Self-Myofascial Release - Foam rolling etc. (version februari 2015)

SELF-MYOFASCIAL RELEASE

JELLE DUTHOIT

Kinesitherapeut

21/02/2015 JELLE DUTHOIT - SELF MYOFASCIAL RELEASE 1

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SMR is a growing trend


INTRODUCTIONQuestions?◦ What is fascia, muscle, muscle tightness?

◦ What is Self-Myofascial Release?

◦ What benefits are derived? Scientific evidence?

◦ When is the best time to do it?

◦ Modalities of foam rolling?

◦ Can it replace other soft-tissue therapies?

◦ Exercises?


“Muscle spasms cause the muscle to fatigue very quickly, and also cause tightness that prevents the muscle from working through its full ROM. Foam

roll exercises release knots by applying deep pressure on these muscle spasms. It relaxes the muscle and allows it to be stretched back to its

normal length. Apply pressure for at least 20 to 30 seconds. This may get a little uncomfortable,

probably even a little painful.” (Michael Clark)


BACKGROUND AND TERMINOLOGY


BACKGROUND AND TERMINOLOGY◦ Fascia: soft tissue component of the connective

tissue that provides support and protection for most structures within the human body, including muscle.

◦ Muscle: consist of individual muscle cells or muscle fibers bundled together by fascia.


BACKGROUND AND TERMINOLOGY◦ Muscle tightness:

– Normal

– Tightness

– Excessive muscle tightness: result of brain over-stimulating(facilitation) the muscle



Poor posture (postural imbalance)Postural strain (hypoxia)

Postural strain (micro-trauma)Movement stain (overuse/repetitive

movement trauma)Acute injury

Chronic injuryJoint instabilityJoint irritation

Hydratation (dehydratation) / nutrition(malnutrition)

Stress (physical, emotional, environmental)

Temperature

Soft tissue canbecome restricted


Poor posture (postural imbalance)Postural strain (hypoxia)

Postural strain (micro-trauma)Movement stain (overuse/repetitive

movement trauma)Acute injury

Chronic injuryJoint instabilityJoint irritation

Hydratation (dehydratation) / nutrition(malnutrition)

Stress (physical, emotional, environmental)

Temperature



Decreased flexiblityPhysical compensations and movement

alterationsFatigue

CrampingInjury: muscle strainInjury; tendinopathyMuscle dysfunctionMuscle imbalance

Muscular instabilityJoint compression

Joint loadingNerve entrapment

Triggerpoints




alterationsFatigue




Triggerpoints



MYOFASCIAL TECHNIQUES

BACKGROUND AND TERMINOLOGY◦ Myofascial:

– Janet G. Travell, M.D. (1940s): musculoskeletal pain syndromes and trigger points; term ‘myofascial trigger point’ (1976), ‘Myofascial pain & Dysfunction: The Trigger Point Manual’ (1983)

– Current medical terminology: myofascial release refers to the soft tissue manipulation techniques


BACKGROUND AND TERMINOLOGY◦ Myofascial release techniques:

– Direct myofascial release: active/passive

– Indirect MR

– SMR

JELLE DUTHOIT - SELF MYOFASCIAL RELEASE21/02/2015 18

RATIONALESelf-myofascial release (SMR) works on two principles:

1. Mechanical model: ‘Breaks up’ adhesions in myofascial tissue

2. Neurophysiological model: Influence of the autonomic nervous system


RATIONALE



1. Mechanical model: ‘Breaks up’ fascialadhesions and scarr tissue:


Autogenic Inhibition:

The muscle contraction, that precedes the passive stretch,

stimulates the GTO, which causes relaxation that facilitate the passive stretch and allows a greater range

of motion (ROM).


2. Influence on the autonomic nervous system

INDICATIONS AND CONTRAINDICATIONS


INDICATIONS CONTRAINDICATIONS

- Improve mobility and ROM- Reduce scar tissue and adhesions- Decrease tone of overactive

muscles- Improve quality of movement- Fill the gaps between hands-on

sessions of ART and/or deep tissue massage

- Performance

- Recently injured areas (sutures, fractures …)

- Circulatory problems (aneurysm, blood clot, congestive heart failure, bleeding disorders …)

- Chronic pain conditions (ex: fibromyalgia)

