If you've ever read any of my writing, you've probably come to realize that I love learning, studying, getting better and perfecting my craft. I love what I do and make it a point to learn and get better every single day. I recently attended my second ART course in San Diego a couple of weeks ago. For those of you that don't know, Active Release Techniques is a specialized treatment that involves the practitioner putting a very specific tension on an adhesion while a muscle is shortened, followed by the muscle actively being lengthened through its range of motion away from the adhesion. This method is extremely effective for freeing up fibrotic tissue that is causing pain and movement faults. (read my Got CID? Article if you haven't already for more on this) There are hundreds of specific protocols to free up muscle, ligament and nerve entrapments with an upper extremity, lower extremity and spine course making up the big 3. I did the upper course last year and just completed the spine course. Now, before I got into massage therapy, ART was one of the big things that I wanted to be able to do and was a huge driver for me making the final jump into the world of soft tissue. What I would like to do here is provide a little review about the ART courses I've done and what I've experienced with it as a treatment modality.
This technique is very similar to an old school method simply known as “pin and stretch.” Some people seem to think that ART is nothing more than pin and stretch with a patent on the name. In my experience, this could not be farther from the truth. ART treatments involve very specific palpation, contact, tension and motion with each protocol being unique with the specific entrapment that is being treated. Over the years and through tons of experience, Dr. Leahy (creator of ART) and colleagues have discovered many common/specific entrapments that occur between fibers of a single muscle, fibers of adjacent muscles, fibers of a muscle and a nerve, fibers of muscles and ligaments and even joint capsules. If a practitioner is good at finding local entrapment sites through touch and palpation and is able to perform the treatment correctly, it is insane how effective this treatment can be. Chronic pain can often be ridden of in a few treatments. Specific protocols have been developed to treat common entrapment areas for many common problems such as carpal tunnel, plantar fasciitis, tennis elbow, back pain, headaches and issues associated with many activities such as desk jobs and multiple athletic activities.
What is also unique about this treatment is the “combo” movements that it employs in order to facilitate relative movement among adjacent tissues. For example, the rhomboids and serratus posterior superior can get stuck on eachother and cause issues in the upper back. With ART, you can get them to move and slide relative to one another, assisting scapular and neck movement. This is not something that can be done very effectively with your typical stationary massage modalities.
Now, ART is not the end all be all of soft tissue treatments. There are many great tools and modalities that can and should be used for different cases. In my opinion, it is an amazing tool that most manual therapists should most definitely have in their tool box. It is definitely one of the most effective ways to treat areas that need release. The tension combined with the active motion not only effectively breaks up fibrotic adhesions but also stimulates the body neuroligically and can awaken and retrain sleeping muscles.
Another great thing about ART is the mastery of anatomy. Since the protocols and the treaments are so specific, you have to know your anatomy inside and out or you will be lost, suck at doing it and fail the course. You learn and get better with functional anatomy and learn how to develop a good contact and tension that treats tissues extremely effectively. Pretty much every muscle, nerve and ligament from the feet on up are involved in these treatment protocols and you have no choice but to get good with anatomy. With any manual treatment, the therapist should always know what they are touching and treating as very subtle mistakes can cause big effects on the body. As unfortunate as it is, this is not always the case with therapists.
What this course will not do is teach the why behind the treatment. Sure, you are finding fibrotic areas with tissues and treating them, but you still need to be able to figure out WHY they are fibrotic. What caused them to have this issue? You need to have a solid assessment approach to determine what is going on with the body and movement as a whole in order to determine where your treatment should focus and then what should be included in the exercise program to prevent the issue from coming back. So someone has very tender scalenes full of adhesions and inflammation. Why are they like this? Maybe their breathing pattern is off and their diaphragm isn't working how it should be; therefore, the scalenes are working overtime to elevate the ribs all day and are a problem because of this. Treat the scalenes all you want but until you fix the breathing pattern, you'll be treating them over and over again. This is obviously just one example.
That being said, IF you can figure out whats going on with the big picture, then ART is definitely one of the most effective modalities for helping to restore proper function and get rid of pain. The instructors will even come straight out and say this if you attend a course, which I like.
This technique is very similar to an old school method simply known as “pin and stretch.” Some people seem to think that ART is nothing more than pin and stretch with a patent on the name. In my experience, this could not be farther from the truth. ART treatments involve very specific palpation, contact, tension and motion with each protocol being unique with the specific entrapment that is being treated. Over the years and through tons of experience, Dr. Leahy (creator of ART) and colleagues have discovered many common/specific entrapments that occur between fibers of a single muscle, fibers of adjacent muscles, fibers of a muscle and a nerve, fibers of muscles and ligaments and even joint capsules. If a practitioner is good at finding local entrapment sites through touch and palpation and is able to perform the treatment correctly, it is insane how effective this treatment can be. Chronic pain can often be ridden of in a few treatments. Specific protocols have been developed to treat common entrapment areas for many common problems such as carpal tunnel, plantar fasciitis, tennis elbow, back pain, headaches and issues associated with many activities such as desk jobs and multiple athletic activities.
