by John Rusin T-Nation
Here's what you need to know...
• Why are we still treating our soft tissues with techniques and implements that are decades old? You are better than your foam roller.
• For every deadlift session, do one session of soft tissue work to counteract the damage. Every time you hit up the bench, perform two concentrated sessions of soft tissue work. Don't worry, you can do it watching TV. And it's free.
• Just as the tennis ball provides a smaller surface area as compared to the foam roller, your fingertips provide an even more acute area with which to exert forces into your tissues. This high level of proprioception allows you to distinguish how painful trigger points feel, along with the tissue's texture and tone.
• With only your hands and the ability to optimally position your body for force and leverage, your shoulders can be bullet-proofed by tacking on as little as 5 minutes to the end of your training.
The foam roller has become one of the most notorious time wasters in any type of training center. The tennis ball kept us sane for a while, but that too has left us less than ecstatic every time we wedge it under our shoulder blades. With all the advancements in our industry, why are we still treating our soft tissues with techniques and tools that are decades old?
Brief History of Soft Tissue Self-Abuse
Let's dive deep into the T Nation archives for some answers. Ten years ago, Eric Cressey and Mike Robertson were the Christopher Columbus's of the soft tissue game with their article, "Feel Better For 10 Bucks." This article did more than get us to roll out our backsides before squats; it shaped our views as strength athletes on how self-myofascial release (SMR) could enhance an existing performance program.
Overnight, people from all corners of fitness were starting to make sweet, sweet love to foam rollers. Today, you'd be hard pressed to walk into any gym in America and not see at least one post-menopausal woman getting a little too over stimulated while rolling out that gnarly piriformis.
A few years later Tony Gentilcore jumped on the soft tissue horse with his "Soft Tissue Work For Tough Guys," which provided some smart modifications to standard SMR practices by using a tennis ball. By changing the tool, SMR was now more effective than ever. This was especially evident when working those stubborn little structures like the rotator cuff. Tony's goal – more hardened men shedding tears for the sake of tissue quality – was achieved. Amen.
While Tony left a heavy mark on SMR, he also addressed the missing link in most self-soft tissue programs. In that same 2006 article Tony stated, "The subscapularis is pretty much impossible to get to without going to a deep tissue massage therapist or to an Active Release Techniques (A.R.T.) practitioner." The first time I read this statement the solution seemed clear cut; go see your soft tissue specialist. What else could you do?
The rotator cuff isn't the only hard-to-hit tissue in the body. The cuff along with many other smaller, less superficial tissues is nearly impossible to self-treat with rollers or tennis balls. This of course doesn't stop us from trying over and over again to wedge the edge of the roller up against our ribs or into our armpits. However, after years of experimentation and implementation, I can attest that there's a better, more evolved way to effectively self- treat these stubborn tissues.
But First, the Problem With Sports Medicine
As a manual physical therapist and Active Release Techniques (A.R.T.) provider, I take great pride in the services and treatments I provide my clients. I continue to seek the most effective and efficient techniques available to enhance my clients' performances. That being said, in today's medical model, the effectiveness of soft tissue specialists is hugely limited.
The insurance industry has placed hand-cuffing restrictions on what they can and cannot do. Furthermore, rising cash rates and co-pays have made it harder on your wallet, but the whole boondoggle is even more costly on your time. It's no shock that more and more serious trainees and strength athletes are over the idea of rehabilitation and therapy. The model is failing, and the majority of the practitioners in the field of orthopedics are doing patients and clients a monumental disservice.
It's taken me years to figure out that manual therapy and soft tissue practitioners aren't the only answer to get your body functioning at a world-class level. The harsh reality is that the better part of a decade's worth of education and study of the biomedical movement model isn't making the difference for the population that's in dire need of elite service: strength athletes.
The origin of the problem is unclear. It may have started when the doctorate program in physical therapy started emphasizing the BOSU ball rather than deadlift technique, or using rubber tubing instead of the barbell. It's clear that for the seasoned strength athlete, the traditional physical therapy model isn't cutting it. What's even more disheartening is that many sports performance rehabilitation "specialists" are anything but experts in their field.
