Active Release Techniques

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Original Editors - Annelies Beckers

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Search Strategy

Words:

• Active release therapy 
• Leahy

Search engines:

• Pubmed;
• Web of Knowledge;
• American Academy of Family Physicians;
• Archives of Physical Medicine and Rehabilitation.

Result: a few case reports, some literature reviews and pilot studies but no RCT’s.

Introduction

Active release technique (ART) is developed and patented by P. Michael Leahy. But there is little scientific proof about the effects of Active Release Techniques on different pathologies. Most evidence on ART is anecdotal and based on case reports.

Definition

Active Release Technique (ART) is a soft tissue method that focuses on relieving tissue tension via the removal of fibrosis/adhesion that develops in tissue. This is because the tissue is overloaded with repetitive use. (copied from External coxa saltans (snapping hip) treated with active release techniques: a case report).

Purpose

It is used to treat problems with muscles, tendons, ligaments, fascia and nerves. [4] [2]

Active release technique 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. [9]

Technique

First the clinician locates the areas of tension or adhesion in a specific tissue. Then the tissue is taken from a shortened position to a lengthened position while using a manual contact to maintain tension along the fibers of that tissue. [2] In treatment with ART the clinician uses compressive, tensile and shear forces applied by manual (hand) touch to address repetitive strain, cumulative trauma injuries and constant pressure tension lesions.[4]

During ART therapy the practitioner applies deep digital tension at the area of tenderness. The patient is then instructed to actively move the tissue of the injury site through the adhesion site from a shortened to a lengthened position. [6] [5] ART is used by conservative care practitioners (chiropractors, physiotherapists and massage therapists) with an understanding that anatomical structures throughout the body have traversing tissues located at oblique angles to one another. Areas of tissue overlap are prone to negative changes with trauma producing local swelling, fibrosis and adhesions that can result in pain and tenderness at the location of injury. During ART therapy the practitioner applies digital tension along the tissue fibers at tender areas of adhesion. The patient is then instructed to actively move the tissue fibers of the injury site from a shortened to a lengthened position [5] [6]

Effectiveness ART

A few pilot studies reported the effects of ART on different pathologies. Pilot studies do not have a control group and the group of subjects is small.

ART and adductor strains

The pilot study evaluated the effectiveness of ART to modulate 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 is a short term study.[4]

ART and hamstring flexibility

The subjects (n = 20) were significantly more flexible after ART treatment on the hamstring origin and insertion. But these results aren’t generalizable because of the small sample that included only young healthy males. The pilot study was a short term study. [2]

ART and carpal tunnel syndrome

ART was used to affect the median nerve of 5 subjects who were diagnosed with carpal tunnel syndrom. Both symptom severity and functional status improved after two weeks of treatment intervention. This is a small clinical pilot study that suggests that ART may be an effective management strategy for patients with the carpal tunnel syndrome. [1]

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. (copied from Influence of active release techniques on quadriceps inhibition and strength: a pilot study )[3]

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. There were 8 treatments over a 4 week time period. The range of motion increased and the pain was decreased at the end of the treatment. (the conservative treatment of trigger thumb using Graston Techniques and ART: a case report)

An athlete with chronic, external coxa saltans is relieved from his symptoms because of treatment with ART. After her first visit the patient reported a pain reduction of 50%. After the fourth treatment the patient didn’t feel any pain anymore but the non-painful snapping was still present at that time. When the treatment was complete the non painful snapping was gone too. [9]

A 51 year old male was treated for epicondylosis lateralis over two weeks (6 treatments) with ART, rehabilitation and therapeutic modalities. At the end of the treatment there was complete resolution of his symptoms. [7]

Active release technique was used in treating a novice triathlete. Initial treatment consisted of medical acupuncture with electrical stimulation, therapeutic ultrasound with Traumeel, Active Release Technique of gastrocnemius, soleus, and tibialis posterior muscles above and below the injury and Graston Technique soft tissue mobilization posterior to the medial malleolus followed by ten minutes of ice and elevation. The athlete was relieved of his symptoms and was able to return to his triathlon training. [6]

An adolescent soccer player was relieved from his pain after 4 treatments over 4 weeks of soft tissue therapy and rehabilitative exercises focusing on the lower limb specifically posterior tibialis muscle. He had chronic medial foot pain due to striking on an opponent’s leg while kicking the ball. [5]

Diagnostic Procedures

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Outcome Measures

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Examination

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Medical Management

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Physical Therapy Management

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Key Research

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Resources

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Clinical Bottom Line

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Recent Related Research (from Pubmed)

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References

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