Tag Archives: active release therapy

Running Essentials (Vol. 1)

Posted on May 28, 2015 | Leave a comment

Being a runner myself, and working with a good amount of road warriors leaves me sympathetic to some of the wear and tear suffered due to this (sometimes) healthy addiction.  While injuries and causes come in all shapes and sizes, there remain various foundational issues that can be applied universally in order to curtail potential issues along the kinematic chain.

Hyper contraction of the hip flexors is a common issue in our society mostly due to the amount of time we spend seated.  In the car during a commute, at a desk glued to computer or a couch glued to the television, around the table while breaking bread with family and friends, even putting in miles on the bike; these all lend themselves to a shortening of the front side hip flexors.

Two immediate issues created by this are a higher propensity for low back pain, and a longer stride out in front while running, which leads to a higher risk of injury due to the increased instability that accompanies a longer lever arm.

Low back pain is perpetuated by shortening and tightness in the chief hip flexor, the psoas.  This muscle has its origin on the lower lumbar spine and when over contracted, will pull down on the lower spine when standing, creating discomfort, and the perception that standing causes pain.  In actuality, while the discomfort is indeed experienced while vertical, the catalyst can be the shortened psoas due to bouts of long, uninterrupted sitting.

Tight hip flexors become an issue while running as it can lead to a longer stride out in front.  The further that leg lands out in front of you, the less stability.  This can interfere with an optimal strike, pronation, and ankle and knee stability.  Unless you are a sprinter or huddler this also is a less efficient way to run.

Modifying gait is a multi-pronged task, with frontside dominance being a key factor.  The flipside to this shortening of the hip flexor is the lengthening and weakening of the antagonist hip extensors, mainly the gluteus maximus and hamstrings.  These posterior chain muscles are designed to move us efficiently and powerfully through life, including while running.

Again we look to front side dominance now being a logical contributor to strain and aggravation to the posterior structures and tissue including the hamstrings, piriformis, SI joint and surrounding ligaments.

Easiest way to begin to avoid this is by breaking up the long, uninterrupted sitting.  Obviously total avoidance of sitting is not possible, but in most cases breaking it up is.

Try to get up and move AT LEAST twice every hour or utilize the increasingly popular and available stand up desk.  Set a silent timer on your phone as a reminder to get up every 15-30 minutes.  Not only will you create more of a balanced state between your hip flexors and extensors (advantageous for low back pain and running) but you will be metabolically awakening your system, which can help control blood sugar/insulin, as well as weight.

Another way to combat this is by working on your movement pattern and neurological firing to the hip extensors.  If when you squat your knees track forward past your mid foot, you are exhibiting front side dominance.  A good way to work on this is to practice getting into a squat with your toes underneath a chair.  The seat of the chair will serve as a barrier to your anteriorly drifting knees and force you to utilize and fire the gluteus maximus, the main hip extensor and power generator during a proper stride.

In directly addressing the actual tightened hip flexors, a foam roller works well with the quadriceps.  However the psoas (and adductors) become more difficult to release due to their positioning and may take the assistance of a trained practitioner in order to reap optimal results.

(The facial expressions and sound effects produced by patients undergoing the psoas release in our office serves as an attestation as to the necessity of the treatment.)

The front side dominant, tight hip flexor issue is obviously not the end all be all when it comes to addressing any problem a patient may present with, nor are the methods mentioned the complete package for doing so.  However, more often than not, there is some hip flexor involvement with low back pain or lower extremity issues in runners and non-runners alike.  Therefore the suggestions mentioned above are a solid addition to any athlete’s preventative or maintenance program, in order to intelligently reduce the risk of potential injury.

Be well and go get it.

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To Stretch or Not to Stretch

Posted on April 30, 2014 | 2 comments

Pop into most gyms or swing by any race and you’re more than likely to observe numerous motivated souls performing the time honored tradition of stretching.  Starting with the good old days of gym class and continuing well into organized sports, stretching became ingrained in our minds as a necessary, injury preventative task suitable for pre and/or post activity.

But is this alleged work out staple really beneficial?

Could it actually be hindering our performance?

If so, is there a better alternative?

First off, let’s look at the most basic goal of the static stretch.  (Static stretching refers to getting into a position that elongates some aspect of the soft tissue, and holding it for some duration of time.) Outside of general habit, people tend to resort to stretching when they feel tight.  If this is the case, the goal of the stretch would be to “loosen up” by way of elongating tissue.  However, studies have shown that in order to actually physically lengthen the muscle by way of static stretching it must be held for 3-5 minutes, 4-6 days a week, for 10-12 weeks.

