The Effectiveness of Soft Tissue Release for Healing

Lower Limb Injury

B. M. Wara Kushartanti

, Rachmah Laksmi Ambardini

, Bambang Priyonoadi

, Ali Satiagraha

Faculty of Sport Sciences, Yogyakarta State University, Colombo Street No.1, Yogyakarta, Indonesia

Keywords: Soft Tissue Release, Lower Limb Injury

Abstract: Soft tissue release massage has been widely applied for injury rehabilitation. The massage aims to eliminate

muscle tension that precedes or follows the injury. It is not yet known how effective it is in healing injuries,

especially lower extremity injuries that often occur. With this rationale, this study examines the effectiveness

of the massage method in healing lower extremity injuries. The Quasi Experiment Method was used in this

study with 20 research subjects with subacute and chronic lower limb injuries. Lower extremity injuries that

occur can be caused by strains, ankle sprain, knee sprain, or lower pelvic sprain. Convenience Random

Sampling will be used to recruit subjects, which is preceded by the signing of informed consent after being

given sufficient explanation. Before and after treatment, all patients would assess the degree of pain with the

Visual Analog Scale (VAS) and its level of function with Lower Limb Functional Scale (LLFS). The collected

ordinal data is processed by a different non-parametric test after it has been described. The results showed

that Soft Tissue Release massage can reduce pain and improve function significantly (p = 0,000), with the

effectiveness of 61.1% for pain and 24.7% for improvement in lower limb function.

1 INTRODUCTION

Massage has been used for thousands of years

throughout the world. Massage is applied to various

indications, including preparation of competition,

during competitions, assisting recovery, therapy and

rehabilitation of injuries.

In 2009, the first book on the Soft Tissue Release

(STR) was published by Human Kinetics with Jane

Johnson as the author who discussed massage

techniques for the whole body. The definition of soft

tissue in this case is the fibers of muscles, tendons,

and fascia that surround the tissue both on the surface

and inside. Basically, this massage technique

combines emphasis on certain points (locking) and

stretching (stretching) on soft tissue. The advantage

of Soft Tissue Release is that it can involve patients

actively, so that it will be safer and more comfortable,

both for patients and their therapists. Patients are

asked to move their joints according to their range of

motion (ROM) and with the speed and breadth

according to their stiffness and pain. Stretching on

STR allows realignment of joints and tendons.

Streching is designed to improve the mobility of soft

tissue and further improve ROM by extending the

structure that is shortened due to chronic injury due

to lack of movement. When the muscles, tendons,

ligaments are stretched, the strength of the strain is

transmitted to the muscle fibers through the

connective tissue of muscle wrapping around the

fibers.

Anatomically, basically, the human skeleton

consists of bones that connect to the joints. The joint

is lined by ligaments and is strengthened by muscle

tendons that attach to the bones, joints and connective

tissue that make up the joint capsule. Excessive and /

or repetitive movements can lead to disposition of the

ligaments, tendons, and even joints. Likewise with a

static position that is maintained for a long time. All

of that can happen both when working and exercising.

These musculoskeletal disorders (bones and muscles)

are often complained of by employees and sportsmen.

Disorders of the lower extremities are more often

complained of because the task is to support body

weight.

Massage is one methods of relieving pain and

related symptoms. Mechanical pressure in muscle

tissue can improve local microcirculation of blood

and lymph flow which can further reduce swelling,

ischemia or buildup of substances that directly or

indirectly cause pain (Vegar, 2016). The benefits of

therapeutic massage against muscles include

Kushartanti, B., Ambardini, R., Priyonoadi, B. and Satiagraha, A.

The Effectiveness of Soft Tissue Release for Healing Lower Limb Injury.

DOI: 10.5220/0009797305570559

In Proceedings of the 3rd Yogyakarta International Seminar on Health, Physical Education, and Sport Science in conjunction with the 2nd Conference on Interdisciplinary Approach in Sports

(YISHPESS and CoIS 2019), pages 557-559

ISBN: 978-989-758-457-2

557

relieving muscle tone and stiffness, accelerating

healing of muscle strains and sprains and ligaments,

reducing muscle pain, and restoring range of motion

(ROM). Massage is known to stimulate cutaneous

receptors so that it can potentially cause local lateral

inhibition of pain feedback in the spinal cord. The

pull and strength applied to muscle fibers from

various massage techniques also activate the Golgi

tendon and nerve organs. They are afferents that have

large diameters. Activation of large nerve fibers

capable of sending nerve impulses quickly can

partially block smaller and slower nerve fibers so as

to reduce pain.

The role of massage in handling musculoskeletal

injuries is strongly related to the duration, type,

technique, and time of intervention of massage.

Massage techniques, types of manipulations, the

duration of treatment used as therapeutic modalities

vary so much that there is difficulty comparing one

massage study with another massage study. So far, it

has not been known to what extent the effectiveness

of soft tissue release techniques in curing lower limb

injuries, especially in cases of sprain and strain.