- Bony prominences/joints- Cancer or tumors conditions- Anti-coagulant therapy- Osteoporose or advanced

degenerative changes- Advanced diabetes- Organ failure

PROPOSED BENEFITS• Improved mobility and ROM

• Reduction of scar tissue and adhesions

• Correct muscle imbalances

• Reduced muscle soreness

• Reduced neuromuscular hypertonicity

•Decreased tone of overactive muscles

• Increased extensibility of musculotendinous junction

• Increased neuromuscular efficiency

• Improved quality of movement

•Maintain normal functional muscular length

• Relieve joint stress

• Increased performance


Injury prevention + Optimal performance

+ Rehab(but should be used as part of a comprehensive physical

conditioning program)

LITERATURE


Acute effects of FR on FLEXIBILITYSTUDY SIGN

INCREASESIGNCOMPARED TO CONTROL

CONTROLGROUP

FLEXIBILITY TEST

MacDonald (2012) Yes Yes Non-training control

Knee flexionROM

Sullivan (2013) Yes Yes Non-training control

Sit-and-reachtest

Kaminski (2014) Yes (SS + FR) / / Sit-and-reachtest

Mohr (2011) Yes (SS + FR) Yes Non-training control

SLR with Bubbleinclinometer

Jay (2014) Yes Yes Non-training control

Sit-and-reachtest

Halperin (2014) Yes ND SS control Ankle flexionROM

LITERATURESMR increases ROM without a subsequent decrease in muscle activation or force (MacDonald et al., 2012)◦ Purpose study: effect of SMR on knee extensor force and activation

and knee joint ROM.

◦ Method: 2 x 1’ FR. quadriceps maximum voluntary contraction force, evoked force and activation, and knee joint ROM measured before, 2 min and 10 min after; group with and without SMR.

◦ Result:

– ROM sign increased by 10° and 8° at 2 and 10 min

– Sign negative correlation between subjects’ force and ROM before foam rolling, which no longer existed after foam rolling


LITERATURESMR on hamstrings flexibility within 5 to 10 sec without performance impairments (Sullivan et al., 2013)◦ Purpose study: acute effects on lower extremity ROM and

subsequent muscle length performance using roller-massager.

◦ Method: 4 trials (1 set: 5 sec, 1 set: 10 sec, 2 sets: 5 sec, 2 sets: 10 sec); constant pressure (13 kg) and constant rate (120 bpm); control group; sit and reach test for ROM, maximal voluntary contraction (MVC) force and muscle activation of hamstrings were measured before and after session.

◦ Result:– Main effect: increase of 4,3% in ROM

– Trend for 10 sec of rolling duration to increase ROM more than 5 sec

– No sign changes in MVC EMG activity after rolling

– No sign effect on muscle strength, sign increase in ROM


LITERATUREThe acute effects of MR and SS on flexibility (Kaminski et al., 2014)◦ Purpose study: compare acute effects of SS and SMR on flexibility.

◦ Method: 23 completed 3 research trials. Beginning with a generalwarm-up and a sit-and-reach test, followed by one of the 3 treatment protocols (SS (7 stretches, 14 min), SMR (7 exercises, 14 min), controls). Sit-and-reach 3 and 10 min after treatment.

◦ Result:

– Sign main effect for time points (initial, as well as 3 and 10 min after protocol completion)


LITERATUREEffectiveness of FR in combination with SS protocol of the hamstrings flexibility (Mohr, 2011)◦ Purpose study: effects of FR in combi with SS

◦ Method: 46 divided in 4 groups (SS, FR + SS, FR, control), hip ROM were obtained (SLR), 2-week period.

◦ Result:

– FR, SS, FR + SS sign increased hip ROM (+ 4,39°; + 7,41°: + 8,97°)

– FR + SS had the greatest increase in hip ROM (+ 8,97°)


LITERATURESpecific and corss over effects of massage for musclesoreness: RCT (Jay et al., 2014)◦ Purpose study: Effects of Thera-band roller Massager on hamstrings

muscle soreness and cross over effect to the non-massaged limb.

◦ Method: 22 men divided in 2 groups and tested on 2 moments (1st: 10x10 stiff-legged dead-lift; 2nd: 10 min roller massage on one leg and rest for the other leg) with 48h in between, Tests (VAS, PPT andaROM) 0, 10, 30 and 60 min after treatment.