Moreover static stretching actually diminishes blood flow to the area being stretched.  We don’t want this when dealing with an injured or injury prone tissue that requires the oxygen and repair mechanisms delivered by blood.  And we definitely don’t want this when preparing to participate in an event where the muscles being utilized require any type of stamina or endurance, of which is metabolically maintained via utilization of oxygen that is delivered by, you guessed it, blood.

From a neurological standpoint, static stretching actually diminishes feedback to the central nervous system, especially to a part of the brain known as the cerebellum.  This is a part of your brain that is highly involved in motor coordination, balance and proprioception (having a sense of where your body parts are in space when not looking at them); a part of your brain that you want to be on point at all times, but especially when engaging in any type of activity.  Slower activation and reaction times, decreased coordination and balance all add up to subpar performances and increased likelihood of injury.

So what other options exist?

Well, you can start by implementing dynamic stretching as your warm up.  This would include movements like walking lunges, “butt kickers,” air squats, shoulder circles, etc.

WALKING LUNGE:

“BUTT KICKERS:”

AIR SQUATS:

In preparation for any activity a smart move would be to increase blood flow to the region being utilized.  We’re learning that static stretching can actually do the opposite.  However, performing a proper dynamic warm up, including a basic light jog, encourages blood flow, which equals more oxygen and quicker waste removal from the muscles.  It also literally warms up the tissue, many times alleviating that tight feeling which provokes so many of us to stretch in the first place.

So you decide to be proactive and try something different; ditching the static holds and intelligently warming up, yet you still feel stiff, tight and an overall lack of mobility.  So much so that you’re tempted to revert to your old ways and bend over and touch your toes for 30-60 seconds.  Slow down there. We just explained that unless you perform static stretching for an extended time over at least two months, the tissues don’t actually lengthen.  Contrarily this method also diminishes blood flow to the tissue and feedback to the brain.

A better option at this point would be aiming to improve mobility in your tissues.  For various reasons, whether it postural or remnants of an old injury, our tissues lose their full range of motion due to scar tissue or adhesions within the tissue.  When an injury occurs, traumatic or otherwise, eventually your body lays down new tissue in order to repair the damage.  Many times due to various reasons, the tissue does not get laid down in the proper orientation and can lead to a lack of mobility or discomfort within the tissue.

These adhesions or scar tissue can be addressed utilizing soft tissue mobilization techniques.  This includes everything from the foam roller or LAX ball to techniques frequently applied in our office, mainly consisting of deep tissue stripping, Graston and Active Release Therapy (ART) in order to efficiently eliminate these adhesions and restore mobility to the tissue.

It should also be noted that simply applying these techniques to soothe discomfort and restore mobility is only part of the job.  The next stage comes in the form of post mobilization movements.  We like to implement a unique, flowing combination of isometric and eccentric contraction, mixed with PNF stretching to encourage optimal recovery and stability.

The one thing static stretching may indeed supply is a mental benefit, especially if it’s been part of your regimen for years.  At that point it’s more of a habit that many hold on to for dear life, like our toes when performing that awkward hamstring stretch.

However, as new research and information becomes available it should be analyzed and if it makes sense, applied. This holds true for all aspects of health from high intensity interval training to eliminating gluten from your diet.  Even if you are one of the fortunate souls to have skated though an active life unscathed up to this point, if you’ve already made the effort and lifestyle changes to achieve a higher level of health, it would be foolish not implement the latest sound strategies due to habit or sheer stubbornness.

If you’re experiencing stubborn stiffness or tender tightness, or are still suffering residual effects from an injury that should’ve packed its bags and vacated a long time ago, we would be glad to collaborate with you in working towards the common goal of restoring mobility, banishing loitering injuries, and providing you with the tools to enable continued play well into the future.

REFERENCES

Page P. CURRENT CONCEPTS IN MUSCLE STRETCHING FOR EXERCISE AND REHABILITATION. International Journal of Sports Physical Therapy. 2012;7(1):109-119.

