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Dr. Horwitz is certified in Upper Extremities, Spine, Lower
Extremities, and Nerve Entrapments
CHECK OUT THE ACTIVE RELEASE WEBSITE!
Active Release Techniques® is a new and highly successful
hands-on approach to injuries of muscles, tendons, fascia,
nerves and the surrounding soft tissues." "It is similar to
some massage techniques, only it's more aggressive. 'The art
of it all is being able to know where to look for adhesions, how
to feel for them and how to use active motion of the body part to
break them up,' says inventor Mike Leahy, D.C."
The technique is extremely effective on injuries like muscle strains,
rotator cuff tendinitis, tennis elbow, achilles tendinitis and carpal
tunnel syndrome.
When a muscle, tendon, or ligament is torn (strained or sprained) or
nerve is damaged, healing occurs in three stages called the
inflammatory response: acute inflammation, repair and remodeling.
In acute inflammation, redness, swelling, heat and pain
occur. This phase lasts approximately 72 hours. After the
inflammation recedes, repair begins. The damaged tissues heal with
adhesions or scar tissue formation rather than the formation of
brand new tissue.
Scar tissue is weaker, less elastic, less pliable and more pain
sensitive than healthy tissue. These adhesions disrupt the normal
muscle function, which in turn affects the biomechanics
of the joint complex, and can lead to pain and dysfunction.
This makes prompt and proper treatment essential for healing
and rehabilitation.
Active Release Techniques® is applied by hand using a very specific
pressure and tension on the muscle involved while moving the muscle
underneath the contact (thumb or fingers of doctor's hand).
"The affected tissue is trapped while
the body part is moved, taking the tissue from its shortened
to elongated position. Relative motion between tissues is
introduced in order to restore gliding between those tissues"
(Leah). This method softens and stretches the scar
tissue, resulting in increased range of motion, increased strength,
and improved circulation which optimizes healing.
The treatments are combined with proper stretching and strengthening
of the involved tissues. Proper body posture and ergonomic instruction
are also imperative for optimal results.
Leahy, Michael. Improved Treatments for Carpal Tunnel and Related
Syndromes. Chiropractic Sports Medicine 9(1):6-9, 1995
Men's Health Magazine, November, 1999 pp.80-82
A NEW FIX FOR OLD INJURIES
You thought you'd have to live with that bum shoulder or trick knee forever.
But a breakthrough treatment may prove you wrong…
BY LOU SCHULER
The first time Ming Chew sticks his thumb into my armpit, I understand
why torture is a profession. Not that this is torture, by definition;
it's a new form of physical therapy called active release techniques,
or ART. And it may completely change the way we treat muscle injuries.
Chew's thumb is in my armpit to undo the damage caused by a high-school
football injury. It's a partial separation that has recurred many times
since then. Most recently, I strained it doing exercises in the gym.
(Most comically, I once separated the shoulder in the middle of sex.
I mean, I can laugh about it now.)
The goal of this thumbing exercise is to break up scar tissue that has
formed between the fibers of a rotator cuff muscle called the subscapularis.
This most recent injury rendered my shoulder so weak that I couldn't throw a
basketball 20 feet.
While Chew keeps his thumb in my armpit, I must pull my arm through a
full range of motion. On one maneuver, I start with my hand overhead,
then slowly rotate my arm so my hand ends up behind my back. It hurts
like a broken marriage. While I'm in the middle of this move, I can't
help but think that Chew could make a nice side income thumbing trade
secrets from the armpits of powerful industrialists.
When it's over--the entire treatment has taken about 5 minutes--I feel
sore but strangely exhilarated. Chew then takes my shoulder on a test run.
We repeat some exercises that we tried before the treatment, and use find
that the strength in my right shoulder has improved by several hundred
percent, and that the flexibility has also improved a bit.
Chew has a set of dumbbells in his office, and I ask if I can try some
lateral raises. Before the treatment I could barely do any repetitions
with 12 pounds. But now I easily do a set with 15 pounds, rest a minute,
do a set with 20, rest a minute, and then try 25 pounds. This is more
weight than I've ever been able to use in this exercise, and I easily
complete a half-dozen repetitions.
Chew says my shoulder is about 40 percent of the way back and predicts
that after a couple more ART applications it will be 100 percent.
I walk out of Chew's physical-therapy office and into the streets of
Manhattan's Upper West Side feeling as if I'm both witness to and
beneficiary of a miracle.
LOURDES, COLORADO
Miracle or not, ART certainly has an unconventional and controversial
origin. In 1984, Michael Leahy, D.C., a chiropractor in Colorado, was
working on patients who had suffered repetitive-motion injuries, mostly
carpal tunnel syndrome. While doing standard manipulations, he found himself
hitting scar tissue in places it wasn't supposed to be.
Most of us think of scar tissue as something that occurs at the point of an
injury. You slice your finger on a beer can, the doctor sews up the tear, and
the scar that eventually emerges at the site is a permanent reminder of how
drunk you were.
But there's a second way scar tissue forms. When a muscle tightens up--
through a repetitive motion such as typing, or after it has been slightly
injured--some swelling occurs, and the swelling chokes off the oxygen supply
to the muscles and connective tissues. This condition is called hypoxia, and
it, too, causes scar tissue to form. That scar tissue can adhere to muscle
fibers, preventing them from sliding back and forth properly. It can adhere
to connective tissues, limiting the flexibility of a muscle or joint. And it
can adhere to nerve cells, leading to carpal tunnel syndrome, chronic back
pain, and other conditions.