◦ Result:

– Sign group by time interaction for soreness and PPT

– Sign reduced soreness and increased PPT in massage group (0’ after treatment; no effects at 10’)


LITERATURERoller massager improves ROM of plantar flexor muscleswithout subsequent decreases in force parameters (Halperin et al., 2014)◦ Purpose study: Compare effects of SS and SM with roller massage of

calf muscles on ankle ROM, MVC, EMG and single balance test.

◦ Method: 14 subjects (SS group and SM group), tested before and 1’ and 10’ after treatment.

◦ Result:

– SM increased and SS decreased MVC

– SM and SS increased ROM at 1’ and 10’ after intervention

– No sign effects for balance and EMG measures


LITERATUREChronic effects on FLEXIBILITY


STUDY SIGN INCREASE

SIGNCOMPARED TO CONTROL

CONTROLGROUP

FLEXIBILITY TEST

Sherer (2013) Yes Yes No treatment Sit-and-reachtest

Mohr (2014) Yes ND SS Passive hip flexion ROM

LITERATUREEffects of utilizing a myofascial foam roll on hamstring flexibility (Sherer, 2013)◦ Purpose study: identify if using FR on h muscles would have positive

effects and in turn increase h flexibility. Lack of flexibility is a possiblecause for injuries.

◦ Method: 18 students (weight trainers) in 4-week study. 8 in control, 10 used FR 2x/week (3-5 min). Sit-and-Reach test.

◦ Result:

– Sign increases in h flexibility in FR group (+ 2,07 cm)

– Control group stayed the same after 4 weeks


LITERATUREEffectiveness of FR in combination with SS protocol of the hamstrings flexibility (Mohr, 2014)◦ Purpose study: FR prior to SS produces a sign change in passive hip

flexion ROM over 6 sessions of treatment?

◦ Method: 40 subjects with <90° of passive hip flexion ROM. 6 weeks intervention.

◦ Result:

– SS group en FR group has sign increases in ROM

– SS group displayed a non-sign trend towards a greater increasein ROM than the FR group


LITERATUREAcute effects of FR on PERFORMANCE


STUDY SIGN CHANGE SIGNCOMPARED TO CONTROL

CONTROL GROUP PERFORMANCE TEST

MacDonald (2012) ND (reduces) ND (superior to control)

Non-training control

Isom knee ext torqueand RFD

Sullivan (2013) ND (reduces) ND (inferior tocontrol)

Non-training control

Isom knee flexiontorque

Kuruma (2013) Yes Yes SS Reaction time

Healy (2014) ND ND Plank control Vertical jump heightand power, isomforce, agility

Bueti (2011) ND Yes (inferior tocontrol)

Dynamic warm-up

Power, strength, plyometry

Halperin (2014) ND (improves) Yes (superior to control)

SS Isom plantar flexiontorque

LITERATURESMR increases ROM without a subsequent decrease in muscle activation or force (MacDonald et al., 2012)◦ Purpose study: effect of SMR on knee extensor force and activation

and knee joint ROM.

◦ Method: 2 x 1’ FR. quadriceps maximum voluntary contraction force, evoked force and activation, and knee joint ROM measured before, 2 min and 10 min after; group with and without SMR.

◦ Result:

– ROM sign increased by 10° and 8° at 2 and 10 min

– Sign negative correlation between subjects’ force and ROM before foam rolling, which no longer existed after foam rolling


LITERATURESMR on hamstrings flexibility within 5 to 10 sec without performance impairments (Sullivan et al., 2013)

◦ Purpose study: acute effects on lower extremity ROM and subsequent musclelength performance.

◦ Method: 4 trials (1 set: 5 sec, 1 set: 10 sec, 2 sets: 5 sec, 2 sets: 10 sec); constant pressure (13 kg) and constant rate (120 bpm); control group; sit and reach test forROM, maximal voluntary contraction (MVC) force and muscle activation of hamstrings were measured before and after session.

◦ Result:

– Main effect: increase of 4,3% in ROM

– Trend for 10 sec of rolling duration to increase ROM more than 5 sec

– No sign changes in MVC EMG activity after rolling

– No sign effect on muscle strength, sign increase in ROM


LITERATUREEffect of MR and stretching technique on ROM and reaction time (Kuruma et al., 2013)◦ Purpose study: effect on ROM, muscle stiffness and reaction time.

◦ Method: 4 groups (MR for quadriceps, MR hamstrings, stretch quadriceps, stretch hamstrings) and control group.

