Soft Tissue Work for Tough Guys
by Tony Gentilcore, CSCS, CPT
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Tough [tuhf], adjective: 1. strong and durable; not easily broken or cut. 2. capable of great endurance; sturdy; hardy. 3. hardened; incorrigible.
When I see or hear the word "tough," I immediately think back to when I was a kid and I watched Rambo: First Blood I and II for the first time. To me, John Rambo (Sylvester Stallone's character) was the epitome of tough. Not only did he open up a can of whoop ass on a small town's entire police force using nothing but a hunting knife, but he also seemingly took on the entire Vietnamese army with a bow and arrow no less, and won! I guess that's what they get for torturing him with a box spring juiced with electricity.
You want tough? Try eating mice for breakfast!
Honestly though, what man couldn't endure being tortured with electricity? If the "bad guys" were smart, they would have used a foam roller instead.
No, please. Anything but the foam roller!
In their article (link) "Feel Better for 10 Bucks," Eric Cressey and Mike Robertson espoused the many benefits of using a foam roller to help with improving overall soft tissue quality and range of motion. Since that article was released, I've been witness to numerous self-proclaimed "tough" guys breaking down into wee, little girly men when performing their foam rolling. Although, those same guys are now walking around pain free for the first time in years.
Yes, using a foam roller hurts (initially) and can be viewed as a form of torture to some. But one can not argue the plethora of benefits and see the advantages FAR outweigh the disadvantages.
However, as with resistance or endurance training, you also need some form of progression when it comes to soft tissue work. You wouldn't recommend that someone continue to perform three sets of ten for every exercise, or do nothing but walk on the treadmill for a straight year to make progress with their physique, right? So why would foam rolling be any different? While it's a fantastic modality, I find that trainees come to a point where they need something a bit more "focused."
First, a Quick Analogy
I won't go into too much detail (you can click on the link above if you want more), but the best analogy I like to use when describing why foam rolling works so well is by using a band. Suppose I took a regular mini-band and put a knot in it:
Many fitness professionals advocate that all people need to do is perform a series of static stretches to improve range of motion. However, if I stretch the mini-band, all that happens is that the knot gets tighter and tighter (it doesn't go away) and before long, the band will break (either above or below the knot).
This would be akin to someone tearing a hamstring playing slow pitch softball or attempting to perform the "Indrani" from the Kama Sutra. Go ahead and Google it, I know you're going to.
With a foam roller, you will break up all those knots, adhesions, and scar tissue that tend to accumulate over time and not only will you improve range of motion (no more knots), but you'll also improve overall tissue quality as well.
That being said, there will inevitably come a day where the foam roller won't be as "effective" as it originally was, and you'll more than likely have to find other modalities to get the same benefit. Essentially, you need to find something else that hurts.
Time To Get "Focused"
In her book The Trigger Point Therapy Workbook, 2nd Edition, Clair Davies defines a trigger point as "a highly irritable localized spot of exquisite tenderness in a nodule in a palpable taut band of muscle tissue." Where I'm from, we simply call that a knot.
Trigger points exist when the muscle fibers are over-stimulated and are unable to "release" from the contracted state. Interestingly enough, trigger points can be actively painful or could manifest no pain at all unless touched directly (latent trigger point). This "subconscious pain" afflicts more people than you'd think.
Ask someone if they have any pain in their calf, and more often than not you'll get a "no," along with a weird look. However if you were to poke around, I'm willing to bet that you'll find quite a few active trigger points that'll have that same person jumping out of their seat. The next time you're out at the bar, try it as an ice-breaker.
Even more interesting is that trigger points send the pain elsewhere (referral pain). For example, when someone has anterior shoulder pain, it's not because there's an issue with the front part of the shoulder. Rather, the culprit is more than likely a trigger point that's located posteriorly, in the infraspinatus. Someone can do all the stretching they want, but nothing will alleviate the pain in the front part of the shoulder till the real "issues" are addressed in the back: where the problem started in the first place.
Feel Better For One Buck (Ha!)
A tennis ball gives you the advantage of being MUCH more focused with your soft tissue work compared to a foam roller and allows you to really hammer those hard to reach trigger points that you never knew existed in the first place.
Your new best friend
I obviously can't go into detail on the literally hundreds of trigger points that are located throughout the body. Nonetheless, I can elaborate on the more prevalent "trouble spots" that the average weekend warrior should focus on and show you some techniques that I have found to work quite well.