2 METHODS

This study is a quasi-experimental study with one

group pretest-posttest design. The population in this

study includes YSU Physical therapy Clinique

patients who suffered lower limb injuries. Samples

were obtained with inclusion criteria over the age of

20 years, sub-acute or chronic injury conditions, and

willing to be the subject of research indicated by the

signing of informed consent. The exclusion criteria

were lower extremity injury patients who used anti-

pain and anti-inflammatory drugs, had fractures /

fractures, and dropped ligaments. Data collection in

this study was done using a test technique to assess

the scale of lower limb function using a questionnaire

that had been adapted from Lower Limb Functional

Scale. The data was taken before and after the

treatment of massage (pretest and posttest). The data

was collected in an ordinal scale. The data analysis in

this study used descriptive statistics to describe

gender, age, weight, height, duration of injury, level

of physical activity and cause of injury. Inferential

statistics with a non-parametric difference test for two

pairs of groups (different pretest and post-test) with

the Wilxocon test.

3 RESULTS

3.1 Subjects Characteristics

The research subjects amount to 20 people, consisting

of 10 women and 10 men. The average age of the

subjects was 33.4 years, 164.3 cm in height and 63.3

kg in weight. Based on the causes of injury, from 20

subjects, 12 people (60%) experienced sprain, 5

people (25%) strains and 3 people (15%) experienced

delayed onset muscle soreness (DOMS). The level of

subject

activity, 14 people were in the mild category

(70%), 5 people in the moderate category (25%), and

1 person in the heavy category (5%). Meanwhile, the

average duration was 12-day personal injury.

3.2 Descriptive Results

3.2.1 Pain Scale

Pain levels before and after the treatment are shown

in Table 1.

Table 1: Pain scale

Method Total Pretest Posttest

∆

Mean

STR 20 4,75 1,85 2,9 61,1

Based on Table 1, it can be seen that in the STR

group there was a decrease in pain level of 61.1%.

3.2.2 Lower Limb Function

Lower limb function before and after treatment is

shown in Table 2.

Table 2: Lower limb function.

Method Total Pretest Posttest

∆

Mean

STR 20 70,15 87,45 17,3 24,7

Based on Table 2, it appears that the STR method

increases the function of lower extremities by 24.7%.

3.3 Statistical Analysis

Different test before and after the treatment with the

Wilcoxon Signed Rank Test are shown in Table 3.

YISHPESS and CoIS 2019 - The 3rd Yogyakarta International Seminar on Health, Physical Education, and Sport Science (YISHPESS

2019) in conjunction with The 2nd Conference on Interdisciplinary Approach in Sports (CoIS 2019)

558

Table 3: The level of pain and function of the lower limb

before and after treatment.

Method Variable Pretest Posttest Z p

STR Pain 4,75 1,85 -3,938 0,000

Function 70,15 87,45 -3,928 0,000

In Table 3, it can be seen that the STR method can

significantly reduce pain and improve lower limb

function (p = 0.000).

4 DISCUSSION

Soft tissue release (STR) massage method has been

applied to cure lower limb injuries. In this study, the

cases handled were sprain, strains, and DOMS in the

lower extremities. The STR method can reduce pain

levels and improve lower limb function.

The STR method involves stretching fascia and

releasing bonds between fascia and skin, muscles, and

bones with the aim of relieving pain, increasing ROM

and body balance (Namvar et al., 2016). If the pain

decreases and the ROM increases, the function will

also increase. The results

of the study which

examined the effects of 3 types of soft tissue

manipulations, one of which was the myofascial

release technique also showed that this technique

could reduce pain and improve ROM in plantar

fascitis cases (Pattanshetty, 2015).

There are at least 3 mechanisms that underlie the

effects of massage therapy on chronic pain

conditions, namely by increasing vagal activity,

reducing the inflammatory process, and reducing P

substances. Stimulation of pressure receptors will

increase vagal activity and in patients with chronic

pain show lower vagal-mediated heart rate variability

as indicated by increased vagal activity (Field, 2018).

The principle of handling with the STR method is

emphasis on trigger point points, then stretched. The

aim of STR is to free fascia and maintain network

functions. This technique is used to relieve pressure

in connective tissue. Careful myofascial stretching

and maintaining a certain amount of time are believed

to free the bond, soften and extend the fascia. By

freeing the fascia, where the nerves and blood vessels

are located, it helps increase the transmission of the

circulatory and nerves system. This technique is

widely used in chronic conditions to help change the

basic viscosity of the substance to a more fluid state

which eliminates the fascia pressure on the pain

sensitive structure and restores proper alignment

(Pattanshetyy, 2015).

The advantage of the STR method is the

involvement of patients, in other words, patients

actively participate in therapy. Methods by involving

patient activity are seen as safer, as are therapists.

This method is felt to relieve the therapist because

there is patient involvement. In addition, lotions or

lubricants are not needed so that they can be more

practically applied in the field. The effect of

relaxation is longer, although the onset of therapy is

slower and patient comfort is somewhat lacking.

5 CONCLUSION

The Soft Tissue Release Method is effective in

reducing the level of pain in lower extremity injuries.

The method of soft tissue release massage is effective

in improving the function of the lower limb.

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Pattanshetty RB & Raikar AS. 2015. Immediate Effect of

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Randomized Control Trial. Int J Physiother Res, Vol

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Effect of Myofascial Release Technique on pain

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Vegar,S. 2013. Causes and Management of Delayed Onset

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