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1st Aug

2009

Chronic Soft Tissue Restrictions and Neuromyofascial Pain

In our clinic, we frequently encounter patients who over the years have developed chronic soft tissue mobility restrictions, leading to, or adding to painful conditions and inefficient movement patterns. These people are prime candidates for specific soft tissue mobilization-release, often in conjunction with specific joint mobilization, provided by well trained certified orthopedic manual therapists.

POSSIBLE CAUSES

As young children, we typically have a well balanced muscular system and free mobility of connecting fascia, joints and neurovascular tissues (nerves and blood vessels), unless we were born with congenital deformities or deficiencies, or there was e.g. substantial trauma during the childbirth process.
However, as the years go by, we may experience traumas, expose ourselves to repetitive strain or overuse micro traumas, or for various reasons develop muscle imbalances and postural dysfunctions. Others may develop metabolic or connective tissue disorders, such as fibromyalgia syndrome or diabetes.

VICIOUS CYCLE CAN DEVELOP

Traumas and repeated micro traumas cause tissue strain and irritation, usually with varying degrees of tissue inflammation, which causes pain, and sets off a reflex producing contraction of certain muscles-primarily deep slow twitch fiber muscles, whose main job is to stabilize joints. This increased static muscle tension usually causes more pain, until sufficient tissue healing has occurred, allowing these muscles to relax again. However, if the trauma was significant, or the overuse micro trauma is ongoing, the increased muscle tension continues. This may then become programmed into our nervous system as our “normal state of muscle tension”.

Blood vessels may become compressed and preventing normal circulation to tissues, and the pain and inflammatory reaction, however subtle, may cause adhesions, or scar fibers, to form in an around soft tissues. This can result in reduced mobility of local joints, and reduced mobility of and between layers of fascia, which connect muscles and internal organs throughout our body.

Interwoven in this myofascial system are also nerves and blood vessels, which as a result may become compromised due to lack of mobility, as we move our limbs and neck and back. The result often is more pain, and more guarding of muscles. Metabolic or connective tissue disorders can have a similar effect, and healing often occurs slower following traumas.

Furthermore, stabilizing and postural slow twitch fiber muscles often weaken with time, and become inhibited as we start to compensate by contracting other muscles which are not designed for such tasks. This results in poor joint stability and our movements start to become abnormal and inefficient, which makes us even more susceptible to developing joint and soft tissue compromise.

The described vicious cycle typically leads to muscle imbalances, but other times muscle imbalances and postural dysfunctions develop for less obvious reasons, but the end result can be the same: abnormal movement patterns and increased likelihood of developing painful conditions.

MANUAL THERAPY TREATMENT EFFECTIVE

A skilled orthopedic manual therapist can assess where soft tissue restrictions exist, and apply specific manual treatment to release such restrictions and restore more painfree movements.

As soft tissues are allowed to move more freely, whether it pertains to joints, muscles and fascia, and/or nerves, the result is that tissues are subjected to less stretch or compression forces as we move, resulting in reduced firing of our nerves responsible for pain-the nociceptive fibers. As a result, we feel less pain.

We can also better recruit and voluntarily contract deep stabilizing and postural muscles, although some training with a skilled clinician is usually helpful to facilitate this process. This will enhance improved joint stability and posture, and allow the longer fast twitch fibers to move us in a more efficient and effortless manner.

RESTORING MOBILITY ADDS QUALITY OF LIFE

My most influental mentor as an orthopedic manual therapist, Ola Grimsby, stated simply that “motion is life”. Certainly, for many, being able to move more freely and engage in various activities brings enjoyment and quality to our lives. It may allow the athlete the excel versus merely producing medium results, the non-athlete to return to hobbies or recreational activities, the injured worker to return to work and support his or her family, and the disabled individual to gain some degree of independence with daily activities.

Best wishes,

Gunnar

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