Posts

Anatomy Trains in Rehabilitation and Fitness

I am really super excited to announce that Tom Myers, the author of Anatomy Trains, has contributed a series of webinars on the Anatomy Train concepts to RehabWebinars.com.  I have been a fan of Tom’s work since getting together with him a few years ago and have recommended his Anatomy Trains book for sometime.

The first webinar was published this morning and is available to all subscribers.

Anatomy Trains in Rehabilitation and Fitness

 [divider]

Introduction to Anatomy Trains for Rehabilitation and Fitness Professionals

This is the first of two webinars.  These webinars will discuss an introduction to fascia and the Anatomy Trains concepts, covering topics such as:

  • An Introduction to fascia – what it is and what it isn’t
  • Tom’s definition of fitness
  • The influence of posture on structural adaptations
  • Fascia in rehabilitation in fitness
  • Cadaver dissection examples of the interconnection of muscles

Here is a preview of the webinars where Tom addresses why he doesn’t like the term “musculoskeletal:”

YouTube Preview Image

[divider]

Tom is a fantastic speaker and educator and has done some amazing work in the field of fascia.  I watched him record this live and it came out great, I learned a ton!  For more information, please visit Anatomy Trains in Rehabilitation and Fitness at RehabWebinars.com

 

 

[hr]

 

3 Tools to Get More Out of Your Programs in 2013

Ah, it’s that time of the year again, time for New Year’s resolutions!  While many people will be taking the plunge and dedicating some time and energy to fitness goals, the real challenge is sticking to these New Year’s resolutions for more than a month!  There are many reasons why people don’t stick to their workouts and fitness New Year’s Resolutions.  Some of them are just facts of life, such as time commitments, financial concerns, and lofty expectations.

Two common reasons for not sticking to your fitness resolutions that I have observed are soreness from the initiation of a new program and plateaus in your progress.  These are much more manageable and something that I think are sometimes related to mobility issues that can be addressed.

For the person just beginning a fitness program, muscle soreness and tightness after performing new exercises is essentially expected.  But there are some ways to reduce this soreness and get over the initial hump a little easier.  Movement and massage are two prime examples.  For the person that has some workout experience but aren’t working with a qualified professional, they often have some muscle imbalances and movement restrictions because someone isn’t helping them address their weaknesses.  Everyone wants to work on their strengths, right?

These are both obvious reasons as to why you want to work with a qualified strength and conditioning coach or personal trainer that can help identify and address your mobility concerns.  But what if you don’t have the access to a great coach and just want to start a home workout program or buy a generic gym membership?

Here are 3 tools that I recommend for you to get more out of your programs in 2013.  For a small amount of money, you can start your own package of tools that you can use at home between workouts.  Use these tools daily for 10 minutes and you’ll move and feel better between workouts, which will allow you to get more from your programs.

 

[hr]

Foam Roller

GRID foam roller Foam rollers are a staple for many people and certainly not anything new.  While foam rollers are popular at the gym before a workout, having one at home to use between workouts is a must as well.  Many people consider a foam roller a “self-myofascial release” tool.  I’m not sure if we are making any significant fascial changes when we foam roll, but the combination of the compression on the tissue and movement associated with foam rolling likely has a positive effect on neuromodulating tissue soreness and tightness.  What does this mean for you?  You’ll feel better and move better when you are done!

How to Use a Foam Roller

I recommend two uses for foam rollers – 1) as a generalized full body program, and 2) on specific sore muscles.  I would recommend rolling out the major hot sports of the body, such as:

  • Low back
  • Mid back
  • Posterior shoulder
  • Lats
  • Glutes
  • Hips
  • Quads
  • Hamstrings
  • Groins

I essentially recommend 5-10 full length rolls of each area, performed in a slow and controlled pace each day.  If specific muscles are sore after a workout, I would emphasize these and perform another 5-10 reps, however, if you find a specific point of discomfort, you can pause at that spot for 10 seconds.  Take a few deep breaths and try to relax.  I would also recommend performing a few thoracic spine extensions while rolling the mid back.  Here is a great video demonstration from Eric Cressey.  He hits a few different areas, however, the general concepts are the same and these are great examples.  There are also a few trigger point ball examples towards the end, but more on that later:

YouTube Preview Image

What Foam Roller to Buy?

I currently recommend two foam rollers, one for beginners that are just looking to incorporate foam rolling and another for more advanced uses that don’t mid spending a little more.

  • For Beginners: Perform Better Elite Molded Foam Rollers.  Pretty much a great basic foam roller that you can get for around $25
  • For Advanced Users: The Grid Foam Roller.  When you are ready to step up to a more firm roller, the Grid is by far the best on the market.  I don’t really think all those ridges and nubs do anything, but this is a great firm and durable roller that will last you a lifetime.  It’s a bit pricier between $30 and $40, but worth it.