Leahy didn't know about hypoxia in 1984. He just knew he'd found a problem
he thought he could solve. "I devised movements and manual pressures to break
down the scar tissues," he says. "The two materials"--muscle and scar--"are
still there, but now the tissues will slide and move."
The technique, which he trademarked as ART in 1988, soon became popular
with Olympic and professional athletes. Leahy says he can treat any muscle
or joint with ART, and that he has worked on big-name athletes, including
the Boston Red Sox pitcher Bret Saberhagen, Gary Roberts of the National
Hockey League's Carolina Hurricanes, and the sprinter Maurice Greene.
Leahy has also trained and certified about 800 other ART practitioners.
Most of these are chiropractors, but he has certified orthopedists,
physical therapists, and some massage therapists as well.
THE CONTROVERSY, AS PROMISED
There are few studies on ART. It's relatively new and continually
evolving; if Leahy finds a better way to break up scar tissue in a
patient with carpal tunnel syndrome, for example, he'll change his
techniques and teach other practitioners to do things the new way
when he can.
And ART is wholly owned by Leahy. The name is trademarked, and his
scar-busting protocols are patented. He has taught almost everyone
who is certified in the technique, although he's now training others
to teach it. The only way to find an ART provider, aside from word of
mouth, is to call Leahy's office in Colorado Springs for a referral.
Some people wonder what, exactly, Leahy has invented, other than the
trademarked name. "ART is not a new technique," says Dean Cummings, M.D.,
an orthopedist. "It was called contractile myofascial release back in
Europe about 50 years ago."
Everyone agrees that the technique is a form of myofascial release,
which refers to the breakup of scar tissue inside muscles and connective
tissues. Myofascial release is a well-accepted therapeutic treatment,
generally covered by any health-insurance plan that covers physical
therapy or chiropractic care. Rolfing is probably the best-known form
of the treatment.
But ART is different from other types of myofascial release. First, the
patient actively participates, moving his own limbs through a range of
motion while the ART practitioner presses a thumb into the muscle. Second,
ART differentiates between the tiniest of muscles, and between different
muscle actions within muscles.
ART seems fast, safe, and remarkably effective for injuries to muscles
and connective tissues. For $40 to $125 per session, a seasoned ART
practitioner can fix up new or decades-old problems in a few sessions.
"It has a lot of advantages in treating people with myofascial problems,"
says Dr. Cummings. "I don't have a lot of skepticism about it."
"The odds of fixing a problem with ART are about 95 percent. That's using
my database of 3,000 cases," says Leahy. He acknowledges that other forms
of hands-on therapy--myofascial release, chiropractic, whatever--"all work.
But we're talking about fixing 95 percent of problems in four visits,
versus 50 percent of them in 30 visits."
Chew says his cure rate is between 85 and 90 percent within six visits.
And he says that he's able to fix 8 percent of his patients' problems in
a single visit.
FASTEST THUMBS IN MODERN MEDICINE
All of which I would be inclined to dismiss as unprovable hyperbole,
were I not living with absolutely no pain in my shoulder. After a second
session with Ming Chew, I found that I was able to rotate my right arm in
a circle with no discomfort, no feeling of something "clicking" in the
socket. That's after 26 years of clicks.
"What's amazing to me is that it works so fast. It seems like black magic,"
says William Goldman, 68, a screenwriter. The owner of a bad back for more
than 30 years, Goldman has been to a succession of orthopedists, chiropractors,
and acupuncturists. But he says none of those disciplines can match ART for
pure speed. He's had ART for four different problems, and each time the cure
was nearly instant.
"The bottom line is that anything that works is good, as long as it's not
detrimental. This is not detrimental, and it does work," says Andrew Feldman,
M.D., an orthopedist and the author of The Jock Doc's Body Repair Kit. Dr.
Feldman has successfully referred several patients to Chew. "We're seeing
the genesis of something that could be huge in the future."
The only question is how many people are willing to have a thumb in a place
where one has never been inserted before.
ART Class
How to decide whether active-release techniques will work for you
Before seeking an ART practitioner to treat an injury or chronic problem,
you should first see a physician. ART can't fix broken bones, torn ligaments,
thyroid disease, or ruptured spinal disks. You need to rule out such problems.
Second, if your insurance requires it, get a referral or prescription for
either chiropractic care or physical therapy. (ART falls under the category
of myo-fascial release, which is covered under many health plans.)
If your physician can't recommend an ART provider, call the office of Michael
Leahy (719-473-7000), the chiropractor who invented the technique, and ask for
a referral in your area. If your insurance won't pay for it, expect to fork
out from $40 to $125 a session.
Not all ART providers are equally experienced. Four different ART
credentials can be earned--upper body, lower body, spine, and total body--
so if you have a choice of practitioners, choose the one with the most
credentials.
Once a problem is fixed, you'll need to follow a program of stretching
and strength building. If your problem is associated with an injury that
occurred long ago, you probably have some weakness and inflexibility in
the surrounding muscles.
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