Daily Foam Rolling

Myofascial release is a hands-on technique using sustained pressure to the connective tissue restrictions to relieve pain and restore motion. But does it work? Dr. Betsy Webb certainly thinks so, stating “this is one of the most common modifications I suggest to patients. Maintaining soft tissue and joint mobility is so important in preserving joint health and building strength.”

According to a systematic review conducted by Beardsley and Škarabot, myofascial release can help to increase flexibility and reduce soreness. Regular maintenance helps with joint and soft tissue extensibility and mobility, will improve tissue length and pliability and its ability to accept force and load. This allows the body to do more work with less strain overall. Methods like foam rolling, gua sha and massage can improve arterial and vascular endothelial function, or the flow of blood and lymph through the tissues. Self-myofascial release allows for consistent and cost-effective management. Athletes of all levels most commonly use a foam roller or ball of varying density.

Despite being versed on the benefits, Betsy has trouble incorporating soft tissue work. “I love working on strength and cardio work,” she laughs, “but often under prioritize mobility in my own physical fitness. I know how valuable mobility work is, yet I struggle to incorporate it into my routine.” As part of our Athlete Within Challenge, Betsy agreed to spend 10 minutes foam rolling everyday for two weeks. Here’s how it went:

As with any new habit, the most challenging part about for Betsy was adherence. “I started out really strong for the first week but then the weekend hit and falling out of my daily routine made it more challenging to stay diligent,” she says. Sound familiar?

In order to stay consistent, Betsy found three different techniques to be most helpful: routine, external accountability, and increased accessibility. “I found using an alarm worked really well. I set an alarm for 9:15 every night to remind me.” (As an added benefit, myofascial release can also help to improve parasympathetic nervous system activity, allowing us to mentally and physically calm down so our bodies can regenerate. Soft tissue work in the evening can set you up for a great night’s sleep!)

Betsy shared her goals with her fiancé, finding that having “someone to hold me accountable, who knew to remind me if I hadn’t done it for the day” helped to keep her on track. The last thing she found to be helpful? Relocating her foam roller. “I ended up putting it next to the tv,” says Webb, “so that when I would sit down to watch tv at night I would see the roller and be reminded to use it.”

So is it worth the time? After the two weeks were up Betsy’s body was thanking her. “Foam rolling is something I know I should do more of, especially for my thoracic spine, but never was able to get into a routine." Like so many of our patients, Betsy saw tremendous benefit from going back to the basics: “After the first week I felt good but not too much different, but a full two weeks really started to make a difference in how I felt from a mobility standpoint.” The true payoff for myofascial release work is in the consistency. Studies have yet to show if any of these improvements in flexibility and tissue quality have longterm effects once treatment is stopped. “I fully intend to maintain this behavior. As I saw with the two weeks, the longer I remained consistent the better I felt,” states Webb.

Our vote? Yes to myofascial release!

Looking for Dr. Betsy Webb? As of July 1st, she will be practicing in the Chicago Area!

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Back At It

To wrap up our section on lumbar disc injury, Nina and I break down some of the most common patient questions we receive. As an AT, Nina is accustom to triaging athletes in pain, helping them find confidence in their plan of care.

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SV: For the past month, we’ve been sharing the latest research on lumbar disc pathologies. As a recap, what are your top three take aways for experiencing back pain?

NS: We’ve covered a ton of information on this topic recently, looking at the impact of pregnancy as well as injury. The overall takeaway is that each individual’s experience can be different- this goes for symptoms and solutions. That’s why personalized care can have such a big impact for back pain. Similarly, there isn’t one guaranteed strategy for managing a lumbar disc injury. A combination of treatments, including soft tissue work, stability and mobility exercises, and pain management, is typically needed. Last, use this as an opportunity. For most people, an injury like a disc herniation can be a catalyst to make adjustments to their behaviors, allowing them to emerge stronger than before.

SV:  How does this differ from the type of back pain caused by pulling a muscle?

NS: Discogenic pain has a different quality; many patients report feeling sharp, electric sensations, while others complain of weakness. Nerve pain can “travel,” sending irritation down one or both legs. Muscle spasm often accompanies a disc injury- it’s a protective strategy. Muscles of the back will automatically tighten above and below the injured disc to limit movement. This tightening makes it difficult to use muscle systems, or groups of muscles designed to support compound movements, effectively.

