Self Myofacial Release (SMR) is a technique used to assist in the alleviation of muscle, fascial and joint imbalances. Imbalances such as tightness, trigger points or muscular weakness or one-sided dominance tend to happen due to a multitude of reasons such as sitting or standing for prolonged periods of time, overuse, activities dominated by one side of the body and/or injury. They may eventually lead to complications and potentially pain or further injury. There are various tools used to prevent and treat imbalances in conjunction with proper form, stretches, bodywork and other therapies. Foam rollers, tennis or lacrosse balls and other specialty items are usually found in gyms, sports shops, yoga studios or therapist’s offices.
Utilize SMR techniques before and after your workouts. Pre-workout 5 to 10 total minutes is adequate while post-workout longer SMR sessions are beneficial.
- Place the area of concern over a foam roller or similar tool. Remember to incorporate appropriate posture even while lying on your side.
- Roll back and forth over the area to increase circulation and “feel for” tight spots.
- Some points will stand out as ‘tender’ or tight; allow your body to breath and sink onto the foam roller in those spots. Hold this position for 20 to 60 sec. (some conditions allow for 120 sec. under supervision). If it is too tender with direct pressure work above and below the area of discomfort. [Remember this should not normally hurt but some areas may be more noticeable than others]
- Reassess the area you worked on. Repeat as necessary.
- ‘Roll’ on the opposite limb and compare.
Common areas that benefit from using this techniques include but are not limited to the calves, hip flexors (quads), iliotibial (IT) band, piriformis (glute area), paraspinals (parallel to the spine) latissimus dorsi (lats/”wings”…), rotator cuff and pectoral muscles.
Avoid rolling directly on joints, bones and especially your spine.
By regularly incorporating SMR techniques into your daily routine you will become more limber, recover from workouts more efficiently and reduce your chances of injuries due to tight fascia.
70-85% of all Americans experience back pain at some point in their lives. It is the fifth most common reason for all physician visits in the U.S. and is the most frequent cause of activity limitation in people younger than 45 years old.
Most cases of back pain are mechanical or non-organic, which means they are not caused by serious conditions like inflammatory arthritis, infection, fracture or cancer. Within 4 – 6 weeks of initial back pain in athletes, 80% of individuals recover without medical assistance. Although this is a favorable statistic, there is a 58-90% chance of recurrence; this is potentially greater in non-athletes. (Kolber, 2007)
Back pain may be described, based on symptoms, as acute (< 4 weeks), sub acute (4–12 weeks) or chronic (> 12 weeks). Most back pains stem from benign musculoskeletal problems and are referred to as “non-specific back pain”. This type is often due to muscle or soft tissue sprain or strain, with pain lateral to the spine resulting from sudden physical loading of the back. Nearly all back pain falls within this category.
Less common conditions occurring with some frequency fall into the following categories:
• Mechanical – osteoarthritis, degenerative discs, spinal disc herniation (“slipped disc”), spinal stenosis, spondylolisthesis, fractures and other congenital abnormalities;
• Inflammatory – ankylosing spondylitis or rheumatoid arthritis;
• Referred pain – pelvic/abdominal disease, menstrual cramps, prostate cancer.
The spine is a complex strong structural pillar and a fragile functional mechanism. Each vertebra is stabilized by ligaments, muscles and fascia. Rather than bearing weight directly from top to bottom, the spine behaves more like the center pole in a circus tent held by suspension wires. The mere act of sitting increases the potential pressures placed on the intervertebral discs to 140% of normal, with potential discomfort immediately met by muscle contractions that stiffen and pull the spine into imbalance. (Chek, 2000)
Internal abdominal musculature such as the multifidi, pelvic floor and diaphragm must work in unison to provide an adaptable capsule of support for the spine’s postural muscles.
The mere act of breathing elicits basic support for the spine, as the diaphragm muscle has lower attachments at the antero-lateral portions of the second and third lumbar vertebrae. This placement allows these vertebrae to lift pressure commonly found in between the fourth lumbar, fifth lumbar and first sacral vertebrae. The diaphragm is innervated by the phrenic nerve which is formed from cervical nerves 3, 4 and 5. (Richardson 2005) The useful mnemonic “C3, 4, 5 stay alive” has profound meaning in ease of life and also implies how cervical postures affect the rest of the spine.
