The Soft Tissue Center Inc. is an athletic and injury rehabilitation facility located in Los Angeles, California, that provides a unique health-care service. The soft-tissue therapy we give to patients with musculoskeletal
and neuromuscular injuries is not the standard, common approach seen so often. To fully understand it, you must first understand the nature of the injuries.
When a major trauma or repeated micro-trauma occurs, inflammation sets in and an anti-inflammatory medication is usually administered. The body responds to inflammation by forming fibrous adhesions (scar tissue) in the muscle itself, between the muscle groups and also between the muscle and the fascia (connective tissue). This fibrous adhesion formation prevents the muscle's normal ability to lengthen and contract, which leads to loss of range of motion, pain, decreased stability in the joint, predisposition to re injury and the associated fear of re injury. In other words, the biomechanics of the joint (the way it moves) have been altered, and this can lead to further wear and tear around the joint.
Normal and abnormal joint movements are gauged by the body's various pressure receptors located in the muscle, tendon, fascia and joint capsule. When you attempt normal movement in a joint whose structures are physically incapable of it, the muscles and the areas of fascia around the joint that provide stability as well as prime movement will compensate, which can lead to further problems. Pro bodybuilder Gary Strydom experienced this when his heavy training over time finally placed a stress on his shoulder that the stabilizing muscles were unable to recover from. Gary tried several other forms of therapy before he was referred to the Soft Tissue Center (STC), where we were able to resolve the injury.
The standard physical therapy approach to an orthopedic problem is to use hot or cold packs, electric muscle stimulation, ultrasound, whirlpools, traction and therapeutic exercise to aid the healing process and to reduce inflammation. These methods do, in fact, facilitate the healing process; however, since the fibrous adhesions form as a result of the normal healing process, the fibrous tissue is the leftover residue, so to speak. And once a certain plateau of therapy is reached, it is difficult to make any further progress. While more of the same therapy may be ordered, it will not take you any farther down the road.
Patients usually try to resolve their injuries with more therapy sessions and also prescriptions of anti-inflammatory medication. If patients cannot perform their sport, activity or hobby as they did before, their physicians usually tell them not to do that movement anymore. Patients may make several attempts on their own, in vain, to rehabilitate the injury. A visit to an accupuncturist generally brings inconsistent results even with similar injuries on the same patient. Visiting a chiropractor often follows, which is a step in the right direction because a chiropractor or a physical therapist will mobilize the involved joint and may well bring very short-term relief; however, such therapy does not address the soft tissue.
Simply strengthening an area may not produce the desired improvement either. The assumed premise is that normal muscle will respond in a normal manner. The flaw in this is that we are not dealing with normal muscle. Strengthening without addressing the injury or adaptations can cause further imbalance and more setbacks later.
Joints do not move by themselves; muscles move the joint. If the muscles and myofascial planes do not allow proper lengthening and shortening, then an ab-normal torque may exist about the injured joint, and it is the abnormal biomechanics that cause the pain and continued low-level inflammation.
Years after an initial injury patients frequently ask if their injury "has never healed." The fact is that it probably healed approximately six weeks after it occurred. The continuing problem is the end result of healing, which is why some long courses of chiropractic or physical therapy may be of no avail.
Soft-tissue therapy addresses the soft tissue around the involved joint. This includes anything other than bone-i.e., muscle, fascia, tendons, ligaments and bursae. Two factors make this type of therapy different from more traditional treatments.
First, since all of the muscles work together to form an action about the joint, all of the muscles around the involved joint are treated, not just the site of pain. The point of complaint may be the accumulation of factors and force vectors involved and not necessarily the sole source of pain. Secondly, both active and passive motion are used by the patient, as well as the therapist, to increase the resting length of these muscles in order to restore the proper biomechanics of that joint. Since it is pain occurring during some type of motion that usually brings the patient to the doctor, it makes no sense to treat the pain in a static manner. Why should a baseball pitcher, who is experiencing pain at a given point in his pitch, be treated by having two electric muscle stimulation pads strapped to his shoulder with an ice pack or hot pack surrounding it and then following that with ultrasound?
Soft-tissue therapy uses all planes of movement. In each plane there are limiting factors-that is, areas of adhesions or adaptive shortening. At the STC we select and treat the limiting factors one by one until there are none left. The therapist uses manual pressure over these areas of limitation to release adhesions and regain lost resting length in the muscle that occurred through compensation and also to decrease inflammation.
