (blood doesn’t flow too well through knots, as you can imagine) and reestablish proper function.
Soft tissue work, whether for chronic muscle strains or for tendon issues, is really a kind of stimulus. In effect, what the therapist is doing is irritating the tissue to produce a chemical response. The chemicals produced are what begin the healing process; which is why soft tissue work is often painful and can leave you feeling similar to a workout the next day.
Done regularly, this kind of work improves tissue quality and extensibility, which allows your tissue to properly lengthen.
Now, these adhesions are going to happen no matter what. That’s just part of training. However, they don’t have to cause injuries. In fact, if included as part of your regular regimen, you can drastically reduce your chance for injury.
Soft tissue quality is sort of like strength—there’s strong, and then there’s strong. Training will generally make you stronger, but if you pay special attention to your strength and make it a goal, you can really see it take off.
It works similarly with soft tissue quality: If you really pay attention to it, you’ll be able to maintain healthy tissue and prevent injury. Diligence pays off.
However, injuries often do occur, and various types of soft tissue work (which we’ll cover below) can be used to treat it. But what’s more important that, and something that nowhere near enough people focus on, is that doing soft tissue work as a regular part of your exercise regimen will improve your tissue quality and help prevent injury.
This is of particular importance to younger weightlifters, who almost invariably think of themselves as invincible (I should know, I was one of you).If you wait until pain or discomfort if felt you are facing that much more of a challenge. If you wait until you’re injured to start caring about your soft tissue, well… then you’re like most people who foam roll. It’s hard to impress the importance of injury prevention before someone’s ever been injured, but just believe me that you need to pay attention to this.
This is the type of soft tissue work you can do yourself, using various tools. This can be done with a roller (foam roller, PVC pipe or something like “The Stick”) or a ball, such as a lacrosse or tennis ball, which are handy for getting deeper into problem areas. The most popular of these tools (both in usage and discussion) is the foam roller—in fact, the foam roller is recommended so often that some consider it to be synonymous with SMR, which isn’t true.
A dense, cylindrical object on which you rest your body then set in slight motion. Basically, sit on the thing—sandwich the roller between the floor and the tissue being treated. Bear down with your body weight and roll slowly back and forth.
The guys over at Cressey Performance put together one of the best videos on foam rolling there is. Watch and learn:
The Foam Roller (my favorite, from Perform Better)
Another SMR tool worth mentioning is the Stick. The principle is the same to foam rolling, but because the tool is in your hand, you have a bit more control in terms of directionand pressure.
The Stick was recently featured on CBS’ The Doctors amid a surprising plethora of dick jokes. Check out this vid for more info.
To pick up the Stick, just head over to the site.
(Basically, stuff you don’t do yourself.)
I have to assume you know what this is, but in brief, it involves a therapist working through some of your hot spots, trigger points, painful areas and tightness with their fingers. Some massage is just for pleasure, some is for treatment. Pain is a good indicator of which you’re getting, since the therapist has to un-do the damage you have done to your tissues and that isn’t easy work.
Basically, if you are getting a massage and don’t at some point feel enough pain to hate the therapist, you are not getting “treated.”
If you are serious about improving your soft tissue quality, find a good massage therapist and try to go at least 1 massage per month; just keep in mind massage therapy for soft tissue treatment shouldn’t be a walk in the park.
Developed by Dr. Tim Leahy and now used all over the world in a variety of fields, Active Release is a manual therapy that works by putting tissue in a shortened state, applying pressure to the scar tissue/adhesion and then taking the tissue through a lengthening movement which serves to break up the scar tissue.
The differences between massage therapy and ART are many and varied, but the most practical distinction is that massage therapy performed on muscles in a stationary position, whereas ART is performed on a muscle moving through a range of motion.
It is very effective, painful, and not cheap. I have had it done on my shoulder and it worked quite well, but as with a lot of these therapies, don’t expect a day at the beach.
Charles Polquin has said that, “in 70% of patients, ART is 100% effective.”
Now, that sort of sounds like a commercial for Sex Panther—and everyone knows that 60% of the time, it works every time. (They’ve done studies.)
But in the case of ART, the take home is that while ART won’t work for everyone, it is extremely effective for most people. While I think that anyone who lifts heavy, is an athlete, or can afford it should go regularly—maybe once every 3 months for a check-up—ART really shines when it comes to injuries. And if you’ve neglected your regular soft tissue and SMR, you’re probably going to wind up at an Active Release Therapist.
Here is a video of me getting treatment on my shoulder by Dr. Christopher Anselmi—one of the best in NY and a guy who giggles when he hurts me.
Fore more information on Active Release Therapy, or to find a practicioner in your area, check out their site here. If you’re in the NYC area and looking for a great therapist, here’s a link to my Doc’s website.