 

[hr]

Massage Stick

theraband massage rollerWhile foam rollers are great, they aren’t perfect for every body part.  Essentially, if you can’t put a lot of weight through the foam roller, it doesn’t feel like you are doing much.  If you notice the above list of muscle areas does not include the entire body.  To hit more specific areas, a massage stick is a great tool and essentially a foam roller with handles!  You can use your hands to put more pressure into the movement when body weight isn’t available.  I see a foam roller and massage stick as complementary, and a massage stick is great for:

  • Calfs
  • Outer side of lower leg
  • Upper traps
  • Forearms

As you can see, pretty important areas, and spots that foam rollers really don’t hit well.  Not only do these areas get sore, but limitations often result in poor performance when training.

How to Use a Massage Stick

I use a massage stick just like a foam roller, with about 5 full length rolls on each area.  If sports are sore, which is pretty common in the calf and upper trap, I will pause there for about 10 seconds.  Here is a demonstration I have used in the past on how I use massage sticks for the forearm:

YouTube Preview Image

What Massage Stick to Buy?

I have used several massage sticks in the past and must say that there is only one I would currently recommend as it is by far superior to the others:

  • TheraBand Roller Massager+.  I was skeptical when I first used this massage stick, assuming that the ridges were just a way of separating themselves from the rest of the market.  However, the combination of the ridges and the material of the roller makes for a great combo and the best roller on the market!  The material grabs the skin well and the ridges create a drag sensation in addition to the compression.

 

[hr]

Trigger Point Ball

sklz reaction ballWe have progressed from a foam roller, to a massage stick, and now to a trigger point ball, the third component of a great self-help tool package!  Even with a roller and a stick, there are still some areas that are just too hard to get to.  As you can see, we are getting more specific with each tool.  Here is what I use trigger point balls for:

  • Specific trigger points in the glutes and hips
  • The QLs
  • Upper and middle trap areas
  • Posterior rotator cuff
  • Plantar fascia

If these are areas of concern for you, you’ll want to get some sort of trigger point ball to hit these spots with ease.

How to Use a Trigger Point Ball

Using a trigger point ball is a little different from a roller or a stick, I usually don’t recommend rolling the body on the ball, but rather just stick to a trigger point release.  These balls can get to a small specific spot, so you can hit multiple points in each area, holding each for about 10 seconds.  Here is an example of using a trigger point ball on the posterior shoulder:

YouTube Preview Image

What Trigger Point Ball to Buy?

I typically use a couple of different trigger point balls, depending on how firm I want the ball to be.  I would recommend the softer balls for beginners and firmer for advanced users.  I think lacrosse balls are great, but they are pretty firm and don’t have a small nub to use, making them less than ideal for some areas.  Here is what I recommend:

  • For Beginners: Trigger Point Therapy Massage Ball.  These are a little more expensive than lacrosse balls at about $15, but they are softer and have a little nub than you can wedge into different areas, which I like.  This is a good starting point, but if you weigh a lot or plan on using it exclusively for the glutes, the brand new Trigger Point Therapy X-Factor Ball is a little larger and more firm.  I use these a lot.
  • For Advanced Users: SKLZ Reaction Ball.  You know those little yellow reaction balls that you drop and bounce all over the place?  A friend just recently turned me on to these as trigger point tools!  They work great!  They are firm and have great little nubs to really get in to the tissue.  Plus you can usually find them for under $10.
  • You can always just go with a simple lacrosse ball as well.  But they are pretty firm for beginners some times and don’t have the added benefit of any points or nubs to emphasize an area.  That being said they are under $2!

 

By combining these 3 tools, you’ll have a perfect home kit to help you move better and feel better between workouts, which means you’ll get more out of your programs and hopefully stick to those New Year’s resolutions!

 

 

[hr]

Vince Lombardi, Corrective Exercise, and Fascia

Today’s Stuff You Should Read comes from Greatist.com, Phil Page, and Jeff Cubos.

 

Contest Winner!

I want to sincerely thank everyone that entered my contest to win the Neck and Back Massage Chair Cushion from RelaxTheBack.com.  I chose one entry randomly.  I am happy to announce BJ Garlick of Minnesota is the contest winner with her testimonial for my Inner Circle program.  Thanks BJ and thanks RelaxTheBack.com!

[quote]As an older Therapist with 36 years of experience, I am always learning updated info from the Inner circle information & Webinars. An easy way to spend valuable money & and precious time. Thanks for all you do Mike. Your passion & joy in your work is greatly appreciated. – BJ Garlick, MN[/quote]

 

[hr]

Inner Circle Update

My next live webinar will be next week on Friday 9/28/12 at 10:00 AM EST.  I will be talking about my 5 Top Tweaks for Hip Exercises.  Use these tips to get the most out of your hip exercises and make your programs more effective.  If you can’t make the live webinar I will get a recording up on the Inner Circle Dashboard ASAP.  Log in to the dashboard to sign up for the webinar or learn more about joining my Inner Circle.

 

[hr]

RehabWebinars.com Update

My friend Tim Tyler, PT, MS, ATC discusses his assessment and treatment for posterior shoulder tightness in this week’s webinar addition to RehabWebinars.com.  Tim, who is the president of the Sports Section of the APTA, does a great job breaking down the different theories of why posterior shoulder tightness occurs and how to fix it.  Click here to learn more about RehabWebinars.com and get access to over 4o webinars for one low price.

