The Importance of Soft-tissue Work

Soft tissue work is imperative if athletes wish to perform optimally, and should be utilized in any sport or activity that requires substantial physical exertion. Soft tissue work focuses on “trigger points” in skeletal muscle and fascia, with the aim being to improve tissue quality. Poor tissue quality is the result of an accumulation of knots, adhesions and scar tissue. These areas are referred to as the trigger points and are often palpable.  Soft tissue work, often through self myofascial release, alleviates these symptoms and leads to improved athletic performance.  Some theories also point to soft tissue work ‘stretching’ muscles through a reaction known as autogenic inhibition; however, a number of researchers claim the pressure applied by a foam roller does not elicit such a response.

Myofascial release is particularly important for strength trainers, as much of their training revolves around heavy loads. The constant heavy loading puts extremely high demands on soft tissue and results in a breakdown of tissue quality. This diminished quality can result in nagging aches and pains as muscles aren’t able to work (pull) at an optimal efficiency. Poor tissue quality leads to point tenderness in the actual muscle, but also leads to pain and discomfort being transmitted through joints. This can lead to discomfort that is actually some distance from the trigger point. For example, poor tissue quality in the quads often results in knee pain, as there may be uneven pulling on the patella. Additionally, poor tissue quality in the calves can also result in knee pain. The human body has a remarkable ability of masking the source of problems by transmitting pain and compensating in different areas. This is the joy of physical therapy as a patient will enter a therapist’s office with neck pain, only to exit with a manual on hip stabilization exercises to correct it.

The gold standard for self myofascial release is foam rolling. You can begin with a soft roller and progress towards a harder one. One can be hardcore enough to work themselves up to rolling on raw PVC pipe – oh how wonderful it feels. Even that first roll with a rather soft foam roller can be excruciatingly painful. It’s amazing how a grown man who squats 700lb can be brought to tears if/when he begins to roll. As adhesions and kinks are worked out of the muscle, the rolling will become much easier and less painful. In terms of progression, logic tells us that moving to a harder surface as well as decreasing the surface area of the object used is the way to go. So progression may look like this:

soft roller –> harder roller –> small med ball –> softball –> lacrosse/cricket ball –> golf ball

If you are finding a lacrosse ball too hard, substitute it for a tennis ball.

With areas that are tough to get to with a foam roller, you should turn to smaller objects. Golf balls are perfect for using on the bottom of the foot to ameliorate symptoms of plantar fasciitis.

Self myofascial release through foam rolling, med ball etc., cannot be used with all clients, as it may be impossible to carry out with proficiency. An inability to carry out the exercise will prevent a client from doing it, but more importantly, foam rolling may be something that shouldn’t even be included in the program. A 290lb male with stage II hypertension is better off spending their time doing things that will actually benefit their health. This comes down to prioritizing and is especially important because clients have limited time with trainers and are relying on them to know what’s best. Trainers must be disciplined and avoid hopping on bandwagons they think are the end all be all. Successful trainers should have the ability to take in a magnitude of information and sift through it, developing a unique sense of how they conduct themselves and how they train each individual client. They must take a step back, analyze, and determine how something should be implemented into a program, if at all.

Many exercises and pieces of equipment in fitness are considered and used based on a binary system. A coach or trainer either thinks they are awesome and uses them all the time, or they are useless and completely disregarded. Certain things need to be placed on a continuum and must not be considered a yes/no subject. This is important for exercises and equipment, but also in terms of training philosophies, concepts, and methodologies. An excellent trainer should have their standard fundamental principles, but should constantly be reviewing and altering minor aspects of the way they work. This is to avoid stagnation, boredom, and will ensure the trainer is constantly improving and acting in a self reflective manner.

If you’ve read a bit on foam rolling, or have witnessed it in the gym, you’ve probably seen the same few areas being worked on: the IT band, quads, and hamstrings. Although working on these areas is beneficial (perhaps not all three, as we’ll discuss later), other areas must be considered.

After having nagging pain at the very end of my heel, I increased the amount of soft tissue work on my calf muscles and these symptoms soon subsided. This could easily have been attributed to tight calf muscles, or improper pulling placed on the calcaneus through the Achilles tendon. If this continues, ‘heel spurs’ can develop which can be very painful. The pain isn’t necessarily from the actual heel spur, or laying down of extra bone, but is from the inflammation surrounding it. The Achilles tendon runs down and attaches to the calcaneus (heel bone). However it does not attach directly to the bone, rather it attaches to the periosteum, or bagging/wrap which surrounds the calcaneus. A tight Achilles (perhaps due to poor tissue quality) will yank on this bag, creating space between the bag and heel bone. Now, our bodies don’t just sit here and take that abuse! We react and adapt to this change. Building cells called ‘osteoblasts’ are programmed to fill in these gaps and get to work right away, thus creating heel spurs. Thomas Myers illustrates this very well in his book, ‘Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists’. 

