Clients who spend an extended amount of time seated such as during travel or office work likely suffer muscular imbalances. Some muscles are constantly shortened while others are lengthened. This dysfunction leads to a cumulative injury cycle. After ensuring your client has proper ergonomics at work, and proper posture while seated, implementing a self-myofascial release protocol is the next step in avoiding and preventing pain.
Self-Myofascial Release (SMR)
Self-myofascial release is a flexibility technique using gentle force to release trigger points or micro spasms and break up fascial adhesions. Adhesions in the fascial system can prevent the client’s ability to lengthen his or her muscles through stretching techniques. The fascial system is a connective tissue network that surrounds, supports, separates and connects every cell, muscle, bone, nerve, blood vessel, and organ of the body. Dysfunction in this system can entrap nerves, blood vessels, cause ischemia, pain and loss of function.
Dr. of Physical Therapy John F. Barnes gave the term myofasical release to methods aimed at healing this system. His analogy of a “straight-jacket” surrounding the muscles paints a perfect image. On his website myofascialrelease.com he explains this in further detail and writes about the 2,000 pounds of pressure per square inch of connective tissue dysfunction. Myofascial release can be done by a series of modalities such as foam rollers, yoga/lacross/bouncy/tennis/massage balls, thera-canes, pvc/abs pipes, myofascial release therapists and more. Research on self myofascial release is derived from evidence surrounding ischemic compression and myofascial release.
Ischemic Compression is simply pressure into a trigger point. Doing so simulates the golgi tendon organ (our receptors sensitive to tension), providing an inhibitory effect to the muscle spindles. A randomized, controlled trial of 119 patients found that ischemic compression therapy provides immediate pain relief and trigger point sensitivity (Hou). Another randomized trail of 40 adults found a program including ischemic pressure was shown to be effective in reducing trigger point sensitivity (Hanten).
Put SMR into practice
Training your clients to pay attention to the following regions using Self-Myofascial Release (SMR) techniques (shown by clicking links below) can help unbundle muscle fibers, stretch fascia and prevent pain. These muscles are shortened while seated:
Feet & Ankles:
*each video linked may need modification for individual conditions
SMR Program Design
Choosing an area
Pick four muscles from above that a) you’ve deemed tight though an assessment (postural analysis, overhead squat, single leg squat, star balance, etc. b) you’re comfortable instructing your client though, c) he/she can do despite any limitations. Stick with these four for a month and note any difference in static and dynamic posture. Move to another four after a month.
SMR should be performed daily.
On days of exercise clients should SMR muscles deemed tight, but aren’t being worked that day. For instance, on a leg day for someone with an anterior pelvic tilt, you’d want to SMR the soleus, calves, adductors and hip flexors but maybe not the piriformis as SMR’ing the piriformis may also deactivate the gluteus maximus, and you don’t want to “deactivate” or “turn them off” before activating them in exercise. After exercise the client should SMR the muscles worked that day to bring them back to the proper resting length. SMR’ing should be done before stretching as breaking up fascial adhesions (knots) can help improve the tissue’s ability to lengthen through stretching techniques. On days of no exercise SMR can be performed at any time.
It is crucial the client roll from insertion to origin within the muscle to find the most tender spot. Once found, have them hold the pressure for a minimum of 30 seconds and up to 90 seconds depending on the intensity. Ischemic pressure at a high intensity (max pain tolerance / 5-7 on a pain scale of 1-10) for a low duration (30 seconds) or ischemic pressure at a low intensity (minimal pain threshold / 2-3 on a pain scale) for a longer duration (90 seconds) significantly reduces pain and trigger point sensitivity (Clark). Suggest the client record which modality was used (roller/ball), and the tenderness each day. This way they have numbers that demonstrate their progress.
A massage ball can essentially be carried anywhere with you including kept in your desk, purse, gym or travel bag. I have a massage ball with me at all times and also have a short PVC pipe I keep in my gym bag.
It is ok to practice SMR techniques with your senior clients, if tolerated by them. With obese clients, use SMR with caution. Ensure your client is always, ALWAYS, comfortable during a training session. These clients might not be comfortable doing SMR techniques in the gym. Can be performed at home. Those with diabetes need extra care when SMR’ing. Those with peripheral neuropathy should avoid it completely. Anything involving lying down can be a contraindication for those with hypertension. Consult with a licensed physician for anyone with coronary heart disease. Teach SMR to clients with arthritis only if tolerated by the client. Avoid SMR on anyone undergoing chemotherapy or radiation. Clients who are pregnant can SMR but avoid varicose veins and areas of swelling.
Read about SMR tools you can use:
- Hou, C., Tsai, L., Cheng, K., Chung, K., Hong, C. (2002). Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger point sensitivity. Archive of Physical Medicine and Rehabilitation. 83(10: 1406-14. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/12370877. Accessed 10 Jul, 2016
- Haten, W., Olson, S., Butts, N., Nowicki, A. (2002). Effectiveness of a home program of ischemic pressure followed by a sustained stretch for treatment of a myofasical trigger points. Physical Therapy. 80(10): 997-1003. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/11002435.
- Clark, A., Lucett, S., Sutton, B. (2012). NASM Essentials of Personal Fitness Training. Baltimore, Maryland: Lippincot Williams & Wilkins, a Wolters Kluwer Business.