◦ Result:– Active ROM sign increased in MR and stretch groups– Passive ROM sign increased in MR q and stretch groups– No sign differences in muscle stiffness between before and after

interventions– Premotor time sign reduced by MR q and h, with sign

differences observed in this parameter between both the q and h groups and controls after interventions

– Reaction time was sign lower after interventions compared to control group


LITERATUREThe effects on MR with foam rolling on performance(Healey et al., 2014)◦ Purpose study: use of myofascial rollers or planking before athletic

tests can enhance performance.

◦ Method: athletic tests (vertical jump height and power, isometric force and agility); fatigue, soreness and exertion were measured.

◦ Result:

– No significant differences between foam rolling and planking for all 4 of the athletic tests

– Sign difference between genders on tests

– Postexercise fatigue after foam rolling was sign less than after planking

– No effect on performance


LITERATUREEffect of SMR on lower extremity plyometric performance (Bueti, 2011)◦ Purpose study: effect of foam roller warm up routine and a dynamic

warm-up routing on strength, power and reactive power using a squat jump, countermovement jump and depth jump.

◦ Method: warm-up protocol and control protocol.

◦ Result:

– Sign increase in jump height following dynamic warm up in CMJ, sign difference with the foam rolling warm up

– Foam rolling warm ups are not recommended prior to physical activity requiring increased neurologic activation because of the decreased jump performance as the neurologic demand of the jumps increased

– Foam rolling warm up may be beneficial for the injured athlete prior to activity but should be followed by a dynamic warm up before partaking in activity


LITERATURERoller massager improves ROM of plantar flexor muscleswithout subsequent decreases in force parameters (Halperin et al., 2014)◦ Purpose study: Compare effects of SS and SM with roller massage of

calf muscles on ankle ROM, MVC, EMG and single balance test.

◦ Method: 14 subjects (SS group and SM group), tested before and 1’ and 10’ after treatment.

◦ Result:

– SM increased and SS decreased MVC

– SM and SS increased ROM at 1’ and 10’ after intervention

– No sign effects for balance and EMG measures


LITERATUREAcute effects of FR on RECOVERY


STUDY SIGN REDUCTION


CONTROLGROUP

MUSCLE SORENESS

MacDonald (2014) Yes Yes No treatment BS-11 NRS

Jay (2014) yes yes No treatment VAS

LITERATUREFoam rolling as a recovery tool after an intense bout of physical activity (MacDonald et al., 2013)◦ Purpose study: Effectiveness of foam rolling as a recovery tool after

exercise-induced muscle damage, analyzing thigh girth, muscle soreness, ROM, evoked and voluntary contractile properties, vertical jump, perceived pain while FR and force on the foam roller.

◦ Method: squating protocol with and without FR.

◦ Results:

– Muscle soreness reduced

– ROM increased

– Muscle activation and vertical jump increased

– Force on FR: 32-55% body weight

– Pain perception: 2,5-7,5 points


LITERATUREAcute effect of FR on hamstring muscle soreness (Jay, 2014)◦ Purpose study: Effect on hamstring muscle soreness directly in one

leg and also the potential cross-over effect to the non-massaged leg.

◦ Method: . 10 x 10 stiff-legged deadlifts with kettlebell. 48 h post-workout test: VAS and pressure pain treshold. Testgroup started FR while controlgroup did nothing. Retesting 0, 10 and 30 min post-massage.

◦ Results:

– Sign reduced muscle soreness

– Greater pressure pain treshold


LITERATUREEffects on ARTERIAL FUNCTION and HEALING


STUDY SIGN CHANGE


CONTROLGROUP

TESTS

Okamoto (2014) Yes ND No treatment Brachial-anklepulse and NO measurement

STUDY SIGN CHANGE


CONTROLGROUP

TESTS

Ebrahim and Elghany, 2013)

Yes yes No treatment Growth hormone, stem cels CD34+% and speed of healing

LITERATUREAcute effects of SMR using a foam roller on arterial function (Okamoto et al., 2014)◦ Purpose study: effect of SMR on arterial stiffness and vascular

endothelial function.

◦ Method: brachial-ankle pulse, blood pressure, heart rate and plasma nitric oxide (NO) concentration were measured before and 30 min after both SMR and control trials; muscles used (adductors, hamstrings, quadriceps, iliotibial band and trapezius).