Here's a simple test:
1. Bend forward (as if to touch your toes with the knees straight). Notice the resting position of the hands and how far down to the floor you're able to get them.
2. Now take a tennis ball and simply roll it across the deep plantar fascia on one foot, making sure to be slow and thorough.
3. After one minute, switch and do the same for the other foot. Make sure you roll across the ENTIRE surface of both feet.
4. Now perform the forward bend again and notice your hand position.
Most people (not all) will notice a drastic difference in hand placement compared to what it was at the start of the test. How is this possible?
In his rather exceptional book, Anatomy Trains, Thomas Myers explains the theory that "muscles operate across functionally integrated body-wide continuities within the fascial webbing. These sheets and lines follow the warp and weft of the body's connective tissue fabric, forming traceable 'meridians' of myofascia. Strain, tension, fixation, and compensation are distributed along these lines."
Beginning at the bottom of the foot, the plantar surface (plantar fascia) is often the source of trouble that communicates up through the rest of the line. This line is referred to as the Superficial Back Line:
Superficial Back Line
By manipulating the fascia at the bottom of the feet, you change the status of the fascia all around the body and in a sense, there's a "systemic release" and everything lets go.
The Lower Leg
To me, the lower leg region is a perfect example to showcase the prevalence of subconscious AND referral pain. I've been dealing with a rather pesky left knee issue for close to two years now. I've done everything from taking time off, to doing additional glute activation work, to using slow eccentrics to help promote collagen growth. Nothing has really worked to a great degree.
A few weeks ago, I was in New York City for a seminar and coaxed Mike Robertson into taking a look at me to see if he could offer any suggestions. He put me through several assessments and noticed that my left lower leg was out of whack. And by "out of whack," what I really mean is I can do an awesome Verbal Kint impersonation from the movie The Usual Suspects.
Long story short, he suggested that I start doing some soft tissue work on my peroneals and calves to see whether or not that would loosen things up and give me some relief with my knee. And boy, have I noticed a difference!
My first "session" with the tennis ball on my lower leg was more painful than watching a David Hasslehoff music video. I had NO idea that I had so many trigger points in that area. Needless to say, in the weeks since, I've noticed vast improvements with how my knee feels. And now I walk a little bit more like Kaiser Soze.
Causes: The majority of people are on their feet all day walking, running, climbing, etc. and all these can be seen as repetitive actions that perpetuate trigger points in the peroneals. Also, certain awkward positions like sitting at your desk with your feet plantar flexed (which I do all the time) or sleeping on your stomach with your toes pointed can cause trigger points to appear. For women, wearing high heeled shoes can lead to trigger points.
Treatment: The three peroneal muscles are located on the outer side of the lower leg and run all the way down the fibula. Sit on the floor and place the tennis ball on the outer portion of your lower leg and simply roll on top of it. You'll have to tilt your body slightly to one side to really hit them. Be sure to go slow and when you do come across a tender spot, apply a bit more pressure and then continue on. This probably won't be pleasant for many people.
Causes: Walking, running, and climbing are still the main culprits here. Other causes include:
1. Leaning forward while standing for extended periods of time.
2. Driving without cruise control
3. Wearing high-heeled shoes
4. Foot stools or recliners that put pressure on the calves.
5. Running on sand or gravel.
Treatment: Same as the peroneals, except that you're more focused on the "meat" of the calves. Again, be sure to go slow and deep. When you find a tender spot, apply additional pressure for a few seconds, and then move on.
Because I don't want to make this article an anatomy lesson, I'm just grouping all six hip external rotators into one bunch (the piriformis is the main one, however).
Causes: Inactivity and too much sitting can cause trigger points to develop in this region of the body. People sit all day. They sit in the car or on the train to and from work. They sit while at work. Then they sit and watch television for 3-4 hours every night. [Side Note]: unless you're watching a "24" marathon, there's no reason to be watching television for 3-4 hours straight.
Treatment: Take the tennis ball and sit on one of your butt cheeks with a slight tilt and find your hip rotators. If you need a point of reference, try to find the boney prominence of the greater tronchanter (hip). Trust me, you'll know when you "hit" it, because it will hurt. From there, just play around with the angles and roll over all the bumps you come across.
You can also make this a bit harder by crossing your leg onto the opposite knee. Doing so will place the hip rotators on stretch and be A LOT more painful. It will take some getting used to, but it's very effective.
Tensor Fasciae Latae
Causes: This is another area that is afflicted by too much sitting. When you sit, the TFL is put into a shortened position and is unable to "relax." Additionally, people who are overweight tend to put a lot more stress on their TFL compared to people who aren't overweight.