Pulling a muscle, or overusing a muscle, can usually be correlated with a specific action or activity. You may feel tight, or restricted. This should resolve, or feel considerably better, in 72 hours if it’s just muscular.

SV: Here’s a popular combo question- do patients need to get imaging for this type of injury? How likely will they need surgery?

NS: It’s a valid question- too often, we only hear about worst case scenarios for injuries. Unless you’ve suffered a traumatic injury, like a car crash, we don’t typically recommend imaging right away. Rehab exercises and pain management will be the most productive first steps. If you eventually need surgery down the road, being as strong as possible going in will dramatically help your recovery!

Surgery makes the most sense for patients who have a high risk of complications- like if your herniation or displacement is so severe you may cause permanent damage to your spinal column- or for those who haven’t succeeded with conservative care after a number of months.

We’re big believers that patients should be the center of their plan of care, with a variety of clinicians and specialists, coaches and supporters surrounding them. Without a different perspectives, you can overlook options. Ask questions, get second options- be your best advocate!

SV: Once someone injures their back, does that mean they can never workout or play sports again?

NS: In the vast majority of cases, definitely not! Most patients are able to return fully to their previous level of activity. Like any major injury, it will take dedication and focus to recover. It’s essential to allow your body enough time to heal, and to correctly learn, or re-learn, movement patterns. Look for rehab practitioners that understand the demands of your activity, and can help get you there. Stopping at 65-75% better increases your chance of re-injury significantly.

SV: With back pain being one of the most prevalent injuries, how can someone lower their risk for injury?

NS: Regular physical activity will help to protect against a number of ailments and injuries. Particularly with the recent transition to virtual learning and working, movement is even more important, as we are naturally more sedentary in this scenario. Adding in tri-planar exercise, including linear, lateral and rotational work, can help make sure you’re prepared for whatever life throws you! If you’re new to exercise, or struggling with home exercise routines, setting up an appointment to work with a clinician or coach can give you the confidence you need to move safely.

SV: At Physical TheraPT, as many of our patients know, we love staying current on the latest innovations in exercise and rehab equipment. What’s your favorite product out there right now for back pain patients?

NS: For patients still in the early stages of recovery, I really like the biofeedback cuff. This deconstructed blood pressure cuff helps increase awareness of pelvic stability and highlights how well someone is able to maintain a braced position when you add on movement. For those who are out of pain, and show progress with more challenging exercises, the 3D strap is my favorite. Don’t be deceived by the simple nature of this piece of equipment! It adds rotational load to almost any movement pattern, allowing athletes to adapt and practice in a safe environment.

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SV: Last question- what’s your go-to strategy for pain relief with this type of injury?

NS: Finding a position of comfort that you can rest in. Back injuries can feel unrelenting- having a position that gives you some relief is critical in the beginning stages of recovery. Laying on a firm surface, resting on your back with knees bent and feet planted, referred to as Hook-Lying Position, is generally safe for most patients. Others may find relief with a bit of light traction, leaning into your elbows at a counter, or floating in a pool.

Consistent Advice for Inconsistent Times

Seemingly almost every day, this year has thrown unprecedented challenges our way. As a country, and as a community, it can feel like we simply can’t catch a break. This air of overwhelming chaos and danger can trigger feelings of distress and distraction, and impact our normal immune response, throughout coping strategies like emotional eating or alcohol consumption, or poor quality sleep. Good news, these feelings and responses are very normal. Bad news, these behaviors are correlated with an increased risk of injury.

“I don’t know if I can do this”

As athletes and performers, we each possess a deep spirit of resilience. Resilience is defined by the American Psychological Association as “the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress.” Each tryout, audition, tie breaker, performance and championship game has reinforced that spirit. We have each gone through challenge, and emerged stronger.

Brené Brown reminds us in her 2015 book, Rising Strong, that resilient leaders all show three key attributes:

First, they recognize the central role that relationships and story play in culture and strategy, and they stay curious about their own emotions, thoughts, and behaviors. Second, they understand and stay curious about how emotions, thoughts, and behaviors are connected in the people they lead, and how those factors affect relationships and perception. And, third, they have the ability and willingness to lean in to discomfort and vulnerability.

