Soft Tissue Mobilization Take Home Points:
- Every instrument can have an advantage and disadvantage but as long as they are use appropriately, they can be beneficial.
- Research supports the use of all of them combined with therapeutic exercise and neuromuscular re education.
- The goal is to not blast the tissue but rather reduce tension and stimulate a response in the central nervous system to return back to a baseline.
- A preference over one tool than the other is acceptable and finding what works for you is most important so you can implement it into healthy routine for recovery.
- Don’t buy cheap because you will get cheap. Your body is worth it.
- The most commonly used soft tissue mobilization tools are graston, foam rollers, theraguns, and kinesiotape.
Recovery is a continuing area of interest amongst athletes, coaches, trainers and healthcare providers.
The ability to return oneself back to a stable state and reset during the endeavor of completing hard tasks, training or work loads is very desirable.
Athletes especially, are always looking for an extra edge to help them continue to train, complete tasks and compete at a high level. As more research becomes readily available demonstrating the balance of rest and work is crucial towards success, not only as an athlete but also for basic human function, the demand for aide from recovery tools has increased.
Of the many resources used for recovery, one component is soft tissue mobilization.
What Is Soft Tissue Mobilization?
Over the past decade, the implementation of soft tissue mobilization tools has become extremely popular in the healthcare profession and amongst athletes.
Tools such as foam rollers, Instrument Assisted Soft Tissue Mobilization (IASTM) tools and the latest, Theraguns have been making their way into the hands of active people.
Currently, it is not uncommon to find many of these tools in local gyms being used by trainers, coaches, therapists and athletes.
With the abundance of these tools reaching the general population, knowledge on how to use these tools properly is important.
Improper application due to poor knowledge of the tools and lack of education on human anatomy and physiology has resulted in undesirable results in the past. If not used properly, these tools can actually cause more harm than good.
This article will cover how to properly use these tools should you acquire them for your personal use.
It will also give you a reference point of what to expect should you seek treatment from a healthcare provider and receive treatment with these tools.
What Is Soft Tissue?
Soft tissue consists of all the layers of tissue in the region from the muscle fibers to the skin. The structures lay together, pretty much like a sandwich except they need to move in every direction, not just one way.
This is why when we stretch in some directions we feel a pull and sometimes other directions we don’t. Ultimately we want to be able to move in all directions without feeling a limitation.
Not only do our tissue layers slide and move but our blood vessels such as arteries and veins need to move as well. Our nerves act in the same manner as when we move our arm or leg, all these structures need to move smoothly with the rest of the body.
If there is a limitation due to tension somewhere, the movement may be delayed or limited. These limitations can result in joint tightness and muscle tightness.
When the tightness continues to stay there such as with someone who is sedentary or never restores the motion through mobility drills, the body begins to adapt, resulting in chronic joint tightness and soft tissue restrictions.
Muscle Spasms
A muscle spasm and/or tension, “trigger point” is usually a result from a stimulus such as from an emotional response, repetitive behavior or an overload of force such as weight and load.
Spasm can occur from a stressful situation emotionally, a hard workout or a sudden movement under certain stress such as a reaction to a slip and fall or a motor vehicle accident.
What Causes Soft Tissue Restrictions?
“Soft tissue restrictions” occur when that muscle and tissue stays in that position for long periods of time such as what occurs with poor posture. They also can result from limited range with an exercise due to compensation from poor stability or limited strength.
An individual that never achieves proper range during a squat or lunge and trains that same range continuously can result in adaptations in the joint and soft tissue.
A hockey player that never practices ankle mobility after playing continuously in ice skates can limit dorsiflexion range of motion and calf extensibility resulting in soft tissue restrictions.
An athlete completing a high intensity Metcon workout with box jumps and plyometrics can wind up with a calf muscle spasm.
These are all examples of different styles of stimuli that can affect the tissue differently.
Soft Tissue Adaptations
When these tissue adaptations result, the goal is to restore the normal tissue property.
The change not only takes place in the localized tissue but also in the central nervous system.
The brain needs to receive feedback to reduce tension in the area as well. This is why relaxation and reducing tension during these techniques is crucial towards achieving the desired result.
Breathing techniques can also be implemented which is a whole other topic.
Overview of the Motor System and Muscle Contraction
Without being overly scientific and confusing, breaking down the concepts behind muscle contraction and what causes spasm can help to better understand the logic behind using these tools on the body.
Not everyone is in the medical profession and even those who are can have a challenging time understanding neuroscience. So let’s keep it simple.
A basic movement such as picking up an item involves a sequence of events.
Neural Component Of A Muscle Contraction
From the time the thought of the action is perceived in the brain to making a decision to complete the action, neural activity travels from the frontal lobe of the brain to the cerebellum and basal ganglia, transmitting to descending motor tracts.
These tracts deliver signals to lower motor neurons (LMN). These are what transmit the signals directly to skeletal muscle causing the action.
Voluntary contraction travels: brain to spinal cord to muscle.
What Are Motor Neurons?
Motor neurons are basically nerve cells that control skeletal muscle.
