There are many modalities and methods that can be used when it comes to recovery and treatment of an injury. The main goal when it comes to recovery is to provide the right amount of circulation to the affected area to supply it with new nutrients to stimulate growth and repair of damaged cells as well as improve range of motion and function to the area. What this article is going to aim to do is provide knowledge and insight on some of the most common forms of therapy so that anyone can make the best possible decision when it comes to picking which modalities they feel will benefit them the most. Now, as a rehabilitation specialist, I personally am unable to perform some of these methods myself, but the ones I have performed I will also provide my own personal experiences with using them as a professional.
The first therapy method we will look at is probably the most common. This would be foam rolling. Foam rolling, also termed self-myofascial release, is done using a foam roller or some other cylindrical device. I have used a PVC pipe for the longest due to the major price difference (~$40- ~$5) and the difference in longevity. This can also be done with smaller devices like tennis balls or lacrosse balls. First we must understand what the kinetic chain is. The kinetic chain is made up of the soft tissue system (fascia, collagen), neural system (nerves and CNS), and the articular system (joints). This chain works together as a unit and all components exist interdependently, meaning that if one is not functioning efficiently, then the others will compensate, which leads to overload, fatigue, faulty movement patterns, and then eventually injury. Let’s first discuss what fascia and collagen are. Fascia, or the tissue we are trying to target with these techniques and tools. Fascia is the termed used for the connective tissue covering of most muscles. I often analogize it with clients as saran wrap covering a piece of meat. The tissue fulfills many structural and chemical functions and is responsible for the freedom of movement possessed by human beings. In a nutshell, it keeps everything where it needs to be and it helps us be able to perform daily activities. Collagen on the other hand, is the primary structural component of fascia. You have heard me discuss collagen and the benefits of ingesting collagen and collagen formulating foods in other publications. Collagen protein is designed to primarily resist tensile stress and is what makes up skin, tendons, and ligaments.
Collagen actually changes fiber density and arrangement based on different stresses to the structure, tissue memory, and genetic make up. This tissue is proportionally stronger than steel cable and is arranged in such a way that allows for maximum distribution of load with minimal framework. Foam rolling does not actually affect collagen at all. In a normal, functional musculoskeletal system the fascia supports the free movement of our muscles during the daily activities that we participate in and when the tissue becomes dysfunctional it can change and cause a great deal of discomfort, pain and movement restriction. The nervous system comes into play via two neural receptors located within the skeletal muscle tissue called muscle spindles and golgi tendon organs. Muscle spindles are located parallel to the fibers of the muscle and record changes in fiber length, and rate of change to the CNS. This will trigger the myostatic stretch reflex, which shortens muscle tissue, alters the normal length-tension relationship, and will often cause pain. Golgi Tendon Organs are located at the musulotendinous junction and are responding primarily to changes in tension and rate of tension change. Stimulation of the Golgi Tendon Organs past a certain threshold inhibits the activity from the muscle spindles and will often decrease muscular tension in a phenomenon called autogenic inhibition. I see foam rolling done often incorrectly and ineffectively. Optimal self-myofascial release needs to be done so that this autogenic inhibition can occur.
How I often instruct individuals to classically foam roll is to use the roller as a tool to locate the trigger points and other extremely restricted areas within the muscle. Using the roller, apply pressure to that spot for 30-45 seconds and allow the body to send signals to the receptors instructing the golgi tendon organs to autogenically inhibit the muscle spindles (continuing to roll when there is pain will activate more muscle spindles, causing more tightness and pain). This reduction is tension will often decrease pain, improve function and restore optimal muscle length-tension relationships. In my opinion, foam rolling can also benefit from a circulation standpoint because the friction caused by the foam roller moving back and forth on the connective of the muscle will raise and separate from the muscle, thus inducing increased blood flow to the area, stimulating more recovery.
Deep Tissue Massage
Deep tissue massage is another very common therapy method. This is usually done with the guidance of a therapist or qualified professional. The same mechanism is working in deep tissue massage as in self-myofascial release. The only difference is that deep tissue is done with the help of someone else. When the professional applies pressure to the trigger point, the technique is working with the sensory receptors within the muscle. I use deep tissue massage frequently and the benefit that I apply to it is that the individual can relax during the treatment. Often afterwards they are tired and this is because the nervous system is able to be completely suppressed. When the muscle gets to much activation, the nervous system is sending a lot of stimuli to the area, causing over activity. The tired feeling is often a good thing, in my opinion.
