Human life involves movement. Movement is behaviour and it is communication. From the moment, we wake up to the moment we go to bed we are moving. It’a an endless array of activity expressed from our nervous system to our neuromusculoskeletal system to order to produce movement ongoing all day long.
Movement can also be a stressor, when we push too hard, when we create injury or just from poor habits, this is why in corrective movement we prepare the body FOR movement and FOR our daily activities, not just exercise. Not doing so can result in an inability for the tissues to efficiently accept, communicate and properly adapt for the load in which we apply, which can result in injury and pain. Most often this includes elements of “self soft tissue rolling.”
This 2 part series was spawned by a recent video circulated earlier this month called “Foam Rolling is NOT Myo Fascia Release,” by Dr. Andreo Sipna, Sports Specialist Chiropractor and Medical Acupuncturist and Manual Therapist out of Ontario, Canada. His findings and approach are valuable to our industry in understanding the difference between rolling for release and actually changing myofascia structure.
In the health and wellness industry we speak of health first, before fitness. Part of this health model is ensuring the layers of our skin, muscle, fascia – all tissue, are ready for life’s movement. One of the trends we have seen over the course of the last few years, has been that of “self myo fascia release,” using rollers, trigger point balls, magic sticks and knobby things of all shapes and sizes.
Research is starting to show that even though self foam rolling and other tools works for movement preparation, and for those who require a little tone reduction, but it may not be the best tool for breaking up scar tissue or for those with significant structure concerns and have excessive mobility issues. Scar tissue that causes adhesion, contractures, and tissue fibrosis, cannot be changed through self means (self administered techniques).
Most often, clients are asked to preform “rolling” before their workout as a warm up, but what is rolling good for? And do they perform it properly? Do they know why they are asked to roll? Is it the right prescription for a client? And is it enough? These are questions that circulate in our industry, where many health professionals have differencing views on whether or not foam rolling can benefit the body.
As is with any debate I look at rolling and how it will benefit movement, it’s two pronged (1) rolling is only as effective as the coach who provides the tool and educates the client (2) are you using these tools to reduce tone, or are using these tools to reduce pain and break down scar tissue? Both of these questions ask you to know the difference between tone/tension and scar tissue/fibrosis.
My place in the debate is this: There is scientific data that foam rolling or “self” myofascia release does indeed, warm the system, release surface tension, and reduce tone, but it is temporary and if a client suffers from chronic pain, has scar tissue or adhesions, it most likely will not be enough to truly break up fibrotic tissue, as a stand alone method. There is also scientific data to say that rollers and trigger points can’t break up scar tissue, it compresses vs laterally shear and therefore, the more effective approach would be hands on treatment. Again, tis is client specific.
Perhaps the best place to start is building from the inside out – a brief look at the fascia and at how scar tissue forms.
Brief Overview of Fascia Layers:
We have the outer skin covering the muscular skin and tissue and between the muscular skin and tissue we have a layer a connective tissue layer, which has been known as the subcutaneous fat layer. However, upon closer examination of this layer we can see that the is made of the scaffolding of fascial tissue, where pockets of fat live. It adheres the skin and the the underlining tissue. This is known as the Superficial Fascia layer.
The complexity of fascial tissue can be simplified into three divisions: fascia superficialis (superficial layer), fascia profunda (middle layer) and deepest fascia (deepest layer). Since fascia is a contiguous interconnected soft tissue, each layer smoothly transitions from one layer to the next. Thus there is no “clear” division between layers.
There is a movement between these layers, which can be seen merely be touching your skin and feeling the bouncy, a gliding effect between these layers of connective tissue and muscle tissue. However, with age, previous trauma or injury or even lack of movement and a sedentary lifestyle, the connective tissue layers can start to become fibrotic or abnormal.
Recently, a video has circulated by Dr. Andreo Sipna outlining that rolling, in fact, is not myo fascia release. Now before we get into that debate, take a quick read below on his findings related to the difference between surface tension and inside tissue tension, in it’s relationship to scar tissue development.
Fibrosis & Scar Tissue:
When the fascial tissue becomes more mature, more dense or restricts normal movement, it becomes stiffer and can form fibrosis of tissue or scar tissue.
This can happen on two levels:
1. Inter layer restriction (via the Inter Sliding : the restriction of movement of the skin, on top of the muscles and fascia themselves.
