Over the past 15 years I have been privileged to teach soft tissue methods in the UK and at chiropractic, osteopathic and massage schools throughout the USA, Scandinavia and Israel. More recently my teaching has formed a module in the new MA in Therapeutic Bodywork at the University of Westminster. Where chiropractors are concerned the vexed, sometimes highly charged question which forms the title of this article is never far from the lips of those attending, many of whom seem to have made up their minds in advance of asking the question.
I believe it is vital that all those treating musculoskeletal dysfunction have available a range of skills which can address both joint (intra-articular) restrictions and those of a soft tissue nature, or results will never be as good as they might be.
The Evolution of Musculoskeletal Dysfunction.
The normal response of muscle to any form of stress is to increase its tone.
Stress affecting musculoskeletal soft tissues produces hypertonicity, irritation and pain, and can include:
- Acquired postural imbalances
- ‘Pattern of use’ stress (occupational, recreational etc)
- Inborn imbalance (short leg, small hemipelvis, fascial distortion via birth injury etc)
- The effects of hyper or hypomobile joints, including arthritic changes
- Repetitive strain from hobby, recreation, sport etc (overuse)
- Emotional stress factors
- Trauma (abuse), inflammation and subsequent fibrosis
- Disuse, immobilisation
- Reflexogenic influences (viscerosomatic, myofascial and other reflex inputs)
- Climatic stress such as chilling
- Nutritional imbalances (vitamin C deficiency reduces collagen efficiency for example)
A chain-reaction of events may evolve as any combination of these or other stress factors demand increased muscular tone in those tissues obliged to compensate for, or adapt to them.
- Muscles antagonistic to the hypertonic muscles become weaker (inhibited) - as may the hypertonic muscles themselves.
- Stressed muscles develop localised areas of relative ischemia while simultaneously there will be a reduction in the efficiency of metabolic waste removal.
- The combined effect of toxic build-up (largely the by-products of the tissues themselves) and oxygen deprivation leads to irritation, sensitivity and pain, which creates more hypertonicity and pain. This often becomes self-perpetuating.
- Oedema may be part of the soft tissue response to stress.
- If inflammation is part of the process fibrotic changes in connective tissue may follow.
- Neural structures in the area may become facilitated, and so hyper-reactive to stimuli, often evolving into active ‘trigger points’, adding to imbalance and dysfunction.
- Initially when stressed the soft tissues will show a reflex resistance to stretch and after some weeks a degree of fibrous infiltration may appear as the tissues under greatest stress adapt to the situation.
- The tendons and insertions of the hypertonic muscles become stressed and pain and localised changes will manifest in these regions. Tendon and periosteal pain and discomfort start.
- If any of the hypertonic structures cross joints, and many do, these become crowded and some degree of imbalance will manifest, as abnormal movement patterns evolve (with antagonistic and synergistically related muscles being excessively hypertonic and/or hypotonic) leading ultimately to joint dysfunction.