 

[hr]

Leaders Are Made

To celebrate the start of the NFL season this year (and fantasy football, of course), Greatist.com has a classic quote from Vince Lombardi that is applicable to us all.  Leaders are made, no born.  Remember that next time you are working with an athlete.

 

[hr]

Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction

This week I wanted to share a couple of new book reviews.  Jeff Cubos reviews Evan Osar’s new book on Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction.  I am about 10% into this book myself and agree with Jeff, I was impressed with what I have read so far.

 

[hr]

Fascia: The tensional network of the human body

Phil Page has a nice review of Rober Schleip and Leon Chaitow’s new book on Fascia.  I am looking forward to cracking this one open too.  Looks like the editors did an awesome job accumulating a wide body of our current knowledge regarding fascia.

 

 

[hr]

Self Myofascial Release for the Forearm

I wanted to show a quick video of a technique I use for self-myofascial release of the forearm.  Obviously, this is a hard area to get with a foam roll and some of the techniques I have seen using the various trigger point balls don’t seem to apply enough pressure for me.  Here is a quick clip demonstrating:

 YouTube Preview Image

The video uses the new Thera-Band Roller Massager+.  Obviously you can use you stick of choice, like the original Massage Stick or Tiger Tail, however I must admit that the Thera-Band stick is my current go-to massage stick device.  I was a little skeptical at first about the ridges, thinking it was just a way to differentiate itself from the competition, but it really does feel better than the other sticks.  The rubber surface with the ridges makes for a nice combination of compression and superficial drag.

 

Self Myofascial Release for the Forearm

In the video above you’ll notice a few things:

  • I position the stick at an ~45 degree angle and really wedge it into a firm surface.  This gives me a nice rigid platform to roll on.
  • I use this just like a foam roll.  I start with simply rolling back and forth the length of the muscle groups, then stop on any trigger points that I find and hold for a sustained released, then I progress to include multidirection movements that include fascial release techniques.
  • For the flexor and pronator group, I start with the wrist flexed and pronated and as I roll I extend and supinate.
  • This is reverse for the extensor and supinator group, I start with the wrist extended and supinated and as I roll I flex and pronate

This is a great warm-up for the forearm and also a great technique to include in home exercise programs for those with injuries such as medial epicondylitis and lateral epicondylitis.  Try it and let me know what you think about this or if you have any other self-myofascial release techniques for the forearm that you find to be helpful.

The Problem with the Kinetic Chain Concept

I remember when I first heard about the kinetic chain concept when I was in undergraduate physical therapy school.  It was the first introduction to the concept that joints in the body can be causing dysfunction elsewhere.  Simply put, brilliant.  We just spent the last year talking about anatomy and physiology and learning how to evaluate a joint.  Now we realize that while we do have to evaluate the joint, the answer probably lies elsewhere!

[quote]A chain is only strongest as its weakest link.[/quote]

The last two decades or so has really seen a large push towards understanding human movement and dysfunction.  We have made many significant breakthroughs in understanding things such as:

  • How the scapular influences the glenohumeral joint
  • How pelvic tilt influences the thoracic spine, scapula, and shoulder
  • How the hip and foot influences the knee

This is obviously just a small glimpse into these concepts, and there have been many more, but I remember learning about treating the symptoms of patellofemoral pain and how “challenging” these patients were.  Well, I would agree, if we all just simply treated the location of the symptoms rather the the source of dysfunction.  To me that is really always our goal:

[quote]Treat the source of dysfunction rather than the location of symptoms[/quote]

 

The Problem with the Kinetic Chain Concept

Just like anything else, the more I experienced and the more I learned, I realize that my original understanding of the kinetic chain concept was probably not ideal.  There were two important pieces that I had originally not fully grasped, but feel like I better understand now.

 

Not all Links in the Human Body Kinetic Chain are Equally as Important

The first thing that I quickly realized was that unlike the actual “chain” analogy, where if you break one link, the chain is pretty useless, the human body did not act this way.  Not every link in the kinetic chain is equally as important.  How many times have we heard about a story about someone that stubbed their toe and then started having contralateral shoulder problems?

While I agree this MAY be possible…  I get it.  You limp, change your gait, changes your hip, pelvis, spine , scapular, and whammy you hurt your shoulder.  This CAN happen.  But this is pretty extreme to me and the person probably had some underlying issues going on prior to the dreaded stubbed toe incident that drastically altered the course of the rest of their life.

That stubbed toe can have a huge impact, but I would say it’s biggest impact is actually at the joints closest to it, the rest of the foot and ankle.  Those areas are going to be influenced by the stubbed toe a lot more than the shoulder.

This is why I like to think of the kinetic chain as more of a ripple in water than an actual chain.  So, not a chain, but a chain reaction.  I have talked about the kinetic chain ripple effect in the past, but in general, the joints closest to the area of dysfunction are going to be most impacted.  Take the hip as an example.  Any tightness, weakness, or imbalance of the hip is going to have a large influence on the low back and knee, and a much less impact on joints the further away you get from the hip.

