The majority of certified personal trainers do not possess licensure as Accredited Manual Therapists. As such, our scope of practice limits us from direct manual manipulation. While we must remain “hands-off” to be legally compliant, we can help our clients to learn the art of self-myofascial release or SMR.
What is Self-Myofascial Release?
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 coined the term myofascial release in reference to his 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 on 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 trial of 40 adults found a program including ischemic pressure was shown to be effective in reducing trigger point sensitivity (Hanten).
SMR focuses on trigger points that are often painful and limit range of motion. Pressure applied correctly can facilitate recovery of deep muscle tissue by enabling a more normal pattern of blood flow. Releasing trigger points, also referred to as “knots”, will lead to pain-free movement patterns, thereby enhancing physical performance.
The practice of myofascial release is not new. Massage therapists have been applying this technique for decades in an effort to release clients’ painful muscle tissue. Fascia refers to the soft component of the body’s connective tissue system, involved in the transmission of tension forces.
The virtues of Self Myofascial Release are numerous. Muscle imbalances can be corrected by the relaxation brought on through SMR, thereby sending positive feedback to the central nervous system.
By improving circulation, recovery is achieved in a more expedient manner. Improving blood flow, in turn, provides more efficient oxygenation of the muscle tissue.
According to Joe Hashey, a Certified Sports and Conditioning Specialist, such manipulation lengthens the muscles by breaking apart adhesions and scar tissue. This will allow the muscle to achieve the desired relationship between length and tension.
Self-Myofascial Release Dangers and Precautions
Manipulating trigger points is not without its downside. Such a practice will often involve what is known as pain referral. While a client may experience discomfort similar to what is felt while stretching, it should never escalate to the point of feeling unbearable. Upon completion of a self-myofascial release session, or SMR, the muscle tissue should feel and move dramatically better.
As a trainer, it is our job to remind clients that engaging in SMR may bring on more than mere discomfort. If done with too much force, bruising has been known to occur at the site of the massage.
For clients who have been diagnosed with deep vein thrombosis or are regularly taking blood thinners, such conditions may worsen with SMR; in some cases, the result could be internal bleeding. Likewise, SMR is strongly contraindicated for clients with fractured or broken bones or who have a history of brittle bone abnormality.
Tools for Self-Myofascial Release
While the mechanism by which self-myofascial release affects flexibility remains unclear, scientists do acknowledge that the neurophysiological process differs from that of stretching.
There are many tools for myofascial release on the market today that are used in the practice of self-myofascial release:
- Foam rollers of varying densities (Rumble Rollers, Vibrating Rollers, the Grid etc)
- Therapy/Massage balls with or without textured surfaces (Like Neuroball by Naboso)
- Massage Guns
- Muscle Sticks like TigerTail Massage Bar
- Trigger Point Massage Tool (that looks like a hook)
Regardless of the tool used, some basic tenets apply to help ensure a safe and effective process. Understanding these will enable trainers to guide clients as they embark on self-myofascial release sessions.
When using a foam roller, the pressure applied to the target area should be smooth and moderate. Choosing a slow cadence is best, not to exceed one inch per second. Once the tight muscle area has been reached, guide the client to relax and inhale deeply as pressure is being applied. The release of the muscle, hand-in-hand with a decrease in the pain’s intensity, will generally be felt within 30 seconds.
Navigating Around the Pain
If a client feels that the target area is too uncomfortable to receive direct pressure, suggest he move the foam roller/ball to the surrounding area and attempt to start loosening muscle tissue there.
Once the release has been achieved, gradually moving toward the target area is once again attempted. This process will thwart excessive inflammation, and also allow the client to specifically identify the real source of the trauma or injury to the muscle.
Exercises and Techniques
An athlete engaging in intense physical exercise on a regular basis is no stranger to sore feet, and SMR can afford much welcome relief. The process begins by placing a lacrosse-type ball under the ball of the foot and rolling it toward the heel. When a trigger point is encountered, gentle pressure is applied.
The IT band is a common site of injury and soreness even among recreational fitness enthusiasts. To work on this area, place a foam roller at the top of the hip and gently roll down to an area just above the knee.
Repeat this up-and-down rolling, pausing to apply direct pressure on any particularly painful spots. Another method involves rocking from side to side on the trigger points. While it will be painful initially, the ensuing release is worth the effort.
Tight piriformis muscles can impinge on a variety of lower body muscles. Guide the client to sit on the foam roller, distributing the majority of his weight onto one glute cheek. By crossing his opposite foot over the leg, thereby forming a letter “P”, the tightness should be easily recognizable. Rolling backward slightly will allow the client to find and release tight spots.
Flush It Out
After having been diagnosed with fibromyalgia 30 years ago, I have become keenly aware of the value of SMR on my classic trigger points. As I worked on my traps today in the gym, using a 5-pound exercise ball to knead out “hot spots” that were acutely painful, I was once again reminded of a crucial element of SMR: hydration.
Similar to the recommendation immediately following a deep-tissue massage, it is important to consume a significant amount of fluid after a grueling session of SMR. Toxins will be released if the dynamics have been effective, and flushing them out of the body can expedite recovery from the discomfort.
When teaching SMR to clients, remember it is not in the scope of practice of most personal trainers to do the manipulations on the client. Demonstration only is the appropriate path to take when instructing myofascial release.
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- 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.