Postural muscles have a tendency to become inactive within eight hours of a person being sedentary or bedridden. In repetitive motion, acute injury and inactivity these structures become less accommodating which further exacerbates painful areas and creates new inefficient biomechanics. These pain patterns cause tightening, guarding, compensation and simultaneous weakening of surrounding musculature. The tendency of muscular inhibition and imbalance tie into risk factors for back pain, which include impaired muscle control, delayed muscle activation, decreased endurance of extensor musculature and weakness of spine extensors relative to flexors.
Standard anatomical descriptions fail to notice the seamless integration of the body. When one part moves the entire body responds. In addition to soft-tissue injury and motor control components, when there is joint pain there is now a joint mobility dysfunction that may cause or was caused by faulty movement patterns.
Oriental Medicine (OM) Treatments
OM alleviates pain and speeds healing by utilizing a holistic approach that takes into account all contributing environmental and internal factors, including food choices and emotions.
Acupuncture treatments, initially at one to two times per week, may incorporate moxa, cupping, gua sha, or electrical stimulation. Tui na, a form of Asian bodywork, uses similar points and protocols to those used in acupuncture. Common herbal prescriptions such as Du Huo Ji Sheng Tang or a customized version are a strong component in successful treatments. Nutritional recommendations from meal timing to the energetics of food provide continued benefits, decreased pain and inflammation and improved recovery time. Prevention includes rest, exercise and ergonomics. Most treatments result in immediate relief, improvement at the end of a treatment and some lasting improvement after the patient goes home. Overall a person will have a reduction in inflammation, decreased pain and/or increased range of motion and improved quality of life.
Postural Considerations and OM
“Posture is the position from which all movement begins and ends.” (Chek, 2000) Early Oriental diagnostics took note of posture, but it may not have been as common an issue as it is in today’s sedentary world. More often than not, OM diagnosis in clinic is correct but results may not last regardless of treatment frequency. Poor posture may contribute to or even cause the symptoms that are occuring. This raises the question of qi vs. structure (muscle/fascia) and is answered with: “when qi flows, pain goes”. Postural alignment optimizes the flow of qi and blood to the brain, organs and extremities; allows normal breathing patterns to take effect; improves organ function and digestion; and makes movement easier.
One can treat from a meridian anatomy or zang-fu (organ) perspective and then find that anatomical orientation may play a more significant role. A practitioner may see compression of an L5 nerve root with radiation of pain down the lateral thigh as a Gallbladder (GB)/Shao Yang problem, though it is much more likely a Du/Governing vessel or a Bladder (BL)/Tai Yang problem because it is caused by a disc in the lower back. Just because the pain is in the GB meridian doesn’t necessarily mean that the channel is diseased or disturbed. (Reeves, 2009)
Back Pain due to quadratus lumborum (QL) injury is often one-sided and commonly overlooked. It presents with a wide range of pain patterns that may refer to the lumbar, groin, sacral or gluteal regions. Characteristic one-sided pain and guarding tend to stand out. The acute patient may hold themselves in a laterally flexed position towards the side of pain or the hip may be elevated on the same side, while the chronic patient may not present the same. The QL is deep to the paraspinalis muscles where the inner and outer BL lines are located. From a OM perspective it is too far lateral to be only BL meridian-related while it’s not exactly on the GB meridian either, making treatment based on OM location somewhat difficult. When palpating and pressing towards the spine, ashi (tender) points are usually found below the 12th rib, .5-1 inch lateral to L1. (Reeves, 2009)
Common variations in postural deviations may include:
Lower Cross Syndrome/ Anterior Pelvic Tilt
• Refers to a measurement on a horizontal plane from the anterior superior iliac spine (ASIS) to the posterior superior iliac spine (PSIS). An average-height male with lower cross syndrome will measure > ½”, while an average-height female will measure > ¾.”
• Common to people who sit at desks for extended periods of time, high-heel wearers, the obese or pregnant.
• Excess (Overactive): internal rotators of the hip, adductors, vastus medialis, semimembranosus, TFL, shortened lumbar erectors, hip flexors (ilio-psoas, rectus femoris), and calves.
• Deficient (Underactive, Inhibited): External rotators of the femur, hamstrings, gluteus maximus, pelvic floor muscles, lower abdominals, thoracic extensors, cervical flexors.
Upper Cross Syndrome/ Rounded Shoulders
• Common in those who do repetitive work in front of the body, students or computer users.
• Excess (Overactive): pec minor, subscapularis, scalenes, SCM, cervical extensors, upper trapezius, biceps, possibly latissimus dorsi.
• Deficient (Underactive, Inhibited): Mid and lower trapezius, rhomboids, supraspinatus, infraspinatus, teres minor, cervical flexors.