Okay, so now you’ve completed Soft Tissue 101: What it is, why it’s important, and methods of treatment. Admittedly, I left a number of methods out (such as Graston Therapy), but this should give you the basics of all of the important points and treatments.
Comments for This Entry
golda11I have used this therapy and it has strengthen my body tissue. Now I am feeling new energy and strength in my body. Chiropractors, physical therapy – http://www.spineandsportsmed.com
January 7, 2014 at 6:09 am
A Different Type of "Exercise" - Roman Fitness Systems[...] use my foam roller for about 10 minutes to work out any sore spots. (If you haven’t read this post on soft tissue [...]
November 13, 2013 at 2:09 pm
adwanesI am actually in need for this particular info. Good thing I had the chance to visit your site, you really made your blog a good source of learning. I'll be checking out for more updates. thanks a lot and a job well done for you! active release therapy
November 3, 2011 at 11:41 am
JohnThe real trick is a combination of chiropractic and myofascial-release/deep tissue massage. The chiropractor puts your spine into proper alignment, and the massage therapist loosens the muscles so they don't keep holding the bones in improper alignment. Get them within 24 hours of each other, but preferably one right after the other.
June 18, 2011 at 1:25 am
Ken ZelezYou are welcome. Keep the content coming!
February 21, 2011 at 10:53 pm
John RomanielloThanks for the kind words, Ken, I appreciate it. This article was one of my favorites to write, glad you enjoyed it. I appreciate you sending some readers over =)
February 21, 2011 at 10:35 pm
Ken ZelezVery cool blog John. I really like your rules for commenting. I have to admit that you have one of the most comprehensive content on SMR I have seen in a while. Nice work. The comments people are making are fantastic as well. Keep up the great work. I will be sure to send my readers to your blog.
February 21, 2011 at 9:58 pm
james quigleyGreat writing, awesome topic! I cant even begin to tell you how much I stress this with the two meat head trainers I work with. Im gonna print this out and stick it in there pump magazines. Thanks buddy, continue the great work.
February 10, 2011 at 8:19 am
JohanI do the foam rolling thing. I believe it has helped me a lot with a groin problem. At least it has helped getting rid of some tightness I didn't even knew I had
February 7, 2011 at 9:56 am
PerBeen going to a naprapat slightly less then once a month (soft tissue work and cracking some stuff, feels like a 2-4-1 deal compared to just the massage) Luckily we have it partially paid by my employer so it's fairly cheap. Since everyone knows it's just as straining to sit stationary at a desk compared to pumping da metal, I don't feel guilty using the company health care funding. I have been looking at getting me a foam roller and after pulling my low back a little bit during my last leg workout, I think I ought to get one pretty soon.
February 4, 2011 at 12:43 am
YlwaThere seems to be a common missperception that massages are a pleasant thing. As pointed out, they are not. My fiancée has stopped asking for massages, unless he's looking for pain, since he knows whats coming. If he just wants the nice, cuddly stuff he nowadays asks for some "gentle fiddleing" (sex joke too obvious to insert). ART hasn't really hit Scandinavia yet, at least not in the form you're talking about. I'd love to take a closer look at it when we head over, it looks a bit like hold-release therapy which is used quite frequently in physiotherapy over here
February 2, 2011 at 3:09 am
KurtI use PVC pipe, and a baseball. I do soft tissue work 5 days a week. It definitely makes a huge difference.
February 1, 2011 at 11:09 pm
KurtI use PVC pipe, and a baseball. I do soft tissue work 5 days a week. It definitely makes a huge difference.
February 1, 2011 at 11:09 pm
PropaneFitnessGreat article. I personally find a foam roller doesn't reach my lumbar spine, and a tennis ball twists you a little - so I've been using two tennis balls sellotaped together to use on my QL and lumbar erectors. Your spine sits neatly in the middle without pain.
February 1, 2011 at 6:34 am
DanI have been using a foam roller religiously every day ever since reading and performing Eric Cressey's Maximun Strength workout. I haven't had to see my chiro in months. This stuff is powerfully awesome!!!
January 31, 2011 at 7:48 am
RobWhat about rolfing?
January 31, 2011 at 6:50 am
Peter Meireles PicolinART seems very much like AORT with the difference being in NOT moving the muscle. It stays thorugh 90 secs or till 2 minutes in a shortened position while the therapist hold the trigger points. After this little time of pain (the shortened position reduces the pain), the therapist can feel the cardiac pulsations and knows blood is entering in the tissue what releases the tension proprioceptive. look for Raphael van Ashe. Is a easy to repeat procedure. and even without a minimum of anatomy knowledge anyone can follow the instructions and do the tecnik. It works 100% of the time. 8) have fun.
