Many years ago I came upon a very simple idea: use active motion with soft tissue manipulation. Many people were using it but nobody seem to know the potential.
For each spinal nerve there is a possible site of nerve pressure or entrapment. We know these very well and treat these with very good results. We also treat the improper motion or function of the joints at these sites. I would like to suggest that there are almost as many sites where peripheral nerves are subjected to undue pressure or entrapment. There are at least 42 common sites where peripheral nerve entrapment occurs. There are even more sites where altered soft tissue mechanics cause structural/mechanical problems. If we apply our same principles of analysis to these sites we can double our effectiveness with patients. Nobody ever said that the spine is the only site of nerve entrapment.
If the doctor is willing to spend one to two years learning about soft tissue mechanics and their treatment, the rewards are immeasurable. Those who need to be instant experts will only experience a fraction of the effectiveness of MRT. General guidelines used with MRT:
- Doctor's contact is as "soft" as possible. Surface area used is as large as possible.
- Work is done longitudinally along the tissue fibers.
- All motion is as slow as possible.
- Motion is done in the direction of venous and lymphatic flow.
- Active or passive motion is used to take the tissue from short to long position.
- Treatment frequency starts at every other day.
- Amount of pressure applied is limited by three major factors.
- MRT is never done over inflammation.
- Method of contact and motion is modified for each tissue.
MRT
Level 1 -- Tissues slack, no motion
Level 2 -- Tissues taut, no motion
Level 3 -- Passive motion employed
Level 4 -- Active motion employed
Muscles must slide over one another. Muscle and fascia must slide over nerves, sometimes as much as 1.5 cm. When a muscle or fascia is injured an adhesion usually forms between soft tissues or inside the tissue itself. These can be palpated and isolated. They can then be "released" by manual methods. Levels 3 and 4 MRT combine motion of the affected area with a longitudinal "stripping" of the tissues to literally break up the adhesions. Deep soft tissue work, trigger point therapy and passive myofascial methods are all valuable but fail to physically change the tissue structure. If this key difference is understood and the unique variations for each of the specific tissues are mastered, then a major difference in treatment effectiveness is achieved.
A group of 150 patients received treatment for repetitive motion/cumulative trauma injuries to the arm and hand. Most of these had been diagnosed as having carpal tunnel. Some had already had unsuccessful surgery. Many were in splints and had received months of traditional treatment. All cases, except for one, were resolved in three weeks or less. The average was 4.5 visits. Two cases developed the same symptoms within one year. One of these had stopped doing the prescribed stretches and one had a significant strength problem. The only successful treatment was level 3 and level 4 MRT. This kind of result is very predictable.
The principles are very simple: examine and locate altered soft tissue mechanics, texture, tension, and strength. Apply the MRT techniques. Progress is usually 50-100 percent reduction in objective and subjective complaints within three visits. If not, re-examine and adapt accordingly. The areas that usually bring the so-called miracle cures are rotator cuff, carpal tunnel, psoas with hip/femoral nerve or facet problems, and shin splints. I am amazed at how often the treatment of specific soft tissue problems is necessary for speedy recovery. In fact, it is seldom not involved.
The problems that arise in soft tissue are remarkably similar to those of the joints. Lack of free and proper motion causes pressure and breakdown problems. Tissues actually degenerate under these influences. Restoring normal mechanics can restore tissue function. I have found that the doctor who learns these techniques becomes a beehive of activity. The public quickly learns where the most efficient help is located.
References
Hunter JM: Recurrent carpal tunnel syndrome, epineural fibrous fixation, and traction neuropathy. Hand Clinics, 7:491-504, 1991.
Leahy, Mock: Altered biomechanics of the shoulder and subscapularis. Chiropractic Sports Medicine, 5:3, 1991.
Leahy, Mock: Myofascial release technique and mechanical compromise of peripheral nerves of the upper extremity. Chiropractic Sports Medicine, 6:4, 1992.
Leahy, Mock: Synoviochondrometaplasia of the shoulder: a case report. Chiropractic Sport Medicine, 6:1, 1992.
Scarpelli DG, Chiga M: Cell injury and errors of metabolism. In: Anderson WAD, Kissane JM, eds. Pathology, 7th edition. St. Louis: C.V. Mosby, 90-147, 1977.
Totten PA, Hunter JM: Therapeutic techniques to enhance nerve gliding in thoracic outlet syndrome and carpal tunnel syndrome. Hand Clinics, 7:505-520, 1991.
Michael Leahy, D.C.
Colorado Springs, Colorado