Some Notes on Active Release Techniques

Stephen Barrett, M.D.

Proponents describe Active Release Techniques® (ART®) as "a patented, state of the art soft tissue system/movement based massage technique that treats problems with muscles, tendons, ligaments, fascia and nerves." [1] The patent abstract describes it as:

A method for the non-surgical treatment of soft tissue lesions includes placing a contact point near the lesion and causing the patient to move in a manner that produces a longitudinal sliding motion of soft tissues, e.g., nerves, ligaments, and muscles, beneath the contact point. Treatments are continued at sequential time intervals until the symptoms produced by the lesions are alleviated [2]

ART was founded and developed during the mid-1980s by P. Michael Leahy, D.C., of Colorado Springs, Colorado [3]. Proponents claim it can resolve headaches, back pain, carpal tunnel syndrome, frozen shoulder, shin splints, shoulder pain, tendinitis, temporomandibular joint problems, whiplash injuries and many other problems they attribute to muscle overuse that causes scar tissue buildup that restricts movement, traps nerves, and leads to pain [4]. In January 2008, the ART Web site listed one medical doctor and about 200 chiropractors in its staff directory and stated that there were more than 3,000 "full body certified providers." The leading chiropractic textbook classifies describes ART as "the myofacial technique perhaps most commonly used by the chiropractic profession." [5]

ART techniques differ from spinal manipulation. Its treatment sessions combine examination and treatment in which the provider hands are said to evaluate the texture, tightness, movement and function of each individual tissues. Tissues that are perceived as abnormal are then treated with stretching and sliding movements at specified tensions that are intended to increase movement of the tissues by removing or breaking up adhesions [6]. The treatment protocols—of which more than 500 are said to be unique to ART—are said to allow providers to identify and correct specific problems that affect each patient.

Active release techniques resemble what massage therapists call "anchor and stretch," "pin and stretch," and similar names. ART also includes movements in which the patient is instructed to move a body part while the chiropractor applies pressure. The patent document describes the procedures this way:

A key principle of the invention is that soft tissue adhesions can be treated by longitudinal manipulation of soft tissues in cooperation with active or passive motion of the patient's body. Active patient motion is most preferred. It is most desirable to implement treatment by manually contacting the exterior skin of a patient at a contact point that is selected to place subcutaneous tissues of a patient in tension. The subcutaneous tissues include muscles, nerves, ligaments, or tendons. The patient is then moved or moves to slide the subcutaneous tissues longitudinally beneath the contact point. This technique is distinct from traditional massage techniques, which typically do not require patient motion and also move laterally, as opposed to longitudinally, across the respective muscles, nerves, ligaments, or tendons. Thus, the techniques described herein are referred to as manipulation, not massage.

The patent document states that "an expert medical practitioner" who diagnosed soft tissue adhesions in 447 patients was able to determine within an average of about six visits that 418 (93.5%) had "significantly improved" and 19 (6.5%) would not be helped [2]. This suggests that whether ART can help is likely to be apparent within two weeks, but it does establish the extent to which is helps or how long any helpful effect lasts. That would require studies that validate the diagnostic techniques and compare the short- and long-term outcome of patients treated with ART with similar patients who were not. As far as I can tell, no such studies have been done.

A review published in 2004 noted that many case studies had been published but (a) no studies had compared whether different practitioners would agree on what tissues were affected, and (b) treatment outcome had not been assessed in controlled studies [6]. Since that time, two pilot studies have been published. One found that that ART protocols did not reduce inhibition or increase strength in the quadriceps muscles of athletes with anterior knee pain [7]. The other found that a single ART session had lengthened hamstring muscles of healthy males, but there was no follow-up to see how long the effect lasted [8].

Aetna's chiropractic clinical policy bulletin classifies ART as "experimental and investigational" because there is inadequate evidence of effectiveness in the peer-reviewed published medical literature [9]. It remains to be seen whether its advocates can produce publishable results that will establish it as effective. Practitioner Web sites state that many other insurance plans cover ART.

My purpose in writing this article is to describe what ART involves. I have no opinion about whether or not it works.

References

  1. Active Release Techniques home page, accessed Jan 23, 2008.
  2. Leahy PM, Patterson T. Expert system soft tissue active motion technique for release of adhesions and associated apparatus for facilitating specific treatment modalities. Patent No. 6,283,916, Sept 4, 2001.
  3. What is ART? Active Release Techniques Web site, accessed Jan 23, 2008.
  4. Abelson B, Abelson K. Release Your Pain: Resolving Repetitive Strain Injuries with Active Release Techniques. Berkeley, CA: North Atlantic Books, 2005.
  5. Perle SM. Soft tissue manual techniques. In Haldeman S, Dagenias S. Principles and Practice of Chiropractic, 3rd edition. New York: McGraw Hill, 2005, pp 805-820.
  6. Soft tissue techniques: The case of active release technique (ART). In Cooperstein R, Gleberzon BJ. Technique Systems in Chiropractic. Philadelphia, PA: Churchill Livingstone / Elsevier, 2004, pp 221-226.
  7. Drover JM and others. Influence of Active Release Technique on quadriceps inhibition and strength: A pilot study. Journal of Manipulative and Physiological Therapeutics 27:408-413, 2004.
  8. George JW. The effects of Active Release Technique on hamstring flexibility: A pilot study. Journal of Manipulative and Physiological Therapeutics 29:224-227, 2006.
  9. Clinical Policy Bulletin 0107: Chiropractic Services. Aetna, Oct 26, 2007.

This page was posted on January 23, 2008.

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