Over the last 10yrs, I’ve used L.A.S.T. in numerous types and stages of injuries. I’ve worked on many acute injuries, with patient consent, in an effort to determine the boundaries of risk of harm for the technique.
In many of the acute cases, I’ve had the opportunity to treat the patient with in the first 6-12hrs of the injury. These injuries have ranged from acute inversion ankle sprain/strains, MCL sprain/strain, FOOSH’s resulting in AC separation’s to elbow sprain/strains to carpal fractures to phalanx sprain/strains. In one case I was fortunate to work with a cyclist who had fractured his scaphoid (vasculature confirmed intact via MRI).
As with all acute conditions, providing it’s the first time the tissue has been injured to that degree, typically present is large amounts of swelling, pain, loss of AROM/PROM/RROM, muscle guarding, compensatory postural changes, altered gait regardless of the area injured and so on. If left to progress to the chronic stage, patients complain about a loss of ROM’s, stiffness, re-injury when challenging the tissues beyond their tolerances and usually present with further compensation to their gait and posture.
In most all of the cases either immediately or within 12-24hrs post treatment utilizing L.A.S.T. only, swelling/inflammation and the other signs and symptoms decreased dramatically. Many patients return later with in the same week requesting the technique to be performed as opposed to other techniques. In continuing treatment, there have been far fewer complaints of chronic issues. Patients have reported that they are able to continue with a greater quality of life.
When questioned about the decrease in inflammation and longer term effects of L.A.S.T., I’ve always used my knowledge of physiology to explain possibly what healing process’s could be affecting the condition, but in reality I’ve never truly known for sure exactly why… until now….possibly.
While on a course from Willem Fourie PT, I was discussing this subject with him. He was kind enough to pass on a research paper (Bouffard et all, 2007) discussing the effects of mechanical forces on transforming growth factor-beta1 (TGF-b1) and collagen deposition. Their hypothesis was that brief static stretching of tissue following injury would decrease soluble TGF-b1 levels, attenuate TGF-b1 auto-induction and decrease new collagen deposition.
During wound healing or chronic pathological conditions, fibrosis and tissue tension can slowly increase over days to weeks due to the contractile activity of myofibroblasts. Transforming growth factor beta1 (TGF-b1) is well-established as one of the key cytokines regulating the response of fibroblasts to injury, as well as the pathological production of fibrosis. Increased levels of TGF-b1 lead to increased synthesis of collagens, elastin, proteoglycans, fibronectin, and tenascin, aka scar tissue/adhesions.
In the case of minor sprains and repetitive motion injuries, scarring is mostly detrimental since it can contribute to maintaining the chronicity of tissue stiffness, abnormal movement patterns, and pain (Langevin and Sherman, 2007). The amount, timing and duration of therapeutically applied stretching therefore is likely critical to obtain beneficial anti-fibrotic effects.
In the time course experiment, tissue exposed to stretch had significantly lower overall mean TGF-b1 levels compared with non-stretched tissue. Stretching the tissue by 20–30% for 10 min twice a day, 24 h after injury, partially suppressed the rise in TGF-b1, significantly reducing the amount of subcutaneous new collagen 7 days following injury.
The results of this study suggest that stretch-induced therapy decreases TGF-b1 and mediates new collagen formation which may be an important mechanism limiting excessive scarring and fibrosis following injury. Reducing scar and adhesion formation using stretch and mobilization is especially important for internal tissue injuries and inflammation involving fascia and organs.
The authors have proposed that therapies using brief, judiciously applied stretching of tissues beyond the habitual range of motion (physical therapy, massage, yoga, acupuncture) locally inhibit new collagen formation for several days after stretch and thus prevent and/or remodel soft tissue adhesion’s.
L.A.S.T. affects the surrounding tissues of joints by mobilizing the tissue up to its elastic barrier. Using permitted motion of the tissue; we progress to the end of the tissues physiological range, and then slightly beyond, within the client’s comfort level. Treatment durations for the injured area/tissues can range up to and beyond 10minutes.
In acute cases, holding the tissue in this stretched state until the innate self correcting processes of the body correct the injury; both the patient and I have noted a decrease the inflammatory response, a decreased sense of pain and increased proprioception/stability.
Once the injury progress’s to the chronic stage, we have noted minimal differences when compared to the non injured side. We have found that we are able to introduce strengthening rehabilitation programs sooner and that the patients progress through the rehabilitation process faster.
All of my experience with L.A.S.T. is anecdotal and I recognize that more research into the effects of the techniques needs to happen. I will endeavor to continue to communicate with the likes of Dr. Robert Schiep and Dr. Moshe Solomonow who are leaders in the advancement of research in fascial tissues. It’s an exciting time for all of us as we are on a path to understanding more than we ever have about this wonderful mechanism we live in.
If you have research you would like to share with me concerning this topic, I welcome it and look forward to your comments.