Soft Tissue Mobilization

7,8 Grieve 7 emphasized this by stating that “ the nerve, connective tissue, muscle, and articular complex produces multiple and varied arthrokinetic systems, which are functionally interdependent upon each other. ” Many authorities have stated that dysfunctions of the soft tissue system play a primary role in the onset and perpetuation of musculoskeletal symptoms. 7,9-13 Grieve 7 stated the following: “ An explanation of the incidence of vertebral joint syndromes, and of some unsatisfactory long-term therapeutic results, might be assisted by regarding joint problems in a wider context than that of the joint alone. Much abnormality presenting, apparently simply, as joint pain may be the expression of a comprehensive underlying imbalance of the whole musculoskeletal system, i.e., articulation, ligaments, muscles, fascial planes and intermuscular septa, tendons and aponeuroses ... ” The human system can develop to be effi cient, strong, and fl exible by responding appropriately to the various types of controlled physical, mental, and emotional stress. 14-16 When the system is unable to adapt appropriately, physical compensations occur ( Figure 27-1 ). The most common factor that precipitates soft tissue pain and functional impairment is trauma. 17,18 Trauma, whether from a signifi cant external force or from repetitive internal or external microtraumas, can produce long-standing soft tissue changes ( Box 27-1 ). 19,20 These soft tissue dysfunctions may be the primary source of symptoms or the secondary source through impeded structural and functional capacity. All injuries, regardless of site, have a basic infl ammation cascade. Infl ammation has three distinct phases: (1) acute, (2) granulation, and (3) remodeling. The fi rst phase, acute, occurs 0 to 4 days after injury. The ruptured cell releases debris and chemicals (prostaglandins) into the plasma, which attract leukocytes. The white blood cells clean out the bacteria and prevent infection. Prostaglandins are released from the injured cell, causing pain. 21