◦ Result:

– Brachial-ankle pulse sign decreased, plasma NO sign increased after SMR, and differed not sign after control trials

– SMR reduces arterial stiffness and improves vacular endothelial function


LITERATUREThe effect of foam roller exercise and nanoparticle in speeding of healing of sport injuries (Ebrahim and Elghany, 2013)◦ Purpose study: reveal role of foam roller exercise program and drug

omega 3,6,9, vitamine on growth hormone, stem cels CD34+% and speed of healing for fourth year in physical education with hamstrings muscle injury.

◦ Method: exercise program for 3 weeks (4 days / week), 2 capsules in a day per 3 weeks; estimation of growth hormone and flexibility tests.

◦ Result:

– Sign increase in GH and flexibility

– Sign decrease of stem cell CD34+%

– Foam rolling and medication affect all parameters positively


CONCLUSION LITERATURE


SMR

Performance

InjuryPrevention

(ROM, flexibility, arterial function, …)

Recovery tool

Therapeutic(Healing sport injuries,

ROM, …)

Recommendations: before and after sport activity, treatment tool

MODALITIES◦ Density = Mass/Volume

– Increase by increased mass, decreases volume or increase mass and decrease volume

◦ Pressure = Force/Area– Increase by increase force, decrease area or increase force and

decrease area


Tools◦ Foam roller: varying densities

◦ Medicine ball

◦ Tennis ball / lacross ball: special for smaller surface areas

◦ The Stick

◦ Other commercial products



Foam rollers vary in density and forms:

FAQWhen should I do it?

◦ Before your workouts (help your restricted areas improve their mobility and function allowing you to perform better)

◦ After your workout (release build-up tension)

◦ Any time you feel you have excessive tension in a area = Prevention

◦ Rehab


FAQHow do you do it?

◦ Positioning!



◦ Positioning!

◦ Frequency/Sets/Duration:


APPLICATION OF SMR

Frequency Sets Duration

Daily 1-2 - Hold Roller on TrP until the tenderness is decreased by 75%

- Depending on experience andcurrent tissue quality

- Hold 30-90” depending on:

(Hou, Tsai and Chung, 2002)

30” with max pain tolerance

90” with minimalpain tolerance


◦ Positioning!

◦ Frequency/Sets/Duration:


APPLICATION OF SMR

Frequency Sets Duration

Daily 1-2 - Hold Roller on TrP until the tenderness is decreased by 75%

- Depending on experience andcurrent tissue quality

- Hold 30-90” depending on:

(Hou, Tsai and Chung, 2002)

30” with max pain tolerance

90” with minimalpain tolerance

Best result: in combination with SS (Hanten, 2000)

Opmerking: Industry Expert Interview - Ian O'Dwyer

“My good friend Ian O’Dwyer taught me that often it’s not the central area of either muscle

or fascia that gets stuck down, it’s near the bony prominences. This makes a lot of sense, as it is near these bony areas where there is a lot of fascial overlap and opportunity for the fascial

planes to get stuck to one another.”

FAQWhat muscles?

◦ Best utilized on your functionally and/or chronically tight muscles

◦ This can be determined by having a proper assessment done by a qualified professional such as a physiotherapist, sports med. doctor, chiropractor.

◦ Assessment test muscles to treat

◦ Anatomic Trains (Tom Myers)

◦ FMS


FAQ◦ Assessment test muscle to treat:

– Identifies your muscle imbalances and measures

your total body flexibility, strength, balance and

control

◦ Tests:– Overhead squat

– Single-leg squat


ObservationInterpretation

FAQ◦ Anatomic Trains (Tom Myers)


EXAMPLES


EXAMPLESCalves / achilles tendon


EXAMPLESPeronei


EXAMPLESTibialis anterior


EXAMPLESQuads


EXAMPLESTensor fascia latae / iliotibial band


EXAMPLESGluteus maximus / medius


EXAMPLESPiriformis


EXAMPLESAdductors


EXAMPLESThoracic spine / rhomboidei


EXAMPLESHamstrings


REFERENCES- NASM

- Grid

- youtube

- PerformBetter

- Artikels


JELLE DUTHOIT

[email protected]

0498 39 35 13


Self-Myofascial Release - Foam rolling etc. (version februari 2015)

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Transcript of Self-Myofascial Release - Foam rolling etc. (version februari 2015)