The true answer to maintaining and enhancing an advanced athlete's iron game can't be quantified in co-pays or minutes. Do you need your strength coach every time you get in the rack to squat? Soft tissue work is no different. Take the initiative and be accountable for your own self-soft tissue management.
For some movement restrictions and chronic injuries, we have no choice but to travel the path of professional soft tissue treatment. This isn't a loss; it's just the less than glorious cost of doing business. It's been said that nothing wrecks an athlete's day more than being prescribed the death sentence of physical therapy. If you've trained long and hard enough, you've been there and it sucks.
Sure, sometimes concise, concentrated therapy can clear up the symptoms of a nagging irritation and pissed off joints sooner rather than later, but most of the time, the "recovery" is anything but permanent. The number one predictor of a future injury is a previous injury, and many movement patterns and deep restrictions aren't being addressed, let alone effectively treated. The band-aid created by therapy only stays sticky for so long, and you damn well better hope healing took place before it decides to rip off.
After treating patients for years using gold standard, cutting-edge manual therapy and soft tissue techniques, I've come to a clear conclusion. We, as physical therapists and soft tissue practitioners, can only do so much. It's not a lack of mastery, or poor hands on soft tissue skills. It comes down to the frequency of treatment and the commitment level of the client.
In a perfect world, daily soft tissue treatments from kick-ass practitioners would keep every athlete's body feeling and functioning at an optimal level. This isn't a perfect world, and to be honest, being dependent on another person for the work you're capable of doing yourself is downright pathetic, not to mention dainty.
Scheduling treatments weekly or monthly is also a financially infeasible option for all the non 1-percenters out there who are training hard and in need of more advanced soft tissue work than the roller or tennis ball is able to offer. In order to even put a dent in some of these major soft tissue dysfunctions we see as practitioners, more sessions, more education, and even more client compliance is needed.
The Recovery Ratio
A general programming method I learned from a mentor of mine is the need for a 1:1 ratio between training and recovery. More specifically, with each compound movement pattern or emphasis that causes mechanical, metabolic or tensional stress to the tissues involved, a focused recovery session working on those active tissues is not only recommended, it's an absolute necessity for the long term health and functionality of those tissues.
Of course, this 1:1 ratio is only true for dynamic musculature and prime movers of the posterior chain. As you train the anterior chain and postural stabilizers more exclusively, the ratio is shifted to a 2:1 ratio in favor of soft tissue work.
Let's bring these ratios to reality. For every deadlift session, one session of soft tissue work will be needed to counteract the mechanical and metabolic damage of the foundational movement being performed. These recovery techniques are best programmed directly following your training session, when your tissue temperature is high enough to make some serious progress. By timing your self-treatments within your post-training window of recovery (around 30 minutes), you'll strategically increase your overall mechanical stress on the tissues and movement patterns being trained. This means decreasing your recovery time and not tearing down your tissues between workouts with additional days of soft tissue work.
Even harder to swallow, for every time you decide to hit up the bench, it'll take two concentrated sessions of soft tissue work to maintain your optimal alignment and function of the joints and soft tissues involved. For best results, get a self-treatment in after your workout, and one more later that same night. The grim news I'm conveying is that the average well-balanced, Monday-through-Friday strength-training program would require 5-6 soft tissue specific sessions. If this doesn't sound fun, let alone a feasible option to you, you're not alone!
Make Yourself Hurt So Good
The days of being forced to rely solely on the foam roller for a majority of our soft tissue needs are over. I'm not going to sit here and tell you that foam rolling is a complete waste of time. The roller can be a powerful addition to any performance program, especially if it's been underutilized. But for advanced trainees seeking the next progression that will streamline soft tissue health, the foam is no longer the best option.
Getting hands-on with your own soft tissue provides a seriously intense therapeutic stimulus. By doing so, you'll be able to pin point specific regions of dysfunctional soft tissue with your newly found mastery of functional anatomy and discriminative touch. Accessing tissues on your own that was never before possible can be a game changer for not only your recovery, but also your long term progressions and performances.
