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Active Release Techniques as an Alternative Treatment for Soft-Tissue Injuries and Ailments

Mike Kranzler

23 October 2008


What is Active Release Techniques?

Active Release Techniques (ART) is a patented treatment utilized by chiropractors, massage therapists, and others to treat soft-tissue pain. Dr. P. Michael Leahy, the developer of this treatment, claims that ART can be used to treat ailments such as headaches, plantar fasciitis, sciatica, shin splints, carpal tunnel syndrome, and other myofascial issues. These issues often stem from overuse of the muscles, tendons, and ligaments, which leads to the buildup of scar tissue. The scar tissue makes regular motion within these structures difficult, which is where ART comes in.


Who Practices Active Release Techniques?

Anyone can become certified in the ART treatment process with the correct training, but the majority of ART providers are chiropractors, massage therapists, and athletic trainers who offer the treatment on the side along with their conventional methods. No treatment method works for everyone, which is why these professionals are willing to branch out and learn new treatments in order to best serve their patients.


How Does Active Release Techniques Work?

Active Release Techniques is a treatment that begins with an ART provider feeling the affected area for the telltale soft-tissue adhesions that can be felt by hand. Once the cause of the pain is located, the provider does a series of treatments similar to deep-tissue massage in order to break up the scar tissue and free up the body to work as it naturally should. With many of the techniques, the patient is tasked to extend or flex the intended area as the provider breaks up these adhesions using his or her hands and fingers. According to the ART web site, “abnormal tissues are treated by combining precisely directed tension with very specific patient movements.” This participation by the patient lends the ‘Active’ part to the name Active Release Techniques.


ART Worked for Me: A Testimonial

I played football and volleyball in high school, and began to suffer from severe back pain due to sciatica during my sophomore year. It got to the point where I had to suspend all athletic activities, as I had pain radiating up my leg and into my back with every step I took. After ten months of doctor visits and physical therapy, I happened across information on Active Release Techniques and decided to give it a shot. My provider, a chiropractor named Dan Selstad, was very friendly, and told me about his experience in treating patients with ART. He even showed me a picture of himself with Kobe Bryant of the Los Angeles Lakers, who was one of his regular patients.


Once the treatment got started, I began to understand just how helpful it could be. While the ten-minute session was extremely painful (as Dan was using his entire body weight to put pressure on small spots in my back and legs), I could literally feel the scar tissue tearing as he broke it up with his fingers. When I got home that night, I noticed that the pain that had been plaguing me for close to a year was completely gone, replaced only by some muscle soreness where he provided the treatment. I was lifting weights the very next afternoon in ways that had caused me excruciating pain for months before my session. To this day, I credit Active Release Techniques as a miracle treatment, and recommend it to everyone.


Who Can Benefit from Active Release Techniques?

While athletes are the most common patients of ART practitioners, Active Release Techniques can be used for all sorts of overuse injuries, regardless of athletic background. However, athletes are some of the most devoted supporters of ART, as it is the treatment of choice of professional athletes such as Bryant and Olympic Gold Medalist figure skaters Jaime Sale and David Pelletier. Active Release Techniques is widely practiced in the National Football League, National Basketball Association, Olympics, and many other professional sporting bodies. Countless triathletes, marathoners, and other endurance race enthusiasts swear by ART as a way of recovering from injuries much faster than they normally would without the treatment.


How Effective is Active Release Techniques?

Many studies have been done on the efficacy of ART in treating overuse injuries and increasing overall physical health although much of the available literature is about individual case studies. In a pilot study by James W. George et al (2006), a single ART treatment on twenty male subjects’ hamstrings increased their flexibility immediately after the treatment. The treatment was provided “on the origins and insertions of the hamstrings and the dorsal sacral ligament” (224). Flexibility was measured using a standard sit-and-reach test, with three trials occurring immediately before and after a single ART treatment. Each subject had his average flexibility score calculated from his three pre-treatment trials, and those were compared to his three post-treatment trials. The results found that the subjects’ flexibility increased by an average of 8.3 cm immediately following treatment.