Here is a slide I just recently used during my Functional Stability Training seminar:

Kinetic Chain Ripple Effect

 

This may not change your thought much, but it does impact the way I evaluate.  Using this concept, I always start from the center of the ripple and branch outward from there.  Using this method, you will find the areas of imbalance and dysfunction that are having a large influence on the area of pathology.  Basically, work from the center outward.  Once you address areas closest, re-evaluate and assess if the problem is better or if you need to move further away in the kinetic chain.

The Kinetic Chain Needs to Include what is Between Each Link

Kinetic Chain MuscleThe other big omission I often see people make when considering the kinetic chain is that they think of each link in the chain as a joint.  This is a simplistic version of the kinetic chain in purely the sense of biomechanics an arthrokinematics.  Instead, realize that there are many influence on the kinetic chain between each joint.

[box]This includes the muscles, fascia, ligaments, tendons, and anything else you can think of.  Basically, it’s not just the joints, but also everything in between.[/box]

We have made great strides in this area over the last decade, especially with concepts like Myers’ Anatomy Trains, Stecco’s Fascial Manipulation, Sahrmann’s Movement Impairment Syndromes, and Cook’s Functional Movement.  (Photo by pratanti)

The kinetic chain shouldn’t be just how the neck influences the shoulder, which influences the elbow, which influences the wrist.  It should be all encompassing include things such as how:

  • Serratus anterior weakness influences subacromial impingement
  • The plantar fascia influences the Achilles tendon and calf
  • The psoas influences patellofmoral biomechanics
  • Pec minor tightness influences lower trapezius weakness

A joint doesn’t have to just influence a joint and a muscle influence a muscle.  All these structures work and interact together.  A great example of this is the upper body cross syndrome.

upper body cross syndrome

This is a great example of how both tightness and inhibition influence different areas around a joint.  This is the real kinetic chain concept.  Not simply joint to joint, but structure to structure.  Something to consider next time we think about how the body functions and how motion is achieved.  These factors related to the kinetic chain concept should be applied when discussing functional movements.

Thoracolumbar Fascia – An Area Rich with Activity

Today’s guest post is about the thoracolumbar fascia from Patrick Ward.  I have been reading Patrick’s website for a while now and have always been impressed his content, but he also has the ability to write and communicate in a fashion that fosters thought and learning.  I have been talking with him for months about sending me a guest post, so I am happy to finally have one, thanks Patrick!

Thoracolumbar fascia: An area rich with activity 

The thoracolumbar fascia can be thought of as a transitional area between the lower extremity and the upper extremity where forces are transferred in athletic and sporting movement.  For this reason, the thoracolumbar fascia plays an integral role in the movement system of the body as it connects many joint systems – hips, pelvis, lumbar spine, and thoracic spine.   Also, considering that the latissimus dorsi has attachments onto the thoracolumbar fascia and inserts onto the lesser tubercle of the humerus, the glenohumeral joint can also be thought of as ‘connected’ with the thoracolumbar fascia.  Additionally, the cervical fascia and the thoracolumbar fascia are continuous, so this fascial structures effect can be seen into the cervical and potentially even the cranial regions.

For this reason, the thoracolumbar fascia can be an important area for treatment both in instances of injury/pathology or when developing a recovery/regeneration treatment protocol for certain athletes.

 

Three layers of Thoracolumbar Fascia

Thoracolumbar FasciaThe thoracolumbar fascia can be thought of as having three layers which help to separate the muscles in this region into compartments:

  • Anterior layer – Attaching to the anterior aspect of the lumbar transverse processes and the anterior surface of the quadratus lumborum.
  • Middle layer – Attaching to the medial tip of the transverse processes and giving rise to the transverse abdominus
  • Posterior layer – Covering all of the muscles from the lumbosacral region through the thoracic region as far up as the splenii attachments.  Additionally, this posterior layer attaches to both the erector spinae and gluteus maximus aponeurosis.  It is in this posterior layer that the gluteus maximus and contralateral latissimus dorsi attach with each other and coordinate together to allow for pendulum like movements between the upper and lower extremity that make walking and running possible.

 

Together, the muscles that connect into the three layers of the thoracolumbar fascia help to provide both a stabilizing and biomechanical role for the body.  Additionally, the vast amount of mechanoreceptors in this region hint to the importance of the thoracolumbar fascia’s sensory role, making it a potentially rich target for hands on therapy.

Photo from Wikipedia

 

A Stabilizing Role 

The transverse abdominus, internal oblique, and quadratus lumborum all invest themselves into portions of the thoracolumbar fascia.  According to Neumann (2010), the transverse abdominus provides anticipatory/feed-forward stabilization of the lumbo-pelvic region via a tensioning of the thoracolumbar fascia and an increase in intrabdominal pressure.  The connection that the thoracolumbar fascia has with the posterior ligaments of the lumbar spine allows it to assist in supporting the vertebral column when it is flexed by developing fascial tension that helps control the abdominal wall (Gracovetsky, 1981) and it may also provide some sensory function to the body aid in both postural and protective reflex activity (Yahia, et al., 1992).