Cupping is a very popular form of therapy that has gotten a lot of attention in the rehabilitative world since the demonstration of its use during the 2016 Rio Summer Olympics. Cupping has been around for centuries, going back to ancient Chinese medicine during 300-400 A.D. This method has also been seen in Egyptian and Middle Eastern cultures. So what is this method of therapy that leaves these red rings on the body? Also termed myofascial decompression, cupping involves suction cups that are placed on the body in various spots where the problem is originating make these rings. The suction draws stagnant blood to the surface of the skin and can help improve blood circulation through the tissues. This increased circulation can help speed up healing, reduce pain, and improve muscle soreness. Cupping has been associated with helping relieve other conditions as well such as chronic neck and shoulder pain. Cupping can also have influences on your immune system by helping trigger cytokine production that modulates the body’s immune system response. It is believed that mechanically, cupping will increase the blood circulation, whereas physiologically it will help to activate the immune system and stimulate mechanosensitive fibers, which will lead to reductions in pain. It should be stated that cupping should be done along with other forms of treatments for an injury. These include controlling inflammation through nutrition and resting when needed.
A treatment method very popular amongst licensed and certified physical therapists is dry needling. Dry needling is the only treatment method, aside from acupuncture, where the muscle fibers will be penetrated. The difference is that dry needling is not based on Chinese medicine to unblock energy meridians to create balance within the body. In this treatment method, a thin needle is inserted into the muscle to stimulate the healing process of soft tissues and will help to release tight muscle bands associated with trigger points that often radiate pain in the body. When the needle is carefully inserted into the skin, the therapist will guide the needle toward the trigger point until he/she feels resistance or notices that the patient develops a localized twitch response. This twitch is a spinal cord reflex that creates an involuntary response. This can be caused by release of immune system related chemicals, inflammation, or spontaneous electrical activity. When this twitch occurs, it is often a sign that the needle has hit the right point. The needle creates a small “injury” site in the muscle and when the needle is taken out, blood will rush to this spot and point to stimulate recovery. Dry needling has benefits of reducing pain, improving movement, and helping to speed up recovery processes. It is a very safe method, assuming the professional was taught well, and has been shown to improve other conditions such as migraines, carpal tunnel, spinal dysfunction, tendonitis, and post-herpetic neuralgia to name a few. Just like with cupping, dry needling has the best outcome for success when combined with other forms of therapy and treatment.
Graston technique, or fascial abrasion, is the next therapy method we will discuss. This method has been shown to successfully treat soft tissue conditions of all kinds to help an individual improve their qualities of daily life. Using specifically designed tools, professionals are able to address certain areas of scar tissue or fascial resistance to help improve ranges of motion for the affected individual. If the tools cannot be used or afforded, I have found that a dull butter knife works well in its replacement at time. This is a more superficial technique but does have the potential to get as deep into the tissue as necessary to induce change. This is completely dependent on the tolerance of the individual. The tools are moved over the restricted and affected area to break up scar tissue and to reduce the size of adhered fibers. This, over time, will help to restore range of motion and eliminate associated pain, as well as provide the muscle with fresh new oxygen and nutrients to help stimulate a stronger set of tissue. The Graston Technique has been clinically proven to improve conditions such as Achilles tendinitis, fibromyalgia, trigger finger, rotator cuff tendinitis, women’s health (caesarean scarring and post-mastectomy), etc.
The last therapy method we will discuss is whole body cryotherapy. Cryotherapy is becoming an extremely popular method of treatment for the population and has been used by many sports teams and athletes everywhere as a replacement for ice bathing. As opposed to ice baths, no ice or water is used. Cryotherapy uses extremely cold temperatures to treat tissue damage, decrease inflammation, and increase circulation, amongst its list of benefits. With temperatures often exceeding -225 degrees F (yes, negative!), the individual steps into the chamber with gloves, socks, and shorts on. It is often a 3-minute experience using liquid nitrogen vapor that circulates the body and rapidly cools the body’s external temperature. This stimulates the body’s defense mechanism and shunts blood to the center of the body where all of the vital organs are held. While the blood is here, it oxygenates and prepares to be released back throughout the body. The time spent in the chamber will switch the body’s brain activity from panic to figuring out where trauma is at and when the individual steps out of the chamber and the blood is able to circulate again, it will likely go directly to injury sites or areas that need to be recovered with fresh, nutrient dense blood. Cryotherapy is still a method that needs more studying, but many people have seen benefits from it and even has been used to help treat multiple sclerosis and rheumatoid arthritis. Not everyone can do cryotherapy however. Individuals affected by Reynaud’s syndrome (poor circulation), individuals with artificial limbs, individuals with extremely low heart rates, and pregnant woman, are among the individuals who cannot use cryotherapy.
The take home message of this article is to show that there are many different and effective modes of therapy when it comes to treating an injury. Some are thought to be more beneficial than others and what I would recommend is to use multiple forms of therapy because as you see, their levels in which they affect the body are much different. The key is to find which mode of therapy and treatment is going to benefit YOU most. The only way to know if one is going to benefit is to try it out and give it a chance. A lot of these take time, and just as in generally rehabbing an injury or ailment, patience. So when an injury occurs, try and rehabilitate in a safe and effective way to help improve circulation, improve range of motion, and optimal function in order to return to everyday activities faster.
If you have questions or would like my opinion on which one I would recommend first for any injury you are experiencing, please do not hesitate in reaching out.