- Lower Motor Neurons (LMNs) deliver the information to the muscle. There are connections in the spinal cord or brainstem that determine the activity of these LMNs.
- Upper Motor Neurons (UMN) are in the cerebral cortex or brainstem they basically travel in tracts that synapse with the LMNs in the brainstem or spinal cord.
Throughout the central nervous system, sensory information adjusts motor activity.
Skeletal muscle is excitable, contractible, extensible and elastic. Muscles act like springs in that the force they produce depends on their length. A stretched spring generates more force then a shortened spring.
When muscle is continuously immobilized or placed in a shortened position for extended periods of time, its properties change.
The Structure Of Muscle Fibers
Individual muscle fibers consist of myofibrils that run parallel to the muscle fiber center and they are arranged in proteins called sarcomeres.
What Are Sarcomeres?
Sarcomeres are the functional units of the muscle and are structural and contractile. Think about muscles that hold your posture such as in the head and face as structural and then the very contractile muscles such as your biceps that need to move through large ranges.
Sarcomeres are lost due to prolonged muscle shortening which results in structural adaptation to the shortened position.
Prolonged sedentary time or poor stretching and mobility are common causes. This is what is often referred to as a “soft tissue restriction”.
As explained earlier, these can alter joint position and movement quality but chronic loading during physical training with appropriate execution stimulates mechanoreceptors, which will help produce collagen and properties to improve the muscles tensile strength.
With understanding how a muscle contracts and can achieve a shortened position, you can better understand why it needs to be restored back to its normal property.
Using a form of stimuli such as soft tissue mobilization techniques helps to provide a form of pain relief from the shortened tissue, improve blood flow, stimulate the nerves and restore normal gliding of the tissue.
This stimulation not only rebalances the properties at the local level, the site of the spasm, but also sends the appropriate messages to the brain to help make the change as well.
Instrument Assisted Soft Tissue Mobilization (IASTM) Tools
Graston Tools
Graston tools are the most popular because they were the first patented brand. They are still only available to licensed healthcare professionals who have to complete the formal course and demonstrate proper knowledge on how to use them.
Over the years, more brands have been coming out with their own sets of tools. These tools are specifically shaped and designed to contour different parts of the human body, reaching large areas such as the thigh and small areas such as the wrist and forearm.
The tools are designed to have a specific weight evenly distributed throughout the size of the tool so it glides and moves thoroughly. They also have a beveled edge to allow for penetration into the tissue layers.
The tool is angled based on how aggressive and deep the desired effect is.
Graston tools tend to be the gold standard but there are some good brands that can rival the quality of Graston.
Generally more expensive tools are of better quality and cheaper, knock off tools don’t quite get the job done because of poor design.
How to use graston tools:
It was originally thought that heavy bruising needed to occur for a positive response but this has since been retracted through research and clinical outcomes.
A mild redness and mild bruising is acceptable as this is indicative of blood flow to the area and stimulated tissue.
If tissue is very restricted, some mild bruising occurs due to the tissue layers moving again. Heavy black and blue markings are not acceptable and can result in increased pain, tissue damage, extended sensitivity and deficient muscle function.
- The tool should be applied to match the anatomy of the body part and muscle orientation with a light pressure applied in a stroking motion along the muscle orientation.
- Long and short strokes or sweeps can be implemented. For tissue that is very restricted such as a “trigger point” or area of spasm, the tool can be angled more vertically to get deeper into the layers.
- The pressure remains the same. Pushing with more force, more aggressively, will not yield a faster response or better result.
- In more distal regions such as the calf and hamstring, sweeping towards the body and heart can help with the blood flow return.
- Areas such as the upper trap muscles and mid back can be swept away from the spine towards the extremities.
Examples of using the IASTM to address quadriceps and gastroc regions.
IASTM tools can be used directly on the skin with use of a Vaseline or emollient made out of mineral oil and bees wax to provide a nice glide and reduce friction to avoid skin irritation.
The tools can also be used over thin clothing such as compression tights or athletic gear.
Examples of using various sides of an IASTM tool to address the contour and anatomy of the wrist extensors and forearm region.
The desired time is usually anywhere from 5-8 minutes to allow for the stimulation of the tissue.
Mobility, stretching and corrective exercises should be implemented following the application to reinforce the neuromuscular control of the tissue that has now been released.
The goal is to help tissue that that been in spasm or restricted, return to its normal property so it can efficiency accept and produce force through training loads and demands.
Foam Rollers
Foam rollers have been around longer than IASTM tools and are probably more popular, especially amongst the general population. A standard foam roller is usually three feet long and six inches in circumference.
Smaller versions are also available for convenience regarding storage and travel.
Standard rollers have a smooth surface but there are some special ones available with nubs or a rigid surface. Standard foam rollers work well but the rollers with nubs allow the ability to target areas of localized restrictions or spasm.
Larger individuals such as football players or power lifters may need something more aggressive than a standard foam roll to help get through the layers of tissue mass.
Lacrosse balls can be used to apply to smaller areas such as the plantar fascia or between the shoulder blades.
There are hand held devices often referred to as “the stick” which can be used to roll the tissue in the same manner, almost similar to IASTM tools but with less pressure.