One of the biggest mistakes that many doctors and therapists make in this type of therapy involves the appropriate amount of manual pressure to use. Frequently, therapists use entirely too much pressure, falling back on the old adage "More is better." Excessive pressure is usually an excuse for a lack of skill or knowledge. More is only better when it means more specificity with more precision: There exists a pressure, X, that will yield the maximum results with the minimum discomfort to the patient. Therapists cannot approach a 50-year-old sedentary patient in the same manner as they would someone like bodybuilder Jim Quinn.
Specificity is a vital component in proper rehabilitation. The nature of the injury or the patient's need to perform a given motion demands that we apply specificity to the biomechanics. A perfect example of this is Steve Kerho, a high hurdler who represented Canada in the 1988 Summer Olympics. Steve had a history of groin injuries and subsequent treatment that included 14 cortisone injections. When he arrived at the STC, his coach informed us that the cinemagraphic analysis of Steve running the hurdles showed that he crouched slightly as he approached the hurdle in an attempt to protect his injuries. This crouching took up 0.03 seconds per hurdle over the 10-hurdle race.
In treating Steve, we added sport-specific work early in the initial phase of our therapy. This included a takeoff position to the hurdle, a clearing phase over the hurdle and a landing phase coming down from the hurdle, positions we reproduced in a treatment room, frequently with the assistance of a second therapist.
The specificity allowed for two situations to occur: 1) His muscles and fascia were mechanically able to attain their needed length, and 2) Steve learned that it was okay to be in the proper upright position to run over the hurdles and that the crouching wasn't necessary anymore. Steve's first meet of the '88 season found him duplicating his personal record, an achievement that typically occurs at the end of a season. We simply gave back to Steve the 0.03 seconds per hurdle that he had lost due to improper biomechanics.
We've applied the same type of treatment to hockey players with groin injuries from slipping on the ice while skating- reproducing the actions of the muscles. One gym owner we treated had a hip injury that severely limited his squatting. We reproduced a squatting motion with no weight and were able to address the injury and the improper biomechanics while the specific action was occurring. His squat improved significantly. The same biomechanics apply to the golf or tennis buff with low-back complaints or, as we treated recently, a windsurfer with elbow problems who had previously at-tempt to resolve them through surgery.
The Soft Tissue Center came into being after I dissolved a previous association with another office and formed the STC with my business partner, Ashly W. Plourde. The staff now includes chiropractors and therapists who have been thoroughly trained in this effective means of treatment. The priority of the STC has always been to achieve results and not to lend itself to meaningless theories.
Our soft-tissue therapy, evolved over 12 years in the health-care field, has drawn many top professional bodybuilders, including Samir Bannoul, Mike Christian, Gary Strydom, Charles Glass, Mike Quinn, Laura Beaudry, Dorothy Herndon, Susie Jaso, Tonya Knight and Sandra Blackie. The likes of Don Ross, Tim Belknap, Jim Quinn, Rick Valente, Teagan, D'Marko Blewett, John Richling, Vaughn Jipner, Jim Morris and Raye Hollitt also come to us to resolve their injuries.
In addition, we have treated world-class athletes of all sports. In 1988 we treated on a regular basis 35 athletes who were going to the the Summer Olympic Trials. Nineteen of them made their respective Olympic teams from six countries, and four won medals: Jackie Joyner-Kersee (two gold), Mike Powell (silver), Valerie Brisco (silver) and Kim Gallagher (bronze).
We also see many professional sports greats like hockey players Luc Robitaille, Dino Ciccarelli and Ron Duguay. To use Dino as an example, he was sent to the STC by his agent, Ron Salcer. Dino was in a predicament: He had a hip-flexor strain (a so-called stomach pull) that was preventing him from skating at a time when he was having a contract dispute with the Minnesota North Stars. Dino flew out to Los Angeles, and within two treatments over a 72-hour period he was able to return to the ice at full intensity.
That soft-tissue therapy has been validated by those who use their body's performance for their living is a proving ground in itself, but it is the measured data that will ultimately lead this type of therapy into major research projects and then to the physical therapy teaching institutions and, finally, hospitals and major outpatient clinics, where the public will have easy access to it.
Documentation is now in its early stages, and we are pleased with the data so far. One well-documented case involved Pain Marshall, who was the 1986 national champion in the 100- and 200-meter sprints, the '87 national champion in the 200-meter and second in that event at the '88 U.S. Olympic Trials. Pam suffered a hamstring injury in early '86, but later that year she won two national titles, as listed above. The Athletic Congress (TAC) was conducting cinema-graphic analyses of the top three performers in various events at the time of Pam's national titles, and in '86 her left stride length measured 7'5 1/4".