What is also unique about this treatment is the “combo” movements that it employs in order to facilitate relative movement among adjacent tissues. For example, the rhomboids and serratus posterior superior can get stuck on eachother and cause issues in the upper back. With ART, you can get them to move and slide relative to one another, assisting scapular and neck movement. This is not something that can be done very effectively with your typical stationary massage modalities.
Now, ART is not the end all be all of soft tissue treatments. There are many great tools and modalities that can and should be used for different cases. In my opinion, it is an amazing tool that most manual therapists should most definitely have in their tool box. It is definitely one of the most effective ways to treat areas that need release. The tension combined with the active motion not only effectively breaks up fibrotic adhesions but also stimulates the body neuroligically and can awaken and retrain sleeping muscles.
Another great thing about ART is the mastery of anatomy. Since the protocols and the treaments are so specific, you have to know your anatomy inside and out or you will be lost, suck at doing it and fail the course. You learn and get better with functional anatomy and learn how to develop a good contact and tension that treats tissues extremely effectively. Pretty much every muscle, nerve and ligament from the feet on up are involved in these treatment protocols and you have no choice but to get good with anatomy. With any manual treatment, the therapist should always know what they are touching and treating as very subtle mistakes can cause big effects on the body. As unfortunate as it is, this is not always the case with therapists.
What this course will not do is teach the why behind the treatment. Sure, you are finding fibrotic areas with tissues and treating them, but you still need to be able to figure out WHY they are fibrotic. What caused them to have this issue? You need to have a solid assessment approach to determine what is going on with the body and movement as a whole in order to determine where your treatment should focus and then what should be included in the exercise program to prevent the issue from coming back. So someone has very tender scalenes full of adhesions and inflammation. Why are they like this? Maybe their breathing pattern is off and their diaphragm isn't working how it should be; therefore, the scalenes are working overtime to elevate the ribs all day and are a problem because of this. Treat the scalenes all you want but until you fix the breathing pattern, you'll be treating them over and over again. This is obviously just one example.
That being said, IF you can figure out whats going on with the big picture, then ART is definitely one of the most effective modalities for helping to restore proper function and get rid of pain. The instructors will even come straight out and say this if you attend a course, which I like.
 |  From Trail Guide to the Body |
Releasing these and activating this can be a beautiful relationship
Now, for a little review on the course itself. I've attended the upper extremity course in Chicago last year and the spine course in San Diego a couple of weeks ago. They were both amazing learning experiences. Now, when you sign up for a course, you get a book and dvd to study and practice with before attending. I usually spend a few months going over the material so that I have it pretty well mastered before attending. There are just under or over 100 some protocols for each different course. If you don't know the stuff before going, good luck! So you learn a ton before even attending. What amazed me is the significant amount that I improved my contact and skill after a 3-4 day hands on seminar. The instructors at both courses were amazing and know the body inside and out. I improved my ability to locate and palpate specific tissues, improved my specific contact and tension for each specific treatment and improved myself as a hands on therapist ridiculously. Like anything else, the more you practice the better you get. So the course helps a ton and you then take those skills and perfect them on clients. I have personally had great success using ART to get people out of pretty chronic pain and even acute pain or a movement fault from a bad movement on, say, a set of squats. When combined with the proper movement and exercise training, this stuff is wicked effective. Forearm problems, back issues, headaches, shifting or rotating in a squat, poor hip extension; you name it and this stuff can help.
Whats cool though is that you even help other modalities outside of ART. My touch and palpation skills have improved so much that I feel that I have gotten better with other modalities as well, which is a very great thing!!
Another great thing about these courses, like many courses, is all of the other great motivated professionals that you meet and network with. I met lots of great people in San Diego, many of whom I will probably stay in contact with. Great strength coaches and therapists like Kevin Neeld, Brad Lecraw, John Rusin, Jeremy Ward and Tara Parsons to name a few. Everybody always has something to offer and advice to give out so between the instructors and other students, you have no choice but to get better. I even had a great time just hanging out with new friends when we were done for the day. Just a great overall experience! Any time I attend a seminar, I always come out of it feeling refreshed, rejuvenated and ready to make myself, my clients and my business better than ever. This San Diego seminar definitely did that and more.
So, if you are a manual therapist in any way, shape or form, I highly recommend taking an ART course. It will take your mastery of anatomy to another level, improve your touch and hands on skills and give you a great tool to put in your toolbox that can help improve client's lives significantly.
