Posted by Stephen Messineo on Fri, Apr 30, 2010 @ 03:43 PM
Our muscles produce movement through the generation of force as they contract. Muscles take on many different shapes sizes and capabilities, but one thing that they all have in common is the way that they react when injured.
Damaged muscles release chemicals that cause pain which alerts the body to the stress placed upon it. Scar tissue forms around the injured area in an attempt to heal the damage.
Despite the body's remarkable ability to detect injury and heal itself, the system is not without inherent faults. The chemicals which are released during injury can accumulate and cause lasting pain. The newly forming scar tissue is less organized and less elastic than the original(1).
It is possible to facilitate a more efficient healing process through the use of soft tissue mobilization. In doing so you can return from injury more quickly and as strong as before with less risk of re-injury.
The use of foam rollers is an excellent way to help treat injured muscles; it is extremely effective and becoming more and more widely used by our patients.
A foam roller is a firm foam log about 15cm in diameter and 1.5 meters long (the black tubes you may have seen in our clinic). It can be used for a variety of exercises which help stretch the body and activate the core, but it is arguably most useful for the massage like effects it can produce on muscles.
The foam roller can be used to produce a massage like affect; you lie on the roller with the affected muscle(s) on top. Slowly rolling over the target area using body weight to produce force mobilizes the soft tissue in much the same way that a massage would. In the picture to the right, the foam roller is being used to massage the person's hamstring muscle.
Effects of foam rolling on injured muscle
The major benefits of foam rolling on injured muscle tissue are twofold:
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Increase in local blood flow
Chemicals, toxins and debris that surround the injured area can be cleared and flushed away via increased blood flow to the area. This debris is often a painful stimulus when collected in one place so by clearing it, we can reduce pain and discomfort.
We need scar tissue to form in order to repair the injured area; however this scar tissue has a tendency to become excessive, tight and immobile. Rolling to break down fibrous scar tissue increases the flexibility and pliability of the muscle.
Precautions of Foam Rolling
Mobilizing an injured muscle too soon could be detrimental; rolling too soon might risk re-injury or excessive scar production (2). Injured muscle needs a little time to form scar tissue and actually begin to ‘knit' the injured areas back together. 48-72 hours is usually enough time for the scar tissue to form without it starting to become too tight.
When used correctly foam rolling will help to maximise recovery from a muscle injury, it can be used instead of, or in addition to physical/manual therapy. The use of a foam roller to aid recovery from muscle injury should be based on an accurate diagnosis; you should always seek professional advice if you are unsure.
References
1. Kolt, G S and Snyder-Mackler. Physical therapies in sport and exercise. 2nd Edition. London : Churchill Livingstone, 2007.
2. The effect of early mobilization and immobilization on the healing process following muscl injuries. Jarvinen, M and Lehto, M U K. 1993, Sports Medicine, Vol. 15, pp. 78-89.
Posted by Stephen Messineo on Mon, Apr 05, 2010 @ 07:33 AM
The successful treatment of any injury depends not only on resolving the presenting problem but also addressing the factors which contributed to the cause of the problem. In order to do this the clinician must look towards the kinetic chain to understand where the problem might have come from.
What is the kinetic chain?
The kinetic chain referrers to a biomechanical model of movement; segments or joint of the body work as a whole to achieve motion. This chain of movement transfers forces from proximal (near to the body) to distal (away from the body). For example when kicking a football the kinetic chain of movement passes from the trunk through the hip, to the knee, onto the ankle and then is transmitted through the ball as it is struck by the foot. They say that a chain is only as strong as the weakest link, this is certainly true here. Any disruption to the kinetic chain, i.e. if one body part is not functioning normally, will mean that it places stress/strain on the other segments which will ultimately result in injury.
Consider the example of a tennis serve; an activity which uses the upper limb. The kinetic chain of the upper limb is as follows:
How can the trunk and shoulder cause problems at the elbow?
If the shoulder is not able to fully rotate inwards, then the wrist will have to compensate in order to get the racquet face to the ball at the correct moment (1), this places undue stress on the tendon which is likely to develop into injury if this pattern is repeated.
The Kinetic Chain and Tennis Elbow
The pain around the outside of the elbow joint that is associated with lateral epicondylitis (tennis elbow) develops when there is an abnormal level of stress on the tendon of the wrist extensors which attach the forearm muscles to the lateral epicondyle of the elbow. Issues surrounding the trunk and shoulder can be the cause of this undue stress to the tendon.
Rotator Cuff and Mid Thoracic Strengthening in the Treatment of Tennis Elbow
The rotator cuff consists of the tendons of 4 different muscles: Infraspinatus, Teres minor, Supraspinatus and Subscapularis. These muscles are responsible for providing stability at the shoulder by drawing the head of the humerus (arm bone) towards the glenoid fossa (socket of the shoulder joint). They also produce rotational movements around the shoulder. When strengthening around the shoulder the articulation between the scapula, ribs and thoracic spine (middle back) cannot be forgotten. The muscles around the middle back and shoulder blade work to extend the thoracic spine, and tuck the shoulder blade in towards the rib cage. This serves to place the glenoid fossa into its optimum position for movement of the shoulder.
By stabilizing and generating force within the first two links; it is possible to improve the efficiency of the kinetic chain, thus, helping to not only remove the stressful stimulus that may have caused the elbow injury, but also to prevent further problems in the future.
References
1. Occult periarthrosis of the shoulder - A possible progenitor of tennis elbow. LaBan, MM, Iyer, R and Tamler, MS. 11, 2005, American journal of physical medicine and rehabilitation, pp. 895-898.