Yet, before introducing the self-rolling progression system it is important to understand some basics about manual therapy. Even though we don't know what is occurring there are multiple sound theories based upon fundamental scientific principles that many clinicians refer to. And many of these clinicians vehemently debate these theories on what is changing and how. Is it fascia, muscle, nerves or all of the above? Personally, I think it is a combination of all. However, the take away is nobody truly understands what occurs when we massage, rub, twist, prick, roll or pin & stretch soft tissue.
Further complicating the topic is the lack of cohesive terminology used by various methods and practitioners. For example, trigger point release, myofascial release, foam rolling and soft tissue mobilization are just a few terms describing essentially the same thing. I prefer the term soft tissue mobilization because muscles, ligaments, fascia, nerves are all forms of soft tissue. However, many, especially consumers are more familiar with the popular foam rolling and trigger point terms. Therefore, for consistency and simplicity I've chosen to use the term trigger point rolling (TPR) because many consumers recognize the term trigger point and rolling includes not only foam rolling but also ball and hand-held rollers.
Anecdotally many clinicians, including myself, recognize TPR methods help. Unfortunately, there is limited research available but thankfully that is beginning to change. Chris Beardsley of the Strength & Conditioning Research blog provides some of the latest research on the topic of foam rolling. During my twenty-five year career I have used and seen many forms of self-rolling help patients. However, I believe a better system for progressions is necessary for safer and effective techniques for self-care.
Most coaches and clinicians follow a progression system with training athletes and rehabilitating patients. Within a season and practice, a track coach likely starts with easier workouts and progresses to more challenging and difficult workouts. Similarly, in rehabilitation patients usually are not allowed to progress until they demonstrate proper form and function with their exercises. The same should hold true for TPR.
Rolling the iliotibial band (ITB) on a firm foam roller is a common starting point for knee pain recovery. But, why is the hardest and most painful technique commonly recommended first? Unfortunately it's become ubiquitous probably because it's easy to demonstrate and recommend- there isn't much of a thought process to it. I am guilty of starting clients on the foam roller to roll their ITB. However, over the years I recognized many of my clients could not tolerate it or would not comply. Others, didn't have the upper body strength to roll while some couldn't get on the floor because of issues like back pain. Thus the process of using alternative tools, methods and techniques for clients began.
The TPR system was developed to provide clinicians and patients with a safe and effective systematic progression for injury recovery. The beginner level starts with utilizing balls or hand-held rollers in a non-loading position like standing. The force is applied by using the hands to roll rollers or a ball over the restricted region. These techniques are most commonly performed in standing,kneeling or sitting and are best for acute injuries or when the patient has other limitations. The intermediate level utilizes partial-loading positions. These techniques require users to partially apply body weight as a force. For instance, using a wall or chair between the roller and body part for micro-rolling or pin and stretch techniques. The amount of pressure applied is controlled easier with this technique. These techniques can also be used in various positions like standing or sitting on the floor or chair. The third level or advanced levels is the full-load position. In this technique full body weight is used as the force and is performed with chronic injuries. Users typically lie prone, supine or side lying on a ball or roller for rolling and pin& stretch techniques.
While many clinicians likely already use some type of progression, many do not. Our goal with this method is to influence therapists, ATC's and personal trainers to consider more appropriate applications of TPR for their clients. One size does not fit all, and not everybody should be rolling on a foam roller. Stay tuned for more specific ideas on the knee and hip. For more more information on trigger point rolling and techniques visit our website www.therawheel.com
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