Recently there has been much discussion on various social media outlets concerning the topics of releasing ligament, lengthening ligaments, ligaments being weak, some therapists perception that ligaments need to be strengthened and so on. These are all great topics for discussion and require their own posts.
My “Go To’ site for all things Ligamentous its the Journal of Prolotherapy. It’s a fantastic source of current information to help the clinician understand exactly what happens to ligaments and soft tissues as they are injured, the typical healing and challenges that are faced when rehabilitation doesn’t go as the text book promises it will. Rather than attempt to regurgitate the work of those who have come before me and who have done an amazing job at providing the information, I direct you the reader to read Ross’s article on Ligament injury and Healing.
Concerning Releasing Ligaments. This simply does not happen.
“But I felt a change in the ligament under my hands. What’s that!?”
Briefly, Mechanoreceptors and nociceptors in ligaments trigger a ligamentomuscular reflex activation of associated muscles. This reflex has been shown to exist in the joints of the extremities and in the spine. Muscular activity elicited by this reflex allows muscles and ligaments to work together as a unit, inhibiting muscles that destabilize the joint and increasing antagonist co-activation to maintain joint stability. Injuries to ligaments and joint soft tissue can evoke 2 types of responses; 1. to attempt to help minimize immediate harm 2. to restore and maintain stability, and prepare the joint for future potential destabilizing events. The first response can occur through a fast acting monosynaptic reflex directly from the afferent nerve to the motor neuron. The second is through a relatively slow acting polysynaptic reflex that is guided by input from higher centers to provide a more measured outcome, activating the gamma muscle spindle system to induce muscles to produce joint stiffness, which can remain indefinitely and play a role in altered firing patterns and coordination throughout the body.
Manual techniques which target mechanoreceptors and joint soft tissues have been shown to affect autonomic functions by lowering sympathetic nervous system activity, globally decreasing deep tissue pressure sensitivity, increasing pressure pain threshold, lowering resting pain perception, increasing local, proprioceptive attention, decreasing muscle tonicity and changing local blood supply and local tissue viscosity.
I believe that the feeling of ANS changes being felt by the clinician can be mis-interpreted as a releasing of tissue, when physiologically what is happening is that the ANS is “Unprotecting” the area causing a decrease in neuromuscular protection. The unfortunate reality that exists, post manual therapy treatment, is that joint instability is still present. Risk of harm occurs when reduction of protective mechanisms without re-establishing joint stability and function provides an opportunity for potential re-injury or an increase in neurological sensitization. This creates a scenario whereby patients continually return to their Manual Therapy clinician to be “fixed” while their injury is permitted to progress to a chronic stage of healing, greatly diminishing the patients’ enjoyment of life. This topic will be discussed more in the future.
For now, please enjoy a video I’ve taken from my Online Hip & Pelvis Course. If you have any questions, please feel free to contact me. I receive all your emails, questions, comments and testimonials. I may be a little slow in getting to them as I teach globally and still maintain a very full practice of 30 patients a week. I appreciate all of your positive communications and encouragements.