Reviewed by Tyler Tice, PT, DPT, OCS, ATC
This article is a systematic review of eight different studies on the effectiveness of soft tissue therapy (STT) for people who have knee joint problems or recovering from knee surgery. The different techniques used were hands-on manual techniques including soft tissue massage and myofascial release along with other manual techniques. The theory behind STT is to improve flexibility, reduce pain and speed up the recovery time by improving blood flow, reducing swelling, and loosening the area by ways of manual therapy to muscles, ligaments, tendons, and fascia. Unfortunately, there is not a clear agreed upon definition of what fascia is although most agree that it is the connective tissue that holds everything together and with the crossing of muscles, ligaments, and tendons at the knee joint it is a very important structure in that area that many believe that most of the pain in the area is derived from. The review looked to answer the questions: Does STT reduce pain, improve range of motion, improve muscle strength and coordination, improve functional outcomes, and is it a good treatment intervention for people with knee joint pathologies.
All eight studies addressed pain, and the results were very similar. Overall, the studies showed that patients reported a significant reduction in pain after STT interventions using the Numeric Pain Rating Scale, Visual Analog Scale, as well as other pain assessment tools. One pathology that stood out was patients with osteoarthritis reported a significant reduction in pain following just a single session of STT.
Looking at range of motion the studies in the review showed that MFR and manual therapy led to significant improvements in ROM especially in knee flexion. The study however did not say if this was due to STT or other therapy interventions because there was not a control of patients who did not receive STT.
Muscle strength and coordination were also addressed by many of the studies as it is tremendously important for knee function and stability. Patients who received STT were able to perform better on MMT due to a reduction in pain when performing the tests. STT is a pain modulator that helps reduce the frequence of pain signals sent to the brain from the muscles, fascia, tendons, and ligaments allowing for these structures to perform better in other intervention that increase strength without pain.
The studies used functional outcome measures such as the Western Ontario, and McMaster Universities Osteoarthritis Index (WOMAC) and the Lower Extremity Functional Scale (LEFS). Patients who received STT showed significant improvement in functional outcome measurement scores demonstrating that using STT in a treatment session helped improve patient function and quality of life outside the therapy setting.
Two of the studies focused on patients recovering from a total knee arthroplasty (TKA). These studies showed that STT significantly improved the patients pain levels and most saw improvement in range of motion compared to patients who only received standard care with out STT. Another pathology that saw significant improvement was patients with osteoarthritis in the knee joint as STT greatly improved their pain levels and ROM.
Limitations of these studies included the fact that many of these studies did not have a control group that did not receive STT meaning it is hard to determine for certain the STT was the cause of the significant improvements reported in the studies. There were also small sample sizes which could limit the generalizability of the findings meaning we cannot definitively say that it will be beneficial to the majority of patients with knee pathologies. There is also not a standardized treatment regimen for all of these studies meaning that there is a lot of variability in the techniques that were used, how long it was used, and what other interventions were used. The follow-up periods were also very short which makes it hard to analyze the long-term effects and benefits of STT.
In conclusion, STT is a useful intervention that can be helpful for pain modulation in patients that have a knee joint pathology but there is no evidence to support any physical changes on the body structures that are being targeted. This intervention should be used in conjunction with other interventions such as manual joint mobilizations and muscle strengthening to help achieve the best results.
Reference:
- Jurecka A, Papież M, Skucińska P, Gądek A. Evaluating the effectiveness of soft tissue therapy in the treatment of disorders and postoperative conditions of the knee joint—a systematic review. Journal of Clinical Medicine. 2021;10(24):5944. doi:10.3390/jcm10245944