Next up for me is the Postural Restoration Institute's myokinematic and respiration courses. I have heard and seen some amazing things from their stuff and look forward to growing my toolbox with some more new skills. I also plan on checking out David Weinstock's Neurokinetic Therapy and would like to do one of Thomas Myers' Anatomy Trains/BodyReading/Fascial Release courses as well. Always so much more to learn!!! I just turned 27 yesterday and as I think back to how much I've learned and gotten better at what I do since I started working with the body at my age now, I can only imagine how much I can learn and get better with by the time I'm, say, 37 and so on, so forth. It has been, continues to be and will be an exciting journey for sure. I look forward to every step of the way.
In closing there are some main points that I have taken away from the courses that might help you. Some are new, some are things I've improved with.
*Use a flat contact, don't poke your client
*Generate tension, don't compress. Do this using your whole body, not the thumb or hand.
*Use an appropriate amount of tension for the individual, the tissue and the treatment at hand
*For many treatments, allow the movement to help create tension. Too much on your own can hurt the client
*Give tissue time to free up. Don't rush
*Don't forget about breathing. Deep breathing helps tissue to relax easier.
*If you are not sure if you are on the right muscle, have your client fire it and get good and differentiating what is what.
*Understand the anatomical layers and know how to differentiate the amount of depth you use with your contact. (i.e. erectors deep to rhomboids deep to trapezius in the upper back)
*Learn how to feel nerves and whether or not they are sliding correctly (This is one area I'm working on getting better with)
*Develop a feel for relative motion between adjacent tissues
*Don't do more work than is needed to get the job done. Just like training, doing too much can be detrimental rather than helpful
*If something is not holding, then look elsewhere to fix the problem
*Understand repetitive motion injuries and how they change tissue. Read my Got CID? article for more on that.
I could go on forever but these are some big bang points that, without getting too specific and in depth, can help out with many people.
Get better everyday and enjoy the journey.
Whats cool though is that you even help other modalities outside of ART. My touch and palpation skills have improved so much that I feel that I have gotten better with other modalities as well, which is a very great thing!!
Another great thing about these courses, like many courses, is all of the other great motivated professionals that you meet and network with. I met lots of great people in San Diego, many of whom I will probably stay in contact with. Great strength coaches and therapists like Kevin Neeld, Brad Lecraw, John Rusin, Jeremy Ward and Tara Parsons to name a few. Everybody always has something to offer and advice to give out so between the instructors and other students, you have no choice but to get better. I even had a great time just hanging out with new friends when we were done for the day. Just a great overall experience! Any time I attend a seminar, I always come out of it feeling refreshed, rejuvenated and ready to make myself, my clients and my business better than ever. This San Diego seminar definitely did that and more.
So, if you are a manual therapist in any way, shape or form, I highly recommend taking an ART course. It will take your mastery of anatomy to another level, improve your touch and hands on skills and give you a great tool to put in your toolbox that can help improve client's lives significantly.
Next up for me is the Postural Restoration Institute's myokinematic and respiration courses. I have heard and seen some amazing things from their stuff and look forward to growing my toolbox with some more new skills. I also plan on checking out David Weinstock's Neurokinetic Therapy and would like to do one of Thomas Myers' Anatomy Trains/BodyReading/Fascial Release courses as well. Always so much more to learn!!! I just turned 27 yesterday and as I think back to how much I've learned and gotten better at what I do since I started working with the body at my age now, I can only imagine how much I can learn and get better with by the time I'm, say, 37 and so on, so forth. It has been, continues to be and will be an exciting journey for sure. I look forward to every step of the way.
In closing there are some main points that I have taken away from the courses that might help you. Some are new, some are things I've improved with.
*Use a flat contact, don't poke your client
*Generate tension, don't compress. Do this using your whole body, not the thumb or hand.
*Use an appropriate amount of tension for the individual, the tissue and the treatment at hand
*For many treatments, allow the movement to help create tension. Too much on your own can hurt the client
*Give tissue time to free up. Don't rush
*Don't forget about breathing. Deep breathing helps tissue to relax easier.
*If you are not sure if you are on the right muscle, have your client fire it and get good and differentiating what is what.
*Understand the anatomical layers and know how to differentiate the amount of depth you use with your contact. (i.e. erectors deep to rhomboids deep to trapezius in the upper back)
*Learn how to feel nerves and whether or not they are sliding correctly (This is one area I'm working on getting better with)
*Develop a feel for relative motion between adjacent tissues
*Don't do more work than is needed to get the job done. Just like training, doing too much can be detrimental rather than helpful
*If something is not holding, then look elsewhere to fix the problem
*Understand repetitive motion injuries and how they change tissue. Read my Got CID? article for more on that.
I could go on forever but these are some big bang points that, without getting too specific and in depth, can help out with many people.
Get better everyday and enjoy the journey.
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