Active Release Technique

© Dane Roubos, D.C.

While I usually prefer the gentler techniques, some people simply need deeper work.  Active Release Technique is the best method I’ve found for this.  It provides the greatest benefit, while causing the least pain of the deeper methods.  ART was developed by chiropractor Michael Leahy.

Intense Upper Back Pain Opens the Door

I first learned about Active Release in 1996, when I was teaching at Northwestern College of Chiropractic. I had developed pain in my upper back around the shoulder blade. It was getting nasty and I had to sleep sitting up in order to avoid pressure on the area.

I sought help from one of the docs in the college clinic, and he soon discovered the primary source of pain. There was an adhesion of a nerve to the muscle on the front side of the shoulder blade (subscapular nerve to the subscapularis muscle for you anatomy officianados).

He was a “no pain, no gain” kind of guy, and it was soon painfully obvious that he was in the right spot. As I moved my arm through the requested motion, an intense, burning pain was “referred” over my shoulder area. (Referred pain comes from one location – the nerve in this case – and is experienced someplace else. It’s a common trick of the nervous system).

The results got my attention nearly as much as that first treatment did. In about three visits, I was basically back to normal. I soon added Active Release to my toolkit after taking a seminar from Dr. Leahy, and studying all his videos in the college library.

An Overview

Active Release Technique works best for releasing scar tissue adhesions between superficial muscles, fascia or nerves.  You can read an enlightening description of scar tissue and its effects in Visceral Mobilization.

There are roughly 150 places in the body where peripheral nerves (away from the spine) can become “entrapped.”  This means they get squeezed or tethered down in some way – most commonly by scar tissue adhesions. Restriction of peripheral nerves is a relatively common source of pain that most practitioners are not aware of.

These adhesions usually develop as a result of  tissue inflammation due to repetitive movements or strain.  The result is called repetitive motion injury, or repetitive stress syndrome.  Another term is cumulative trauma disorder.  Medicine is great with naming things.

Active Release is very successful for common problems like “tennis” elbow (pain on the outside), “golfer’s” elbow (pain on the inside), and carpal tunnel syndrome (wrist).

Poor Medical Results for Carpal Tunnel Syndrome

Let’s use carpal tunnel syndrome as an example.  This is a condition wherein the median nerve is thought to become compressed where it passes under the carpal ligament in the front of the wrist.

Surgeons came to this conclusion because nerve conduction tests often showed a functional loss at this location – so they sever this ligament to “release” the nerve, by allowing more space in the “tunnel.”  Sometimes the problem is here, but mostly this is a mis-diagnosis, and surgery is often ineffective.

Surgical Results
“Only 23% of all Carpal Tunnel Syndrome patients were able to return to their previous professions following surgery.”
Source: NIOSH

“Carpal tunnel surgery has about a 57% failure rate following patients from 1-day to 6-years. At least one of the following symptoms re-occurred during this time: Pain, Numbness, Tingling sensations.”
Source: Nancollas, et al, 1995. Jnl. Hand Surgery.

Results from steroid injections are no better:
“Failure rate (Including “partial success” as failure) is 72.6% after 1-year follow up.”
Source: Irwin, et al. Jnl. Hand Surgery

Active Release Technique Offers Relief

There are five sites where the median nerve can become entrapped.  One of them is inside the carpal tunnel.  The most common sites are in the front of the forearm (palm up).

All five sites can be effectively treated with ART, leading to complete relief of symptoms.  This is a good example of the premise that the actual problem is not always where the pain is.

In our rush to explain things we don’t truly understand, we humans are easily fooled by appearances.  We are also highly prone to make unwarranted assumptions!

Most humans are creatures of habit.  Once an erroneous “convention” becomes established in medicine (or any discipline, for that matter), it takes about 20 years to change course after enough courageous souls dare to face ridicule and declare that the emperor has no clothes.

Of course, the ultimate cause isn’t the nerve adhesions – it is the repetitive strain and movement patterns that gave rise to the inflammation in the first place.

But once the scar tissue is present, it needs to be treated for lasting results.  So stopping or changing the activity that caused it, and direct manual treatment of the adhesions is a good starting place.

Contributing Factors to Consider

The following factors may well be parts of the puzzle, and should be at least considered in a holistic workup for any problems with pain or dysfunction:

  • Spinal dysfunction causing nerve irritation of the involved nerve
  • A nutritional imbalance that promotes inflammation (e.g. fatty acid deficiency)
  • A pro-inflammatory condition like diabetes
  • Reduced lymph flow in the area
  • Previous injury, especially if accompanied by strong emotion
  • Stress (especially at work – where most repetitive injuries develop)
  • Past history of emotional trauma
  • Blocked or weak energy in the acupuncture meridians

Other Uses for Active Release Technique

In addition to nerve adhesions, I’ve found ART to be extremely helpful for nearly any localized pain in the skeletal soft tissues (muscles, ligaments and fascia).  I use it most commonly around the neck, shoulders, elbows, hips and knees, with good results.

Regardless of where this or any other technique is used, results can usually be enhanced by evaluating for the contributing factors mentioned above, and addressing those found with appropriate natural methods whenever possible.

How Active Release is Performed

The “Active” component differentiates this technique from the “passive” approaches like deep massage. I’ll take you through an example, using the biceps muscle – the one that weight-lifters like to show off in the upper arm.

The following scenario assumes that an evaluation of nerve, muscle and joint function has already been done to accurately identify problem area.

The doc tests the tissues to locate restrictions in their mobility. Once a restriction is identified, the doc uses their knowledge of anatomy to set up a movement that will take that tissue from a shortened position to a lengthened (stretched) one.

In the case of the biceps, the client would bend their elbow to make it shorter. The doc places a soft, flat contact below the restriction, tractions upward, and asks the client to slowly straighten their arm.

The doc adjusts tissue tension and pressure to maintain a “hurts good” level of discomfort as the elbow is straightened. This action draws the restriction under the doc’s contact, stretching and separating the knotted fibers of scar tissue.

To avoid inflammation from over-treating, no more than three or four repetitions are done on the same area. It is usually better to start more gently with the initial treatment, to gauge the person’s tolerance. Ice can be used after treatment to reduce inflammation, if needed.

Tissue movement is then reassessed, and other tests, like muscle strength are repeated to get a before and after comparison. There is usually a noticeable decrease in pain along with an increase in tissue movement and muscle strength.

The results can be amazing, with chronic pain disappearing in a matter of minutes.  This occurs when scar tissue is a primary cause of the pain.  There are often other causes, and this is where a good detective doc comes in handy.

Chronically tight muscles can also contribute to scar tissue formation. Somatic Technique is a nifty, pain-free way to relax those tight, tense muscles, and it gives your mind a break, too.