Restoring Smooth Movement

How Active Release Technique Can Help Athletes (And All Your Clientele)

By Yael Grauer

Shoulder injuries can be hard to manage for even the most seasoned massage therapists. But what do you do when your client is an athlete who uses his shoulders on a constant basis? Not only does this client come in seeking pain relief, he also needs to use his shoulders to do his job. Soft-tissue therapies might provide the answer you’re looking for with this client, and Active Release Technique (ART) might offer the relief your client seeks.

ART, an efficient form of manual soft-tissue therapy that is particularly helpful for repetitive motion injuries, was created by P. Michael Leahy, DC, a chiropractor in Colorado Springs, Colorado, whose background is in anatomy and aeronautical engineering. He began teaching ART in 1991 under the name myofascial release. He trademarked the name ART in 1995 in order to standardize treatment for his chiropractic patients, and because ART extends beyond treating muscle and fascia.

The goal of ART is to restore the smooth movement of tissues and release entrapped nerves and blood vessels. ART is useful for diagnosing and resolving fascial, myofascial, and neuromyofascial restriction. It works with contact and active client motion to reduce adhesion and soft-tissue restrictions. 

If you come across an athlete whose soft-tissue complaint has not resolved after two or three general massage treatments, you may want to refer the client out for a diagnostic workout and ART as an adjunct treatment, says Dale Buchberger, DC, a physical therapist and chiropractor who uses ART in his practice and treats many athletes, including tennis players and professional baseball pitchers. “The main goal is to reestablish motion between fascial planes, thus reducing fibrous adhesions and reestablishing neural and myofascial glide between tissues,” Buchberger says.

Every ART session is actually a combination of examination and treatment. The ART provider uses hand pressure to evaluate the texture, tightness, and movement of muscles, fascia, tendons, ligaments, and nerves. Abnormal tissues are treated by combining precisely directed tension with very specific client movements. ART is most commonly used to treat conditions related to adhesions or scar tissue in overused muscles. As adhesions build up, muscles become shorter and weaker, the motion of muscles and joints is altered, and nerves can be compressed. As a result, tissues suffer from decreased blood supply, pain, and poor mobility.

For massage therapists who see many athletes whose sports involve overhead movement, such as baseball players, tennis players, and swimmers, Buchberger recommends ART certification. “It’s a good marketing tool … and massage therapists can blend it into their practice,” he says, adding that the work has made inroads in both athletic and professional sports communities. Buchberger uses ART on athletes with shoulder strains, impingement syndromes, and even tendinitis.

Athletes like it because it is focused and aggressive, and it primarily treats acute, chronic, overuse conditions (such as pulls and tears), as well as microtrauma, which are rampant in sports. Athletes often have dense scar tissue that can lead to shortened and weakened muscles, tendinitis, and even trapped nerves. This leads to diminished range of motion, pain, and strength loss, all of which ART can readily address.

Putting ART into Practice

Neil Rampe, manual and performance therapist for Major League Baseball’s Arizona Diamondbacks, is certified in a variety of modalities, including massage and sound assisted soft tissue mobilization (SASTM), but he sought ART training to address upper body issues in his clients. “ART is super-specific,” Rampe says. 

Rampe found that his ART training made him better at assessing the cause of his clients’ issues. “The difference between a good therapist and a great therapist is your ability to sift out the details,” he says. “Instead of kind of being in the ballpark, you can address the issue head on if you know what to look for. You can’t fix something if you don’t know it even exists, and once you know it exists, you need to know how to find it.”  

Because reproducible results are often hard to come by when working with soft-tissue injuries and conditions, ART’s standardized treatment protocols appeal to Rampe. When an athlete is sent to him for ART, he knows exactly which protocol to use. This also allows athletes from other states to receive standardized treatment from an ART practitioner when they are traveling.

ART offers 106 protocols for dealing with upper extremities, including peripheral nerve entrapments. It is helpful for addressing tennis elbow, shoulder injuries, and carpal tunnel syndrome. With lower extremities, ART has 96 protocols, including peripheral nerve entrapments, which can be used to address everything from the toes to the hips. For low-back and hip problems, ART has 82 protocols, including peripheral nerve entrapments in the cervical, lumbar, and thoracic spine.

