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Soft Tissue Mobilization in Orthopaedic Manual Physical Therapy

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CHAPTER OBJECTIVES

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Chapter Objectives

At the conclusion of this chapter, the reader will be able to:

  • Identify the major influences that led to the development of the functional orthopaedics approach to soft tissue mobilization.

  • Understand the relationship between structure and function and how it relates to the application of soft tissue mobilization.

  • Conduct an examination including structural evaluation and functional testing consisting of the vertical compression test, elbow flexion test, and lumbar protective mechanism.

  • Understand the importance of muscle play.

  • Understand and apply the concept of three-dimensional identification of soft tissue restrictions.

  • Understand and apply the cascade of techniques for soft tissue mobilization.

  • Demonstrate entry-level performance of soft tissue mobilization of superficial fascia, bony contours, and myofascial dysfunctions on all regions of the body.

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HISTORY AND DEVELOPMENT

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Massage may be the oldest form of medical care. The history of massage dates back to ancient times. In China, as early as 2700 BC, massage was recommended for a variety of ailments in The Yellow Emperor's Classic of Internal Medicine.1 In the 5th century BC, Hippocrates, the father of Western medicine, stated that "the physician must be experienced in many things, but assuredly in rubbing… for rubbing can bind a joint that is too loose and loosen a joint that is too rigid."2 The physician Galen, in the late first century AD, also advocated the use of massage for a variety of maladies.2

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In the late 19th and early 20th centuries, clinical interest in the cause and treatment of pain of muscular origin continued in the medical community.3,4 St. George's Hospital in London had a department of massage until 1934.1 It was in 1894 that physical therapists began using massage techniques based on the work done by the Swedish physician, Per Henrik Ling.1 In the mid-1930s, a German physical therapist, Elizabeth Dicke,5 developed a more specific manipulative technique for connective tissue called Bindegewebemasssage. This form of connective tissue massage (CTM) later spread to the Englishspeaking world through the work of another physical therapist, Maria Ebner.6 With the advent of clinical modalities, however, massage fell out of favor within the medical community.7

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Today, many forms of sophisticated soft tissue intervention techniques have emerged, bringing us back to a more hands-on approach to the treatment of myofascial pain and dysfunction. Travell and Simons's3 trigger point therapy (see Chapter 16), Cyriax's8,9 deep friction massage (see Chapter 5), Dicke and Ebner's5,6 connective tissue massage, and osteopathic myofascial release (see Chapters 4 and 14), as well as alternative approaches including Rolfing,10,11 Feldenkrais12 (see Chapter 20), Hellerwork, Aston patterning,13 and Trager7,14 have emerged to promote the use ...

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