tissue

Why Compensate: The 4 Types of Tissue Compensation

Why Compensate: The 4 Types of Tissue Compensation

imagesCAK79GHC1.       Tissue Tightness, Tension & Tone:

The four corners of the dreaded “T.” Tightness, tension and tone often become interchangeable when discussing a lack of mobility in tissue, yet they are vastly different things bio mechanically.

  • Tension: Whenever you train a movement pattern, the tissue (muscles and fascia) retains the tension generated by the degree, direction, range and load and is specific to the tissues used.
  • Tightness is usually determined by a lack of tissue length. Take the hamstrings for instance; during the (ASLR) active straight leg raise screen if a person scores a 1 or 2 actively, we then check the muscle length through the passive range. If the client till cannot straighten their leg or score higher; we can assume the hamstring tissue is tight.
  • Tone: However, if the client has improved range in the passive hamstring test, and can indeed reach the optimal 70 degrees, then this is most likely not a muscle length issue, but one of too

much tone in the tissue (tightness in the resting state of muscle) and a lack of motor control.

2.       Myofascial Restriction/ Density:

Deep fascia are layers of dense fibrous connective tissue that interpenetrates and surrounds muscles, bone, nerves and blood vessels of the human body. It provides connection and communication in the form of tendons, ligaments, aponeuroses, retinacula, septa, and joint capsules. It encompasses bones and nerves and is the nervous systems transportation highway.

Our fascia also has the capability to initiate relaxation. Deep fascia can relax rapidly in response to sudden muscular reaction or rapid movement, this ensures that the tissue does not tear and limitis end range response. When we neglect to release residual tension from our fascia, the pre-tense tissue lays down collagenous fibers to make it easier to maintain, which substitutes for muscle activation. It is this collagen which gives it it’s strength and integrity, but when there is an increase in tension the fascia bag increases in thickness as a counter measure to limit movement and effort. Thus resulting in compensation. This diminishes mobility.

3.       Sensory Motor Amnesia/ Motor Control:

Sensory Motor Amnesia (“SMA”) is a term introduced by Thomas Hanna, the inventor of Somatics.  SMA occurs when inefficient patterns of muscular activation become so habitual you can’t sense or control them due to the nature of habit. For example, those who have desk jobs or spend many hours seated often struggle with neck and shoulder pain. Part of this is because of the nature of their job and thus have forgotten how to relax tissue such as the neck, low back and shoulders, and thus we often see a concurrent concern with the inactivity of engagement or how to activate muscles like the glutes or “core.”

This leads to weakness, inefficiency, poor coordination and eventually pain.When tissue can’t move through a particular range or degree of direction, our connective tissue/ fascia web adapts and reacts by reducing biofeedback and innervation of the tissue. This means less of the muscle is activated and less of the nervous systems signals make it to the desired tissue to result in the desired movement pattern. If left dormant too long, the tissue can start to develop protective mechanisms to avoid any and all movement. This can result in bio mechanical compensations and dysfunction, which can lead to injury.

Somatic Yoga and Corrective Movement are two modes of rehabilitation which have showed significant success and are designed take your body goes through all the subtle little movements you have unconsciously avoided for years. It takes precise concentration and attention to recover them without “cheating” or deviating into a compensatory pattern.  After the movement is recovered, it is integrated back into your movement patterns, leading to increases in performance and reductions in pain.

4.       Fear – Reactivity:

This is a great term, which I first came across in Scott Sonnon’s TacFit course. It relates to the tissue’s inability to recover and recoordinate itself to its true resting and activation state. It’s defensive in nature, where muscles and tissue develop measures to protect itself from moving into an unknown, dormant capacity. Tissue will react by bracing, shaking, flinching or freezing because of the fear associated with long term forgotten movement potential. Our muscles can then start to atrophy, adipose tissue can accumulate and our fascia can thicken. Compensation can come in the form of pain, injury, increased tone or inability to move as you once could. This fear then becomes embedded in the muscle memory system and can be more than just a physical issue, but then a mental and emotional one as well, which could lead you to not pursue your goals or aspirations.

All 4 of these compensations must be carefully monitored. We must stay under the radar of the signs so that we can counter balance and not reinforce compensatory patterns. The more we move, the better we feel and the more we see not just our gym time, but our profession, our daily activities as “movement” as well the easier it will be to provide functional balance to our integrated system.

Don’t Let Your Tissue Get Uptight:  Tone Vs. Tightness

Don’t Let Your Tissue Get Uptight: Tone Vs. Tightness

tone 2

As a movement coach, the question of “what is the difference, between tone vs tightness” is a common occurrence and one that is of significant importance to those who suffer the burden of chronic pain and compensatory dysfunction. To better understand, not only the difference, understanding how to identify the different are key factors that can make or break your intervention strategy.

