Myofascial Pain Syndrome and the Effects of Self-Myofascial Release

Karlye SmithAthletic Training Student

Gustavus Adolphus College

Objectives

• What is myofascia?• What is myofascial pain syndrome?• What are myofascial trigger points?• What is myofascial release?– Purpose– Restrictions

• What is self-myofascial release?• What is foam rolling and how to• Anatomy review• Interactive time

What is myofascial?

• Myo = muscle• Fascia = connective tissue covering muscles

from head to toe providing support, stability and cushioning

• Myofascial = dense, tough, flexible tissue that surrounds and covers all muscles and bones

What do you believe pain is?• Merriam – Webster definition of pain– Physical suffering or discomfort caused by illness

or injury• But, everyone’s perception and tolerance of pain is

different

Myofascial pain

• Refers to pain that is caused by muscular irritation from repetitive movements

• Tightening of the fascial system is a protective mechanism due to micro-trauma or an acute injury

What is myofascial pain syndrome?

• Myofascial pain syndrome refers to pain and inflammation in the body’s soft tissue– This accounts for roughly 85% of pain most people

are having• This is a chronic condition that affects the

fascia, which is a connective tissue that covers the muscles, involving either a single muscle or a group of muscles

What is myofascial pain syndrome?

• Myofascial pain syndrome may develop from a musculoskeletal injury or from excess strain on a muscle, ligament or tendon

• Signs & Symptoms:– Muscle pain– Tenderness and trigger points– Spasm– Muscle weakness– Stiffness– Problems sleeping

What are myofascial trigger points?

• With myofascial pain syndrome, there are hypersensitive pressure points in muscles that can cause either pain or referred pain– Referred pain is pain felt at a site other than the location of the cause

• A common example of a trigger point is felt while foam rolling your iliotibial (IT) band as it causes pain to radiate up to the hip or all the way down the leg to the ankle.

• Trigger point occur due to repetitive motions or by stress related muscle tension

• Trigger points can also occur due to trauma, such as accidents or sports injury– Other causes include long term muscle strain from poor ergonomics,

posture and physical or emotional stress.

What are myofascial trigger points?

• Two types of trigger points:– Active which is an area of extreme tenderness that is

typically found within the muscles and may cause weakness or restriction in movement

– Latent are inactive and cause no pain during activities but are tender when touched. These points can be activated when the muscle is strained, fatigued or injured

• Trigger points cause:– Tenderness– Tingling– Burning– Weakness

What is myofascial release?

• Myofascial release is a soft tissue therapy for treatment of muscle immobility and pain.– This is most commonly done by massage

therapists, physical therapists and athletic trainers• The goal of myofascial release is to elongate

and soften the connective tissue

Myofascial Restrictions

• Unwanted bonding may occur with inflammation, injury, postural stress or lack of full active range of motion

• Creates excessive deposits of tissue resulting in thick bandaging around joints, fibrous masses, and in belly of muscles

• Weakens the muscle and holds the skeleton in insufficient alignment

Shah & Bhalara, 2012

Purpose of myofascial release

• Release the restrictions within the deeper layers of fascia

• Allows for restoration of length and health to the myofascial tissues will take the pressure off the pain sensitive areas as well as restoring alignment and mobility to the joints (Barnes, M. F., 1997)

• Alleviation of pain, improvement of athletic performance, and greater flexibility and ease of movement to posture (Shah & Bhalara, 2012)

What is self-myofascial release?

• This is when an individual uses a soft object to provide myofascial release under their own power by using gravity to induce the pressure– Foam roller– Theracane– Ball

• Tennis ball, soccer ball, softball, lacrosse ball, etc.

• Allows for the adhesions that have been made on the fascia to get broken up or “looser”

Foam Roller• Are inexpensive and effective tool that help break up the

adhesions• There are multiple types of foam rollers

1. Grid roller • Which is firm on the inside, but has a soft foam outer layer• Best for serious massage work on injuries

2. Molded foam roller • Which are tiny beads compressed into a solid log shape• Know for their durability

3. EVA foam roller• Easy to carry, keep their shape to provide a lot of pressure and last a long time

4. High-density foam roller• Best suited for serious athletes

5. Low-density foam roller• Doesn’t work out the trigger points like the others

• Range in lengths 6”-36”

Grid Roller

Molded Foam Roller

EVA Foam Roller

High-Density Foam Roller

Low-Density Foam Roller

Benefits

• Correct muscle imbalances• Increase extensibility of musculotendinous junction

– Ability to be stretched at muscle-tendon conjunction– Flexibility

• Increase joint range of motion• Decrease muscle soreness and relieve joint stress• Decrease neuromuscular hyper tonicity

– Spasms• Increase neuromuscular efficiency

– Ability of nervous system to recruit muscles properly to produce and reduce force

• Maintain normal functional muscular lengthShah & Bhalara, 2012

IMAGINE…

• A bungee cord with a knot tied into it and then envision stretching the cord. This creates tension, stretching the unknotted portion of the muscle and the attachment points. The knot, however, has remained unaltered. Foam rolling can assist in breaking up these knots in the muscle

How to..

• Place the foam roller at the proximal portion of the muscle

• Put full weight onto foam roller• Roller distally, down the muscle massaging the

fascia• Upon a sharp pain, back up and hold the position • By holding position right before pain, allows the

fascia time to relax and release before continuing to roll

How do I know when a release occurs?

