With the increased attention paid to “soft-tissue work” and “myofascial release” techniques, I think it’s important that everyone understands the basics that provide the underlying foundation for why these methods are effective and necessary.
I went into this at a very superficial level here: Foam Rolling Science Made Simple but I want to dive a bit more into the, well, slightly less superficial science behind it.
In laymens terms, these techniques are used to release or remove restrictions from the muscle. Most people are familiar with the feeling of having a “knot” in a muscle; that understanding will do for now.
Restrictions can be broadly categorized as adhesion or trigger point based. Wikipedia provides an easy-to-understand definitions:
Adhesions are fibrous bands that form between tissues and organs, often as a result of injury during surgery. They may be thought of as internal scar tissue.
In contrast:
Trigger points are hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut muscle fibers.
A display of potential trigger point areas
My understanding is that adhesions are more the result of damage (contact, improper muscle under-/over- use, injury, surgery, etc.), and that trigger points are more neurally mediated (excessive or inappropriate neural input to a localized area). In both cases, an adhesion or trigger point will pull on or otherwise affect surrounding areas in the presence of movement. This is ONE of the driving factors behind the idea that symptomatic areas aren’t always the cause of the problem.
Years ago, Michael Boyle provided a great illustration of this at a seminar one year where he put a band around someones neck and lightly pulled. “Where do you feel the pain?” “On the side of my neck.” General wisdom would say to ice, massage, and stretch the area. In reality, these methods may bring temporary relief, but as long as there’s a rope around your neck, it’s going to hurt. You could save yourself the ice, massage and stretching by just removing the rope (in this example).
For something a little less abstract, let’s consider that the glutes and/or TFL can become restricted and increase the tension on the IT Band.
This scenario, which is pretty common in athletes from various sports, can lead to a host of painful symptoms including lateral knee pain (one of the locations of this potential pain is pictured above). Some manual therapy work to the TFL and glutes will release the tension and therefore return the athlete to a pain-free condition.
In many cases, adhesions and trigger points, which can be thought of as “soft-tissue restrictions” present because of positions we hold our bodies in for prolonged periods of time. For that reason, many people will have restrictions and common areas (e.g. hip flexors, pec major and minor, lats, cervical extensors, etc.). Because of the diagonal and rotational nature of the skating stride and the lateral nature of crossover patterns, hockey players tend to have pretty predictable restrictions in the hip rotators and the adductors.
Digging a lacrosse ball into these muscles will make most players yelp
The high, inner area can become especially problematic for hockey players
Both of these pictures are especially illustrative of how adhesions between any two structures or triggers points in any one structure could affect surrounding areas, as optimal movement is dependent upon proper extensibility of and gliding upon these individual and collective muscles. By the time hockey players are in high school, the muscles around their hips’ are completely gunked up. This will impede blood flow, lead to abnormal firing patterns, and generally increase the amount of resting tension put on surrounding structures. In other words, the associated changes aren’t just mechanical, they’re also circulatory and neural. Maybe more importantly, addressing these restrictions will make the athlete FEEL better.
With a basic understanding of what the restrictions are and the effect they can have on the body, the question becomes how to get rid of them. Adhesions tend to break up in response to localized pressure driven along the direction of the adhesion. Trigger points, on the other hand, tend to respond better to sustained pressure in one location. Using foam rollers, medicine balls, lacrosse balls and other implements to perform self-myofascial release work (to address these restrictions) is a great way to minimize the risk of these turning into more substantial problems. With that said, these methods aren’t nearly as specific or effective as getting worked on by an experienced manual therapist.
Check out the video below of Cole Hamels talking about his experience working with my friend Dr. Michael Tancredi:
Cole Hamels Explains Benefits Dr. Tancredi Chiropractic Care from Harry Scheid on Vimeo.
The thing I like the most about this video is that it’s straight from the athlete’s mouth, meaning it’s not overly scientific. If players started getting regular work done from an Active Release practitioner or a great massage therapist like my friend Craig Bohn at Hockessin Athletic Club, I think a lot of the chronic groin and hip flexor strains and sports hernias that we’re seeing through the high school, college, and pro levels would start to disappear. I know our athletes have had tremendous success in warding off these injuries (and returning from soft-tissue injuries sooner) as a result of getting regular soft-tissue work done.
Whether you perform self-myofascial release work or go see an experience manual therapist is secondary in importance to not neglecting soft-tissue quality altogether. Because it can be difficult to enforce this stuff on a team-wide basis in most youth programs, it’s up to parents to go buy a foam roller or look up a manual therapist for their son/daughter. It’s well worth the investment; your kids will thank you later!
To your success,
Kevin Neeld