First order of business is looking at the tools for assessing and screening dysfunction and compensatory movement:

The FMS and SFMA:

The FMS and SFMA protocols are tools used to capture movement dysfunction at the level of the pattern and then address whether the limitations are mobility, stability or motor control based. On average many practitioners often attribute “tightness” as a lack of muscle length or “weakness” to muscle inhibition like having “a weak core” or “weak glutes.”  Now, they would not be wrong in their conclusion, but this is not the be all and end all. It’s only one piece of the puzzle and the puzzle (your body) has many moving parts that work together to give you performance output and synergistic movement. Now, the SFMA is only used by clinicians, therefore, my form of screening, is more an overall postural screen, luckily working in an integrated model, allows me to refer to a physiotherapist or most often the initial functional assessment has already been performed… now, I just want to see the client move through my own lens.

Our first role is to demonstrate how your muscle acts in association with the connective tissue, the nervous system etc and then also address how perhaps glute weakness affects a movement pattern, increases tone, redistributes engagement to other muscles; which in turn causes compensatory movement and tone.

Through this protocol we can go through the body like a checklist of the many imperfections we all carry on a day to day basis, or we could try to discover each individual’s major dysfunctions so that we can remove these negatives to uncover our strengths.   Corrective intervention and a well-designed strategy is crucial for improvement, doing more of any exercise; corrective or other, can result in more pain if we do not address the full scope of limitations. If they could do more, they would, but most often pain is a limiting factor… and they can’t.

aslr

The ASLR:

Let’s take the ASLR drill as an example of addressing the vast difference between tone vs tightness.  During the FMS Screen and Y balance tests I will be able to identify the largest area of need, and most often in new clients with or without pain, the shoulder mobility (SM) and active straight leg raise (ASLR) are the two most often needing corrective intervention. The ASLR is also most often the starting point for the discussion of tone vs tightness.

Depending on your scope of practice, if you work in a clinical setting  like in rehabilitation, you can apply a manual intervention, by mobilizing or manipulating  a joint or you could apply soft tissue work either with our hands or tools; like the foam roller or magic stick, or if you are an RMT, FST or KMI practitioner you could provide deep tissue work into the muscles or on the fascia. You might use needles to do a musculoskeletal technique called trigger point dry needling, like in IMS or Acupuncture. Or if you are a personal trainer or movement coach, hands on technique may not be in your skill sets; therefore, educating the client and using corrective intervention is where your path for this client starts.

Let’s break down the screen first. Let’s say I deduce that Mr. Smith has the following:

  • D/S (deep squat) – 2
  • H/S (hurdle step) – 2/2
  • In/L (inline lunge) – 2/2
  • ASLR (active straight leg raise) – 1/1
  • S/M (shoulder mobility) – 2/3
  • TSPU (trunk stability push up) – 2
  • R/S (rotary stability) – 2/2
  • Spinal ext. – clear
  • Spinal flex – clear
  • Impingement test – clear
  • Total: 13 out of 21 (no pain, but a lot of discomfort)

To see the ASLR test, please watch this video:

From the basic screen we can see that Mr. Smith has alright movement, but is lacking in some areas and exhibits a low score of 1’s in his ASLR and an asymmetry in his S/M.  I see a lot of athletes and clients that have discomfort and limitations, yet overall do not score too badly on the FMS. The question then becomes why? From here I would then want to clear the spine and take a deeper look at Mr. Smith’s lowest score and asymmetry. This will include what we call “clearing” the spine and active vs passive testing.

I first start with his ASLR. I know that he cannot reach optimal range on his own, which is a minimum of 70 degrees in the leg lift. Therefore, I test this passively by assisting him. If I can take that leg through a larger range of motion and reach a 2 or 3, most often this is a motor control issue, not lack of hamstring tissue length. If I cannot then it’s certainly mobility and leg length. Sometimes genetics and structural elements can play a role, but I work with a lot of clients who do not have a tightness issue – its tone and motor control. That is 1 part physical and 1 part neuroscience. Motor control is in the brain and we know that Mr. Smith has poor motor control’ therefore, what are our next steps?

We could have a certain degree of muscle atrophy. We could have uncoordinated muscle behavior. We could have increased tone. We could have residual trigger points. What we have to do is identify, What are those motor control and movement limitations? What are the problems with mobility and stability?

tone 1

What is Tone?

Let’s focus in on the tone. In physiology, medicine, and anatomy, muscle tone (residual muscle tension or tonus) is the continuous and passive partial contraction of the muscles, or the muscle’s resistance to passive stretch during resting state with a reduced range of motion in active engagement. Tone isn’t bad, but in excess it can limit mobility, stability and power output. When stretch occurs, the body responds by automatically increasing the muscle’s tension, which is ultimately, a reflex which helps guard against danger as well as helping to maintain balance. It helps to maintain posture and declines during REM sleep when that “alarm” of protection is somewhat shut off.