Jeffels and Abelson (2002) found that ART was very effective in treating groin strains, explaining that, “effective treatment of soft tissue injuries requires an alteration in tissue structure, usually effected by breaking up cross-fiber adhesions and restoring normal function to the soft tissue. This process substantially decreases healing time, treats the root cause of the injury, and improves performance” (1). This treatment was found to be very effective in treating and managing injuries to ice skaters, as the muscles of the groin are crucial in skating.


Scott D. Howitt (2006) performed a study on the effectiveness of Active Release Techniques on lateral epicondylosis, also known as “tennis elbow.” He found that “the utilization of a previously undocumented specific soft tissue treatment [ART] which is intended to remove adhesions and restore normal tissue texture appears to have resolved lateral epicondylosis rapidly in this case“ (187). He goes on to suggest that the best form of treatment is a combination of Active Release Techniques and a specific rehabilitation program may be the most prudent way of fixing pain issues associated with tennis elbow.


Howitt (2006) also led a study on the efficacy of Active Release Techniques on the treatment of Trigger Thumb when used in conjunction with the Graston Technique (a similar treatment that uses metal instruments in place of the provider’s hands and fingertips). Trigger Thumb is a painful condition that leads to “painful snapping or restriction of movement, most notably in actively extending or flexing the digit” (249). In this case study, the patient “appeared to be relieved of his pain and disability with increased range of motion after having eight treatments of ART and Graston technique” (253).


Upper extremity overuse syndromes (which include tennis elbow, carpal tunnel syndrome, tendonitis, and other ailments) can be very painful and difficult to treat. Schiottz-Christensen et al. (1999) ran a pilot study with 28 patients, most of whom had failed at conventional approaches to treat their pain. In this study, co-authored by Selstad, the patients were treated with ART twice a week for four weeks, with those patients still complaining of pain being provided with another four weeks of treatment. After the completion of the first four weeks of treatment, 71% of the subjects reported that they felt better after having been treated with ART than they did beforehand. Those subjects that still complained of pain after the second course of treatment were recommended for surgery. The researchers followed up with the subjects after three months, and “of the 15 patients having treatment prior to ART who could be contacted, 12 of 15 stated that the result after ART-treatment was better, 2 of 15 the same, 1 of 15 worse” (209). These results were statistically significant compared to previous literature on the subject.


Does the Literature Support the Treatment’s Claim?

Most of the studies have been on a relatively small scale, but they found very strong evidence that ART was very effective in relieving pain stemming from myofascial trauma and overuse injuries. These claims must be taken with a grain of salt, however, as there are a very limited number of studies currently available that test the efficacy of Active Release Techniques and other similar treatments. Until studies are performed on a much larger scale, many scientists and doctors will have trepidation in recommending ART for their patients. However, many case and pilot studies have shown that ART can be very effective at relieving pain, which should be more than enough support to recommend ART at least as an experimental treatment when conventional methods have failed.




What Does All This Mean?

While research on Active Release Techniques is somewhat limited, with most studies being very small in scale relative to studies on more traditional treatments, the results supporting the efficacy of ART have been significant enough to support the treatment as a viable alternative method for treating soft-tissue injuries and pain. Coupled with the correct rehabilitation program, ART has the potential to be just as effective as, if not more so than, any conventional treatment regimen.


Literature Cited

George, J. W., Tunstall, A. C., Tepe, R. E., & Skaggs, C. D. (2006, March/April). The effects of Active Release Technique on hamstring flexibility: A pilot study. Journal of Manipulative and Physiological Therapeutics, 29(3), 224-227.

Howitt, S. D. (2006). Lateral epicondylosis: A case study of conservative care using ART and rehabilitation. Journal of the Canadian Chiropractic Association, 50(3), 182-189.

Howitt, S., Wong, J., & Zabukovec, S. (2006). The conservative treatment of Trigger Thumb using Graston Techniques and Active Release Techniques. Journal of the Canadian Chiropractic Association, 50(4), 249-254.

Jeffels, A., & Abelson, B. (2002, August). Improved skating performance with Active Release Technique. Skating and ART, 0(1).

Schiottz-Christensen, B., Mooney, V., Azad, S., Selstad, D., Gulick, J., & Bracker, M. (1999). The role of Active Release manual therapy for upper extremity overuse syndromes - A preliminary report. Journal of Occupational Rehabilitation, 9(3), 201-211.



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