Soft Tissues of the Body
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.
The primary function of a tendon is to transmit contraction forces from the muscle to the bone during movement. To create that 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 allow 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. Overstretching of the fibers causes the body to produce an inflammatory response. Next, the fibers may tear either from a mechanical issue (inappropriate use over time or an acute force trauma), or the collagen in the tendon may break down on a cellular level due to degeneration from aging or another metabolic issue. Finally, and most severely, an avulsion is the complete removal of the tendon from the bone. This type of injury requires surgery to reattach the tendon. Massage can be helpful during treatment of these dysfunctions as the muscle needs to remain healthy and pliable to reduce unnecessary tension on the tendon fibers. In case of an avulsion, massage should not be done until the client has been cleared for bodywork by a doctor post-surgery.
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. Bursa are small, fluid filled sacs in the major joints of the body mean to reduce compressive loads and frictions from natural movement. They exists 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.
