Myofascial release and stretch first before mobilisation?

[hermanchauw]

Do you do myofascial release and stretch first before mobilisation or go straight to mobilisation? Could you explain why?

Thanks
Herman

[Coach Bentz]

Mobilize first.

Mobilizing will lubricate the joints and warm the surrounding tissue, and otherwise prepare them for the movement to come.

Muscle tightness is often a positive defense that the body erects to prevent a joint from going into a painful or potentially damaging range of motion. You can, through yoga or manual therapy, "trick" the body into releasing that tension without preparing the joint. However, you're now potentially in a prime spot for an injury.

[Adam Steer]

Generally, the CST System's joint mobility, using the techniques found in Intu-Flow (http://www.profcs.com/app/?Clk=2090594), is done as a stand-alone protocol. This is because mobility is a function of neuromuscular control, which is built into the way in which Intu-Flow Joint Health and Mobility is done. This article (http://coachsteer.typepad.com/coachsteer/2008/05/the-cst-mobilit.html) goes further in-depth on the subject.

Having said that, from time to time I will use some self-myofascial release on myself or my clients for very specific reasons before doing joint mobility. I'll usually do this with a foam roller or ball. But again, I do this only for a specific reason to deal with some type of soft tissue quality issue. I rarely do any type of static stretching.

Hope that helps.

Adam

[madyogi]

I always start workouts, whether they be yoga posture practice, resistance training or otherwise, with joint mobility work such as the stuff found in Intu-Flow or in Dance of Shiva. This gets your blood flowing, lubricates joints, and prepares the body for the more strenuous/specific movements to come.

I wrote this series of articles (http://brickhousebodymind.com/transformations/posture/the-truth-about-stretching-what-you-thought-you-knew) on stretching and am preparing a blueprint on my current dynamic joint mobility warmup.

See also BrickhouseBodymind TV Episodes 1 (http://brickhousebodymind.com/transformations/body/improvements-made-to-brickhousebodymind-tv) & 3 (http://brickhousebodymind.com/transformations/body/brickhousebodymind-tv-episode-3-in-praise-of-asymmetry-the-sweeney-todd-movements) for samples of Andrey Lappa's system. I use these movements in warmups for every workout.

[Joseph David]

Muscle tightness is often a positive defense that the body erects to prevent a joint from going into a painful or potentially damaging range of motion. You can, through yoga or manual therapy, "trick" the body into releasing that tension without preparing the joint. However, you're now potentially in a prime spot for an injury.

Yes!! Well said :)

[hermanchauw]

So can mobilisation alone settle down trigger points?

Do you do activation exercise after your mobility work? Or is mobilisation alone enough for warm up?

[shadow]

From my experience and observation the activation/compensatory work is best done at the end of an entire session.

For a low intensity day it could be:

intu-flow -> prasara yoga -> specific myofascial release and accompanying poses

or a moderate or high day:

intu-flow -> workout session -> compensatory work including specific myofascial release and accompanying poses.


That being said I only have a limited guided experience in this but it makes sense to go deep when your body is warm, lubricated and loose (i.e. "hot yoga" ;)).

[Coach Bentz]

So can mobilisation alone settle down trigger points?


From my experience, the short answer is yes, it *can*. Whether it *will*, that depends on how deep you go in your practice, and the depth and "age" of the imbalance behind the TP formation in the first place, and what other things you're doing to correct the structural imbalance.

If you want to get into a deeper discussion, some questions I have for you, to form a starting point, are: what's your background with trigger points? Are you coming in from an athletes perspective and just have them a lot? As a bodyworker who treats them? Do you have an impression of what trigger points are and how they form? And, what's your experience with yoga?

[hermanchauw]

What's your background with trigger points?

My background is in physiotherapy. In physio school, the focus is mobilisation. We were taught to mobilise every joint in the body. Then i study at www.optimumperformance.com.sg which is a totally different system. Myofascial release should be done before any stretching or mobilisation. Because when you stretch a trigger point, it would get worse. Mobilisation involves stretching to some degree so it is the same.


