Active engagement (AE) techniques are powerful tools that allow you to help a greater number of clients. Incorporating these techniques into your practice will give you a whole new dimension to the techniques you are already using, providing more therapeutic options. These techniques are most conducive to treating clients with specific pain or injury complaints. While they can be used in a relaxation massage, these techniques increase the intensity of your treatment. Consequently, a priority in your clinical assessment is thoughtful consideration as to how, when, and why to use them.

In a nutshell, AE techniques integrate active motion with other commonly used therapeutic techniques. In this protocol, massage is performed on specific muscles while those muscles are actively shortened or lengthened. These techniques are particularly valuable when working with chronic tension, overuse injuries, deep muscles that are difficult to access, or clients with large and bulky muscles. Using massage along with movement routinely produces faster and longer-lasting results with many types of soft-tissue disorders.

With AE techniques, there is greater penetration of massage strokes. When pressure is applied to passive (non-moving) muscle tissue, the pressure is dissipated through the soft tissue. When a muscle is engaged in a contraction—concentric or eccentric—the muscle’s density increases, thus applied pressure becomes more direct and penetrates deeper (Image 1). The increase in penetration means deeper myofascial tissues can be accessed with less pressure than in a passive technique. For practitioners working with muscle-dense athletes, AE methods are a clear advantage for the client and the therapist, as the small-statured therapist who works with football players knows well.

The most common techniques used with AE include static compression, compression broadening, and longitudinal stripping. Each of these are reviewed in this article. The muscle actions that are used include concentric and eccentric movements. Many of these techniques can also be applied during passive muscle shortening or lengthening, in which case they are called passive engagement techniques. Following, you will find the foundational elements you need to perform an AE treatment and considerations for when and where to use these techniques.

Background Principles

The cornerstone of any successful AE technique is accurately applying joint movements along with a specific massage technique. These techniques require the practitioner to understand basic kinesiological principles of muscle actions and how the muscles respond to these actions. There are three different types of muscle contraction: concentric, eccentric, and isometric. Isometric contractions are primarily used just to establish the level of muscular effort prior to engaging eccentric actions in AE techniques; therefore, they (isometric contractions) are not used as much.

Concentric Contraction

Here, the two ends of a muscle are brought together and the muscle is actively shortened. An example would be the classic biceps curl, in which the elbow is flexed and the hand is brought toward the shoulder. In this case, it is the elbow flexors, such as the biceps brachii, that are contracting (Image 2). As the muscle shortens in a concentric contraction, the actin and myosin myofilaments overlap within the sarcomere, which is the contractile unit of the muscle. As a result, the muscle broadens and its cross-sectional area increases.

Techniques that are applied during the concentric contraction aim to enhance this fiber broadening for optimal muscle function. It is also theorized that by applying pressure in a cross-fiber direction during the muscle’s movement, fibrous adhesions may be reduced.

Eccentric contraction

In this instance, the muscle receives a contraction stimulus, but the resistance (or weight) applied to the muscle is greater than the muscle’s effort; the muscle slowly lengthens as it decreases its contraction to allow movement. In the biceps curl example mentioned earlier, if the weight is slowly lowered toward the ground while the elbow is extending, there is an eccentric activation occurring in the elbow flexor muscles (Image 3). The main goals of AE techniques applied during eccentric actions are to enhance pliability and muscle elongation. During eccentric contractions, the myofilaments are pulled apart, the muscle’s cross-sectional area decreases, and the myofascial tissues increase in length.

Foundation Techniques

The fundamental massage techniques regularly used during AE include static compression, compression broadening, and longitudinal stripping. Static compression is used during both concentric (shortening) and eccentric (lengthening) muscle actions. Compression broadening is applied during concentric actions, while longitudinal stripping is used during eccentric actions. There are a number of variations on these techniques, but these form the foundation of AE methods.

Knowing muscle fiber directions and anatomy is useful for correctly applying these techniques. They are most effective when the pressure level is moderately deep. However, consulting with the client and paying attention to tissue response is important for effective treatment. Muscle splinting is a sign that pressure is too much. Gauge the client’s response and tissues for determining the adequate pressure level.

Static Compression

This technique involves applying direct pressure to a specific area. Several massage systems and techniques such as shiatsu, acupressure, myotherapy, and neuromuscular therapy use static compression as their primary technique. These systems differ mostly in their theoretical models and not in the way pressure is applied to the client’s body. Static compression is applied to hypertonic tissues or trigger points using either a broad contact surface, such as the palm, fist, or forearm, or a small surface, such as a finger or pressure tool. A broad surface is applied first. Pressure is held for varying lengths of time, but usually about 8-–10 seconds is adequate. The goal is to reduce tissue tightness and/or local or referred pain.

