Guest Post: Active Release Therapy (ART)

Monday, September 24, 2012


Most non-traumatically caused sports injuries/ exercise injuries are caused by one thing… overuse.  Overuse is actually a big problem because it creates a cycle of injury, inflammation, and pain.  This becomes self-generating and tends toward a condition of decreased blood flow and tissue degeneration over time.  As an example, let’s look at Achilles Tendinitis (AT).  AT is a common overuse injury which involves the calf muscles and of course the Achilles tendon and is almost exclusively caused by overuse of running and/or jumping activities.  Generally an overuse injury will be made better with rest and worse with activity or at least the activity that causes the overuse.  Non-steroidal anti-inflammatories and ice generally help temporarily.  The condition can become very frustrating because a week or two off from the offending activity will often cause a complete resolution of the pain, at least until the activity is reintroduced in which case the pain generally returns rather quickly. 

The question is, is there a good treatment for overuse injuries such as AT?  For a select group of Chiropractors, Physical Therapists and Massage Therapists, there is, and it is called Active Release Therapy or ART.  ART practitioners can almost always be found treating athletes at Ironman triathlon races, which makes sense when you consider that an Ironman is an overuse injury just begging to happen.   Many an Ironman competitor owes their finish in no small part to the work that they receive from these magic-hand practitioners.

So what is this ART of which I speak?  First, let’s look a little deeper into an overuse injury.  According to the ART manual, overuse injury causes a condition called The Cumulative Injury Cycle which goes something like this.   Friction and tension can lead to a soft tissue tear, which leads to inflammation, which leads to soft tissue adhesions and tissue fibrosis, which causes the tissue to become weak and tense, which causes more friction and tension.  At this point the injury can either cycle back through this inflammatory cycle or create another cycle called the chronic degenerative cycle.  In the Chronic degenerative cycle; friction and tension lead to decreased circulation and edema, which leads to more soft tissue adhesions and fibrosis formation, which leads to even weaker and tense soft tissue, which leads to more friction and tension.  This goes on and on until taken care of. 

ART is a hands-on treatment.  The goal of ART is to decrease the adhesions/fibrosis in the soft tissues and increase the circulation and lymphatic drainage from the soft tissues.  The treatment is actually pretty simple.  The practitioner applies a longitudinal tension to the soft tissues while the patient actively moves the tissue from a shortened to a lengthened state.  The adhesions are decreased by holding one tissue while sliding any adjacent tissue past.  This treatment also has an effect on the local tissue circulation, which improves nutrition and oxygenation to the tissue and increasing the removal of metabolic waste products. 

As a side note, I might add that although ART is effective for treating the adhesions and decreased tissue circulation aspects of the cumulative injury cycle, it does not affect the weak soft tissue aspect.  If an athlete/exerciser is to return to full activity, it is vital that they recondition the tissue through a well-controlled strength and neuromuscular re-education program so that the condition does not return in the future.  A complete program to address an overuse injury would include multiple ART sessions followed by a strength program.

So to recap, overuse injuries like AT are very common to people who exercise a lot or perform repetitive activities and treatment for these conditions have not always been effective.  If you are looking to treat such an injury and can find an Active Release Practitioner who will also help you rehab the tissue with a well-controlled strength program, you should be back to your sport/ activity relatively quickly.


Tim St. Onge, D.C. is the owner of St. Onge Chiropractic and Sports Therapy.  He completed his undergraduate studies at Texas Tech University in Lubbock, TX with a Bachelors in Exercise Science.  He received his doctorate in Chiropractic studies from Parker College of Chiropractic.  During his chiropractic studies, Dr. St. Onge received numerous awards for Chiropractic technique, basic sciences, radiology and was named as an outstanding intern.  Dr. St. Onge is certified in Active Release Techniques and has completed numerous hours of post-graduate training in nutrition.    

Dr. St. Onge enjoys working with a wide array of patients and has treated patients as young as 4 years old and as old as 76.  He enjoys helping marathon runners get back to their running as much as he enjoys helping a mom be able to get down on the floor to play with her son.  

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