Are you coming in from an athletes perspective and just have them a lot?

Both. I do kb sport and had a lot of injuries from my gymnastics days in high school. So although i am flexible, i have a lot of trigger points.

As a bodyworker who treats them?

Yes. I do SnC and rehab.

Do you have an impression of what trigger points are and how they form?

In my own words: painful and tight spots in muscles. Can be caused by either weakness or injuries or muscular imbalances or postural distortions or ...

I think Wikipedia has a better answer than me.

And, what's your experience with yoga?

ZERO experience. But my impression is that yoga can make you hypermobile/hyperflexible which is bad. I have seen some footages of yoga masters doing their stuff and i cringe at the ROM they have.

When i was crazy about bodyweight feats of strength, i stayed away from yoga because gymnastics feats of strength are more impressive.

[Coach Bentz]

Herman,


My background is in physiotherapy. In physio school, the focus is mobilisation. We were taught to mobilise every joint in the body. Then i study at www.optimumperformance.com.sg which is a totally different system. Myofascial release should be done before any stretching or mobilisation. Because when you stretch a trigger point, it would get worse. Mobilisation involves stretching to some degree so it is the same.

One of the disadvantages of studying multiple systems, unfortunately. You have conflicting opinions of the founders & instructors that can be tough to sort out. One of the benefits of studying multiple systems is that you are eventually forced to test out the ideas given to you, and experience becomes your guide.

I'm in agreement about not "stretching" a trigger point. However, mobilization doesn't involve stretching, at least not the way I perceive it. Are you familiar with the Intu-Flow® or Warrior wellness programs, and they way joint mobilization is presented there?


In my own words: painful and tight spots in muscles. Can be caused by either weakness or injuries or muscular imbalances or postural distortions or ...

I think Wikipedia has a better answer than me.

They might have a longer answer, but not better. It's your impression and experience of TPs in your personal and professional practice that matters to me.

From your definition, leaving out acute injury (although its my suspicion that TPs there form *after* your body starts trying to use and work around the altered structure), we're basically looking at an imbalance somewhere in the system.

We've got what amounts to a distortion in the structure. One part of the fascial network has gotten too tight or overdeveloped and is taking on a chronically contracted state (the beginnings of what we call residual muscle tension in CST) It's under some tension all the time.

If you can imagine the opposite happening where the TPs are forming, that tissue can be thought of to be in a chronically lengthened state. It's already stretched - which is why increasing the stretch on that area could easily make things worse.

The TPs tend to become more like fixtures as the body continues to progress in its adaptations to the new structure. The fascia starts to tighten and thicken and become less moist which can affect nutrient flow. You press on the TPs, and it feels great for a while after you let go, when the blood rushes back in after the compression. But it's not permanent. Without a change in the structure, without a rebalancing of the muscle tension, the TP reforms pretty quickly. (which I will admit is AWESOME if you like repeat business as a therapist!)

But as my education and experience continued, it became clear that dealing with the excessively contracted areas first made dealing with the TP very easy, if I had to deal with it at all. Often, it would just disappear.


ZERO experience. But my impression is that yoga can make you hypermobile/hyperflexible which is bad. I have seen some footages of yoga masters doing their stuff and i cringe at the ROM they have.

You might have seen examples of what's essentially contortionism. Deforming the tissues by stretching them usually isn't a great idea, particularly if you don't also have the joint mobility and strength to stabilize in the contorted position.

As a bodyworker, I had a very negative impression of yoga initially as well, for that and other reasons. However, i learned that it depends a lot on how its taught. As I started to study yoga as its taught in the CST umbrella, its value as a tool to gradually correcting the structural imbalances became clear, and it absolutely fit in with my experiences in bodyworking. When your focus in your yoga is on *contracting* muscles instead of stretching and deforming them for raw flexibility, its a whole new ballgame. When done correctly, you're giving an internal squeeze to those thick leathery areas of fascia, stimulating blood flow and waking up the nerves and muscles (recovering from sensory motor amnesia, in CST parlance) You are also utilizing reciprocal inhibition to your advantage (rather than fighting the stretch reflex) to release excess tension.