Compression Broadening

This technique uses a broad cross-fiber stroke (perpendicular to the muscle fiber direction). Use a broad contact surface, such as the palm, fist, or backside of the hand in areas of large muscle mass (Image 4). Use the thenar aspect of the hand or thumb on small muscle groups, such as the wrist flexors or extensors (Image 5). Because this technique is primarily cross fiber and applied to the entire muscle length, it doesn’t necessarily need to be applied working toward the heart when treating the extremities as other gliding techniques do. Use firm but moderate pressure and consult your client for appropriate levels.

Deep Longitudinal Stripping

This technique uses slow longitudinal gliding strokes parallel to the muscle fiber direction. The stroke often extends from one tendinous attachment to the other, but can also be applied to short muscle segments, with the intent of encouraging tissue elongation and elasticity. Perform the technique slowly, as moving too fast across the tissue while applying significant pressure is uncomfortable for the client and prevents you from noting tissue changes. Using a broad contact surface, such as the palm, fist, or forearm (Image 6), spreads the pressure over a larger area and reduces its intensity. Apply the broad surface first to reduce tension in superficial tissues before treating deeper ones.

A small contact surface, such as thumb, fingertip, knuckle, elbow, or pressure tool, is used for more precise treatments. Pressure is concentrated on those tissues directly under contact (Image 7). Use slow, deep strokes that do not exceed the client’s pain tolerance. Be sure to move toward the heart when working on the extremities with a longitudinal stripping technique, following circulatory guidelines.

AE Techniques

AE techniques encourage tissue broadening when performed during concentric (shortening) contraction or encourage tissue lengthening during an eccentric (lengthening) contraction. There are numerous variations of these techniques. The primary effects of AE techniques are both neurological and mechanical. In both variations—broadening and lengthening—pressure applied while the muscle is under contraction reduces excessive muscle spindle activity and decreases overall muscle tightness. In the broadening techniques, the cross-fiber pressure helps to spread and broaden muscle fibers, thereby decreasing any intramuscular adhesions and enhancing pliability. In the lengthening techniques, applying pressure while the muscle lengthens helps to pull and stretch the myofascial tissues and decrease overall muscle tightness.

Techniques During Muscle Shortening

Broadening (or shortening) strokes during AE enhance muscle broadening, reduce fibrous adhesion between adjacent muscle fibers, and decrease trigger point activity. Use these techniques after the client has passed the acute stage of the rehabilitation process or with clients whose muscles are in moderately good tone. Broadening techniques use static compression or compression broadening with a concentric muscle contraction.

Static compression is used for muscles that are hypertonic, house myofascial trigger points, or are restricted due to excess tension. Begin with the affected muscle in a lengthened position. Apply either a broad or small contact surface using only a moderate amount of force, then have the client concentrically contract the affected muscle. Maintain pressure during the contraction (Image 8). Either maintain or release pressure as the client returns to the original position.

Compression broadening strokes used during concentric contraction are particularly effective at muscle fiber spreading and reducing adhesions between muscle fibers. Begin with the affected muscle lengthened. Instruct the client to contract the muscle while you apply the compression broadening technique; release the pressure as the client returns to the starting position (Image 9). Repeat this process moving along the length of the muscle until the entire muscle is treated. Be sure to coordinate your actions with that of the client’s muscle contraction, beginning the technique as the client begins moving. The stroke should end as the client reaches the end of movement.

Techniques During Muscle Lengthening

Lengthening strokes during AE decrease muscle tightness, reduce irritable myofascial trigger points, and encourage tissue elongation. Use these techniques during the later stages of the rehabilitative process or with clients whose muscles are in moderately good tone to begin with. Lengthening techniques use either static compression or deep longitudinal stripping with an eccentric muscle contraction. Start with a broad contact surface first to initiate tissue relaxation. To limit client discomfort in more general applications, use only the broad surface, such as your palm. To target more specific muscle tissues, use a finger, thumb, or pressure tool.

With either static compression or deep stripping, the technique begins with the client’s affected muscle in a fully shortened position and in an isometric contraction. For muscles prone to cramping in their shortest position (such as the hamstrings or other multi-articulate muscles), use a slightly lengthened position to engage the initial contraction.