2. Intra layer restriction: the restriction between the layers of the fascia and profunda within the same bundle, meaning within the same particular layer.
Fibrosis occurs anywhere in the fasica, and it will adhere to different structures and bind them together creating adhesions, contractures, and scar tissue. This limits joint range and mobility, can cause compensation and pain and movement dysfunction.
The tag ling “Rolling is NOT myo fascia release,” has spawned the debate on how we classify myo fascia release and whether or not rolling is a tool to administer for fascia release. Dr. Sipna believes it is not, while others believe it is. There is research on both ends of the spectrum, pro and con. My ideology is to never take sides, but to appreciate both conversations. For the sanctity of this post we will look more at Dr. Sipna’s side of the debate.
The Myo Fascia Release Debate: Continues
When we talk in relative terms, most people will interchangeably use the words “myo fascia release” and “foam rolling or trigger pointing” as soft tissue release techniques. When we discuss soft tissue release, we need to understand that what we need to establish is relative tissue motion between the two layers that are bound together from the scarring or fibrotic change in tissue. The only way to achieve this is not merely through compressing the tissue, but by adding in relative tension and relative movement and in doing so establish afferent motion to start the process of breaking up fibrotic tissue.
In the recent video, circulating social media by Dr.Andreo Spina; his approach outlines the various processes that cause soft tissue injury, in his article written for Canadian Chiropractic, titled “Targeting Fascia.” I have noted his findings below.
“Each fibre, bundle and muscle is encased by fascia. The goal of soft-tissue therapies has never been to tear muscle proteins apart. It has been to remove restrictive scar tissue, or fibrosis. But where does this fibrosis form? Here is a list of the various processes that are known to follow soft-tissue injury:
- Remodelling of connective tissue with lower tensile stiffness and lower ultimate strength;
- Randomized collagen fibre direction and deposition (i.e., fibrosis);
- Inability of collagen bundles to slide easily past one another due to cross-linking;
- Substitution of collagen types with those of lesser strength.”
Compression + Tension + Movement
In other words we must be able to slide these layers over the other, or create motion between two fascia planes we are able to break down fibrosis through afferent motion. Rolling can support better movement in tissue, but it cannot fully break down scar tissue or fibrotic tissue on its own. A great explanation of this can be found in the video titled “Why foam rolling is NOT myo fascia release” by Andreo Spina (Functional Anatomy Video) to conceptualize this, he speaks of the inability for rollers and soft tissue tools are unable to create that relative tissue motion because they cannot grab onto muscle and hold them as muscles and tissue slide past one another and are usually held to trigger point without movement, either passive or active.
His conclusion is that research now shows that when it comes to foam rolling, alternating fascia composition requires a lot longer that simply a stroke or roll over the tissue or skin. Studies show that it requires 2 minutes minimum of tension/load or imparted load in order to cause a fascia release to occur. He goes onto say that these tools are still useful if we want to increase soft tissue healing by causing small amounts of tension, they can have a temporary relief in pin pointed pain, but we cannot consider these tools to take the place of hands on treatment and we cannot have long term changes in fascia composition or release adhesion or fibrosis using rollers or tools of this nature.
My conclusion, after watching this video is that soft tissue release is a very subjective term. He makes great points about the lateral shearing needed to break up fibrotic tissue, but to rule out foam rolling as a technique entirely, I am more on the position of keeping an open mind and giving clients tools they can self manage. Research shows significant progress for reducing tone uses these tools, but again it’s client dependant and how the unique make up of, injuries, past history and current biomechanical factors for make up that client.
When there is significant history with combative sports, structural traumas, high stress and mobility restriction I usually refer clients to an RMT, KMI structural integration specialist or other professionals engaging in applications of hands on treatment. Rolling will only make some temporary gains.
Next week we will look at some great responses to the video post and offer insight into the other side of the debate, which is rolling and self managed myo fascia release tools can be of great benefit.
Food for Fascia thought!
Dr. Andreo Spina, Sport Specialist Chiropractor, Inter. Speaker, Mobility & Movement specialist -creator/instructor- Functional Anatomy Seminars including the FR® & FRC® systems – Video – https://www.youtube.com/watch?v=BnYdzaoMyQ8#aid=P–lv2vjPlQ
“Targeting Fascia,” article at Canadian Chiropractor – http://www.canadianchiropractor.ca/index