Pam came to the STC in the spring of '87 and was evaluated. We identified the fibrous area of the involved hamstring and began treatment immediately. When she won the 200-meter national title again, TAC's cinemagraphic analysis revealed that Pam's left stride length was 8'3 1/3"-an increase of 10.1 inches. Our excitement over these results was due not only to the improvement, but also to the fact that we were only involved in the treatment end of this case. The gathering of the initial data base, as well as the analysis, were performed exclusively by TAC, thereby eliminating any bias on our part.
The pathologic and physiologic changes in the formation of scar tissue are well-documented by Cummings, Crutch-field and Barnes in the Orthopedic Physical Therapy Services, in which the researchers pointed out that the first eight to 10 weeks of scar tissue formation reveals weak bonding and that the scar can be stretched and modified fairly easily. There are other types of cells that are involved and other specific changes that occur at four weeks, 10 weeks and on up through 12 months. R.B. Salter, M.D., a well-known orthopedic surgeon in research, has performed some very interest-ing and enlightening studies demonstrating the improved healing of various tissues when motion is involved during the healing process.
At the Soft Tissue Center we take the well-established data of the healing process and push the therapy to a new level. Orthopedists who have observed the treatments have called our type of therapy "revolutionary." Changes can be made in the adhesion formation at any point in the healing process, even if the injury is years old and the healing is long since complete.
The information that TAC gathered demonstrates the lasting results that we have seen for years with our patients. Another good example is sprinter Merlene Ottey of Jamaica, a silver and bronze medalist in the '80 and '84 Olympic Games as well as the '83 and '87 World Games. Merlene had a problem that is very common to sprinters: She could only reach a few inches past her knees when attempting to touch her toes. This lack of flexibility was caused by the stress and strain of world-class sprinting and heavy weight training. During the '87 track sea-son, after 5 1/2 weeks of therapy, Merlene was able to place her palms flat on the floor. She has maintained that degree of flexibility ever since. In 1989 Merlene had a combined indoor/outdoor track record of 54 wins, no losses and no injuries.
Sid Fernandez of the New York Mets was referred to the STC in 1987. His pitching had been severely hampered by a painful shoulder that a succession of traditional approaches had failed to resolve. Growing frustrated with his lack of progress, Sid tried accupressure to no avail. Shortly thereafter, he pulled himself from a game after only six pitches. Sports hypnotist Pete Siegal referred Sid to the Soft Tissue Center, where his injury was diagnosed as a rotator cuff strain. He returned to the starting lineup after two treatments.
Because we have identified unique injury patterns in various sports, the STC continues to draw top athletes. Veteran football players like Art Still, Brian Holloway, Pete Koch, Steve Bono and Calvin Sweeney have found their way to us, as well as boxers and kickboxers such as gold medalist Paul Gonzales, Randall "Tex" Cobb and Benny "the Jet" Ur-quidez. Entertainment figures who have come to the STC include Tony Danza, Steve Bond, Sara Purcell, Gregory Hines, Shadoe Stevens, Judge Reinhold, Richard Jaeckel, John P. Ryan, Martin Kove and noted director Taylor Hackford.
The rapidly growing popularity of this type of soft-tissue therapy has kept this office very busy. Though we have expanded and have had several offers for additional facilities, we don't have enough personnel to staff them. We are currently looking for both chiropractors and physical therapists to add to sites in Los Angeles as well as locations in other cities and states.
I would like to ultimately see this form of treatment become a major adjunct to physical therapy. To this end the STC is initiating its own research programs in 1990, compiling the statistics of treatments per diagnosis to demonstrate the speed of the results of this therapy. We welcome opportunities to share this work with the various research programs at teaching institutions and hospitals so that it may be taught to physical therapists that are both in and out of school.
Too often, patients direct their own cases by seeing an M.D. for various medications, a physical therapist for therapy, a chiropractor for "adjustments" and an accupuncturist for an attempt at pain control. There is no reason why they shouldn't be able to receive everything that is needed to address their injury all under one roof.
The Soft Tissue Center is coming very close to this goal. We provide evaluation, soft-tissue therapy, physical therapy and joint mobilization, and we will continue to expand the staff. This is the approach of physical medicine of the future.