The biomechanical role of the thoracolumbar fascia is generally understood by individuals in the strength and conditioning and rehabilitation professions.  Exercise programs or “core training” programs are typically designed to elicit some sort of stabilization activity to the muscles in this region.  However, insight into the myofibroblasts and mechanoreceptors of the thoracolumbar fascia may require us to look a bit deeper if we wish to make larger changes to the function of the human body.

 

Myofibroblasts

Myofibroblasts are cells that have a sort of dual function, being part fibroblast and part smooth muscle.  It is because of these smooth muscle properties that the myofibroblasts can contract on their own – like other smooth muscles cells – placing them under the control of the autonomic nervous system and allowing the autonomic nervous system to potentially regulate fascial pre-tension independently of muscular tone.  Thus, the fascial system is an adapting organ which almost has a “life of its own.” 

Schleip and colleagues (2006) showed that the lumbar fascia, via its myofibroblasts, has the ability to contract in situations of either chronic tissue contractures, such as tissue remodeling, or during more smooth muscle-like contractions, which may help to influence low-back stability.  Furthermore, Yahia et al. (1993) showed that the thoracolumbar fascia had the ability to spontaneously contract when the tissue was stretched and held at a constant length repeatedly, causing the fascia to slowly begin to increase resistance.  This information could be potentially beneficial in understanding pathologies where increased myofascial stiffness is present.  However, influencing the system to make a change in this stiffness is a more difficult question.

 

Does it Come Back to Breathing?

Given the smooth muscle properties and the control that the autonomic nervous system may have over the fascial network, perhaps a potential window into effectively dealing with increased myofascial tone can circle around to breathing.

Respiratory function is on aspect of the autonomic nervous system that we actually have direct control over.  We can change our breathing and help to elicit a parasympathetic response to allow for greater relaxation and potentially less overall tissue tone/tension, hopefully leading to more of a comfortable state of being a decreased threat perception.  Additionally, the role of the diaphragm in stabilizing the lumbar region cannot be overlooked and the fact that it shares a fascial connection with the quadratus lumborum (as well as the psoas major) and the transverse abdominus fibers invest themselves into part of the diaphragm means that the diaphragm is in a potentially prime position to have an influence over the thoracolumbar fascia, since both of these muscles invest into layers of that fascial structure.

 

Manual Therapy of the Thoracolumbar Fascia

The thoracolumbar fascia is richly innervated with mechanoreceptors providing it with a strong sensory role and making it a target for manual therapy.

There are many ways to address the body with manual/touch therapy.  The idea of treating “fascia” has been a hot topic as of late and oftentimes therapists are doing similar things however explaining them in different ways, leading to large semantics debates.  With regard to treating fascia I believe that it is important to not leave out the nervous system, as the goal of any manual hands on treatment is to somehow effect the brain to create an environment that is ripe for healing – one which decreases overall threat perception, decreases fear avoidance, and opens a window for the individual to perform some sort of non-painful movement that increases confidence, and create relaxation (again, helping to achieve a parasympathetic response).

Several types of receptors have been found in connective tissue (not just the thoracolumbar fascia) such as pacini and paciniform corpuscles, ruffini organs, interstitial receptors, and golgi receptors.  Different receptors are responsive to different sorts of techniques and forms of therapy.  For example, pacini receptors are responsive to pressure changes and vibrations, while ruffini receptors are responsive to sustained pressure and tangential forces such as a lateral stretch.

 

Practical Applications

The thoracolumbar fascia plays an important role in human movement as it not only serves as an attachment site for numerous muscles in the lumbar, thoracic, and sacral regions, but also is an important area of transition between the upper and lower extremities where forces are transferred to allow for coordinated function.

Understanding the implications that the thoracolumbar fascia has over the body will help therapists to develop both exercise programs and manual therapy/hands on treatment programs for either rehabilitation or recovery (to help increase relaxation in this area between competitions and prevent overuse or excessive strain which is common in sport).

The smooth muscle properties of the thoracolumbar fascia (and all fascia of the body) indicate a potential role of the autonomic nervous system in regulating fascial tone.  For this reason, understanding the individual athlete and levels of stress as well as their individual stress resistance can be helpful in managing overall fascial tension.  The pH of the body plays an important role in fascial tension, as greater levels of alkalinity create vasoconstriction and increased muscle tone.  The pH of the body can be influenced by increased levels of threat and changes in breathing, which cause alterations in expired CO2.  Thus, breathing, relaxation, and/or meditation, may be potential ways in which the fascial system can be influenced in a training or therapy session.  Managing stress using a variety of recovery modalities in between competitions can be help to keep athletes healthy and performing well.

Finally, the high number of mechanoreceptors found in the thoracolumbar fascia (and in all fascia) indicate that the fascial system provides an important sensory role for the body.  Various manual/hands on therapies can be utilized to influence the sensory system (and the brain) to help decrease tone/tension, improve proprioception and awareness to the area being treated, decrease threat perception, increase relaxation, and provide a window into the parasympathetic nervous system which can potentially create an optimal environment for healing.

