TRIGGER POINT ROLLING METHOD
Trigger point rolling is a term I use when describing rolling soft tissue for recovery and performance. Both the terminology and topic can be somewhat controversial, but I have witnessed many clients benefit from various forms of soft tissue rolling. The truth is nobody really knows what occurs during soft tissue mobilization. There are several theories and for more insight check out Bret Contreras blog. Personally, I believe it is a combination of theories, but I will let the researches and scientist figure that out. My interest is to create a guideline for personal trainers, athletes, and weekend warrior athletes to use as a model for their recovery and performance. My recommendations are based upon helping countless athletes manage injuries over 25 years. More research is showing the benefits of soft tissue therapy, but little scientific research exists on dosage of these techniques. Keep in mind each person and injury is unique and our dosage suggestions are based upon experience.
Located on the back of the thigh the hamstrings are a commonly injured muscle group. Restricted hamstrings can create local pain as well as joint compression and pain in the knee,hip & back. Often, the hamstrings are already taut and stretching may exacerbate the problem. One substitute for stretching the hamstrings is to provide pressure or rolling via a ball, foam roller, stick or Therawheel to the restricted area.
It is important to understand the body works as a unit and one area may affect another area. Restricted tissue is often a symptom and not cause. For example, if your right hamstrings is tight and sore it may be caused by a weaker left leg requiring the right leg/hamstrings to work harder. However the average joe may not be able to figure out the root or cause. Therefore, the symptoms can be a starting point. Personally, that's where I always start when treating myself. But understanding that other parts of the body may cause symptoms and likely need attention is critical.
Assessing how this process works or if it works is commonly overlooked. Often instructions to foam roll are given without any assessment. So how do you know if it is working? A simple solution is to test range of motion or flexibility and even strength before and after rolling. The lay person can test themselves (see video) by perform a stretch before rolling and perform the same stretch after to compare mobility. This is not highly scientific but provides feedback. Maybe you need to roll more, or less. Keep in mind recovery and performance progressions are rarely linear. Some times you take two steps forward and one step back. Thus the need to constantly assess..
Beginner techniques are typically for acute injuries or if someone is new to trigger point rolling. Additionally, some may have issues like back pain that prevents them from getting in certain positions. Beginning positions are non-loading like standing sitting or kneeling and the force is applied by the user. Start by placing a foot on a bench or single knee position on the floor. The stick is a little flimsy and is fairly superficial but it is a good starting point. A rolling pin is firmer and may be a good substitute. Roll back and forth from the hip & knee using various angles by slightly pulling up on one side of the stick. DO NOT inflict pain upon yourself! This is a gentle to mild roll. Start with 30 seconds and progress to 45 seconds after 2-3 sessions. Perform 2-3x per week for week 1 then advance to 60 seconds every other day.
Intermediate techniques intensity increases by using partially loaded methods. Partial body weight is used with this method to produce the force. The hamstrings are difficult to isolate making the foam rollers less effective. A tennis ball may be to soft or small so we recommend starting with a softball. While it is firm the size disperses the load. In the pin & stretch technique place the ball between bench or chair and rest back of leg on the ball. Keep the back of thigh on the ball and slowly lower foot to floor then raise foot bending at the knee. Position the ball in various areas identifying and focusing on the most restricted spot. For the first week perform 8-10 slow repetitions in each spot, every other day. Progress to more repetitions (12-15) daily.
The advanced level is commonly used for chronic injuries and people who are very familiar with rolling. The body weight produces the force in these full-load bearing rolling and pin & stretch techniques. I rarely use the foam roller for hamstrings because the force is typically not enough. A firm medicine ball is an excellent start progressing to targeted smaller balls like a softball or lacrosse ball. The Therawheel is very focal and penetrates rather deep to the trouble spot(s). Long or short rolling techniques are used as well as pin & stretch techniques. Similar to other levels start every other day with fewer repetitions (8-10) or shorter rolling (30 seconds). Slowly progress to daily use and increase the dosage.