The value of soft tissue work in your chiropractic practice: case studies
The many benefits for patients of soft tissue work in and outside of sports chiropractic
Soft tissue technique was not a big part of general chiropractic care until the late 1970s. At the time, “sports medicine” and “sports chiropractic” began gaining popularity. There is a difference between sports chiropractic and general chiropractic — while these two forms of treatment share similar components, they do vary quite a bit in the intensity and completeness of care to help patients return to pre-injury or pre-disability. Soft tissue work is an essential part of sports chiropractic and is very helpful with non-athletic-related conditions.
Quicker body response to care
Without soft tissue work, the body’s response to treatment may not be as immediate. Soft tissue work is just another part of a more complete care plan that some patients need. These methods are especially helpful for issues athletes commonly experience, but they can be beneficial for non-athletes who have similar conditions as well.
The rise in use of soft tissue work directly changes the original way of thinking when it comes to chiropractic care. Before, chiropractors thought if you adjusted the spine, everything else would take care of itself. For example, if a patient presented with ankle pain, the spine would be adjusted and eventually, as a result, the ankle issue would resolve as well. While this may be true, it’s not always the fastest or most efficient solution. This method of care especially doesn’t work fast enough for athletes, who need to recover as quickly as possible.
The most popular form of soft tissue work is kinesiology taping, which was developed by a chiropractor named Dr. Kenzo Kase in the 1970s. The method started gaining prevalence in the early 1990s when Japanese gymnasts participated in the Olympics with tape on their bodies. Kinesiology taping made its way to the United States in 1995 and is now a major part of every soft tissue course. Taping helps strengthen, reposition and balance muscle groups. It’s not meant to enhance performance but allow muscles to perform at their best.
Additional forms of soft tissue techniques include pin and stretch, Active Release Techniques, massage, trigger point and cupping. Typical forms of massage include effleurage, petrissage, pincement and tapotement. Cupping is used to wake up muscles or to relieve stagnant blood, which increases normal blood supply in the muscles.
Nearly everyone can benefit from soft tissue work, even if they have an issue unrelated to the spine. The most common issues — which occur when certain muscle groups are unbalanced and can change the anatomical structure of a person’s body — including Upper-Crossed Syndrome, Lower-Crossed Syndrome and Compartment Syndrome.
Soft tissue work and Upper-Crossed Syndrome
Upper-Crossed Syndrome occurs when the head is too far forward and the shoulders are rounded. This can lead to shoulder issues, pain down the arms and rotator cuff tears. This usually happens to swimmers because of poor training and the lack of incorporating “dry land” exercises into an athlete’s training program.
In 1988, I was invited to be the on-deck physician for the Santa Clara Invitational Swim Meet, an Olympic-qualifying event. The Team USA coach brought over his star swimmer, a 14-year-old girl, with ice packs taped to her shoulders. Her shoulders were rounded and inflamed. She had weakness and discomfort in her arms and hands. She had already seen several sports doctors, none of whom could help her.
I had just participated in a course on soft tissue work, so I attempted to help relieve this young woman’s pain with the knowledge I had recently gained. Her shoulder muscles were as hard as a rock. I used ultrasound to relax the muscles and decrease inflammation. Then, I was able to do soft tissue work and I adjusted her shoulders afterward. All of this took about 20 minutes. I treated her twice a day for the next four days during the duration of the swim meet. She performed well and even qualified for the national team tryouts. By the final day of the meet, her pain was gone and her posture had improved. She, her coach and her parents were so thrilled with the results, they asked me to refer her to a local chiropractor in Los Angeles to continue her treatments, which I did.
She and her parents thought her only two options were surgery or quitting swimming. Either way, they believed her career was over. Soft tissue work with chiropractic care did what drugs, surgery and regular physical therapy alone could not, which in turn saved her career. This swimmer’s name is Janet Evans. She went on to win eight gold medals — two at each of the next four Olympics.
Lower-Crossed Syndrome occurs when the pelvis comes forward, the behind sticks out a bit and even very thin people have the appearance of a “belly.” This happens when one group of muscles is constantly lengthened and one is constantly shortened.
Runners very commonly experience this, and it causes them to run much more slowly. If the pelvis is unbalanced, the foot is not able to reach out very far in front of the rest of the body, which causes shorter strides.
For example, a patient I treated was a long-time marathoner who was experiencing problems with his knees and lower back. He came in for treatment off a recommendation. I tested the strength of his thighs, and he nearly threw me across the room. Then, I tested the strength of his hamstrings, and I could push his legs down with one finger. This directly showcases the importance of focusing on all muscle groups when exercising.
I provided him with exercises and did some soft tissue work. We worked together for three months of treatments and his pain alleviated. He went on to win the San Francisco Bay to Breakers run, coming in first place out of more than 50,000 runners. This patient had such a positive experience with chiropractic care that he went on to become a chiropractor himself. He is currently practicing in San Diego, Calif.
Compartment Syndrome occurs when the pressure in one compartment of the lower legs increases, which restricts blood flow to the area. This can potentially damage the muscles and nearby nerves.
The body has four major compartments, and this most commonly occurs in the anterior and deep posterior compartments. One common example of this is shin splints.
An older woman came in for treatment of shin splints she had been experiencing for six years. She used to be an avid runner and at this point, she could barely walk. I did soft tissue work on the entire muscle adjacent to the shin, as well as on the bottom of the foot. I taped her with Kinesio tape and told her to take more vitamin C to help her connective tissues heal. After just three weeks of treatment, she had completely recovered and her pain was gone. She was able to return to running again.
When treating a patient, it’s important to do soft tissue work before adjusting, as it will yield better results. If you adjust someone before working on their muscles, everything will shift right back to where it was pre-adjustment. Soft tissue work has its place, not just in sports, but in everyday life. Nearly everyone can benefit from soft tissue work in some form. Dig into your patients’ pain and ensure you’re treating it with effective and efficient techniques.
PATRICK MONTGOMERY, DC, MS, FASA, FICC, graduated from Logan College of Chiropractic (now Logan University) in 1976, where he earned a Bachelor of Science in Human Biology and Doctor of Chiropractic. He also completed Logan University’s Master of Science in Nutrition and Human Performance. He is a professor and faculty advisor at Logan and has also been in private practice since graduating. He has written numerous published chiropractic historical papers, completed many research studies and lectured for continuing education seminars across the country. To learn more, go to logan.edu/faculty/patrick-montgomery-dc-ms-fasa.