With the increased attention paid to “soft-tissue work” and “myofascial release” techniques, I think it’s important that everyone understands the basics that provide the underlying foundation for why these methods are effective and necessary.

I went into this at a very superficial level here: Foam Rolling Science Made Simple but I want to dive a bit more into the, well, slightly less superficial science behind it.

In laymens terms, these techniques are used to release or remove restrictions from the muscle. Most people are familiar with the feeling of having a “knot” in a muscle; that understanding will do for now.

Restrictions can be broadly categorized as adhesion or trigger point based. Wikipedia provides an easy-to-understand definitions:

Adhesions are fibrous bands that form between tissues and organs, often as a result of injury during surgery. They may be thought of as internal scar tissue.

In contrast:

Trigger points are hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut muscle fibers.

A display of potential trigger point areas

My understanding is that adhesions are more the result of damage (contact, improper muscle under-/over- use, injury, surgery, etc.), and that trigger points are more neurally mediated (excessive or inappropriate neural input to a localized area). In both cases, an adhesion or trigger point will pull on or otherwise affect surrounding areas in the presence of movement. This is ONE of the driving factors behind the idea that symptomatic areas aren’t always the cause of the problem.

Years ago, Michael Boyle provided a great illustration of this at a seminar one year where he put a band around someones neck and lightly pulled. “Where do you feel the pain?” “On the side of my neck.” General wisdom would say to ice, massage, and stretch the area. In reality, these methods may bring temporary relief, but as long as there’s a rope around your neck, it’s going to hurt. You could save yourself the ice, massage and stretching by just removing the rope (in this example).

For something a little less abstract, let’s consider that the glutes and/or TFL can become restricted and increase the tension on the IT Band.

This scenario, which is pretty common in athletes from various sports, can lead to a host of painful symptoms including lateral knee pain (one of the locations of this potential pain is pictured above). Some manual therapy work to the TFL and glutes will release the tension and therefore return the athlete to a pain-free condition.

In many cases, adhesions and trigger points, which can be thought of as “soft-tissue restrictions” present because of positions we hold our bodies in for prolonged periods of time. For that reason, many people will have restrictions and common areas (e.g. hip flexors, pec major and minor, lats, cervical extensors, etc.). Because of the diagonal and rotational nature of the skating stride and the lateral nature of crossover patterns, hockey players tend to have pretty predictable restrictions in the hip rotators and the adductors.

Digging a lacrosse ball into these muscles will make most players yelp

The high, inner area can become especially problematic for hockey players

Both of these pictures are especially illustrative of how adhesions between any two structures or triggers points in any one structure could affect surrounding areas, as optimal movement is dependent upon proper extensibility of and gliding upon these individual and collective muscles. By the time hockey players are in high school, the muscles around their hips’ are completely gunked up. This will impede blood flow, lead to abnormal firing patterns, and generally increase the amount of resting tension put on surrounding structures. In other words, the associated changes aren’t just mechanical, they’re also circulatory and neural. Maybe more importantly, addressing these restrictions will make the athlete FEEL better.

With a basic understanding of what the restrictions are and the effect they can have on the body, the question becomes how to get rid of them. Adhesions tend to break up in response to localized pressure driven along the direction of the adhesion.  Trigger points, on the other hand, tend to respond better to sustained pressure in one location. Using foam rollers, medicine balls, lacrosse balls and other implements to perform self-myofascial release work (to address these restrictions) is a great way to minimize the risk of these turning into more substantial problems. With that said, these methods aren’t nearly as specific or effective as getting worked on by an experienced manual therapist.

Check out the video below of Cole Hamels talking about his experience working with my friend Dr. Michael Tancredi:

Cole Hamels Explains Benefits Dr. Tancredi Chiropractic Care from Harry Scheid on Vimeo.

The thing I like the most about this video is that it’s straight from the athlete’s mouth, meaning it’s not overly scientific. If players started getting regular work done from an Active Release practitioner or a great massage therapist like my friend Craig Bohn at Hockessin Athletic Club, I think a lot of the chronic groin and hip flexor strains and sports hernias that we’re seeing through the high school, college, and pro levels would start to disappear. I know our athletes have had tremendous success in warding off these injuries (and returning from soft-tissue injuries sooner) as a result of getting regular soft-tissue work done.

Whether you perform self-myofascial release work or go see an experience manual therapist is secondary in importance to not neglecting soft-tissue quality altogether. Because it can be difficult to enforce this stuff on a team-wide basis in most youth programs, it’s up to parents to go buy a foam roller or look up a manual therapist for their son/daughter. It’s well worth the investment; your kids will thank you later!