How to use a foam roller:
The same concept that applies with the IASTM tools, applies with the foam roller.
- The pressure does not need to be excessive or aggressive.
- If foam rolling produces tears, weird faces and prevents proper relaxed breathing, then the application is too aggressive and counter productive towards the desired result of reducing tension.
- Aggressive application will produce more tension throughout the body and can actually produce more pain in the region the rolling is being applied.
Examples of using a foam roller to address hamstrings and quadriceps regions by controlling pressure through body weight application.
The goal with foam rolling is to use your body’s weight as the force applicator with moving your body across the surface.
- The pressure should be light and move in a smooth, continuous manner along the muscle orientation.
- Controlling the pressure through your available arms and legs will help ensure proper force application.
The desired application is usually 5-8 minutes or sometimes anywhere from 30-50 rolls per area is sufficient.
Mobility, stretching and corrective exercises should be implemented following the application to reinforce the neuromuscular control of the tissue that has now been released.
Theraguns
Theraguns have been becoming very popular recently. The concept is revolved around providing the individual with an ability to target a specific area or region while doing minimal work him or herself.
Using IASTM tools and foam rolling can technically be a task within it self.
For localized areas of soft tissue restriction, the theraguns work well to concentrate a vibration force to the region, stimulating blood flow and reducing tension.
The combination of sweeping and vibration can be effective for stubborn areas where the gun does most of the work and the individual has to guide the pressure and direction.
Most guns come with multiple attachments that help to target different regions of the body.
Theraguns also tend to work well on areas of restrictions in larger individuals that sometimes require more aggressive force only due to the volume of muscle mass.
Essentially it is another tool for the toolbox that can help reduce built up tension in a region.
How to use the theraguns:
Just like the IASTM tools, these can easily be abused and used improperly, especially since it is a newer device on the market and research studies have yet to be conducted with exploring the parameters and usage.
Similar to the IASTM tools, the goal is to provide a steady, smooth and uniform motion over the muscle orientation, concentrating on areas of localized restrictions such as spasm and “trigger points”. Allowing the gun to do the work is key.
The pressure and vibration is enough stimuli to produce a desired effect. Most guns have multiple settings for speed and intensity depending on sensitivity in the area.
Examples of using the theragun ball piece attachment to address posterior tibialis, gastroc and soleus tightness.
The gun is not an impact driver! You are not driving a lag screw into the wall. This is your body and living tissue, which requires appropriate care. Applying more aggressive force will not only cause excessive pain but also result in more tension and counter productivity.
Some guns have a Bluetooth setting where you can follow along with instructions on your phone. Some protocols suggest going across the muscle belly and areas of tightness in combination with the longitudinal patterns.
Circular motions can also provide a form of stimulation to stubborn areas. The guns can be used directly on the skin or through clothing. No emollient is required.
Considering the maneuverability and force direction the guns, some more versatile angles can be applied than what can be applied with IASTM tools and foam rollers.
The desired application time can range anywhere from 2-8 minutes depending on the severity of tension.
Examples of using the theragun attachment double point piece to address Achilles musculotendinous junction region, plantar fascia, and meta tarsal heads.
Examples of using the theragun ball and double point attachments to address areas in the neck, quads and hamstrings.
The Bottom Line On Soft Tissue Mobilization Tools
These three tools are the most commonly available for self-use. They can vary in price depending on the quality of the product.
In the physical therapy field and in other fields such as acupuncture, massage, chiropractor and personal training, there are other methods of soft tissue manipulation that can be used.
Some of these methods require the application from another individual especially if it is to a region that is hard to reach such as the back.
Where To Buy/My Recommendations For The Best Soft Tissue Mobilization Tools
Other Soft Tissue Mobilization Techniques
Other techniques can include cupping, Kinesiotape and of course hands on techniques. Physical therapists use manual techniques such as Active Release Technique (ART) to help attack areas of soft restrictions.
An individual can certainly learn how to complete these techniques themselves but they may be challenging due to the inability to target the areas with the right force and pressure.
The same applies for self-taping, as taping techniques sometimes require a stretch and application that requires someone else to properly apply.
No matter what technique is used, they all should be complemented with a neuromuscular component such as mobility or stability training to reintegrate the body’s natural state of function.
Releasing tension and restoring normal tissue property in a resting state is useless if not implementing the relearning process for the tissue during movement and loading.
About The Author:
Michael St. George PT, DPT has been practicing for 10 years primarily in the outpatient and orthopedic setting. He works for a physical therapist owned private practice based in the greater Philadelphia area and surrounding suburbs. Mike is certified through Functional Movement Systems for FMS, SFMA and FCS which consist of screens and testing used to measure movement quality and performance. Mike also has experience with working with numerous surgeons and physicians from the Rothman institute. Currently he works primarily with ACL, meniscus and post surgical recovery and sports injuries, return to sport testing and performance, running evaluation and re training and hand and upper extremity conditions.
References:
- Lundy Ekman, L. (2007) Neuroscience Fundamentals for Rehabilitation. Ch 9: 187-193
