T Nation

ART and Proof?


#1

Hey all,

I am hoping to get thoughts and experiences on ART therapy, as well as any information anyone might have on clinical research supporting the practice. I am thinking about getting certified in it, but need to get as much research under my belt as possible before I hand off $1000.

It is mostly the research to back it up that I am thinking about. I haven't found anything relevant on Pubmed, but I found a few things on scholar google that have basically said it's promising, just no "double blind, placebo controlled" studies, let alone a met-analysis.

My main thing here is I want intelligent responses. I don't want the "it worked for me so it's perfect and you are stupid for questioning it" angle that I have seen on the net; this website is all about scientific inquiry. This would especially help if there are any practitioners out there who can give me a little more detail than the ART website provided (which was nearly none). Thanks all. I'm hoping this proves to be a worthwhile discussion.


#2

I'm a big fan of ART, I think it represents a big part of the future of health. I can't help you with the clinical research part. I have had it done several times and think it's almost literally a miracle.
I myself have considered getting certified to perform ART, but I'm not in the medical field in any way, and it will be a pretty big undertaking. Just need to make the time to do it.
Are you a doctor or anything like that?
Why do you want to get certified? For a career?
I'm curious to see if you get any good info from T-Nation....


#3

I have had very good experience with it. My practioner is one of the teachers of the a.r.t. courses and has a buttload of experience with the appropriate application of it,his own medical practice, and several other strenght and conditioning certs.
Point being he uses A.R.T. when appropriate and standard medicine when appropriate, also combining the two.
A good deal of success with it will have to do with the quality of the practitioner.
Overall, I'd say it is a valid treatment for certain conditions.


#4

I am a second year student in a physical therapy program. I have been reading T-mag since 2000, so I definitely have heard the ripples that ART has made in this community. Now that I am getting ready to think about when I am out working in a clinic, I find myself with an injury (tendinitis) that traditional methods have not been able to fix due to chronic re-injury. That is when my mind has drifted back toward ART.

Why I am looking for research is that my professors always harp upon evidence-based practice, and if there isn't research to back up some new therapy (which new, bogus ones pop up all of the time), they teach us to be skeptics.


#5

May I ask your condition and the exact application of this therapy? (what did he do? what is the difference between ART and a deep friction massage on the tendon?)


#6

"Overall, I'd say it is a valid treatment for certain conditions."

That's probably the most important thing one can say about ART. As you know, the method is all about breaking up adhesions. Obviously this won't help if the underlying issue is a strength imbalance or something else.

ART isn't very well researched, as you've noted, but the underlying mechanics are good. If you have a serious adhesion in your calf, it's going to effect flexibility, the ability to fire the effected fibers, and mossibly gross motor patterns if left untreated (which as I'm sure you know can lead to big problems). It's very important to note that the practitioner has to have a very solid understanding of biomechanics; often postural assessments, ROM tests, and tests on seemingly unaffected areas (for instance, oblique adhesions on a knee issue) are required to figure out what's wrong. It's usually taught that way, but I've heard of a lot of pupils coming away not really understanding that.

It's helped me personally with knee ROM - I had some sticking in my lower hamstring region for a while that was freed up with ART. The same practitioner couldn't figure out that it wasn't a glute adhesion causing an uneven gait, though. It was gross imbalances in strength and flexibity about the pelvis, but she kept thinking ART was a cureall. Just a word of warning.

Keep in mind there's also other methods of myofascial release, though. You don't need the fancy ART cert to perform the methods if you understand how it works. Well, from a practical standpoint, not sure about legal issues with that. I'm sure it varies by state.

-Dan


#7

Just while I'm around -

Deep friction massage doesn't usually involve the client moving through a ROM IIRC. It's a passive thing where the practitioner just busts stuff up while the patient lies there (to oversimplify, this is how my chiro explained it).

ART involves moving the patient through a particular ROM while applying intense pressure to the suspected adhesion area.

I have no idea how this effects the efficacy of treatment, and I'd doubt anyone really does. The benefits of moving the joint I can think of are immediate feedback to effectiveness and skin irritation over a smaller area. The cons to moving I can think of are false positive results if the joint is just a little inflexible and feels better after a few passes, and potential problems with older adults (some of the motions in the ART book I saw are pretty awkward). Also more chance of discomfort if there's multiple areas affecting the movement of the joint (though that could be a positive too, depending on the situation).

Hope this helps, and someone correct me if I'm remembering the wrong technique for tendon massage.

Oh, duh, ART also focuses on both tendons and the muscle belly while deep friction tendon massage is usually applied to tendons directly, I believe by definition. Probably called something else when that technique is applied to the muscle belly, though I'm not terribly well versed in the terminology massage therapists use.

-Dan


#8

Hey Maxx,

If I remember correctly from some previous chats, you are (or were) in PT school. Your professors are finally getting to you with that whole "evidenced based practice" thing aren't they...

Seriously, though, it is what healthcare is going toward more and more - we are going to have to have not only the basic sciences to justify our reasoning behind our interventions, but also the clinical evidence that our interventions work. Otherwise, we are not going to get reimbursed for our services by third-party payers. So, your question is a big one.

I've been studying various schools of thought in manual therapy for a number of years now, and, honestly, there just isn't a lot of solid published clinical evidence to support its use (ART included). This, of course, does not mean that techniques like ART don't work. (I personally utilize various manual techniques with patients everyday with great success.) It is only that there are not a lot of published articles in peer-reviewed research journals to say that any of these types of techniques are effective. You will often see case studies and even some basic science work being published for techniques like ART, but carrying out randomized clinical trials is time-consuming, labor-intensive, and, often, expensive to complete. And, as you likely already know from your research courses, dealing with human subjects can also be very tough to manage both legally and ethically.

So, my answer to your original question is that I don't think there is much (if any) published clinical research to support ART (or most other methods of manual soft tissue techniques for that matter).

But hey, maybe your the guy...maybe you'll be the one to really get the ball rolling on developing the evidence to support this type of practice. If you are into this type of challenge, you might want to check into the APTA's website and look for info regarding support for clinical research initiatives. You might also want to check into orthopaedic / manual therapy residency and/or fellowship programs, which are often trying to train clinicians to be master practitioners along with attempting to provide opportunities for inquiry into manual therapy methods.

Hope this is helpful.

All the best.


#9

If you don't mind my asking, how do you get paid using these manual therapy / ART techniques when insurance is so stubborn?

(and I definitely agree about the subjects for research issue. I am doing a balance study right now involving LE dominance and direction of fall with a NORMAL population, and that is hard enough to get people to qualify, let alone show up for all of the tests)

I'm sure it wouldn't be too difficult to consult with PTs and DCs on exact methods/ outcome studies if all knew it would help their practice and this particular "art" (pun? maybe...)