Taking all of this into consideration, when assessing an athlete it is important to look at the entire body and keep in mind that the thoracolumbar fascia shares a connection with many structures and its influence can be seen as far up as the cervical region and into the extremities.  With that in mind the thoracolumbar fascia may be a potential area for therapy when attempting to influence other parts of the body.

 

About the Author

Patrick WardPatrick Ward, MS, CSCS, LMT is a certified strength and conditioning specialist and licensed massage therapist.  He owns Optimum Sports Performance (www.optimumsportsperformance.com), a sports conditioning and soft tissue therapy company which provides training, treatment, and consulting to professional, amateur, and high school athletes.  He writes excellent articles on his website OptimumSportsPerformance.com.

 

References

  • Chaitow L, Delany J. Clinical Application of Neuromuscular Techniques – Volume 2: The Lower Body. Churchill Livingstone. Philadelphia, PA. 2002.
  • Benjamin M.  The fascia of the limbs and back – a review. Journal of Anatomy 2009; 214: 1-18.
  • Neumann D. Kinesiology of the hip: A focus on muscular actions. J Ortho Spors Phys Thera 2010; 40(2): 82-94.
  • Schleip R, Klinger W, Lehmann-Horn F. Fascia is able to contract in a smooth muscle-like manner and therby influence musculoskeletal mechanics. Proceedings of the 5th World Congress of Biomechanics, Munich, Germany. 2006. 51-54.
  • Hammer WI. Functional Soft-Tissue Examination and Treatment by Manual Methods. Jones and Bartlett Publishers. Sudbury, MA.  2007.
  • Schleip R. Fascial Plasticity: A new neurobiological explanation part 1. Journal of Bodywork and Movement Therapies 2003; 7(1): 11-19.
  • Schleip R. Fascial Plasticity: A new neurobiological explanation part 2. Journal of Bodywork and Movement Therapies 2003; 7(2): 104-116.
  • Yahia L, et al. Sensory  innervation of human thoracolumbar fascia: An immunohistochemical study. Acta Orthop Scand 1992; 63(2): 195-197.
  • Hoheisel U, et al. Nociceptive input from the rat thoracolumbar fascia to lumbar dorsal horn neurones. Euro J Pain 2011; 15: 810-815.

The Fibroblaster IASTM Tool

[box type=”note” icon=”none”]UPDATE: There is a new article that discusses my current recommendations for the best IASTM tool.  This newer article contains my updated recommendation for several tool options and information on how to learn how to use IASTM.[/box]

 

Over the past several months there has been much discussion about instrument assisted soft tissue mobilization (IASTM) techniques and IASTM tools on this website.  I was pleasantly surprised at the amount of people using IASTM.  For those that know me, you know that I am constantly striving to improve and find the best product to use for IASTM.  I have tried almost all of the products on the market and have shared my past thoughts on IASTM tools in a previous post and discussion.

There was a lot of discussion regarding my previous post on the Graston Technique and during the discussion, I was lucky enough to receive a post from Jacob Fey.  Jacob is a physical therapy student at the University of Buffalo and has started to make a pretty good IASTM tool called the Fibroblaster.  Before we talk about the tool, I asked Jacob to write me a brief background into the development of the Fibroblaster, below is Jacob’s story.

 

 

How and Why the Fibroblaster Started

IASTM ToolDuring undergrad I first heard of IASTM, from a friend and former classmate that was attending chiropractic college; he talked about Gua Sha, Graston and SASTM.  He went into their use and cost (how he was going to try to even pay for it).  He sparked my curiosity and I started to look into IASTM, particularly the major marketers (Graston, SASTM, and ASTYM) and how it was theorized to work.  Also, during my extremities orthopedic class in DPT, an adjunct clinical professor showed us a tool that he had been using.  This was my first hands on exposure to an instrument.  He also talked about some of the IASTM tools on the market.  Most of us were interested in the tools but not the price.  I joked to a couple of classmates that day in class that I could make them less expensively and they said they would buy one if I could pull it off.

I started talking with the Machine Shop staff in the Engineering Department at the University at Buffalo.  Since I was a student I had access to the university’s facilities to do the project at a substantial savings.  I learned to use CAD software to save money by doing the designing and prototyping myself.  Once I had the design, I also figured out the whole machining process and related costs.  It was pitched to my current and former classmates getting enough interest to move forward.  About 75% of the class pre-ordered to fund the project and the first run of Fibroblasters was made in late Fall ’09 (entire project was not-for-profit).

Over the following year, there was enough interest to pursue another run of Fibroblasters with an updated design. This time the entire project was done off campus with a local company to assist with manufacturing (Made in the USA).  After I collected the pre-orders and borrowed some startup money, I completed the necessary paperwork to form Fibroblaster LLC.  Tools were completed and Fibroblaster sales began Nov. 1st, 2010.