Too much emphasis on the IT band:

Foam rolling in general has been a hot topic in the past 5-10 years. In particular, the significance of soft tissue work on the IT band has really taken off. Whether there are any benefits of working the IT band has been put into question. Definitive answers are hard to come by as research is really lacking in this area. However, we do know a few things in terms of stretching the ITB and what the ITB is:

  1. Your ITB is not a separate muscle placed laterally on the thigh. It is simply the thickest part of the Tensor Fascia Lata and is tied directly to the femur.
  2. You cannot lengthen your ITB – any temporary changes in length are due to neurological changes.
  3. The ITB seems to be far too dense and permanent to be physically altered by foam rolling.
Aside from improving the quality of soft tissue (i.e. working out adhesions and knots), basic mechanisms by which foam rolling ‘stretches’ the muscles are being questioned. Rolling puts pressure on muscles, causing a reaction called autogenic inhibition, where golgi tendon organs prompt the muscle to relax – think of this as a defence mechanism.  In the past, this was almost unanimously agreed upon; however, this is currently being investigated.

Here is an excellent article on foam rolling the IT band, along with insightful comments beneath the actual article.

One thing is for sure – more research needs to be conducted regarding soft tissue work, in particular, the mechanisms by which it works. Some researchers are questioning whether or not foam rolling even assists with adhesions and the clearance of scar tissue. People seem to be benefiting from the exercise, but much of the functioning behind it is controversial. What once seemed to be basic understanding is now considered speculation is some people’s eyes.

Self myofascial release works for countless people and obviously has some benefits. It is generally the mechanisms by which they operate that are under investigation. So hold your head high and roll away. I certainly am.

Foam rolling pre and post exercise have both been proven to be beneficial and should definitely be implemented in strength training programs. In fact, any athlete can benefit from soft tissue work. Poor tissue quality may be what is holding an athlete back. Changes in tissue quality can occur after a few rolling sessions and can enhance mobility, explosiveness, and general athleticism.

After having surgery on my knee last September, I found it difficult to get back into the weightlifting scene.  I love pushing my body to the extreme and I absolutely HATED the fact that I couldn’t do anything lower body related. As I had found a new love – deadlifting – I was especially heartbroken because I couldn’t load on the plates. Basketball was out of the question as well for about 4 months and even then, my agility and vertical were severely held back. That’s what was most frustrating for me – the fact that I knew I could have crossed that guy over, or gotten that rebound but my knee was restricting me. I didn’t want my knee affecting me for the rest of my life, so I decided to play it smart and hold back on the intensity of my physical activity for the first 4/5/6 months after surgery. After some strengthening of my knee, I still felt pretty stiff and lacked the mobility in my leg I was hoping for – I figured some soft tissue work wouldn’t hurt.

I bought myself a nice blue foam roller and went to town. I feel it definitely played an important role in terms of my rehab – now I’m deadlifting and front squattin’ my heart out, and loving every minute of it.  I’m not saying that if I didn’t foam roll, I’d be bed stricken, but it was definitely a factor. I have experienced the benefits first hand of soft tissue work and vouch for it’s efficacy.

Even before my surgery, what was restricting the depth of my squat was my hip flexibility. I was carrying out plenty of hip flexor stretches but wasn’t experiencing a whole lot of change. After rolling my quads and what I think to be improving the functioning of my rectus femoris, my squatting improved. I was able to go deeper and I was no longer experiencing soreness. Additionally, I was doing some soft tissue work on some hard to get to areas – I used (and am still using) a hard tennis ball on my illiacus and psoas muscles. These can be hard to reach; even impossible to get to with heavier clients; however, I’m fairly thin and definitely feel I reaped the rewards. Working on them in the gym looked pretty funny as I was face down on the ground, humping and grinding away with this tennis ball in my crotch. The looks on some people’s faces were priceless.

My advice: I feel there are plenty of benefits from soft tissue work, and until some solid evidence based research comes out telling us not to, roll away my friend!

References: http://thebodymechanic.ca/2012/03/17/stop-foam-rolling-your-it-band-it-can-not-lengthen-and-it-is-not-tight/

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