Just as the tennis ball provides a smaller surface area as compared to the foam roller, your fingertips provide an even more acute area with which to exert forces into your tissues. Your fingers and hands generate some of the finest sensory experiences in the human body. This high level of proprioception allows you to distinguish how painful trigger points feel, but also the tissue's texture and tone.
Beyond Treating Trigger Points
Tissues not only need direct trigger point work, they also need to be released from one another. This release creates a more authentic movement pattern, uninhibited by compensation. Each contractile tissue in the body has a primary action of movement, while many play a role in assisting other muscles with secondary actions.
If a muscle's primary and secondary actions aren't being actively trained but are still pulled into the motion being executed, inefficiency and lack of performance in these movements are the least of your problems. A messy pattern that we have all tried to retrain with our clients is the deep squat. When the lateral chain of the lower body (TFL/ITB) is tight and bound to the surrounding tissues, heavy compensations occur, such as knees caving in. These "sticky" muscles cause you to literally work against yourself and create some heavy dysfunctions, which can lead to a host of orthopedic issues in the short and long term.
Learning to identify specific musculature, while also differentiating overlying and underlying structures takes time and practice. These skills can't be developed overnight. You need continuous practice to be as effective as possible. With the need of a high frequency of treatment, your skills will be enhanced every single day, and in many cases it'll ultimately be better than going to a practitioner.
No matter how good the practitioner, or how magical they tell you their hands are, he can't feel what you feel. Your rich sensory experience is priceless in getting the most out of your soft tissue treatments and more specificity means more streamlined gains. You think your foam roller is capable of that?
Where to Start
Lifters lay down some serious scar tissue. This fact makes implementing advanced manual self-soft tissue techniques a pivotal aspect of our performance and recovery pyramid. The most popular techniques I teach to maintain and enhance long term shoulder health and function are focused on the small tendons and muscles attached to the shoulder blade. With only your hands and the ability to optimally positioning your body for force and leverage, your shoulders can be bullet-proofed by tacking on as little as five minutes to the end of your training.
Take Back Your Tissues
Exploration of your tissues is the primary goal of a successful self-soft tissue treatment. Studying your body, and knowing details about your specific anatomy and tissue structure, will enhance your efforts to improve your soft tissue health. Concentrate your efforts on finding tissues that feel leathery, along with clearly painful tissues in need of some serious attention. Due to the self-limiting nature of soft tissue work, the more the better! Save time and increase your return on investment with manual self-treatments. No excuses. Get after it.
The best practitioners spend their entire career perfecting their manual skills. Every single client that's professionally evaluated and treated is unique. No two people's structural anatomy is exactly the same. This creates a continuous revolving door of bodies and tissues, all ****ty in their own unique ways.
Lucky for us as self-sufficient athletes, we don't have to broaden our soft tissue skill set to meet the ever-growing demand of various clients. We have our own bodies to take care of, and that alone will take time and effort to explore fully. Find the little modifications to these foundational technical concepts that enhance your own treatments. This is merely a starting point for you to navigate your way through the shoulder and beyond. Start with these keys to manual self-soft tissue treatments:
• Spend the time and palpate your tissues to differentiate structures from one another. It won't hurt to break out some anatomy literature and study where you want to focus your attention.
• Your goal is to generate a "hurts good" feeling in the tissues being treated. If you've ever been treated by a professional, you'll recognize the correct feeling. Everyone's a bit different, but shoot for a subjective pain scale rating of 6-8/10.
• If you feel a sharp or radiating pain, different from trigger points in soft tissue, discontinue your pressure. You're most likely on a nerve or vasculature. Move off that point and continue your treatment next to the nerve. Many nerves become sticky, just as soft tissues do. Treat the tissue, not the nerve.
• The more tension you create, the less force you'll need to exert. Think twist, not push, with your hand placements.
• Put a strong emphasis on specific movement patterns that mimic exact movements being completed in your training. Reproduction of movement will create motor pathways to relearn and reestablish natural movement.
• Take into account the position of your neck and rib cage when working through the muscles of the shoulder. Many of these structures can be finely manipulated with intelligent positioning from all adjacent joints.
• Deep diaphragmatic breathing will enhance your self-treatment. Regulating your breathing can also provide increased concentration and a better general sensory experience allowing you to treat more effectively.