Sway Back Posture/ Posterior Pelvic Tilt
• Formerly a posture found almost exclusively in older males, it is increasingly common among adolescent computer users.
• Hips will appear tucked and the lumbar spine will have minimal lordosis.
• Excess (Overactive): hamstrings, lower abdominals.
• Deficient (Underactive, Inhibited): lumbar erectors, rectus femoris and iliopsoas.
Excess muscles are tight, ropy bands that are painful upon palpation and may be accompanied by cold or heat signs.
Deficient muscles are characterized by a feeling of weakness. On palpation some are tight but pressure feels better, while some are characterized by a softer quality. Deficient muscles may have additional cold or damp symptoms.
To correct these muscular imbalances overactive muscles must first be relaxed or normalized, then the inactive muscles should be tonified or strengthened.
One to two treatments of acupuncture and/or bodywork per week will result in decreased pain, easier breathing, less tension and increased range of motion. This should be followed by take-home exercises to maintain benefits. Low intensity exercises on average follow 15+ repetitions or isometric holds at 30-90 seconds, repeated throughout the day. Patients should do stretches and self myofascial release, holding their positions for about 30 to 90 seconds or until tightness and discomfort decrease by about 75%. Additional benefits from daily therapeutic exercises include improved biomechanics, improved coordination and overall longer lasting effects.
Foundations for Improved Posture
OM encompasses many effective treatment modalities to address variables in location, cause and progression of back pain. Historically effective movement patterns such as Tai Ji and Qi Gong were incorporated to enhance kinesthetic awareness and establish a mind and body connection. Today we have the benefit of both utilizing these time-tested modalities and recent methods to enhance and retain treatments with postural awareness and improved biomechanics.
The following are a few exercises to use as a foundation:
Posture and breath awareness
At the beginning and end of all standing, sitting or laying movements there is a vertical line that can be drawn from the ears through the shoulders, the lateral center of the hips and past the knees to the lateral malleolus. Imagine the feeling of this line (moved medially) being pulled upward from the pelvic floor (between Ren1 and Du1) through the apex of the head (DU20). Simultaneously breathe into the lower abdomen/dantien to emphasize diaphragmatic breathing.
Foot and ankle movement
Allow the body’s weight to shift forward and backward from the balls of the feet to the heel and inward and outward onto the medial arch. The parts of the foot that should touch the ground while standing are the heel, the underside of the lateral part of the foot, and the balls of the feet. What is felt at the hips and knees as you try to find a center to these movements?
Allow the knees to turn lightly inward and outward. Find a center where they are neither locked nor bent, rather at a soft ready stance. Do your feet stay grounded or do they lift? What does this do for the hips and low back?
Move into an anterior and posterior tilt. Imagine the pelvis as a bowl spilling forward and back. Find a center. What happens at your ankles, knees and neck?
Repeat these movements for 5 to 10 minutes until they become easier. Most can also be done seated or laying down face up.
• Remain active and avoid prolonged inactivity or bed rest.
• Modify training if injured.
• Practice corrective and/or postural exercises.
• Warm up or before exercising or other physical activities and cool down.
• Maintain proper posture.
• Maintain a healthy diet and weight.
• Manage stress.
• Wear comfortable, low-heeled shoes.
• Sleep on a mattress of medium firmness.
• Lift with your hip extensors (primarily glutes) and keep objects close to your body, especially when twisting while lifting.
• Reconsider smoking; it impairs blood flow, resulting in oxygen and nutrient deprivation to spinal tissues.
• Follow OSHA’s basic ergonomic guidelines in seated work areas.
ACA. (n.d.). Back Pain Facts & Statistics. Retrieved March 1, 2011, from http://www.acatoday.org/level2_css.cfm?T1ID=13&T2ID=68
Chek, P. (2000). Scientific Back Training (3rd Ed.). Vista, CA: CHEK Institute. (Original work published 1993)
Kolber, M. J., & Beekhuizen, K. (2007, April). Lumbar Stabilization: An Evidence-Based Approach for the Athlete with Low Back Pain. Strength and Conditioning Journal, 29(2), 26-37.
OSHA. (n.d.). Computer Workstation Checklist. Retrieved January 1, 2011, from http://www.osha.gov/SLTC/etools/computerworkstations/checklist.html
Richardson C, Snijders C, et al. (2002) The Relationship Between the Transverse Abdominus Muscles, Sacroiliac Joint Mechanics, and Low Back Pain. Spine 27(4), 399-405.