When you have time, I'd suggest checking out either the Ageless Mobility®® program, the Prasara Instructional series, or the two yoga flows on the 4x7 DVD, and practice one flow daily for a month. You'll develop a new relationship to chronic trigger points, particularly with a flow that corresponds with your specific fascial adaptations.

For the record, I still do occasionally get them myself. But it's rare, maybe a handful of times a year will I press on them. But if I trace it back, what's usually happened is that I haven't quite got the right combination of yoga asana to compensate for the training & work that I'm doing. So I now look at TPs as feedback on how well I've arranged my work and practice.

[Joseph David]

Regarding Trigger Points:

Technically, a trigger point is a fascial distortion that has a specific referral pattern. This referral pattern could be as simple as pain down a fascial meridian or it could be as complex as a reactive pattern causing neuromuscular inhibition.

There is a model for properly addressing trigger points, and the tenants of Prasara honor that model. First is the application of ischemic pressure. This helps change the pressure of the fluids within the tissue. Second is the strengthening of the tissue. Attention should be paid to three aspects of muscle action: concentric, isometric and eccentric. The third and last stage is tissue lengthening. This is the mobility phase.

:)

[JasonE]

Interesting discussion. I do a lot of trigger point work and have had great success... but the traditional explanations of trigger point theory are still controversial. I have watched videos of Janet Travell releasing trigger points with nothing more than a controlled blast of cold air. This alone suggests that ischemic pressure isn't necessarily needed, and suggests that the nervous system plays a greater role in the formation and resolution of trigger points than is usually thought.

That said, the recommendations already given are certainly appropriate and will help resolve or prevent trigger point issues.

[hermanchauw]

When you have time, I'd suggest checking out either the Ageless Mobility®® program, the Prasara Instructional series, or the two yoga flows on the 4x7 DVD, and practice one flow daily for a month. You'll develop a new relationship to chronic trigger points, particularly with a flow that corresponds with your specific fascial adaptations.I have ordered the Prasara 2DVD, Prasara Instructional and the Prasara book. Looking forward to do them.

[John B]

I perform Intu Flow daily, upon rising in the morning. As of late, I've been using a foam roller for myofascial release (tennis ball for feet and calves, racket ball at work for hands and forearms), followed by Intu Flow just before my training sessions.

I have noticed an increase in the quality of my tissue since incorporating the foam roller work and I've found it a great compliment to my mobility work.

[JayBell]

This alone suggests that ischemic pressure isn't necessarily needed, and suggests that the nervous system plays a greater role in the formation and resolution of trigger points than is usually thought.



Travell is doing "freeze and stretch" techniques. Ischemic pressure is not necessary to release trigger points, but through Travell and Simon's work, it came about as being the most effective. Dry Needling, Freeze and Stretch, Indirect Myofascial Release, etc seemed to be less.

The nervous system is not the primary culprit of TrP's, however. It is a biochemical issue in the tissue. The calcium is unable to be taken up after the contraction.


If you can imagine the opposite happening where the TPs are forming, that tissue can be thought of to be in a chronically lengthened state. It's already stretched - which is why increasing the stretch on that area could easily make things worse.

I'm not sure I agree here, as the tissue surrounding a TrP is taut, not stretched.

[hermanchauw]

Hi Coach Bentz, Coach Steer mentioned about you getting much better results in your manual therapy practice through CST compared to conventional manual therapy. It all makes so much more sense now after attending the CST live. I am going to layoff foam rolling for some time and see how it goes.

[Coach Bentz]

Herman,

I'm very glad you had the chance to attend Coach Steer's seminar.

I like to think of it this way. With CST, you are learning to learn to do for yourself what the best manual therapists do TO you. When CST and manual therapies are utilized together, EVERYBODY wins.

I'm looking forward to hearing more about your explorations.