• NOTE: a release may feel different to every person

• Painful/tender → relief of symptoms

• Tension release, dispersive sensation• Could feel some “crunchies” or “popping”

Warnings

• You may be sore the next day• It should feel as if your muscles have been

worked/released, however you should not push yourself to the point of excessive soreness

Focus

• Hip Flexors• Quads• Hamstrings• TFL and ITB• Piriformis• Calf• Low Back

Hip Flexor Muscles• Quadriceps Muscles• Iliopsoas– Iliacus

• Origin:– Iliac fossa and Iliac Crest

• Insertion: – Lesser Trochanter of femur

– Psoas Major• Origin:

– Transverse process and bodies of T12-L5

• Insertion:– Lesser Trochanter of Femur

• Action (all):– Hip Flexion

Hip Flexor• Place the foam roller under your hip flexors. Using your arms or

leg that if off of foam roller, slowly move your body forward and backwards allowing the foam roller to massage the front of your hip and pelvis.

• This exercise can be performed on your forearms or hands and with both legs off the ground or the leg that is not being massaged in contact with the ground.

Quadriceps Muscles• Rectus Femoris

– Origin:• Anterior Inferior Iliac

Spine

• Vastus Intermedius– Origin:

• Anterior Surface of Femur

• Vastas Medialis– Origin:

• Medial Surface of Femur

• Vastas Lateralis – Origin:

• Lateral Surface of Femur

– Insertion (all):• Tibial Tuberosity via the

Patellar tendon

– Action (all):• Knee extension and Hip

Flexion

Quads• Position yourself face-down with

both thighs resting on top of the foam roller. Support yourself on your elbows and forearms, and keep your abdominal and back muscles lightly flexed to stabilize your spine.

• Roll slowly back and forth on the foam roller, from just above your knees to just below your hips, and pause at any spot that feels especially tender. Your toes should drag the floor.

• To dig down deeper into the muscle and increase the intensity of this exercise, tilt your body to the left or right while rolling.

Tensor Fascia Latae & Iliotibial Band

• Origin: – Anterior superior iliac

spine• Insertion: – Lateral condyle of tibia

via iliotibial tendon• Action: – Hip flexion, abduction

and internal rotation

ITB & TFL• Start by lying on your side, support your body weight with your legs and arms,

and lie with a foam roller under the upper, proximal portion of your IT band.• Use your legs and arms to roll the length of your IT band along the foam roller,

traveling down to just above your knee joint. As you get closer to your knee, you may feel more tenderness, so be prepared to use your arms and legs to ease pressure off of your IT band.

• Roll back towards the upper portion of your IT band, and continue back and forth for a few passes.

Piriformis• Origin:– Anterior surface of the

sacrum• Insertion:– The superior boarder of

the greater trochanter of femur

• Action:– Laterally rotates thigh

and abducts thigh if knee is bent

Piriformis• Sit on the center of the foam roller, with one foot crossed to the

opposite knee. Place one or both hands on the floor behind you to support your upper body.

• Roll forward and backward until a tender spot is felt. • Stay in this position until a release occurs.

Hamstring Muscles• Biceps Femoris

– Origin:• Short head – lateral lip of the

linea aspera• Long head – ischial tuberosity

– Insertion: Lateral surface for fibular head and lateral condyle of tibia

– Action: Knee flexion and external rotation; hip extension

• Semimembranosus & Semitendinosus– Origin: Ischial tuberosity– Insertion: Medial surface of

Tibia– Action: Knee flexion and

internal rotation; Hip extension

Hamstrings• Sit with back of your thighs on top of the foam roller and both hands

on the floor behind you. Keep your leg muscles relaxed, and let your heels lightly drag the floor.

• Roll your hamstrings from just above your knees to just below your pelvis. To increase intensity, shift your weight to one leg by crossing your legs at the ankle.

Calf Muscles• Gastrocnemius

– Origin:• Medial Head – medial condyle

of femur• Lateral Head – lateral condyle

of femur

– Insertion: Posterior calcaneus via calcaneal tendon

– Action: Plantar flexes foot and flexes knee

• Soleus– Origin: Proximal half of

posterior surface of tibia and proximal 1/3 of posterior fibula

– Insertion: Posterior calcaneus via calcaneal tendon

– Action: Plantar flexes foot

Calf• Place a foam roller under one leg, positioned under the

middle of your calf. Take the opposite leg and cross the opposite leg over the top of the leg on the foam roller.

• Slowly roll up and down the calf muscle searching for a tender spot. Roll from knee to ankle searching for points of tenderness.

Low Back Musculature• External/Internal Abdominal

Oblique– Action: Assists in flexing and

rotating vertebral column• Erector Spinae

– Action: Extends vertebral column, bends to one side and rotates head same direction

• Quadratus Lumborum– Action: Abducts vertebral

column toward side being contracted

• Multifidus– Action: Extend vertebral

column and rotates toward opposite side

Low back

• Position yourself with your lower back on the foam roller, both knees bent, and feet flat on the floor. Keep your abdominal muscles flexed to support your upper body and stabilize your spine. Look straight ahead and keep your head and neck in a neutral position. If necessary, place one or both elbows on the floor behind you for additional support.

• Roll from just above your hips to just below your lower ribs. If you feel the roller against your spine, tilt your body slightly to the right or left to refocus the pressure on the muscles.

Caution: This exercise is not recommended for individuals who are experiencing back pain and who have not consulted with their doctor.

Vertical• Lying vertically on the

foam roller with your butt and head supported.

• Gently rest your arms to the ground.

• Inhale and exhale evenly.

• For more of a stretch, scoot head to end of foam roller.

• Foam roller should be placed at the base of the skull.

• Let gravity pull head downwards

Post foam roll

• Drink plenty of water, get enough sleep, and eat healthy– This will help to flush your system and fuel your

muscles more effectively• Give yourself 24-48 hours before focusing on

the same area again– To make sure areas are not aggravated or irritated

Take Home Message

• What myofascial pain syndrome is• What causes myofascial trigger points• What foam rolling is used for and how to do it