Active Release Techniques

Original Editors - Annelies Beckers

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Introduction

Active Release Techniques (ART) was developed and patented by P. Michael Leahy. 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.

Definition

Active Release Techniques (ART) is a soft tissue method that focuses on relieving tissue tension via the removal of fibrosis/adhesion that can develop in tissues from overload due to repetitive use. It is both diagnostic and treating techniques for the disorders which may lead to weakness, numbness, tingling, burning, aching etc.

History of ART

Active Release Techniques (ART) was developed and patented by Dr. P. Michael Leahy, DC, CCSP, a Doctor of Chiropractic, based  in Colorado Springs, Colorado, and the founder of Champion Health Clinic. Dr. Leahy noticed that the symptoms of patients are related to changes in their soft tissue so he developed a this technique which revolve completely around patient's problem and his related soft tissue. He documented his first work in 1985 under the title of Myofascial Release but later patented it under the name of Active Release Techniques.

                                                       

Purpose

It is used to treat problems with muscles, tendons, ligaments, fascia and nerves.

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.

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.

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.

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.

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.

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.

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.

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.

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. 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.

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.

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.

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.

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.

Post ART Treatment Exercises

Once the ART has released the restrictive adhesions between tissues, post-treatment exercises become a critical part of the healing process and act to ensure the RSI does not return.

There are four fundamental areas that must 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 to adhesed tissues will only stretch the tissues above and below the restrictions. The actual restricted and adhesed tissues are seldom stretched, leading to further biomechanical imbalances.

1. Strength - Strengthening exercises are most effective after the adhesions within the soft-tissue have been released. Attempts to strengthen already-shortened and contracted muscles only results in further contraction and restriction. This causes the formation of more adhesions and restrictive tissues, and exacerbates the Repetitive Injury Cycle. This is why the application of generic or non-specific strengthening exercises for RSI seldom works.
2. 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.
3. 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 seen effective in athletes 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 that 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.
• Finds the soft-tissue structures that are the primary cause of the biomechanical dysfunction as well as affected structures along 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.

Recent Related Research (from PubMed)

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Resources

http://activerelease.ca/wordpress/

http://www.drabelson.com/