This is an excerpt from Soft Tissue Release by Jane Johnson.
Three Methods of STR
Soft tissue release may be performed in three ways: passive, active-assisted or active.
1. Passive. When STR is performed passively, the therapist applies a lock and moves the client's body part so as to facilitate a stretch.
2. Active-assisted. This form of STR requires the client and therapist to work together. Usually, the therapist applies a lock, and the client moves his or her body part to bring about the stretch.
3. Active. In active STR, the client applies a lock to himself or herself and also performs the stretch without assistance. Active STR can be performed by almost anyone and does not require a therapist be present.
Throughout this book we use common anatomical language. However, clients are unlikely to understand these terms unless they are therapists or health professionals themselves. It takes practice to explain to clients what they are required to do for active-assisted STR without using technical language. Many clients may not understand what you mean if you ask them to invert or evert a foot, for example, or to flex or extend a wrist. One tip is to demonstrate the action you require before making your lock. If you want to give the command of ‘up' or ‘down' when referring to a wrist movement, for example, then you need to demonstrate what you mean by those commands. Another tip is to avoid mixing different types of STR within the same treatment. If you start with active-assisted STR, a client may think he or she is required to assist throughout a treatment and may not relax when you want to perform passive STR. However, many clients soon become accustomed to STR and will demonstrate a preference for whether they want to take part (active-assisted) or whether they prefer to receive the treatment passively.
Measuring the Effectiveness of STR
It is useful to have a benchmark against which to measure whether a treatment has been effective. This is equally true of STR. Here are some ideas to help you measure the effectiveness of STR.
- Pain. If STR is being used to alleviate the discomfort of muscle tension, one of the easiest methods for measuring effectiveness is simply to use self-reporting measures. Not surprisingly, most clients feel better after massage and report feeling less discomfort, whether this was initially described as pain, pulling, cramping or aching. Most therapists are familiar with asking clients how they feel after treatment.
- Visual analogue scale (VAS). This is simply a horizontal line onto which two extremes have been written. One extreme could be ‘no discomfort' and the other extreme could be ‘worst discomfort ever!' Before and after treatment, ask the client to mark the scale according to how he or she is feeling. A VAS is useful for measuring subjective descriptors such as pain or stiffness.
- Movement tests. If STR has been applied to help increase range of motion in a joint, you could do tests such as the straight leg raise (for hamstrings). Measure the straight leg raise before and after applying STR to the hamstrings and record whether there has been any increase in range at the hip joint as a result of your treatment. A simple test for quadriceps flexibility is the prone knee bend: ask the client to flex his or her knee while in a prone position; observe how close the client's foot comes to the buttock on that side. After treatment to lengthen the quadriceps, the client should be able to reach his or her foot closer to the buttock than before treatment (make sure the client avoids excessive lordosis in the lower back).
- Sit-and-reach test. A simple way to measure the effectiveness of active STR to the hamstrings is to ask your client to reach forward and try to touch his or her toes. Notice how far the client can reach and ask what sensations are felt in the hamstring muscles. Spend five to seven minutes applying STR to the hamstrings, then retest the client. Was the client able to touch his or her toes more easily? Did the client have less tightness in the hamstring muscles? (This test also tests flexibility in the muscles of the back and should not be performed by clients who have recently suffered trauma to the lumbar spine.)
This is an excerpt from Soft Tissue Release.