Confession of a Myofasciaist
I confess. I am a myofasciaist. I am dedicated to evaluating my patient’s myofascia in order to relieve their pain, or if they are an athlete, enhance their performance.
Before you judge me, read this week’s blog to learn about fascia and how it may be the answer to one or more of your health problems. If you are an athlete, learn how you can use this form of therapy to enhance your performance.
Are you knotty?
When I refer to myofascia, I am talking about muscles and the connective tissues that surround them.
The myofascia is susceptible to becoming inflamed and bound up. These taut, tender, palpable bands (knots) are commonly referred to as trigger points.
What causes trigger points?
Trigger points can be cause by:
- Macro trauma, e.g. a car accident or sprain/strain injury that involves overstretching of the tissue
- Micro trauma, e.g. a repetitive strain injury or poor posture that over time will stress tissue
Common signs of trigger points can include:
- Tender and painful nodule(s)
- Limited range of motion with or without pain
- Muscle weakness
- Muscle stiffness often mistaken for arthritis
- Nerve pain often mistaken for a disc problem
- Referred pain to other areas of the body
Trigger points have been implicated in:
- Neck, back, jaw and joint pain (arthritis, tendonitis, and bursitis)
- Carpal tunnel syndrome
- Earaches and dizziness
- Nausea, heartburn and irritable bowel syndrome
- Genital pain
- Sinus pain/congestion
Perpetuating factors: do they affect you?
Trigger points can be perpetuated by: mechanical stresses, nutritional/dietary factors, endocrine problems (e.g. hypothyroid, menopause), stress, chronic infections and other factors (allergies, insomnia, improper breathing, dehydration, smoking, caffeine, medications and visceral disease).
How are trigger points treated?
Trigger points respond to a number of modalities, some of which include: (1) deep pressure followed by stretching, (2) pinning and stretching, (3) foam roller (self myofascial release), and (4) trigger point acupuncture.
When a trigger point is treated, receptors are stimulated. This sends signals to the nervous system to change the tone in the muscles. If there are adhesions in these areas, they are mechanically broken up.
The added benefit of trigger point acupuncture is the release of endorphins (natural pain killers) and an anti-inflammatory effect.
Preventive measure that identify and then treat the perpetuating factors as mentioned above should be taken for long term results.
A 3D approach
In my experience, sometimes releasing trigger points and eliminating pain is as simple as identifying the knots, sticking needles in them and then stretching the area.
Many times however, the area treated is not the primary source, but the compensation.
A trigger point can form in a muscle that is tight because it is short (or overactive) as well as in a muscle that is long (or underactive).
Muscles that are short/overactive respond quickly to trigger point release and stretching, while muscles that are long/underactive are neurologically tight and require a different intervention.
When a muscle is neurologically tight, it is important to deactivate the trigger point, but these muscles do not respond to lengthening, as they are already in a lengthened state. In essence, they are pulled tight.
These muscles need to be activated e.g. positional isometrics, which involves holding an isometric contraction at the end-range of motion.
Isometrics are a static contraction. There is no motion involved in this exercise.
Positional isometrics are intended to increase the neuromuscular activation and coordination of the particular muscle.
Don’t forget the synergists and stabilizers
Synergists are muscles that assist in movements, while stabilizers provide stability with movement. These can be secondary sources of trigger points due to reciprocal inhibition (a neurological phenomenon where a tight muscle turns off the muscle opposite to it, leading to over activity of synergists)
Give yourself a hug. Take note of the muscles in your chest (pecs) and in your upper back (rhomboids/lower traps). Your pecs are anatomically shortened, while your rhomboids/lower traps are lengthened. Both areas can have trigger points.
Trigger point therapy can be performed to release the points in both areas; however, while the pecs will respond to stretching, the rhomboids/lower traps (which are neurologically tight) need to be activated through positional isometrics or an isolated exercise (e.g. cobra) as mentioned above.
This same phenomenon commonly occurs between the hip flexors (psoas) and hip extensors (gluteals and hamstrings).
The hamstrings are often relatively lengthened (and neurologically tight) due to anterior (forward) tilting of the pelvis and over activity of the hip flexors.
Assessing the whole picture
In order to determine which muscles are overactive and which are underactive, it is important to perform an integrative assessment, consisting of:
- General movement screen
- Isolated range of motion testing
- Manual muscle testing
Pain is one of the top reasons that patients see their physicians. Most physicians assume that pain is inflammatory, hence the over-prescription of NSAIDs and other pain medications.
In my experience, while there may be an inflammatory component to pain, addressing the myofascia is often the key. Hence, my Confession as a Myofasciaist.
Almost forgot- What about performance enhancement for athletes?
Athletes need to be demonstrate efficiency in their neuro-musculoskeletal system. To be efficient most sports require optimum flexibility, balance and strength.
Because trigger points can limited range of motion, cause muscle weakness and affect proprioception (position sense), they can have a negative impact on performance.
See for yourself. Spend 12-20 minutes doing self myofascial release with a foam roller before doing your sports and see if you notice a difference. I bet you will.