As with all good stories, I have to give a shout out for my mom.  She went online to be the first to purchase a Fibroblaster from the website, at retail price no less.  She proudly displays it next to the clay knickknacks that were made in elementary school.  For the financially strapped graduate student, there is a student discount for those willing to supply me with their advisor’s name, email, contact number, school name and grad date.  Once status is verified, they receive a discount via email.  Since the start sales have been steady and there has been lot of positive feedback from those who have purchased.  The goal of Fibroblaster is to make a quality soft tissue mobilization instrument without the high price tag that is associated with other stainless steel IASTM tools on the market.

 

My Thoughts on the Fibroblaster IASTM Tool

[box type=”note” icon=”none”]UPDATE: There is a new article that discusses my current recommendations for the best IASTM tool.  This newer article contains my updated recommendation for several tool options and information on how to learn how to use IASTM.[/box]

I thought that was a good story to share and that the product was worthy to promote to my readers (I have no financial interest). I have been using the tool for a couple of weeks now and must say that it is definitely worth looking into.  The design and materials, being stainless steel, are of top quality.

The tool has a great weight to it and resonates well, again thanks to the stainless steel.  The holes in the tool make it real easy to grip, especially when things get a little slippery.  And the sides have good concave and convex edges to them.  It has a single beveled edge but I found that you could using it in either direction to get a slightly different feel that was adequate.  I’m also trying to talk Jacob into working on a second Fibroblaster IASTM tool for more intricate areas of the body like the hand, forearm, foot, and ankle.

Fibroblaster Fibroblaster

I would still advocate that if you are interested in IASTM but worried about cost, that you start with simple Gua Sha tools made of horn, jade, or even bian stone.  I would rather see more people using IASTM with less expensive tools if cost is prohibitive to some.  But if you are ready to make the jump to a more expensive IASTM tool, stainless steel is definitely the way to go.

I have tried almost all of the tools on the market and the Fibroblaster ranks pretty high among them, I would recommend you try it first.  The Fibroblaster is relatively affordable for a stainless steel tool at $125, especially with the huge student discount that Jacob is offering at $75, and you have to respect Jacob’s approach and background story.  Kudos to him for trying to bring a quality IASTM tool to the market without excessive pricing!

For more info visit Fibroblaster.com

 

Do You Have Interest in Learning More About IASTM?

My new online educational program will teach you everything you need to know to start using IASTM today!  IASTM does not have to be complicated to learn or expensive to start using.  Learn everything about IASTM including the history, efficacy, tool options, different stroke patterns, basic techniques, advanced techniques, and how to integrate IASTM into your current manual therapy skills and treatment programs!

Learn more about how to perform IASTM today!

 

Graston Technique: A Case Study and Other Thoughts on Instrument Assisted Soft Tissue Mobilization Techniques

[box type=”note” icon=”none”]UPDATE: There is a new article that discusses my current recommendations for the best IASTM tool.  This newer article contains my updated recommendation for several Graston alternatives and information on my online educational programming teaching you how to use IASTM.[/box]

Today’s guest post is quick overview of the Graston technique and it’s application within a case study by Eric Schoenberg, MSPT, CSCS.  I thought Eric did a great job with the post and have will share some of my thoughts on instrument assisted soft tissue techniques, such as Graston technique, at the end of this article.

Graston Technique

graston techniqueRegardless of treatment philosophy, it is difficult to dispute the importance of soft tissue work to help treat pathology, correct muscle imbalance, decrease recovery time, and restore proper muscle recruitment and firing patterns.

While there are many available soft tissue options, in my practice, I have found Graston techniques to be particularly useful in both treatment and evaluation.  Many people don’t realize that the Graston technique can also be a valuable diagnostic tool to quickly “scan” or evaluate a patient’s soft tissue quality and determine its contribution to a patient’s current symptoms or injury risk factor.

The Graston technoique concept is grounded in the works of English orthopedist James Cyriax and the concept of cross fiber treatment. The treatment edge of the Graston instruments allows for improved precision in the treatment of fascial restriction and fibrotic/scar tissue.

I wanted to share my experience and techniques with the Graston technique and will use a case study to illustrate the benefits and specificity of the Graston Technique.

The patient is an 18 year old male who is a 3-sport athlete (football, basketball, baseball) presenting with 9 month history of anterior knee pain consistent with patellar tendinosis. The patient presents with the following objective findings at evaluation:

  • Point tenderness at inferior pole of patella
  • Pain at end-range supine and prone knee flexion
  • Pain with resisted concentric and eccentric knee extension (Kendall MMT position)
  • Decreased hip mobility B
  • Decreased ankle DF ROM B
  • Decreased lumbopelvic/hip and single leg stability
  • Decreased gluteal/core strength B

The patient is participating in pre-season football conditioning with emphasis on sagittal plane squat/split squat/lunge activities, sprinting (including hills), and plyometrics (sagittal plane). He is using foam roller daily on own to improve tissue quality. His symptoms are gradually worsening with increased training intensity.

