Massage and the Soft Tissues
The body is made up of various structures that connect the musculature to the skeletal system and support the bone system as it connects to and moves against itself. These soft tissues include tendons, ligaments, cartilage and bursa.
Tendons are tough, fibrous, and inelastic connective tissues composed mainly of collagen that anchor skeletal muscle to bone, acting as essential "mechanical bridges" for movement. A key component of the muscle tendon connection is the muscle-tendon unit (MTU). This is a functional, integrated system combining muscle fibers and tendons that drives human movement. The MTU allows muscle-generated force to be transferred to bones, acting as levers to facilitate movement of the joints. Healthy tendons are not especially stretchy and can therefore transfer high movement loads.
To create movement, the muscle receives a neurological stimulus and pulls both ends of the tissue together. As the muscle changes shape and its location in space, the connected bone also moves. The tendons of the body, while performing the same basic function, come in all shapes and sizes depending on where they are located. Some are longer and thinner (as in the shoulder, knee and elbow joints) and others are wide and collect fibers from large muscles allowing them to have a common insertion point (like in the trapezius muscle on the back and the obliques on the lateral abdominal walls). Tendons are composed of collagen, which provides stability and structure, and elastin, which provides flexibility during movement. There are two variations of tendons in the body. First, we have synovial sheaths that exist in distal extremities where the tendon crosses multiple joints. An excellent example of this is the carpal tunnel. Inside the hand is an intricate web of muscles that allows us to hold and grab and move items. As the tendons of these muscles move over and around the wrist joint, they are susceptible to painful friction. But the carpal tunnel exists as a flat, wide sheet of tendinous tissue that gives the cushioning. Second, there are non-sheathed tendons that do not require additional protection because they will not cross any joints.
Common dysfunctions of the tendon increase in intensity depending on the inciting force. Tendinopathy is a broad term for chronic tendon pain, more specifically it may be called tendonitis, which occurs when the damage to the tendon incites an inflammatory response in the body. Similarly, tendon pain can incite an inflammatory response in the protective sheath surrounding the tendon, a condition known as tenosynovitis. Tendons can also be torn due to excessive forces on the muscle tissue as they are transferred to the bone. In severe cases, a complete rupture can happen at the attachment site. Due to the limited blood supply to the tendon fibers, healing can be a long and difficult process. Depending on the severity of the trauma to the tendon, the treatment may be as simple as reducing the mechanical load on the tendon by rest, or as extreme as surgery to reattach severed fibers.
Because forces from the muscle tissue are transmitted through the tendon fibers, any tension reducing massage technique applied to the muscle fibers will reduce the mechanical load transmitted through the tendon. Additionally, massage encourages the formation of fibroblasts, collagen-producing cells that replace cells damaged by injury. Movement during healing is also important. As the body heals and gets stronger, range of motion techniques enhance the regeneration of new tissue and reinforce appropriate movement patterns.
Ligaments, while very similar to tendons, connect bone to bone. They have a higher amount of elastin than tendons because they connect two body tissues that have no pliability of their own. There are various widths and lengths of ligaments depending on where they are in the body. Large joints such as the shoulder and hip are in cased in cross-patterned ligament structures called joint capsules. Joint capsules contain synovial fluid to provide lubrication during movement. These spaces are richly innervated, and injury can cause pressure on or damage to the nerves passing through them. Ligament injuries are known as sprains and the severity ratings are first, second and third degree depending on the extension of the fibers during the injury. In a third-degree sprain, the ligament has completely separated from the attachment bone. The most effective treatment from sprains is known as RICE: rest, ice, compression and elevation. Massage is not usually effective for these injuries as ligaments do not have contractile units, and pliability is not a factor. Joint capsules can suffer a unique dysfunction called capsulitis - any nerve or tendon impingement in the joint will cause inflammation that limits joint mobility. Lighter touch bodywork techniques can assist in reducing inflammation and help restore natural movement.
Joints contain two types of soft tissue meant to cushion and support the skeletal system during movement: cartilage and bursa. Cartilage fibers are separated into two types: Hyaline and Fibrocartilage. Hyaline cartilage surrounds the end of longs bones at the various joints. It allows for smooth movement and decreases compressive loads. Fibrocartilage is found primarily in the spinal column. It sits between the vertebrae to provide rigidity and support and to guide proper joint movement. There is very little innervation to the cartilage, meaning injury can be occurring little by little over time but the body does not feel the pain and does not realize it should send a healing response. Cartilage is susceptible to gradual breakdown over time due to typical use or aging but can also breakdown more quickly if the body is suffering from an autoimmune condition. Bursae are small, fluid filled sacs in the major joints of the body mean to reduce compressive loads and frictions from natural movement. They exist deep in the hip joint and superficially in the knee joint. These sacs can suffer from inflammation from mechanical forces or metabolic insufficiencies. As with ligaments and joint capsules, the RICE method is very helpful during healing after injury to the cartilage and bursa. Light touch bodywork techniques are also helpful for these structures because it will reduce restrictive inflammation.