To your success,

Kevin Neeld

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At least year’s Boston Hockey Summit I had an opportunity to briefly meet Charlie Weingroff. Charlie used to work with the Philadelphia 76ers and was there to present on the basketball track of the seminar. I heard so many good things about him from other attendees that I signed up for his newsletter when I got home and have been following his work closely ever since. In that time, Charlie has been an incredible resource (he provided a ton of guidance for this Hockey Injuries: Sports Hernia Case Study, and introduced me to Dr. Michael Tancredi who is an invaluable referral resource for me) and become a friend.

When I found out he was working on a new DVD set I shot him a quick email to ask when it would be released. As soon as it was available, I bought a copy. With the chaos of the holidays, and working through other books I was in the middle of, I didn’t have an opportunity to sit down and watch it until last week.

My first impression was…wow.

Training = Rehab, Rehab = Training is the most insightful (dare I say groundbreaking!) strength and conditioning resource since Cressey and Robertson’s Building the Efficient Athlete. To give you the quick run-down, there are 12 hours of film split up over 6 DVDs that really dive into how the human body functions and how to train to optimize this function AND minimize injury risk. The novelty of this information stems from the uniqueness of Charlie’s background-part physical therapist, part strength and conditioning coach, part manual therapist, and part powerlifter. The ultimate mad scientist combination for creating a performance enhancement expert.

And with the final ingredient…we’ve done it! He’s ALIVE. MUHAHAHAHAHA.

Over the next week, I’m going to dive into a few of the things that really stuck out for me, starting with:

Click here now to get your copy >> Training = Rehab, Rehab = Training

Redefining Stability
With the popularity of the Mike Boyle and Gray Cook’s “joint-by-joint approach to training” also comes a bit of misunderstanding. Stability has become a garbage term that gets thrown around to mean a lot of different things. Typically, stability is used within the context of “core stability” which usually refers to exercises that involve maintaining a neutral position. Admittedly, I’ve been guilty of this in the past, but have since moved away to defining stability not as neutral, but as control. This is why Charlie’s definition resonated so much with me. He defined stability as:

“An ability to control movement in the presence of change”

With this clear, accurate definition in place, it’s important to recognize the profound implications this has on the joint-by-joint approach to training. Now instead of a “stable” joint being thought of as not wanting to leave neutral, we can see that it’s more a matter of being able to control the movements of the joint, especially in undesired planes (e.g. frontal and transverse plane movements of the knee-specifically the junction of the femur and tibia, and at the elbow, specifically the humerus and ulna).

According to Charlie’s new definition of stability, this exercise would be considered…well, still stupid.

Core Pendulum Theory
The “Core Pendulum Theory” is a term Charlie coined to emphasize the importance of maintaining full joint mobility. To paraphrase, a joint needs to have full mobility for two major reasons:

  1. Full mobility allows the joint to naturally recognize it’s center/neutral location, known as joint centration.
  2. Full mobility provides optimal neural feedback to the nervous system, which can then send more appropriate signals to the surrounding muscles

As an oversimplified example, let’s suppose a hip has 40 degrees of internal rotation and 50 degrees of external rotation, and recognizes it’s central/neutral position as 0 degrees of rotation. If 20 degrees of internal rotation is lost (not uncommon, especially in hockey players), the joint may associate it’s “neutral position” in a few degrees of  external rotation. Or, probably more accurately, the femoral head would shift slightly within the joint, which would affect both the ability of the surrounding muscles to operate optimally AND force transfer through the joint. Also, because the mechanoreceptors no longer provide appropriate feedback to the nervous system, the nervous system is unlikely to appropriately activate the muscles that CONTROL (there’s that word again!) internal rotation (e.g. the external rotators).

Movement vs. Exercise
In many cases, the words movement and exercise can become blurred. After all, wouldn’t functional exercise use functional movements? Well, not exactly. As I alluded to above, Charlie highlights the importance of all joints having full range of motion. Related to a current hot topic in core training, he notes that the lumbar spine should have FULL flexion range of motion. However, repeatedly flexing the lumbar spine as an exercise can damage the discs. In this case, you need full MOVEMENT, but you shouldn’t use it as part of an EXERCISE.

Another example is with valgus collapse of the knee.

Assuming this picture was taken during a jump landing, this picture illustrates:

  • A demonstration of a hip internal rotation MOVEMENT
  • An incredibly dangerous EXERCISE

To elaborate, landing from a jump isn’t inherently dangerous. Landing as in the picture is absolutely dangerous. The point is that there are times to EXPRESS movement capabilities and times not to. In the case of the lumbar spine, there should be full flexion and extension range of motion to ensure proper joint centration, force transfer and a stable dock for attaching muscles, but because the discs begin to fail when they go through a certain number of flexion/extension cycles, that range of motion should not be included as a part of regular exercise.