After evaluating the patient, I decided to include Graston technique treatment focused on the quadriceps, ITB, adductors, hamstring, gastroc/soleus, and tibialis anterior muscle groups.  Here are a couple of examples:

Graston Technique – Seated Quadciceps

YouTube Preview Image

Graston Technique – Seated Patellar Tendon

YouTube Preview Image

One specific application of Graston technique is the ability to effectively treat the injured area in positions of provocation. This patient experiences symptom reproduction in the split squat/forward lunge position:

Graston Technique – 1/2 Kneel Position

YouTube Preview Image

Graston Technique – Dynamic With Squat:

YouTube Preview Image

Treatment Outcomes

The patient was seen for 3 treatments with full resolution of symptoms. Treatments consisted of the following:

  1. 1. Tissue quality: Graston technique, daily lower body foam roller program
  2. 2. Mobility: hip and ankle mobility exercises, active warm-up corrective exercises
  3. 3. Multiplanar strength: frontal and transverse plane strength (emphasized single leg activity, band walks, lateral lunges, lumbopelvic stability- chops/lifts)
  4. 4. Activity Modification: patient educated in proper jump/land technique, limited sagittal plane repetitions, proper muscle firing patterns

Clinical Observations From Using the Graston Technique:

1. The specificity of the treatment edge and the ability to provide uniform pressure is what sets the technique apart from other manual approaches.

2. The instruments truly enhance the clinician’s ability to detect and treat fascial restrictions and adhesions (particularly effective in positions of provocation).

3. Incorporating stretching and strengthening (tendon-loading) exercises with the instrument assisted soft tissue mobilization is the key to promoting re-alignment of the fibers and helping to fully remodel the injured tissue.

4. Coupling Graston in the clinical setting with self myofascial release (SMR) products, such as foam rollers and other similar equipment at home or in an athletic setting (pre/post activity) is an ideal way to achieve maximum success.

Lastly, at least for me, the most exciting part of using Graston Technique in the clinical setting is feeling better suited to treat the more difficult diagnoses (plantar fasciitis, chronic tendonosis, etc) with the expectation of good clinical outcomes.

 

My goal in writing this article is to present a simple case to allow the reader to appreciate the functionality and ease of use of the Graston Technique. In addition, it is important to note that Graston (along with any soft tissue treatment) should be used in conjunction with skIASTMilled movement evaluation and prescription of corrective exercise to allow for the most effective clinical outcomes.

Eric Schoenberg, MSPT, CSCS is co-owner of Momentum Physical Therapy with offices in Milford, MA and Wellesley, MA.  The owners of Momentum PT are experts in the human movement system. Their mission is to bridge the gap between traditional medicine and fitness with emphasis on patient education and injury prevention.  Visit eric’s blog at www.momentumptblog.blogspot.com.

 

Mike’s Thoughts

[box type=”note” icon=”none”]UPDATE: There is a new article that discusses my current recommendations for the best IASTM tool.  This newer article contains my updated recommendation for several Graston alternatives and information on my online educational programming teaching you how to use IASTM.[/box]

Eric, great article and examples of use of the Graston technique.  I’m sure the patient got better from your very well thought out treatment plan and all of the techniques and exercises you performed in combination with Graston technique.

It is important to note that while this article is specifically about the Graston technique, it also applies to instrumented assisted soft tissue mobilization (IASTM) techniques in general.  Late last year I polled my readers and 20% of you said you used IASTM, including Graston technique, SASTM, and ASTYM.  We could also group in the traditional Gua Sha to this mix as well.

I have used these techniques and do incorporate IASTM in my practice, I have also taken the basic Graston class (though have not taken SASTM and ASYTM classes and have not used their tools).  Here are my thoughts:

  • IASTM is a valuable component of my treatments, but just a component.  Just like everything else, it has its value and it has areas where I would choose another technique.
  • There are a lot of misconceptions here and the internet makes this worse – a huge black and blue down the leg is not what you are trying to achieve using IASTM.  I consider this a sign that you’ve done too much.  This is a misconception.
  • The actual Graston Technique tools and courses are really good.  If you have the budget to go all out for these, great, they will be great to work with. Visit their website for more info, I would be surprised if you were not satisfied with the course and their tools.  They have put a lot of thought and effort into their technique and tools.
  • I do not use the Graston instruments.  I think many more people should learn IASTM techniques.  If you really like the technique and want to learn more or get the better Graston tools, great.  But cost should not be a reason that you don’t learn how to use IASTM.
  • In regard to tools, I go traditional Gua Sha from China.  I have tried other tools, like the Starr Tool, they are good, but more expensive.
  • In regard to Gua Sha tools, you can Google them, there are many shapes and materials for anywhere from $2 to $10.  Horn is a good starting point, but in the grand scheme I would grade them as stone > jade > horn.  Just my opinion.  I have a bunch of horns as they come in a variety of versatile shapes, and a few jades and stones.  So far Bian or Energy stones have felt best for me, but these are closer to $20-$40.  Still cheap in contrast to some of the other instruments.  If you are not sure, start with the horn.

 

What do you think?  What has been your clinical experience with Graston technique, instruments, and other instrument assisted soft tissue mobilization techniques?