It hurts so good

Can self-administrated release techniques relieve muscular pain?


Self-myofascial release (SMR) is a sub-type of a wider array of inhibitory techniques designated to release, and in turn, lengthen, over active muscles and neuro-myofascial connective tissues and sensory organs through external and intra fusal fibers manual utilization (Clark & Lucett, 2010). SMR may be applied in conjunction with static stretching, positional release therapy (PRT), active release therapy (ART) and trigger point pressure release (Mauntel et al., 2014).


Rationale and effectiveness of SMR in the research

The physiological rationale for SMR is rooted in the thought that the muscle spindle reacts to constant, precise and elaborated pressure on the muscle’s trigger point, or the point of the most hyper tonic fibers and taut bands formation (Roylance et al., 2013). The muscle’s sensory organ, known as the Golgi tendon, will elicit a Gamma loop process; motor neurons, directly responsible for the stimulation of the muscle intra-fusal fibers and called Gamma neurons, will change the spindle’s length. This is a negative feedback based-loop which ultimately aims to keep the muscle in a certain length and operates in response to external loads. Relevant to our discussion of inhibitory effects, static gamma neurons have the most effect in a muscle spindle’s decreased response to load. The gamma neurons, however, are not able to change the entire muscle’s length as they elicit mostly the spindle’s fibers and require the co-activation of alpha neurons to create an overall change in the muscle’s length (Wiesendanger, 2012).

SMR has been widely studied, however its effectiveness is somewhat equivocal in the current research. Some studies reported significant increase in muscular flexibility following SMR techniques; hamstrings flexibility, measured by the sit and reach test, has increased by 4.7% among a SMR intervention group (Sullivan et al., 2015). Other studies found no clinical evidence to the effectiveness of SMR. When comparing hamstring stiffness to the earlier study by Sullivan et al. (2015), no differences in post-intervention in hamstring flexibility were found following a combined treatment of SMR and static stretches (Morton et al., 2015). Those examples represent the conflicting reports regarding the effectiveness, and reliability of SMR as well as the need for more empirical testing to establish its effectiveness in the corrective exercise continuum. As its name suggests, SMR is a self-administrated treatment. As such, it may divert from an optimal and precise protocol due to the self-nature of the application. While qualified practitioners are familiar with the biomehcnaics and are skilled and licensed to apply manual therapy, most individuals are not or at least not to the same degree; palpating, identifying taut bands, applying sustainable and prolonged pressure are all at risk of improper use when self-administrated by an unqualified individual, therefore diminishing the effectiveness of SMR again.


Phases of SMR use in exercise programs

Program design in corrective exercise is based upon the continuum of four phases: inhibition, lengthening, activation and integration (Clark & Lucett, 2010). The first phase, inhibition, is when SMR is applied. The mechanism of over activity in muscles and fascial sheets can benefit from inhibition techniques as a first line of defense, followed by an effective use of static stretch (lengthening), activation of under-active muscles and an integrated dynamic movement to create a wholistic corrective exercise program for the individual. A over active muscle is characterized by an increased, involuntary activity of motor units and the relative inability to cease their recruiting, not allowing the muscle to relax (Gracies, 2005). Muscle over activity can be stretch-sensitive or not and the plasticity of the muscle will eventually change into a shorter state, assuming the overactive muscle has not been inhibited and lengthened, according to Davies’ law (Clark & Lucett, 2010). The timing of SMR is therefore significant to its success, as initial implementation of release technique may assist in the reduction of motor units excitations and lead to an acute inhibition and relaxation of the muscle and fascia, allowing for the second phase of lengthening to commence.


Positive gains of SMR

SMR has been linked to improvements of four main categories; according to Škarabot et al., (2015), SMR can be grouped into positive effects on biomechanical, physiological, neurological and psychological functions. By applying sustained, low-intensity and longer duration (up to 300 seconds), direct and in-direct SMR may reduce sensations of pain and improve functionality. For athletic populations, this may translate into enhanced performance (Schroeder & Best, 2015). SMR can potentially improve the following:

  • Flexibility: acute and chronic, measurable via enhanced range of motion at the joints. It is important to note that acclimation may occur and the effect of improvement in flexibility will be smaller in time (Škarabot et al., 2015).

  • Reduction in delayed onset muscle soreness (DOMS). One interesting explanation by Mauntel et al., (2014), is that SMR restores basal activity in the muscle during rest, which allows for stretching and return to previous, larger levels of ROM. When ROM is again increased, pain can be subsided. This can be useful for athletes in need of enhanced recovery between competitions.

  • Increased functionality of fascia: SMR can alter, or restore, the viscosity of the fascial sheets. The elasticity of the fascia is elevated and allows for greater ROM as well as reduced stimulation of pain receptors due to the more fluid-like state of the connective tissue (Cathcart et al., 2019).

  • Improved operation of the nervous system: SMR can reduce the degree of alpha motor neuros excitation through the central nervous system, leading to inhibition of muscles over activity. The para sympathetic nervous system is also affected by SMR through increased activity, which lowers cortisol levels and reduces stress (Kim et al., 2014).

