Corrected on 12/20/2007: An earlier version of this story misstated Terry Noonan's affiliation. He is at the University of Northern Iowa.
When I get sidelined by an injury or illness, my first stop is always PubMed, the U.S. government's database of scientific research. I want to know what's been shown to work and what hasn't. If there hasn't been a randomized, controlled double-blind study suggesting that a treatment or remedy is effective, I'm likely to regard it with suspicion.
So how did I find myself facedown in a chiropractor's office, undergoing a therapy almost nowhere to be found in the medical literature? I was having my calf manipulated in a procedure called Active Release Techniques (ART), a patented massage therapy that proponents say breaks up scar tissue causing tightness or pain. As a medical writer, I'm always wary of anecdotal evidence, but I'm also an athlete, and here's my anecdote: Twice in the past few years, a seemingly intractable chronic running injury that has kept me off the roads for a month has been improved instantly by one 15-minute session of ART and totally fixed after a few more. And here's another: My friend, Tara Norton, a 36-year-old pro triathlete, coach, and massage therapist in Toronto whose chronic hamstring issues left her almost unable to walk up an incline after a hard race, tried ART after seeing a demonstration tent at the race expo. After one session, "I walked away totally normally," she says. "I kept telling my husband, 'Look! I'm walking!'"
ART is part of a larger group of hands-on therapies targeting the soft tissues (like muscles, tendons, and ligaments) and mostly aimed at athletes with nagging aches and pains. The common idea is that the therapist, whether a chiropractor, massage therapist, athletic trainer, osteopath or M.D., palpates the affected area to loosen tissue and promote healing. ART, the technique with which I'm most familiar, is active rather than passive; I put my foot through its usual range of motion while the therapist provides resistance in tight spots in my calf, with the aim of breaking down the scar tissue that's preventing the smooth tissues from sliding normally against each other. All the techniques are typically more intense than regular massage and may be uncomfortable.
They aren't among the most unorthodox of therapies, but they aren't exactly mainstream, either. "They're alternative to very traditional medicine—drugs, bracing, and extremely formal physical therapy," says Brian Halpern, a nonsurgical sports medicine physician at the Hospital for Special Surgery in New York, who uses them in his practice. "But they can be very valuable for a multitude of ailments."
There hasn't, however, been much research on these therapies, says Terry Noonan, director of outreach athletic training services at the University of Northern Iowa Institute of Sports Medicine. It's hard to structure the kind of gold-standard studies used to test the effectiveness of a drug; what would be used as a placebo? So if you find yourself in my shoes, what can you make of these methods?
Lillie Rosenthal, a New York-based osteopath who is board certified in physical medicine and rehab, says you should always start with a physician's evaluation. "It's important that someone who knows the whole body looks at it comprehensively," she says. Back pain might have gynecological origins; arm pain may spring from a pinched neck nerve. "Many problems can be masked and need to be unmasked," says Halpern. "We don't need to get an MRI of every body part, but we do need a good history and a physical."
Once more-serious issues are ruled out, though, experts say to go ahead and consider soft-tissue therapies. Rather than looking for a specific brand or type, you may want to get recommendations for a good practitioner, who will probably have experience with many different techniques. As with drugs, some people will respond to a given method, but others won't. Ask for a referral from a doctor who treats athletes, or ask local clubs or groups (I posted on my triathlon club listserv). Noonan, who's certified in ART and has used it on football players and track athletes, among others, says you should also expect results relatively quickly. If it isn't relieving pain in a few visits—and doing so over the longer term, not just for a day or so, try something else or head back to a physician to double-check that nothing more serious is going on.
I'm a believer in ART for myself, though if my pain ever comes back, I'm going to take Rosenthal's advice and get evaluated by a physician to see if there's something that needs a more serious fix. But I'll look for one who's open to the idea of using soft-tissue therapies to address injuries. "We have such incredible technology now," says Halpern. But sometimes, he says, you just "need to put your hands on the patient."