Aug 30, 2016 by spinalcare
All joint pain and injuries ultimately can be broken down into two categories:
Mobility/Flexibility Issues and Stability/Strength issues
If you can find the right balance of mobility and stability, your joints will last forever (or at least a lot longer than they might otherwise). As with everything, balance is key. Too much stability often leads to too little mobility and vice versa. In our offices, we tend to see more mobility issues so we will start there.
Many of our patients tend to fall into the “poor mobility” category, but don’t be fooled into thinking that unlimited mobility is the goal. Hypermobility plagues everyone from athletes (think gymnasts and dancers) to the average person (often because they lack the balance of stability). Since we see more problems with limited mobility, we need to review some basics and help get you on your way to improving your range of motion and the oft bemoaned “tightness” that seems to plague most of the modern desk bound world.
“I stretch all the time but I never see improved flexibility.”
We hear this line about as often as Kanye West makes us scratch our heads. We’re sure you have felt this way at times, but in all honesty, who really stretches “all the time”? It’s like flossing and drinking water, we like to think we do it way more often than we actually do. To understand why you see little change in mobility (even if you did stretch for days), you have to understand a little more about the anatomy of the muscle and joint complex.
Muscles themselves are overlapping protein fibers that can be built up by stress. Nothing new with that. The muscles however are surrounded by a thin, multilayer sleeve of fascia (think slimy, film you see when you pull apart a chicken – sorry vegan friends). That slimy layer allows the muscle groups to contract and relax against one another without sticking together. These fascial layers allow for friction free motion in multiple directions. It’s why our kids can snake their arms under the seat of a car to retrieve a lost French fry and drape themselves over the back of the couch to watch Dora. The problem develops over time with repeated injury or trauma (not necessarily big trauma, but repeated microtrauma). Our bodies lay down adhesions (fibers) that cause those filmy slimy fascial layers to stick together (think Velcro between the muscles or cooked pasta as it dries and gets sticky). When enough fibers build up, you can say goodbye to the days of “criss cross applesauce” and back bends. These bound up sleeves of connective tissue won’t allow the muscles to slip and slide any longer. If the fascial layer is bound and stuck together, those muscle fibers inside can’t elongate. If you have enough adhesions built up around the casing of the muscle, you can stretch until the cows come home, but you aren’t going to see any change in muscle length. It’s like blowing up a balloon in a steel box – the balloon is bound by its surrounding. Pull that hamstring up to the ceiling and hold for hours, but the muscle can’t lengthen if it is bound by the sticky sleeve of fascia surrounding it.
The solution to increasing mobility then lies in eliminating those fascial adhesions and then lengthening the muscle fibers. We find that two of the best ways to improve mobility on your own are using the foam roller and the lacrosse (or other similar size and density) ball.
The foam roller is like the wacky noodle or curved shower rod: so simple, effective and grossly overpriced, that we are annoyed we didn’t invent it ourselves. The roller is a cylinder of foam – that’s it. Pretty simple. They come in sizes from 12-36 inches long and are generally about 6 inches in diameter. They come in may colors and densities. The color often dictates the density and the darker color rollers are generally a higher density foam. A high density roller (we like the black 36in roller) is a good place to start for most people. All but the very sensitive and frail will quickly outgrow a soft roller (white, pink, orange) so start with one that is firmer than you think you’d like. A soft roller won’t be able to get in to break down the fibers and you’ll find yourself looking to upgrade too soon. A firmer roller can be made to feel softer by rolling on a softer surface (carpet, towels, yoga mat).
The roller uses your body weight as a means of breaking down the fascial adhesions and at the same time lengthening the muscle fibers. The roller can be used for all areas of the body but is most effective on the hips, back and thighs – the bigger areas. Once you start to work smaller muscle groups, the lacrosse ball is more effective. The best way to start foam rolling is to have someone show you the basics in person. (Call us.) On your first dozen attempts, you will be humbled. Even the strongest, most coordinated athletes hate the roller at first. That’s OK –do it anyway. You will be off balance, sore, and miserable – do it anyway. As with any muscle reforming work, you will feel it. If you don’t, you are probably on too soft a roller. Give it about 2 weeks of consistent rolling and you will feel less like an inebriated noodle and more like the sublimely limber beast that you are. We have attached some photos here and there are great videos on YouTube, however we like it best to get on the floor and roll with you. Schedule an appointment and let us show you. It’s hard to foam roll incorrectly, but there are ways of making it more effective for you.
Here are our top three rules
- Whenever you foam roll, as with any exercise, you want to keep the belly and butt tight (the dreaded core is always in play) regardless of what area you are rolling. It will keep your back protected and you will be amazed by how much you will feel that core in the morning.