Training = Rehab, Rehab = Training is not for everyone. In my enthusiasm for a new product or resource I sometimes forget this part. While Charlie brilliantly breaks down all of his training philosophies and concepts, there is a certain requirement for an underlying prerequisite knowledge in functional anatomy and biomechanics (or kinesiology). If you’re a hockey mom or dad, this wouldn’t be a good allocation for your money. If you train or rehab people for a living, this is a MUST have.

Click here now to get your copy >> Training = Rehab, Rehab = Training

To your continued success,

Kevin Neeld

P.S. Did you remember to sign up for this? 2011 Sports Rehab to Sports Performance Teleseminar

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Last week I had a Tier I U-18 player stop in at Endeavor so I could have a look at his hip. I tend to do these types of favors for players that have trained with us in the past and/or play for coaches that I know (in this case, Jared, my boss at Endeavor).

In these situations, my first question is always, “Have you seen a physical therapist about this?”

This is an important first question to ask because they may have already received a diagnose and/or treatment strategies that will provide some insight into what’s going on. It also helps protect me professionally from stepping on the toes of a profession that, in general, is better suited to handle sports injuries.

With that said, this player had been to a physical therapist who (in his words) “showed me a few stretches for my groin.” Naturally, these didn’t help.

As you know, I’m almost ALWAYS against stretching a strained muscle. In most cases, I think it will make the injury worse. In general, strains tend to occur in areas that move excessively and in muscles that aren’t strong enough to accommodate the workload. In many cases, the strained muscle simply lost a “stiffness” battle with a synergistic muscle. This means that the synergistic muscle would likely need the stretching and the strained muscle would likely need strengthening.

Moving away from injury generalities and back to the case at hand, I went through the normal process of asking him what happened and how long it’s been bothering him. Not surprisingly, he pointed to the inguinal triangle as his area of pain. Because the adductor longus is the most frequently strained groin muscle, I was expecting this area to be painful.

I did a quick search for “groin pain” pictures and this came up. I’m not sure why exactly, but to find out I will have to personally assess each and every one of them! (…just kidding Emily)

I did a simple prone and supine hip internal and external rotation ROM assessment, and this revealed something interesting. He had great ROM in both directions on his unaffected side. On his affected side, he had slightly less internal rotation than his other side, but SUBSTANTIALLY more external rotation. As a follow up, I did Craig’s Test” on his affected side, a test that assesses for femoral anteversion or retroversion.

Interestingly, he had a positive Craig’s Test (>15 degrees), which typically is accompanied by excessive internal rotation and limited external rotation (quite the opposite of what we found). I also performed a Thomas Test to assess hip extension ROM, which was positive (limited hip extension, indicative of a hip flexor restriction) on his uninjured side, but negative/normal on his injured side. While this could be interpreted as a good thing (how could full hip extension ROM be bad?), putting it within the context of the rest of our findings painted a drastically different picture.

In this case, the full hip extension is indicative of anterior hip capsule laxity. Basically the ligaments have become overstretched, which allows for both full hip extension and excessive external rotation. In light of a damaged anterior hip capsule (which provides a “check” to hip extension and external rotation), it’s of no surprise that the muscles that also provide a “check” to hip extension and external rotation (the hip flexors/adductors/internal rotators) would be overworked, and (almost inevitably) injured.

Stretching these muscles would be exceptionally counterproductive. My approach was:

  1. STOP stretching the adductors
  2. Strengthen the anterior glute medius to help return some muscular support to the anterior hip capsule (a concept from the Postural Restoration Institute)
  3. Seek treatment from a great manual therapist (in this case, Dr. Tancredi in Broomall, PA)

I often hear people make the argument that certain things (notably the above example) are more in the realm of a physical therapist’s job description than a strength coach’s. I don’t disagree. I don’t necessarily view my role as “diagnosing and treating injuries”, but it’s helpful to have an understanding of some of the tests that PTs use so I can get an idea of what is going on with our injured athletes. This doesn’t give me the go-ahead to treat them, but allows me to make the most appropriate referral and clearly communicate the situation with that professional.

As a closing note, if you’re a player, the big take home from this is to get your injuries checked out immediately. This player hasn’t played in a couple weeks now, and this is the season he’s supposed to finalize an agreement with an NCAA D1 team. I understand you’re a hockey player so you’re supposed to be tough and not feel pain and fight through injuries and all that crap. You’re also not supposed to be a moron and miss several weeks/months of a season because of a minor injury that got out of hand as a result of your stubbornness. If your going to fight through injuries, October/November isn’t the time. Save the tough guy mentality for playoffs.

Kevin Neeld

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