During these unprecedented times, we find ourselves rebounding more frequently. Today’s challenges require near moment-to-moment adaptation. While we may feel sensitive and vulnerable, athletes and performers are robust. Driven by challenge, each of us have demonstrated incredibly grit and perseverance to reach the position we are at today, overcoming injuries and obstacles. It’s important to acknowledge any feelings of distress, but equally important to have an arsenal of resources to continue moving forward in a healthy fashion. We’ve pulled together our favorites from the author / coach duo behind The Growth Equation, as well as the mental health professions at IADMS:

Practice compassion, for yourself and others

Each new 2020 challenge has shown value of human compassion. If you’re feeling overwhelmed, look to ways you can help someone or look for ways someone else has helped you recently. Being kind to yourself when things don’t go as planned is essential, too!

Stop resisting what’s happening

We’ve all been there. But wishing this wasn’t happening isn’t going to help the situation or your mental state. Focus on what your next three tasks are, and keep cycling through your day.

Focus on what you can control

Rather than worrying about the uncontrollable, put your energy towards productive action. If your league now requires mask usage for competition, build a schedule that allows you to gradually build up tolerance to it while exercising.

Think adaptation, not change

“Change is something that happens to you. Adaptation is something that you are in conversation with.” Stulberg’s view returns control to the individual, and the tasks at hand. What is non-negotiable for you, your family, or your team? Start with these, and work backwards to find to solutions that suit your current challenges. Maintaining an openness to new experiences can help to keep you on track- what opportunities has this scenario brought you?

Practice positivity and gratitude

With so much bad news floating around, it’s easy to get lost in it. When you noticed a persistent negative thought, try to reframe it. For example, maybe you still can’t take that trip you’ve been longing for, but airlines and tourism industries are working hard to provide rapid test options.

If you find yourself getting worked up, try what Stulberg refers to as the 4 P's: pause, process, plan, proceed. This quick exercise allows you to acknowledge whatever is coming up for you, and choose a response that best suits our ever-changing environment.

Finally, tap into memories that remind you why it’s all worth it. The view at the summit, that game winning shot, the performance where everything just clicked. Visualization can help to reignite feelings of purpose.

Use Routines to Anchor you

Some days, internal strategies just won’t be enough. These are the days to lean heavy on your routine lifesavers. Block off 15m breaks to take a walk around the block, schedule tech-free time at the beginning and end of your day, pre-order that instagram worth salad + juice combo. Learn what helps you be your best self on bad days. After all, “creativity resides at the heart of human resilience. Even though adversity will always exist within the human condition, embracing the creative resources within us allows us to not only endure but to prevail.” -Creativity, Trauma, and Resilience by Paula Thomson and S. Victoria Jaque.

To learn more about the connection between stress and injury, check out this article.

Lumbar Disc Pathology: Part II

If you’ve experienced a disc injury before, you’ll know immediate care is all about triaging. You need strategies to help you deal with the pain now and a plan to tackle this ASAP! Depending on your symptoms and how you got hurt, we recommend making appointments with both your physician and a rehabilitation specialist.

A physician will be able to write prescriptions, as appropriate, while ATs and PTs will be able to address your pain from a mechanical perspective. There is tons of evidence supporting various treatment modalities for the management of lumbar disc pathologies. The focus is pain resolution, restoration of function and any associated neurologic deficits associated. 

At your appointment, your clinician will perform an in-depth evaluation and establish a treatment plan to address your specific and unique symptoms. This will often include:

• Mobility exercises for muscle, joint, and even nerves

• Stabilization exercises focused on trunk control and strengthening

• Proprioception, coordination, and balance training

• Functional conditioning 

• Phased return to sport / activity program

While you’re waiting for your appointment, there are several strategies you can try to safely mitigate your symptoms. Often, disc-related low back pain is aggravated by prolonged flexion, or bending at the waist.

1. Try to limit time sitting by standing or walking when you can.

2. Modify your work environment to allow for standing, taking seated breaks as needed. Get creative- using books, boxes or other household items to create an make-shift ergonomic solution.

3. When sitting, use a pillow or support behind your low back to limit rounding of the low back, or slumping.

4. Raising your seat height, whether in a desk chair or in the car, can help you avoid a posterior tilt of the pelvis. This position puts stretch through the muscles and nerves of the low back.

5. Rest lying down if unable to tolerate sitting. Try bending your knees, planting your feet on the ground to help maintain a neutral spine.

6. Use heat to help relax muscle spasm or guarding.

7. Avoid intense stretches for now- while they may feel good in the moment, this can increase muscle spasm.

8. Over the counter pain meds such as NSAIDs can help reduce pain. Double check each individual brand for dosage recommendations.