In this conversation, Mark Ottobre and a fellow practitioner discuss the proper place of soft‑tissue (manual) therapy within rehabilitation and performance training. They agree that soft‑tissue work is a useful tool but should not be the sole, long‑term intervention. When a client is so restricted that they cannot perform basic activation or range‑of‑motion exercises, manual work can “open the door” by restoring mobility, allowing neurology‑focused activation work to be effective. They illustrate this with a high‑level boxer whose shoulder pain resolved after a triceps release, enabling a rapid return to training. The dialogue also critiques the common belief that doing nothing (rest) or relying on occasional massages will fix problems, emphasizing that time alone may appear to heal but often does not address the underlying neuromuscular deficits. Overall, the speakers advocate for a balanced approach that combines soft‑tissue work, neurological activation, progressive loading, and proper exercise prescription.
Chapters
Where does soft tissue work fall in for you?
Okay. Firstly, soft tissue work, it's a tool. So an interesting one, and I've seen, you know, Andrew get criticized about it, and I get criticized a lot the same way. It's like somehow I am against soft tissue work. I'm not. I have a problem when soft tissue work is the primary long-term intervention. That's the only thing someone is relying on As an intervention, right? It's like something is tight, just keep getting massages every week, every week, just keep going back. And well, that is not fixing what the problem is, right? So we spend a lot of time talking about neurology, right? If something is tight, that means probably it's overcompensating. It's doing a very good job of doing its function. There might be some underlying mechanisms that is failing for that to happen. So soft tissue work can come in really handy where someone is so much— like, they're so stuck they can't even do the basic activation work that I'm going to prescribe them to do. In those cases, the activation work kind of like opening the door, right? Do the soft tissue work so you can go do what you need to do. You get your range and the movement back, so now you can actually perform the activation tasks that I'm going to give you comfortably, or at least with effectiveness, right? So I think that's where any kind of like manual therapy work that comes in really, really handy. And I've seen a lot of clients where they're so stuck they can't even create abduction, even with just the leg work. Like something is just so inhibited. But they go see a myotherapist and then they come see me. Now they have some range back, so I can put that range to work and start correcting the which is the task of the neurology. So that's, that's where I see that.
Yeah, totally same, same view. I once did have a client where he was a very high-level boxer and he was getting pain, like basically punching, right? And we were obviously strength coach and the chiropractor said, stop doing all pressing work. Right. Doesn't make sense.
Yeah.
Because what is a punch? Basically, it's a press without load, right? You're doing the same movement.
Yes.
And I referred him to a very good soft tissue therapist, and I said to him, look, let me do your assessment. I assessed, I'm like, look, I think a lot of your issues are coming from your tricep because that tricep runs in through your shoulder. I think a lot of your shoulder pain is from your tricep. I can give you some exercises, but let's get it released.
Yeah.
Get it released. Let's see where it lands. Went to see my myotherapist friend, released the tricep. He's like, my pain's gone. He's like,
yeah,
what the hell? Back into training. This is where a lot of the time people go, well, rest. And one thing that I learned from Andrew many years ago was a lot of injuries, if you simply do nothing, alleviate after 4 weeks.
Yeah.
So often a physiotherapist can look like magic just simply because they waited long enough. They gave us some exercise which the client Doesn't do.
Yeah.
And then they're like, oh, my pain went away. Well, it's because the time lapsed, not because we actually addressed anything.
Right. And then once they start going back to the things that they want to do and then start progressing, the pain comes back or the discomfort comes back, whatever the dysfunctions comes back, which happens a lot, right? You know, I'm going to use Andrew's analogy, which is if you have a flat tire, if you don't drive the car, you don't have a problem. But once you're going to go back, start driving the car, the flat tire is still there. You still got to do something about that. So, yeah, sometimes unloading is necessary, right? When somebody has it, like they're in so much back pain, like I'm not going to get them to do deadlifts. Like I'll have to give them some, you know, specific task or specific activation to create the stability that they need. They need to build that capacity first before I even introduce hip hinge motion. So I have to desensitize that process before I can actually introduce a movement. Once I have developed tolerance to that movement, now I'm gonna start working on their competency with the more complex movement, which is a deadlift. Once I have done that, then I'm gonna start increasing their capacity. So, again, it's that what we discussed at the beginning of the podcast, which is there's no definitive, like, this is this and this is that. No, the path looks different for everybody. For some people, like Patrick, he can just do one activation exercise and he can go from, you know, 300 to 340-kilo deadlift. For other people, they need to do certain activities for about, say, 4 to 6 weeks before they can actually perform the things that they want to perform, but at a lower capacity. Once they have developed tolerance and competency, meaning the technique has been developed, now we can start adding load to that. That's the responsible approach.
