Some back and neck pain needs a doctor today, not a chiropractor. Some back and neck pain is not a case for a chiropractor and needs a doctor the same day. Go to an emergency room, not to us, if you have numbness in the groin or inner thighs, if you have lost control of your bladder or bowels, if a leg is becoming weak rather than just painful, if the pain followed a serious fall or a car crash, if you have a fever with back pain, if you have unexplained weight loss alongside it, if you have a history of cancer, or if a headache came on suddenly and is the worst you have ever had. We would rather you rang your doctor and never rang us at all.
When a back locks up or a neck seizes, a great deal of what you are feeling is muscle. The joint is irritated and everything around it has tightened protectively, which is a sensible short-term response and a thoroughly unhelpful medium-term one. Soft tissue therapy is the part of treatment aimed at that: sustained pressure through muscle and the connective tissue around it, often combined with movement, applied with hands, thumbs, forearms and occasionally a blunt tool.
It is worth being honest about the explanations attached to this work, because the trade offers several that do not hold up. Nobody is breaking down adhesions with their thumbs, nothing is being flushed out of your muscles, and no toxins are released by a massage — that particular story has been circulating for decades without ever acquiring evidence. What actually seems to happen involves changes in how sensitive the tissue is and how much the nervous system is guarding it, which is a less dramatic explanation and a more defensible one.
None of which makes it less useful. It reliably reduces pain and increases range in the short term, it makes people considerably more comfortable, and — practically — it opens a window in which movement and exercise are possible. For a good number of our patients, particularly the necks and the shoulders, the soft tissue work is the main event and the joint work is the accompaniment rather than the other way round.
What we actually do
Four approaches, chosen for the tissue rather than applied as a routine.
Sustained pressure
Steady, firm pressure held on a tender area for thirty to ninety seconds while you breathe. It is the simplest thing on this list and frequently the most effective. The sensation should be a strong but tolerable ache that eases as it is held — if it is sharp, or if you are holding your breath and bracing, the pressure is wrong and we reduce it.
Pressure with movement
Pressure applied to a muscle while you actively move the limb or the joint through range. It covers more tissue in less time than static work, it tends to produce a bigger change in range, and it involves you rather than leaving you passive on a table — which is generally a good thing for how the session translates into the rest of the week.
Working the whole chain
Treating only where it hurts is usually a mistake. A painful neck normally needs work across the top of the shoulders and between the shoulder blades; a sore low back usually needs the hips and the buttock. Pain is a poor guide to where the problem is being generated, which is why the treated area is often larger than the painful one.
Instrument-assisted work
A smooth blunt tool used to apply pressure across tissue, useful for broad areas and for practitioners' hands over a long day. It reddens the skin, which some clinics present as proof it is working — it is not, it is just blood flow. Used sensibly it is a reasonable tool. It should not leave you bruised, and if it does, that was too much.
What it does and does not do
Stated plainly, because this is a field with a lot of confident nonsense in it.
It does reduce pain and increase range
Reliably, in the short term, and often substantially. That is a real and worthwhile effect: it makes people more comfortable, it makes them sleep better, and it makes the exercise and movement that produce the durable change actually possible. Short-term relief is not a trivial thing when somebody has not slept properly in a week.
It does not break down adhesions
The forces required to deform dense connective tissue mechanically are far beyond what a thumb can produce, and the idea that a practitioner is manually breaking up scar tissue or adhesions does not survive contact with the numbers. Something useful is happening; that is not what it is.
It does not release toxins
There are no toxins in your muscles and nothing is being flushed out of them by a massage. This is one of the most persistent stories in manual therapy and it has never had evidence behind it. Drinking water after a treatment is fine and it is not detoxifying anything.
It does not fix the cause on its own
A neck that gets soft tissue work every week while spending fifty hours at a badly set-up desk will need soft tissue work every week indefinitely. That arrangement suits a clinic's revenue and does not suit you. The treatment buys the window; what you change in the rest of the week decides whether you need it again.
What a session is like
So you know what you are booking.
Thirty or forty-five minutes
Thirty minutes covers one region properly — a neck and shoulders, or a low back and hips. Forty-five covers two, or one region slowly. Ten minutes tacked onto the end of an adjustment is not soft tissue therapy, and we would rather book it properly than pretend.
Clothed or not, your choice
Most of this work can be done through clothing, and a good deal of it is. If you would rather remain fully clothed, say so — it changes almost nothing about what can be done. Where oil is used you are draped throughout and only the area being worked on is uncovered.
