Manual Adhesion Release (MAR) is the leading form of soft-tissue treatment to remove adhesion/scar tissue. Adhesion is arguably the number one cause (next to degeneration/arthritis) for muscle and joint pain, but unfortunately a very under-diagnosed condition. Adhesion acts like glue and sticks tissues and nerves together. As a result, this reduces flexibility, strength, and stability to the body. Adhesion along nerves can cause numbness, aching, tension, tingling, and in some cases weakness. This is called nerve entrapment and can happen in an estimated 156 locations throughout the body. Some common conditions in this scenario include carpal tunnel syndrome, sciatica, and tarsal tunnel syndrome to name a few. MAR is one of the quickest and most effective way at fixing nerve entrapment. Other common conditions that are treated are impingement of the shoulders and hips, medial shin splints, neck pain, lower back pain, headaches, knee pain (runner’s knee, ITB syndrome, jumper’s knee), and chronically tight hamstrings or quads. Find out more at 


Instrument Adhesion Release (IAR) is an instrument based form of manual treatment that is designed to effectively remove adhesion without damaging the overlying healthy tissue. Instrument Adhesion Release (IAR) is not generic soft tissue “mobilization” but rather a highly targeted instrument and training combination that improves diagnosis, and allows for faster more effective treatment with less work. Using any instrument to treat soft tissue adhesion requires 3 key components:

  1. A complete and accurate diagnosis.
  2. An instrument with the correct size, shape, edge, and material.
  3. Repeated hands-on training.

Common conditions in which IAR work more efficiently than MAR are tendinitis of the Achilles and elbows (tendinopathy), forearm pain, carpal tunnel syndrome, anterior shin splints, and plantar fasciitis. Find out more at 


Corrective Exercise is frequently implemented in the latter half of a treatment plan and varies with each individual case. This is done to strengthen the muscles that previously had adhesions and correct muscular imbalance. Over time this will improve the overall patient outcome and keep joints healthy.


Sole Supports custom orthotics are the only truly custom orthotic that takes into account your arch height, foot flexibility, body weight, and load factors (activities of daily living). These are not cast for every patient, but can be very useful in conditions of the feet, ankles, and knees to help fully correct your problem. In many cases, these are beneficial to patients that need longer relief and correction after treatment has fixed the soft-tissue adhesions. This is the only orthotic that stays in full contact with your arch as you move and allows your feet to still accommodate as you put your weight into them. A simple way to test if your current orthotic is working or not is to sit on a chair with your orthotic placed directly where it would be in your shoe. Without putting weight into the ground, does your orthotic contact your arch? If not, it definitely won’t support your arch as you walk, stand, or run. If yes, while remaining in the chair, raise your heel as if you standing on your toes. Lift the back of the orthotic to match up to your foot. Does it remain in contact with your arch? If not, your current orthotic is only 50% effective and does not accommodate for movement. If you are unsure, ask Dr. Nottoli to check them out and educate you. Find out more at