Instrumental applications of SMR

Although SMR can be implemented using a variety of instruments, it is the foam roller which received the most research evidence up to date. As such, it should be consider the main tool prior to secondary instruments for the mere reasoning of scientific, peer-reviewed evidence which is somewhat lacking for other tools such as vibration devices and medicine balls. Regardless of the tool used, the movement direction is proximal to distal with a slower phase of prolonged pressure on or around the myofascial trigger point.

Foam roller has been reported to inhibit over active muscles without compromising performance. A combination of pressure and friction allows the fascia to stretch and rise in temperature, creating a more fluid state which can increase ROM through release of fascial adhesions (Sullivan et al., 2013). Other instruments in use are the medicine balls, with larger diameters recommended prior to smaller ones (Clark & Lucett, 2010). Balls are more versatile in the location of tissue they can be direct at (Kalichman & David, 2017); however a higher amount of motor control is needed to operate it. Vibration devises are another tool, gaining popularity in clinical settings and health clubs. The mechanism of operation is, similar to SMR with a foam roller, the triggering of the muscle spindle to create a stretch reflex. Vibration devices are commercially available both as vibrating foam roller or as percussion devices (Clark & Lucett, 2010) with the later sometime requiring the presence of another person, complicating the administration of myofascial release if self-treatment was preference (and is therefore presented here as a secondary device to use).


As with any rehabilitation methods, SMR should be implemented with caution and avoid any contra indication for treatment. Such indication may be global (chronic diseases such as osteoporosis, congestive heart failure, bleeding disorders) and local (open wounds, recent cortisone therapy) (Clark & Lucett, 2010; Duncan, 2014).

To summarize, SMR is viewed as a beneficial tool in the literature for the initial inhibition of over active muscle and fascial tissues in the corrective exercise continuum. Combining SMR with sequential techniques of static stretching, activation and integration can potentially enhance recovery and reduce the risk for more chronic compensatory movement patterns and referred pain.

References

Beardsley, C., & Škarabot, J. (2015). Effects of self-myofascial release: a systematic review. Journal of Bodywork And Movement Therapies, 19(4), 747-758.


Cathcart, E., McSweeney, T., Johnston, R., Young, H., & Edwards, D. J. (2019). Immediate biomechanical, systemic and interoceptive effects of myofascial release on the thoracic spine: A randomized controlled trial. Journal of Bodywork and Movement Therapies, 23(1), 74-81.


Clark, M., & Lucett, S. (Eds.). (2010). NASM essentials of corrective exercise training (1st Ed.). Lippincott Williams & Wilkins.


Duncan, R. (2014). Myofascial release. Human Kinetics.


Gracies, J. M. (2005). Pathophysiology of spastic paresis. II: Emergence of muscle overactivity. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine, 31(5), 552-571.


Kalichman, L., & David, C. B. (2017). Effect of self-myofascial release on myofascial pain, muscle flexibility, and strength: a narrative review. Journal of Bodywork and Movement Therapies, 21(2), 446-451.


Kim, K., Park, S., Goo, B. O., & Choi, S. C. (2014). Effect of Self-myofascial Release on Reduction of Physical Stress: A Pilot Study. Journal of Physical Therapy Science, 26(11), 1779–1781. https://doi.org/10.1589/jpts.26.1779


Mauntel, T. C., Clark, M. A., & Padua, D. A. (2014). Effectiveness of myofascial release therapies on physical performance measurements: A systematic review. Athletic Training and Sports Health Care, 6(4), 189-196.


Morton, R. W., Oikawa, S., Phillips, S. M., Devries, M. C., & Mitchell, C. J. (2016). Self-Myofascial Release: No Improvement of Functional Outcomes in “Tight” Hamstrings. International Journal of Sports Physiology & Performance, 11(5), 658–663.


Roylance, D. S., George, J. D., Hammer, A. M., Rencher, N., Fellingham, G. W., Hager, R. L., & Myrer, W. J. (2013). Evaluating acute changes in joint range-of-motion using self-myofascial release, postural alignment exercises, and static stretches. International Journal of Exercise Science, 6(4), 6.


Schroeder, A. N., & Best, T. M. (2015). Is self myofascial release an effective preexercise and recovery strategy? A literature review. Current Sports Medicine Reports, 14(3), 200-208.

Škarabot, J., Beardsley, C., & Štirn, I. (2015). Comparing the effects of self‐myofascial release with static stretching on ankle range‐of‐motion in adolescent athletes. International Journal of Sports Physical Therapy, 10(2), 203.


Sullivan, K. M., Silvey, D. B., Button, D. C., & Behm, D. G. (2013). Roller-massager application to the hamstrings increases sit-and-reach range of motion within five to ten seconds without performance impairments. International Journal of Sports Physical Therapy, 8(3), 228–236.


Wiesendanger, M. (2012). Pathophysiology of muscle tone (Vol. 9). Springer Science & Business Media.

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