HEMME APPROACH TO SOFT-TISSUE THERAPY

comes first, inflammation of the joint and periarticular tissue is likely to
continue until hypertonic muscles surrounding the joint relax and lengthen.
Continued shortness in a muscle that crosses a joint (1) reduces joint space,
(2) causes abnormal friction, (3) inflames the joint capsule, and (4) erodes
articular cartilage. Treatments such as high-velocity manipulation that have no
permanent effect on surrounding muscles and related tissues will do nothing
more than provide temporary relief. If joints and related muscles are not
treated together as a unit, the body cannot heal itself and pain cycles that cause
weakness and limited range of motion are likely to continue.
Setbacks and reversals are common when treating pain cycles.
Even without secondary gain or litigation neuroses, progressive
improvement will sometimes reverse itself for no apparent reason. The
leading cause appears to be higher levels of activity. As patients improve, they
feel better, become more active, and place more demands on the body. Despite
feelings of well-being, patients should be advised to avoid strenuous activities
until the entire body can handle the added stress. The deconditioning effects
of inactivity are difficult to overcome. Besides pain-free range of motion,
patients need strength, muscular endurance, aerobic endurance, and
coordination to function normally.
The methods for treating soft-tissue injuries are often deficient.
In many cases, soft-tissue therapy begins too late or the methods of
treatment are not appropriate for the problem. If an injury is not mobilized as
soon as possible, pain, spasm, and fibrosis may limit the victim's range of
motion and decrease activity. Extended periods of inactivity may cause
deconditioning—weakness, atrophy, incoordination, or stiffness—and other
pathologic changes that lay the groundwork for a long and durable pain cycle.
Modalities or medication used without manipulation are seldom effective, and
splints or braces worn for more than a few days retard healing, decrease range
of motion, and may cause contractures or capsular adhesions.
Another form of inappropriate treatment is too much focus on reports of
pain by the patient and not enough concentration on restoring function.
8
HEMME Approach to Soft-Tissue Therapy