Soft-Tissue Mobilization

If your clients have postoperative scar tissue or densely restricted tissue, an instrument-assisted technique, such as SASTM, Graston Technique, ASTYM, and the 2,000-year-old Gua Sha, combined with eccentric exercise may yield far better results. “Instrument-based, soft-tissue techniques are superior for true degenerative tendon disease, such as tendinosis, compared to manual techniques using the practitioner’s hands,” Buchberger says.  

All instrument-based, soft-tissue techniques use an instrument applied in multiple directions to produce an ecchymosis, or bruising, response. The therapist and client both feel a vibration when the tool hits an area needing treatment. The purpose of these modalities is to break cross-fiber links, splay fibers, and, ideally, increase fascial mobility, often by reinitiating the inflammatory process. This stimulates a healing response, with blood, nutrients, and fibroblasts rushing to the affected area. 

Nathan Tiplady, DC, a chiropractor who treats many professional baseball players in Boston, Massachusetts, sees a lot of clients who suffer from upper-extremity shoulder and forearm problems. He uses ART, along with other modalities such as Graston Technique, on athletes who come in with general shoulder pain of nontraumatic origin that has accumulated over time. 

Buchberger, who has used both Graston Technique and SASTM, says both techniques are equally effective, yielding similar results when performed by experienced providers. Graston Technique, which is available to chiropractors and other health-care providers, excluding MTs, uses stainless steel instruments, which are more expensive and harder on the provider’s hand, but more comfortable for the client. Instruments used with SASTM, which is open to massage therapists and other health-care providers, are slightly less comfortable for the client, but are also less expensive and not as hard on the provider’s hand. “SASTM’s tools fit the contour of the surface area of the adhesion, fibrosis, or scar tissue,” Rampe says, therefore allowing practitioners to switch tool sizes as needed.

The Graston Technique was developed by David Graston after he suffered a knee injury and subsequent limited range of motion due to reconstructive surgery. When physical therapy didn’t do the trick, Graston used cross-friction massage and developed stainless steel tools to assist his fatigued hands. Today, the instruments help mobilize, reduce, and reorganize fibrotic restrictions in the neuromuscular system.

SASTM, also developed by Graston, is a similar modality that diagnoses and treats skeletal muscle and connective tissue disorders using tools to palpate clients’ bodies, thereby detecting and resolving muscular and tendinous adhesions. 

“I use SASTM with almost every client I work with,” Pederson says. He finds it of particular benefit when working with fascia and soft-tissue adhesions. “With SASTM tools, you can really make some big changes quickly and effectively. The tools also provide feedback for clients, as the tools’ design creates a vibration that, when relating to tissue consistency, both practitioner and client can hear and feel. The feedback this tool provides allows all involved the opportunity to easily compare progress from session to session. Often, after a few treatments with SASTM, many of the deeper adhesions and scar-tissue restrictions are gone, and we can move on to other forms of treatment. I often tell people that three minutes using the tools saves me 20 minutes of cross-fiber friction.” 

Combining the Techniques

Buchberger finds that instrument-assisted modalities and ART complement each other well, especially when combined with strengthening and flexibility exercises. “Graston [Technique] is a good precursor to ART when the patient presents with diffuse fibrous restrictions that, for practical time and financial restraints, are better treated with Graston [Technique]. The examiner must realize that the goal of Graston [Technique] is to create an inflammatory response and allow remodeling to take over from that point. This is contrary to ART, which attempts to establish motion without inducing a dramatic inflammatory response. Once the restrictions reduce and become more isolated, introducing ART into the treatment plan has been a very effective scenario.” Buchberger uses SASTM on very chronic cases and cases where ART, proper rehabilitation, and other traditional forms of treatment have been proven ineffective. 

Rampe also often combines SASTM and ART when treating shoulder injuries. “What happens a lot of times, depending on mechanics or pathology, is that the shoulder may not have adequate eccentric strength to properly decelerate the arm, so the back of the shoulder almost begins to adhere and starts to glue tissues together to decelerate. It starts to get sticky back there.” That’s when a combination of SASTM, ART, and other techniques can help mobilize the tissue and get circulation back so the tissues can work independently, in conjunction with a strengthening program.

When confronted with clients who present significant challenges, sometimes it is the right move to expand your horizons. Blending ART with massage therapy can help give you the tools you need to help your most challenging clients. 

  Yael Grauer is a freelance writer living in Minneapolis, Minnesota. She is the managing editor of Performance Menu: Journal of Health and Athletic Excellence. Contact her through or at