Tissue that has an increase in tone, can be known as hypertonia; which can present clinically as either spasticity or rigidity.

Spasticity is velocity-dependent resistance to passive stretch (i.e. passively moving a leg quickly, like the kickoff in football will elicit increased muscle tone, but passively moving the leg, like in the ASLR slowly may not elicit increased muscle tone). Spasticity can be in the form of increased resistance only at the beginning or at the end range of the movement.

Rigidity is velocity-independent resistance to passive stretch (i.e. there is uniform increased tone whether the leg lift is passively moved quickly or slowly).That sucker ain’t going anywhere. Rigidity can be of the stiff board, or the resistance to passive movement is in a jerky manner.

We must also take into consideration tissue contractures, adhesions, scar tissue and past injuries or structural concerns.

Getting back to Mr. Smith, I now know that Mr. Smith has tone in the ASLR and as an intervention I ask him to foam roll his posterior line (back, lats, glutes and calves), maybe even use a little magic stick). This also will tell me where he has trigger points and an increase in “whoa nelly” that’s the spot, discomfort or pain.

We then re screen his ASLR… and there is an improvement, but we know that this won’t stick. This is a great way to educate the client on the connection between the brain –to-muscle connection, but also the relationship of the fascia and nervous system in connection with the muscle-motor control arena.

To gain a deeper perspective and larger picture, I would also screen Mr. Smith’s spine, clearing the cervical in flexion, extension, lateral flexion and then the whole spine in flexion, extension, lateral flexion and rotation, as well as thoracic mobility. The spine plays a significant role in ASLR patterns, as does the thoracic spine. Most often if the ASLR, the shoulder’s and spine will offer us more information on a client’s motor control and integration of their nervous system and fascia systems functionality, but for the sake of this article, we will just use the ASLR as an example of tone vs tightness.

Corrective Intervention:

By rolling and applying soft tissue release, allows us to free up space and by moving those segments completely changes the neuromuscular support around that joint and associated joints. It will most likely also free up some muscle tone and allow you to move through your spine and lower quadrants a little bit better. This is still without suggesting corrective exercise as of yet, now it’s time to focus on the active part of the intervention strategy. This is merely “protective” not yet “corrective. “Protective measures keep you from getting worse, but may not make you better. Corrective measures actually work toward helping you foster or start the reset process yourself.” – Gray Cook

From this point forward, I will assign a few key corrective exercises for the client to perform on their own 1-2x per day, and will also offer  a sequenced set of mobility movements to either prepare the client for daily life and/or sport, as well as a decompression set of movements to be performed at the end of their day or sport. This program is under 20mins, so that it’s time efficient.

At the end of that, we should see an appreciable change in something we measured. Below is a short sequence I use for clients with increased tone and low ASLR score.

Video on the ASLR correction:

Start: Screen ASLR

Corrective #1: 5 mins of breathing: diaphragmatic strengthening to re-engage posterior diaphragm. Recruiting the diaphragm and mechanics of the breath lowers anxiety, and connects the nervous system to the tissue, as well as biochemically releases chemicals to release and relax tonic tissue.

Soft Tissue Release: 5 mins of soft tissue release; including, foam roller, magic stick and tennis ball

Mobility Sequence:

  • Quadruped spinal rolling (cats flow, with emphasis on spinal waving)
  • Side cats flow (variations on exploring range)
  • Lumbo Pelvic facilitation: supine pelvic tuck and tilt with bridge pattern rolling
  • Bilateral hip rotations with legs crossed (TFL, ITB, lateral line and ribcage)

Corrective #2: Upper and lower body rolling pattern (unassisted and assisted)

Corrective #3: Leg Lowering Pattern (PNF, leg lowering 1 and 2)

Corrective #4: Hip Flexor Stretch with core assist to free up anterior line

Corrective #5: ASLR with core assist to recruit trunk and connect shoulders to hips and trunk to pelvis.

Re Screen ASLR: improvement in screen

Decompression:

  • Repeat mobility sequence (keeps it easy for the first set of notes)

  • Add in Rib pulls or thoracic rotations for good measure – we could all use more of that.

This would then be the clients homework for the next 2 weeks, and each session we work together, I progress or regress as needed. It’s also important to move clients from primitive patterns to foundational patterns, especially if they train with a strength coach or an athlete. Grooving the hip hinge and addressing single leg stance is usually on my session roster with a client so that they can see the long term picture of where and when these corrective exercises can improve performance overall.

To learn more about the FMS and Corrective Intervention Tools feel free to visit our website at www.fittotrain.com or http://www.functionalmovement.com/

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