It should be a good ache
Firm, strong, and easing as it is held. The no-pain-no-gain approach to soft tissue work is both unpleasant and counterproductive: tissue that is being braced against does not release. Tell us to ease off at any point and we will, immediately, without any suggestion that you should tolerate more.
Afterwards
Often a pleasant heaviness and sometimes a mild ache for a day, similar to after exercise. Drink water if you want to, move gently, and do the exercises. Deep bruising, sharp pain, or feeling worse for several days is not a normal outcome and is worth telling us about.
Soft Tissue Therapy in western Queens
Hands, thumbs and elbows applied to muscle and the tissue around it. For a lot of stiff necks and locked-up backs this is where most of the relief actually comes from.
Every course of care here starts the same way: a full hour, a proper history, an examination, and then a plain statement of what we think is going on and how confident we are about it. You are told what we propose, roughly how many visits it ought to take and what should have changed by when — and we agree a date to stop and look at whether it worked. If the honest answer at any point is that this needs somebody else, you get that instead, and we write to them the same week.
Chiropractic care is not a substitute for medical diagnosis. Chiropractic care is not a substitute for medical diagnosis, and nothing on this website is medical advice for your particular problem. We are not physicians: we do not prescribe medication, we do not perform surgery, and we do not treat disease. What we do is examine how your spine and joints move, work on them by hand, and give you something to do between visits. If your problem turns out to be outside that, we say so and refer you — which happens often enough that you should expect it as a normal outcome rather than a failure.
What chiropractic does not treat. We treat musculoskeletal problems: the spine, the joints, the muscles and the nerves that are irritated by them. We do not claim that adjusting a spine treats asthma, allergies, ear infections, colic, digestive disease, high blood pressure, infertility, immune function or any other internal illness. Chiropractors who make those claims are making them without good evidence, and you should be wary of anybody who does. If somebody has told you that spinal care will fix a condition on that list, we will tell you honestly that it will not.
Questions
Soft Tissue Therapy — the questions we are asked most
Does soft tissue therapy release toxins?
No. There are no toxins accumulating in your muscles and nothing is being flushed out of them by pressure from somebody's hands. It is one of the most persistent stories in manual therapy and it has never had evidence behind it. What does appear to happen involves changes in tissue sensitivity and in how much your nervous system is guarding an area — less dramatic, and considerably more defensible.
Are you breaking up scar tissue or adhesions?
No, and neither is anybody else. The force needed to mechanically deform dense connective tissue is far beyond what a thumb or an elbow can generate, so whatever is producing the improvement, it is not that. This matters because the adhesion story is used to justify treatment that is more painful than it needs to be, on the grounds that the pain is doing something. It is not.
Should it hurt?
It should be a strong ache that you can breathe through and that eases as the pressure is held — not sharp, and not something you have to brace against. Tissue that is being guarded against does not release, so treatment that is too painful is actively less effective as well as less pleasant. Say ease off at any point and we will, immediately and without comment.
Do I have to undress?
No. A great deal of this work is done perfectly well through clothing and plenty of our sessions are. Say you would rather stay dressed and it changes almost nothing about what can be done. Where oil is used you are draped throughout and only the region being worked on is uncovered at any time.
Is this the same as a massage?
There is real overlap, and the difference is mostly one of intent and duration. Soft tissue therapy here is targeted at a specific clinical problem, usually thirty minutes, usually on one region, and usually part of a wider plan. A therapeutic massage is longer, covers more, and is as much about general relief as about a specific complaint. Both are useful and they are booked differently.
How often should I have it?
For an acute problem, alongside your other treatment for a few weeks and then not at all. If you find yourself booking soft tissue work every week indefinitely, something in the rest of your week is generating the problem faster than we can treat it, and the useful conversation is about that rather than about scheduling more sessions. We would rather have that conversation than sell you the sessions.
Related
Often seen alongside this
Hands-On Therapies
Therapeutic Massage
An hour in a quiet room with the lights down. Genuinely useful for muscular pain, sleep and stress, and honestly described rather than sold as something it is not.
Read more
Hands-On Therapies
Spinal Decompression
A motorised table that applies slow lengthening through the spine. It suits some disc-related problems well and does very little for others — and we will tell you which we think you are.
Read more
Hands-On Therapies
Rehab Exercise
The least glamorous thing we do and the one that carries the most weight. Two or three specific things, written down, ten minutes a day, reviewed and progressed.
Read moreA fee agreed before the visit, not after it
Book an appointment
Pick a chiropractor and an hour from the calendar — it shows only the times each of them genuinely has free. A first visit is a full hour and costs $95 for the examination on its own, or $145 if we treat you at the same appointment. You decide which after the examination, not before.