In static compression techniques, apply a moderate level of pressure after establishing the initial muscle contraction. The client then slowly releases but does not fully let go of the contraction. The pressure is held throughout the length of the contraction. This action produces an eccentric contraction. Simultaneously, the practitioner pulls or pushes the client’s limb in a direction that lengthens the target muscle while applying the static compression (Image 10).  This technique is a variation of what is sometimes called the pin and stretch technique.

A more effective method of reducing muscle tightness and enhancing myofascial elongation is using deep longitudinal stripping performed during the eccentric contraction. The client engages an isometric contraction of the affected muscle from a shortened position as in the previous procedure. Use a lengthened initial starting position if muscle cramping is a possibility. The client slowly releases the contraction as the practitioner simultaneously lengthens the target muscle by applying deep longitudinal stripping on the target muscle (Image 11). This technique greatly magnifies the effect of deep-stripping techniques.

The intensity of muscle contraction can be altered with either of these methods by adding additional resistance. A greater number of muscle fibers are recruited with additional resistance, which intensifies the pressure level due to increased tissue density. Increase muscular recruitment with resistance bands, weights, or manual resistance (Image 12). However, keep in mind that using additional resistance can be more painful for the client, so this method is best suited for later stages of injury rehabilitation or with muscles that are already well conditioned.

When/Where to Use AE

When to use AE techniques is determined by assessing your client’s goals and his or her stage in the rehabilitation process. AE methods are most effective in addressing some type of soft-tissue pain or injury condition. Thus, knowing where the client is in his or her recovery process is particularly important for knowing how you will address the problem. In the early stages of an injury, it is important not to further stress the soft tissues attempting to heal. Consequently, AE techniques are too taxing for certain soft-tissue pain or injury conditions until they are at a particular stage of the healing process.

The practitioner must use sound assessment and clinical reasoning to determine when it is appropriate to begin use of AE methods, as it will differ for each person and condition. AE techniques can be used in almost any region of the body. However, there are certain regions where AE techniques are particularly well suited. Additionally, certain AE techniques work better than others in particular areas or specific conditions.

The back is one region in which these techniques are not always appropriate because it can be too challenging to move the back in active motion with treatment. For example, it is very difficult to apply compression broadening methods to the back extensor muscles during their concentric contraction phase. The client would have to be actively extending the back while you push down on his or her back at the same time. Mechanically, it just doesn’t work very well, so this is an area where you tend not to use AE techniques. On the other hand, with some specific back muscles these techniques prove quite useful. AE lengthening techniques are an effective way, for instance, to address the quadratus lumborum, which is one of the most important muscles to treat in many lumbar pain complaints.

The neck is a perfect location to use these techniques for a wide variety of muscle pain complaints. Chronic muscle tension, as well as pain from acute injuries such as whiplash, is effectively addressed with AE techniques. Yet, not all approaches described here would work in this region. For example, you would find it challenging to perform compression broadening methods on the neck extensors during concentric neck extension. In contrast, it is highly effective and relatively easy to perform stripping techniques during eccentric neck flexion movements to the neck extensors with the client in a supine position. In most muscle disorders of the neck, the primary goal is to reduce muscular hypertonicity. Muscle lengthening techniques are most effective for this.

AE techniques are particularly suited for use in the upper and lower extremities. In the extremities, the greatest percentage of musculo-tendinous soft-tissue injuries involve chronic overuse injuries. Both AE lengthening and broadening techniques excel at addressing overuse muscular injuries. Increasing tissue mobility and reducing fibrous adhesions is a key goal for these conditions.

Using additional resistance when treating the extremities is often necessary. The extremities contain the largest and most powerful muscles in the body. In some cases, moving the weight of the limb in the active contraction does not require enough muscular effort to recruit a significant number of muscle fibers. In these cases, additional effort provided by resistance bands, hand-held weights, or manual resistance recruits enough muscle activity to make the AE techniques effective.

Conclusion

Using AE techniques greatly enhances the variety of treatment methods you can offer your clients. For those looking to improve muscle function or recover from various injuries, these techniques can help clients achieve their ideal treatment goals much sooner. Not only can you offer more to your clients with these techniques, but you will find that they greatly strengthen your understanding of kinesiology and mechanics in the body, putting your knowledge into action for optimum client results and your own increased clinical success.

Whitney Lowe is the author of Orthopedic Assessment in Therapy and Orthopedic Massage: Theory and Technique. He teaches advanced clinical massage in seminars, online courses, books, and DVDs. Contact him at omeri@omeri.com.