Wilson JM, Hornbuckle LM, Kim JS, et al. Effects of static stretching on energy cost and running endurance performance. J Strength Cond Res. Sep 2010;24(9):2274–2279

Nelson AG, Kokkonen J, Arnall DA. Acute muscle stretching inhibits muscle strength endurance performance. J Strength Cond Res. May 2005;19(2):338–343

Behm, D. G., Bambury, A., Cahill, F., Power, K. Effect of Acute Static Stretching on Force, Balance, Reaction Time, and Movement Time. Medicine & Science in Sports & Exercise 2004, 36, 8, 1397–1402.

Comana Fabio. “Debunkning Fitness Myths: Stretching” American Counsil on Exercise 2011, http://www.acefitness.org/blog/1575/debunking-fitness-myths-stretching

 

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Have You Tried Active Release Therapy?

Posted on November 14, 2013 | Leave a comment

One of the most desired and effective soft tissue treatments we utilize at Clarke Chiropractic and Wellness is that of active release therapy or ART.  My Crossfitters swear by this form of therapy and we normally implement it to some degree or another on every patient.

So what is it?

What we are talking about here is a soft tissue technique whereby the practitioner applies pressure in a specific direction to a specific area of an involved muscle or ligament while the patient then moves through a specific range of motion.  You may note by my use of the 3 “specifics” that proper application of this technique requires a thorough knowledge and understanding of human anatomy and the mechanics of all individual muscles.

It goes way beyond simply massaging a painful area, and includes identifying and addressing all other structures involved with the problematic area.

For example, one of the most common problem areas most athletes come in for is the shoulder, and it’s usually due to anterior or front side shoulder pain.  Rather than directing all treatment at the spot of pain manifestation, the entire shoulder complex is addressed, sometimes including up to 10 separate muscles.  The shoulder complex, like many joint complexes in the body is just that, complex; and addressing all of the muscles that contribute to its function is key to not only alleviate discomfort, but to ensure the issue doesn’t resurface.

How does it work?

By taking a specific contact on a muscle or ligament, the practitioner anchors that tissue in place.  Then, by having the patient move through a precise motion (usually taking the tissue from a shortened or contracted position to an elongated or extended position) tension is created at the site of the practitioners contact.

Benefits to this include breaking up adhesions or scar tissue build up that may be causing discomfort or limiting full range of motion.  Having pain is one thing and is usually the reason people come visit us in the first place, so addressing it is always a priority.

But restricted range of motion due to chronically shortened or tight muscles can be the underlying issue behind a multitude of issues, including pain.

Muscles that are constantly tight, contracted or constantly working means they tend to build up lactic acid which causes the perception of pain.  This can also lead to compensatory postural changes and movement patterns in order to continue to function despite the limited mobility.  This can also lead to accelerated degeneration or early arthritis due to suboptimal posture and movements.

Reduced range of motion also leads to a reduction of blood and waste removal from the area.  You see, the heart pumps blood to our structures but the body relies on gravity; more so, movement to return that deoxygenated blood to the heart.  Without proper movement you now open the door for more swelling which can than place pressure on surrounding tissues, causing more problems.

You also need full range of motion to rid yourself of inflammation.  Just as the veins rely on movement to bring blood back to the heart, the lymphatic system (your waste removal system) relies on movement to pump all the nasty, pain- provoking, inflammatory mediators out of dodge.

Another variation of ART we implement is that which incorporates something referred to as “nerve flossing.”  That’s right.  It’s not just for your teeth.  Many times, nerves and other soft tissue can become “stuck” or irritated by adhesions or simply by a tight muscle.

The term “flossing” comes into play because we essentially pin the area where the nerve is presumed “stuck” and then have the patient move in a way that allows the nerve to slide back and forth as the fluoride-free floss does between your teeth.  This method can be quite advantageous for people experiencing a variety of symptoms including carpal tunnel symptoms, sciatic complaints, neck, shoulder, and elbow pain.

These are just some of the benefits of properly applied ART.  We could fill pages and pages with a broader explanation and other benefits.  Feel free to research on your own or give us a call if you have any questions.

As with all treatments, this particular technique serves as a worthy adjunct to the total package of neurologically based chiropractic care and nutrition.  As described in the previous paragraphs, ART can be part of a perfect marriage of healthcare delivery in finding a way to breakthrough to those stubborn aches and pain.

If you or someone you know has been unnecessarily dealing with pain and have tried other methods with limited success, I invite you to call us and try a fresh approach to natural and holistic healthcare.

When you’re ready, I’m here to help.

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