Active Release Techniques

Original Editors - Annelies Beckers

Top Contributors - Annelies Beckers, Aarti Sareen, Admin, Scott Cornish, Evan Thomas, Kim Jackson, Magdalena Hytros, Scott Buxton, 127.0.0.1, WikiSysop and Claire Knott

Introduction

Active Release Techniques (ART) are described as 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. ART has been reported to be both a diagnostic and a treatment technique. However, there is little scientific proof regarding the effects of ART on different pathologies, with most of the available evidence being anecdotal and based on case reports.

History of ART

ART was developed and patented by Dr. P. Michael Leahy, DC, CCSP, a Doctor of Chiropractic medicine. Dr. Leahy noticed that the symptoms of patients were related to changes in their soft tissues so he developed this technique which revolve completely around the patient's symptoms. He documented his first work in 1985 under the title of Myofascial Release, but later patented it under the name Active Release Techniques.                                                 

Purpose

Active release technique is used to treat symptoms with muscles, tendons, ligaments, fascia and nerves. It is designed to accomplish three things:

1. to restore free and unimpeded motion of all soft tissues
2. to release entrapped nerves, vasculature and lymphatics
3. 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 to apply compressive, tensile and shear forces to address repetitive strain injuries, cumulative trauma injuries and constant pressure tension lesions. The practitioner applies deep tension at the area of tenderness whilst he 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.

The ART patent requires "The medical practitioner and a patient study a plurality of indicia representing symptom pattern images or charts. Each symptom pattern image provides an association between an anatomical image showing a portion of the human body and an expert-derived symptom pattern that is superposed on the anatomical image...."

In simpler terms ART requires the practitioner and patient to view symptom pattern charts. Then select the image that best matches their symptom, then to base treatment on that. The patent even states "The expert system avoids problems that are inherent to traditional medical treatment methods because it permits treatment to begin even before the medical practitioner has made a diagnosis or completed an evaluation."

Effectiveness of ART

A few pilot studies reported the effects of ART on different pathologies. These studies do not have a control group however and the group numbers were small.

ART and adductor strains

The pilot study evaluated the effectiveness of ART to relieve short term pain in the management of adductor muscle strains amongst ice-hockey players (n= 9). Pre and post measurements were significant improved (p = 0,002 < 0,05). The study proved that ART is effective in increasing the Pain Pressure Threshold in adductor muscle pain sensitivity. The pilot study was a short term study.

ART and hamstring flexibility

The subjects (n = 20) were significantly more flexible after ART treatment, but these results cannot be applied across the general population due to the small group sample which only included young, healthy males. The pilot study was also only a short term study.

ART and carpal tunnel syndrome

This study assessed the effectiveness of ART on the median nerve of 5 subjects who were diagnosed with carpal tunnel syndrome. Both symptom severity and functional status improved after two weeks of treatment intervention. This is a small clinical pilot study which may suggest that ART is an effective management strategy for patients with the carpal tunnel syndrome.

ART and quadriceps inhibition and strength

ART did not reduce inhibition or increase strength in the quadriceps muscles of athletes (n = 9) with anterior knee pain. Further study is required.

Case reports of ART

A patient with trigger thumb appeared to be relieved of his pain and disability after a treatment plan of Graston Technique and Active Release Techniques. 8 treatments were given over a 4 week period. Range of motion increased with a concomitant decrease in pain by the end of the treatment period.

An athlete with chronic, external coxa saltans became asymptomatic following treatment with ART. The patient reported a pain reduction of 50% after the initial session. After the fourth treatment the pain had resolved, although the non-painful snapping sensation was still present. When the treatment was complete the snapping sensation had also resolved.

A 51 year old male was treated for epicondylosis lateralis with 6 treatments over a two week period with ART, rehabilitation and therapeutic modalities. At the end of the treatment period there was complete resolution of his symptoms.

An adolescent soccer player presented with tibilais posterior tendinopathy. He was relieved from his pain after 4 treatments over 4 weeks of soft tissue therapy and rehabilitative exercises focusing on the lower limb, specifically the posterior tibialis muscle. He had chronic medial foot pain after striking an opponent’s leg while kicking the ball.

Post ART treatment exercises

Once the restrictive adhesions between tissues has been released, post-treatment exercises become an essential part of the healing process and act to ensure the symptoms does not return.

There are four fundamental areas that should be addressed in any exercise program:

1. 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.
2. 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.
3. 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.
4. 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 - power, strength, and flexibility.