BIG FAIL: See how the belly drops
RIGHT ON: Abs tight, Butt tight
2.You never want to feel any numbness or tingling when you roll. While this won’t result in instant paralysis, it is a sign that you are impacting a nerve that doesn’t generally like to be impacted so get off that specific area.
3. Stay off of the bones. Foam rolling is a “soft tissue” mobilization tool. By rolling over bony areas like the knee cap and the vertebra, you are not only wasting time but putting added stress on an area that doesn’t need it.
Play with it. Move at different angles. Raise and lower the limb. Lean in and out. The more you feel that roller getting into the tissue, the more mobility you will get out of it. We suggest you roll twice a day for about 10-15 mins each session the first 2 weeks. That way you are constantly breaking down adhesions and lengthening the tissue, but 10-15 mins is not so long that you feel overwhelmed by it. If an area needs more attention, you will know by how it feels (that wide eyed, tear inducing, or pursed lip grimace is a good indicator that you need more time on a specific area). If you have more time to roll, use it. Some of our higher level athletes spend 40-50mins/day rolling out.
Below are some tips and pics to help you get started. There are many ways to add intensity but we are starting at the beginning here.
Start just by sitting on the roller and rolling from the bottom of the glutes (the cheek if you will) to the top of the hip – just get the feel for rolling. You will likely fall off the roller a few times. (Laugh if you will- it will happen to you.) Once you feel stable, lift one leg to drive that hip into the roller and dig deeper. By crossing one ankle over the opposite knee, you will get a better result. Use the hand of the hip you are rolling to help you balance.
ITB/ ILIOTIBIAL BANDS
Lay on your side with weight on the elbow and hip resting on roller. Use the top leg bent in front of you to take some weight off the ITB you are rolling (You’ll thank us for that one – trust me). Roll from the top of the ITB up at the hip down the to bottom down to the knee. If you need to dig in more, lift that top leg and let it rest on the bottom leg. You’ll feel that in the morning.
This is a big one. Everybody ignores the adductors and they are a big player in the hip knee pain game. Get into that plank position on your elbows with one leg “frog legged” out over the roller. Keep the roller perpendicular to the thigh and roll from groin to knee and back.
Start by laying in a plank position on the elbows with the quads resting on the roller. Roll down from the top of the quad to the tops of the knees. By spreading the legs wide and rotating the toes out, you can get the dreaded inner quads. Bringing the legs closer and toes pointed inward will get more of the middle quad. (Give yourself a gold star if you noted the poor form in the second photo. The wide leg quad shot got corrupted in transfer. Her legs look great here – her core does not. )
Sit on the ground with the roller under the calves. Left the butt off the ground and roll from under the knee to the ankle and back. To dig in more, cross one leg over the other for added weight. To get the outside of the calf, roll your hips to the outside. To get the inner calf, rotate the hips to the inside.
Lay with your mid back on the roller and give yourself a nice tight hug (that moves the shoulder blades out of the way so you can dig in between them). Roll your torso up to the top of the back and back down. Once you feel comfortable, lean to the right to really get into the heavy muscles of the mid back. Repeat on left.
The lacrosse ball works according to the same principle as the roller. You are using it to get into the fascial fibers and break them down. The ball will more easily get into the smaller areas like the neck, shoulders, elbows, and feet. The foam roller is like using a tooth brush- it gets the big areas in wide swaths. The lacrosse ball is the floss: it can get into the smaller, hard to reach areas. The ball can also put more focused pressure on a larger area. We often use a lacrosse ball to hit the deep trigger points in the glute or hamstrings that the roller is just too wide to hit.
A lacrosse ball can get into the hamstrings better than a roller can. Place the ball on a hard chair or bench and start close to the knee. Flex and extend the knee to dig into the hamstring and repeat 2-3 times. Scoot the ball and inch or two up toward the hip and repeat. Keep going until you hit the glute and then keep going.
A lacrosse ball is a little more portable and we have plenty of patients who keep one at their desk or throw it in a carry-on for travel. The ball can be used up against a wall, on a hard chair or on the floor. On the wall, you will apply pressure against the ball, but on the floor, your body weight will do the trick and you will feel it a little more. The same rules of avoiding numbness and tingling, and staying off of bones apply here. People often ask if a tennis ball will work as well. The tennis ball is hollow and like a soft roller, won’t make much of an impact. You can certainly give it a try but if you aren’t feeling the ball dig in, you likely need a ball with more density.
Once an injury is resolved, people often ask us how they can maintain their mobility and stay out of our offices. Here’s the simple answer: ROLL and MOVE. Just like brushing your teeth, you need to make it a habit. You can stop rolling (and brushing for that matter) but the results aren’t good in either case. One (perhaps fortunate) aspect of pain is that its easily forgotten once you feel good. People have told us they’d sell their first born if it would bring relief, yet two days into feeling good, they decide they are too busy to roll. We suggest you save the children and just keep rolling.