Treatment: The TFL is one of those muscles that's hard to find and it takes a little practice to get it right. To help, simply place your finger on the boney knob on the lateral aspect of your hip.
From there, shift your weight from leg to leg and you'll find that the TFL will contract and relax.
Place the tennis ball on the floor and then lie right on top of it where you felt the muscle contract. You'll need to tilt your torso to one side slightly in order to get the right spot.
I want to make a brief comment. When it comes to foam rolling the thoracic spine, most people do it wrong in the first place. Unless you get the scapula out of the way by hugging yourself, you really limit the effectiveness of the movement.
That aside, the thoracic spine is another prominent area for trigger points.
Causes: Postural stress. Couches, chairs, computer desks, walking with slouched shoulders, etc. have a tendency to reinforce many of the aberrant motor patterns that lead to a kyphotic posture (rounded shoulders).
Treatment: I stole this movement from Mike Boyle and it involves a little bit of "MacGyver" savvy.
Take TWO tennis balls and tape them together with athletic tape like so:
The space between the two balls allows for just enough space for the spine itself to rest in, while you apply pressure on the trigger points around it.
1. Place the balls on the floor so they start on T-12.
2. Sit on the floor and then lie back with the balls under you and perform a modified curl-up so that they apply just enough pressure on the spot and hold it for a few seconds.
3. Remove the balls and repeat the same process until you go all the way up to T-1.
***I should note that if you have back issues, please confirm with your doctor before attempting this exercise.
Again, I don't want this to turn into an anatomy lesson, but the rotator cuff muscles consist of the supraspinatus, infraspinatus, teres minor, and subscapularis. Trigger points in this area are often the most frequent cause of shoulder pain. That, and the fact many trainees still continue to bench press three times per week, but I digress.
Causes: One time incidents of extreme exertion can lead to trigger points developing. But more often than not, it's repetitive strain such as working with your arms overhead for long periods of time (painters, pole dancers), typing at your computer with no elbow rest, or keeping your hand on the mouse out to one side for extended periods of time can cause chronic shoulder pain.
Treatment: The subscapularis (not shown) is pretty much impossible to get to without going to a deep tissue massage therapist or to an Active Release Therapy (A.R.T). practitioner. However, the superficial rotator cuff muscles can be worked rather easily using a tennis ball.
This is yet another movement I got from Mike Boyle and it mimics the concept of A.R.T to a degree. The premise of A.R.T is to find abnormal tissues by evaluating the texture, tightness, and movement of muscles. Once an abnormality is found, the practitioner treats you by combining precisely directed tension/pressure with very specific patient movements.
Find a spot between the medial border (infraspinatus) and the lateral border (teres minor) of the scapula and place a tennis ball between that spot. Now to make things a bit more interesting, internally and externally rotate your arm while the ball stays fixed on that one spot. You're now essentially doing a poor man's version of A.R.T.
Something to Consider
A few weeks ago, I was at a seminar and during one of the practical sessions, I came across the Thera-Cane. Outside of looking like something I would have used as a toy-gun when I was little, it is one of the best tools I've ever come across as far as soft tissue modalities are concerned.
Consider this a "progression" from the tennis ball. You can do the majority of movements I explained above, but with MUCH more focus. And you get the added benefit of leverage. Getting to the rhomboids, levator scapulae, upper/lower traps, etc. has never been easier. Since I received mine, I'll sit there while watching a movie and just play around with it and hammer away at all my trouble spots. If you're interested in purchasing one, go HERE.
So Tough Guy, Have You Had Enough?
By now, I think I've inflicted enough pain on the masses to last awhile. If you're not already using a foam roller to help improve tissue quality, you need to be doing so.
I can't stress enough how much it can help. Conversely, if you've been using a foam roller, I'm willing to bet it's time to take it up a notch. Similar to resistance training, the body needs some form of progression when it comes to soft tissue work.
If you've been suffering from nagging injuries for any length of time, I have full confidence that implementing the movements suggested above into your regular routine will go a long ways in terms of offering you relief that you never thought would be possible.
Not bad for a buck, eh?
About the Author
Tony Gentilcore is a certified personal trainer and strength and conditioning specialist (CSCS) through the NSCA. Currently residing in the Boston area, his expertise lies in body recomposition, program design, and nutrition as well as educating his clients on the best and most efficient ways to obtain their goals. He can be contacted at firstname.lastname@example.org.
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