Reeves, W. (2009). The Acupuncture Handbook of Sports Injuries and Pain: A Four Step Approach to Treatment. Hidden Needle Press, Boulder, CO USA.
Wu, Qianzhi. (2004). Acupuncture Treatment of Disease: Student Study Guide. Austin: AOMA Press. P 120-122.
The “Principle of Use or Disuse” implies that your exercise gains will go away when you do not maintain them. This means that you become deconditioned and muscles atrophy when not in use. Muscle strength tends to go away at about 1/8 of starting strength per week, with larger and stronger fast twitch muscle fibers decreasing in number earlier than slow twitch fibers. Functionally, slow twitch or postural muscle fibers can “turn off” in eight hours while sitting or laying down and must be “prompted” to regain normal capacity. Over time muscles become shorter and less limber with disuse. When we move, gravity forces our muscles to contract and pump blood back to our hearts. It’s also easier to breathe since our postures tend to be better when exercising. Exercise stimulates our metabolism, the formation of new bone cells, improves glucose tolerance and gives us an overall sense of well-being. So enjoy every step, rep, set, lap or mile. Know that it’s worth every minute.
Muscles burn calories and become stronger with use, no matter what… What if they worked synergistically with the core, or chose not to? The “core” can be the center of anything functioning or not. The core in the body is an area that forces are transferred and reciprocated through. For example, when taking a step in running the legs work predominantly. From here forces are transferred through the pelvis up through the diaphragm and spine out ward and around the back and shoulders the skull, similar to the way shoe laces keep your feet secure. Forces are appropriately transferred when posture, breath and proper running or lifting form are in sync. So the next question is are we in sync? If the body moves effortlessly without constraint or pain, in ‘good’ posture with a consistent breath, then more than likely you are in sync. If the body does not move fluidly, fatigues easily especially more on one side, and is generally in pain, and has difficulty breathing then the core area is probably not being utilized efficiently. Using the previously mentioned points to help confirm this, you can also have someone look objectively at you from the front, back, side. When standing still, do your ears sit over your shoulders, shoulders above your hips with a minimal amount of sway or rotation? Do your knees follow your toes in movement? Can you draw a straight line from your forehead down your neck and torso to the point between you ankles? If so these you probably line up well and feel efficient in most movement. Additionally an objective professional opinion may help considerably.
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For most of us we will look in the mirror and see the same person every day. We may neglect the fact that our ability to notice cumulative change diminishes. If we sit for extended periods of time our body will start to sink or slouch which allows our head to move forward. A person’s head is equivalent to about 7% of our total body weight and for every inch that it moves forward of our body the stress on the supporting musculature nearly doubles. What will this do to the muscles that support it?
The supporting muscles immediately become more tense in order to support the extra stress, with time these muscles are working so much that they eventually become longer, tighter, develop trigger points and scar tissue, and may eventually become ischemic (reduced blood flow in tight muscle, where the muscle begins to atrophy and die). All of this will create excess compensation and erratic movement patterns in opposing and assisting muscle groups which “think” they should be working overtime.
Eventually we will decide that it is time to move, dance, exercise or stretch. This results in neck, shoulder and mid back pain or discomfort, headaches and possibly temporomandibular joint disorder (TMJD). So the only logical thought that comes to mind is to stop movement all together and go back to sitting. Well that sounds good but what about exercising to improve our posture and overall health?
The best thing to do is to follow a few check points in posture.
- Breathe diaphragmatically and continuously.
- Make sure that your ears are aligned over your shoulders and not in front of them.
- During movement, place the tip of your tongue between your upper teeth and the roof of your mouth. This will reduce the pulling motion of some muscles on the front of your neck.
- Temporarily reduce the exercises that emphasize the front of the body or pulling forward. This would include sit-ups, crunches, leg raises, leg extensions and chest exercises.
- Avoid placing a large pad/ pillow behind you head for support (this will add to the imbalance) unless you have a structural problem, disc herniations, neck fusion or condition that does not allow for a relaxed neck position.
- Stretch your neck muscles daily. Include the trapezius (shoulders), Sternocleidomastoid (SCM) (long muscles on the front left and right of your neck, chest and latissimus dorsi (they actually tend to pull you forward when it is tight). Also furthest from your neck, check your calves and feet. They will surprisingly be tight too.
- Schedule Acupuncture and Bodywork regularly. As well as consulting with a Fitness Professional well versed in biomechanics.
Remember if your neck discomfort becomes severe, radiates (travels), feels numb or nerve like then make sure your acupuncturist knows.