Active Release Techniques

Written by staff | 18 July 2011

Active Release Techniques® (ART) is a popular, patented system of manual therapeutic maneuvers designed to treat soft tissue injuries including muscles, tendons, ligaments and nerves^{1, 2, 3, 7}. This system is touted to offer relief for headaches, back pain, joint problems and more. To date, however, evidence supporting therapeutic benefit is limited to small case studies and subjective expert opinion amongst chiropractors and other musculoskeletal practitioners^{1, 2, 3, 7}.

ART is theorized to diagnose and treat injuries stemming from “overuse” of soft tissues; these include acute injuries (immediate tears and sprains), long-term strain and accumulations of small injuries with time^{1, 2, 3}. These injuries lead to decreased oxygen delivery and the development of dense scar tissue (termed adhesions) which is weaker, tighter and more pain sensitive than healthy tissue and can inhibit proper tissue function⁴. It is believed that these adhesions lead to shorter, weaker muscles, tense tendons and entrapped nerves which compromise muscular strength and range of motion. Associated edema (swelling) and inflammation is believed to cause pain/tenderness and lead to further injury causing continuous, degenerative cycle^{2, 8}. ART is marketed as an alternative to massage, electrical, ultrasound and other therapeutic modalities¹. Recent studies also suggest that ART may also specifically help with pain in certain soft tissue groups³.

In an ART treatment session, a certified practitioner will examine a patient by manually manipulating affected soft tissues, and provide treatment by combining these manipulations with specific movements by the patient^{1, 4, 5}. The practitioner will place pressure on specific areas of soft tissue and have the patient lengthen nearby muscle from a contracted to a lengthened position⁷. ART is designed to break up, soften and stretch adhesions to improve circulation, healing, strength and range of motion⁴. Treatment can be temporarily painful as the adhesions are broken apart.

Even after ART is applied, it’s still considered important to incorporate the same muscle movements done during treatment into a home exercise program to maintain improvements^{4, 5}.

One study of ART applied to overuse cases of lateral epicondylitis (tennis elbow) and carpal tunnel syndrome, suggests a success rate as high as 71-75%^{5, 7, 9}. However, research on the benefits of ART has produced mixed results. Specific case reports have not only shown improvements for tennis elbow and carpal tunnel syndrome but also for low back pain and injuries involving hip muscles, hamstring muscles and locked “trigger” thumbs. But other case reports have suggested no benefit to ART, specifically when targeting quadriceps-related knee pain and injuries to soft tissues involved in chewing^{2, 7, 10}.

Most successful applications of ART are achieved in conjunction with a variety of other conservative treatments including exercise and other soft tissue techniques, so it has been difficult to elucidate benefits attributable to ART alone. ART may provide the best results when combined with other mobilization and manipulation techniques¹⁰. Larger clinical trials are needed to establish the efficacy of ART¹¹.

References

1. Active Release Techniques. About. Retrieved from: www.activerelease.com/about. Accessed July 14, 2011.
2. Drover, J.M.; et al. (2004) Influence of Active Release Technique on Quadriceps Inhibition and Strength: A Pilot Study. Journal of Manipulative and Physiological Therapeutics. Vol. 27 (6) 408-413.
3. Robb, A.; Pajaczkowski, J. (2011) Immediate effect on pain thresholds using active release technique on adductor strains: Pilot study. Journal of Bodywork and Movement Therapies. Vol. 15 (1) 57-62
4. Voight, M.L.; et al. (2006) Musculoskeletal interventions: techniques for therapeutic exercise. McGraw-Hill Professional.
5. Mooney, V. Overuse syndromes of the upper extremity: Rational and effective treatment. Retrieved from: [PDF]activereleasetechnique.com/pdf/Overuse-Syndrome.pdf. Accessed July 14, 2011.
6. Cooperstein, R.; Gleberzon, B. (2004) Technique systems in chiropractic. Elsevier Health Sciences.
7. Howitt, S. (2006) Lateral epicondylosis: a case study of conservative care utilizing ART® and rehabilitation. Journal of the Canadian Chiropractic Association. Vol. 50 (3) 182-189.
8. Spina, A. Treatment of proximal hamstring pain using active release technique applied to myofacial meridians: a case report. Retrieved from: [PDF]www.sportsperformancecentres.com/articles/scientific/Treatment_of_Proximal_Hamstring_Pain_using_Active_Release_Technique.pdf. Accessed July 14, 2011.
9. Howitt, S.; et al. (2006) The conservative treatment of Trigger Thumb using Graston Techniques and Active Release Techniques®. Journal of the Canadian Chiropractic Association. Vol. 50 (4) 249-254.
10. George, J.W.; et al. (2006) The Effects of Active Release Technique on Hamstring Flexibility: A Pilot Study. Journal of Manipulative and Physiological Therapeutics. Vol. 29 (3) 224-227.
11. George, J.W.; et al. (2006) The Effects of Active Release Technique on Carpal Tunnel Patients: A Pilot Study. Journal of Chiropractic Medicine. Vol. 5 (4) 119-122.