January 31, 2011 at 6:45 am
JosselineGreat blog! I myself am a massage therapist, so I know and preach every day the numerous benefits of having a massage treatment... So thankyou for writing up to post to make everyone aware and bring it to their attention. ATR is also fantastic, I use it in my treatments when needed too.
January 31, 2011 at 1:03 am
ChrisThank you, Roman, for another great post! I have used a foam roller in the past, but I saw techniques on the video that I am anxious to try. I want to use my foam roller on a more regular basis, so thank you for the information and the boost. Also, I have a terrific massage therapist who keeps me going. I had a very painful shoulder years ago, and she got it released. I just realized from your video on ART that that's what she used. It was SO painful, but so necessary. I've also had myofascial release therapy in the past. A lot of progress was made through that. Another tool I've used is the SacroWedgy. Great relief for lower back pain. I've also used the Miracle Ball method, which has been great, too. I really enjoy your blogs, your character, your sense of humor, and the wealth of information you give us. Best to you.
January 30, 2011 at 11:21 pm
TonyI have been using foam rolling and the "Chuck-It!" (thanks to Nate Green) ball for self-release (insert perverted joke) for a while now. Admittedly, I've slacked off a bit. This post made me want to make it a daily routine again. Needless to say, I had a few trigger points that I didn't seem to have a couple months ago. ;)
January 30, 2011 at 11:12 pm
SeanThis might be exactly soft tissue therapy, but I use an inversion table daily and it helps my back and hips from getting too far out of alignment. This also effects soft tissues since being imbalanced causes all kinds of issues.
January 30, 2011 at 9:45 pm
ClementI know that foam rolling is essential and I should probably do it more. At the moment, I don't fo it before training - I just do a dynamic warm-up, lift and then static stretch. However, I foam roll on off-days and whenever I can add it in. You know, during those times when I'm at home and watching soccer matches. That's my time to hump the roller! However, my "roller" is just a tennis ball. I don't have any foam rollers, as I can't find any around in my country. Is a tennis ball enough, or should I just get a foam roller, too?
January 30, 2011 at 9:43 pm
Christinefoam rollers are a great tool to use for therapudic exercises, however rolling is a technique like the other soft tissue treatments. Additionally rolling should not hurt. the video you found is known as the 'steam rolling' technique and does nothing to self-release the soft tissue. For a more up to date rolling technique and great roller (because foam flattens in the middle and you lose the tension) go to www.rollrelease.com
January 30, 2011 at 8:35 pm
DougNow that I have seen one of those foam rollers demonstrated, I have to get me one. Very Hot. :) As for the 'Stick', not much different from the wooden wheeled animals they used to promote. And I agree with massage therapy. Its not a walk in the park, and if it is, then your with the wrong therapist. I must look further for the ART avenues.
January 30, 2011 at 7:53 pm
MattGreat stuff here John. I actually had 5 or 6 sessions with Dr Anselmi about a year and half ago for some shoulder pain. Your right he is awesome, my shoulder felt much better and I make sure I'm foam rolling or using a lacrosse ball as often as possible each week.
January 30, 2011 at 7:53 pm
Raymond - ZenMyFitnessgreat article I don't use any of these ( No comment on the Sex part!) but I've heard casual mention. But I definitely give it a try I'll do anything to help my body repair and recover quicker Thanks Raymond
January 30, 2011 at 7:31 pm
KinsenI've been using something called the rumble roller which basically is a foam roller with spiky knobs on it. I've found it quite effective in finding specific trigger points and knots and really isolating it.
January 30, 2011 at 6:27 pm
John RomanielloThanks for stopping by, Bru. Excellent points. I was going to get into Graston but I didn't want to run over on length. Thanks for posting these sir!
January 30, 2011 at 5:54 pm
Eric CresseyGreat post, John. Another modality that we use a lot with our clients/athletes is Graston, which is an instrument assisted soft tissue approach. ART works very well for focal adhesions, but Graston tends to be a bit better for larger, more diffuse regions of soft tissue restrictions. Good provider locator here: http://grastontechnique.com/LocateaProvider.html And, you can check out some videos of both ART and Graston here: http://ericcressey.com/understanding-elbow-pain-part-2-pathology
January 30, 2011 at 5:46 pm
JanalyneI also love getting Connective Tissue Massage (my massage therapist does a combo of CTM and deep tissue)...great for workout recovery!
January 30, 2011 at 4:11 pm
Mike AroneDef hitting Dr. CA up for ART therapy--- I have been neglecting my soft tissue work and mainly using the stick at night while watching TV or whatever and foam rolling on my weekend workouts. Great vids man. MA
January 30, 2011 at 3:16 pm