Did you get a chance to check out my recent newsletter for April? If not, click below and read it for yourself. It has tons of information like videos on improving great toe motion, self-myofascial release on the foot, a video collaboration with Brady Holt on ‘Ankle Motion as it Relates to Performance,’ to improving hip mobility with a simple, and effective dynamic warm-up. Also, a NEW promotion which includes a FREE functional training or ART session with me at Quest Performance.
It has been 5 and a half years since I graduated from Quinnipiac University with a degree in Athletic Training/Sports Medicine. Throughout my undergraduate coursework, we were tested, re-tested, and tested again on anatomy, this is something I have always known very well. But, our hands-on skills in the areas of soft-tissue mobilization, restoring nerve gliding, and freeing up adhered tissues was limited. In fact, much of what I did after undergrad was ischemic compression, which involved placing firm pressure over a “trigger point” causing it to release.
As I look back to my first experiences working in college athletics, I know I have grown leaps and bounds. There were many injuries, that with Active Release Techniques (ART), would have responded much more effectively, allowing the athlete to return to their sport in a shorter time frame. To recall just a few, the often diagnosed “sciatica,” carpal tunnel syndrome, and rotator cuff tendonitis. Despite being very good with therapeutic exercise and modalities, many of these chronic injuries just didn’t respond well. A missing component within my arsenal of skills was soft-tissue mobilization, specifically ART.
Since becoming a Certified ART Provider, I have come back into contact with many of these injuries that stressed myself and my athletes out for weeks to months. I almost feel bad looking back that they had to miss so many practices and games of the sports which they loved. They also had numerous appointments for diagnostic imaging and with doctors who also did not understand the soft-tissue component, like myself at that time. With ART, I have witnessed several people who were on the brink of surgery become pain-free and regain function. Others who have had nagging injuries that did not respond well to traditional physical therapy get back to what they love. I’m not saying that every injury is miraculously cured with Active Release, it does has a time and place when it should be implemented to achieve the best results. But overall, my effectiveness of treatment has increased significantly with the addition of ART.
It sucks to look back and think, “Man, I wish I knew this then.” But, I’m thankful to have had the opportunity to expand my education and skills, which ultimately provides better outcomes. My hope is that in 5 years I will be writing the same thing again, showing that I have become better at what I do. Growth and learning is a continual process which we will never completely catch up to. There are so many advances and new information developing on a daily basis that all we can do is keep our minds open and keep learning.
Garrett McLaughlin is a Licensed Athletic Trainer, Personal Trainer, and ART Provider in the Nashville area. He implements ART into his fitness and rehabilitation programs to restore normal, pain-free range of motion and function. For more information on ART, click here.
| Article written on April 13th, 2015 at 11:30am | Follow Garrett on Facebook, Twitter, and Instagram |
In January of this year I took my first Active Release Techniques (ART) course. Immediately I saw the value in this soft-tissue evaluation and treatment technique which would be beneficial for almost anybody looking to improve function in some way. I was fortunate to be able to take the lower extremity course last weekend right here in downtown Nashville. This course not only allowed me to improve my hands-on skills, but provided a greater understanding of functional anatomy. This post describes a few things I learned after becoming a Certified ART Provider, that I feel are misunderstood by quite a few people. And, realize that all of these problems can be effectively treated with Active Release.
Tightness, or lack of relative motion?
Many of us suffer from tightness in our lower extremity, whether it be the hamstrings, quads, or the calf, among many other places. This tightness may not actually be shortness in the muscle itself but lack of relative motion from adjacent structures. Have you ever looked at the anatomy of the human body. The picture usually shows muscles, ligaments, tendons, and nerves with clear cut borders. But, things aren’t that clear cut within the human body as certain tissues can become adhered to adjacent tissues causing a restriction in motion. For example, the upper calf and the lower hamstrings. If there is any adhesion between these tissues it will clearly prohibit their normal sliding in opposite directions which may display as tightness in the calf or hamstring.
This is also possible with nerves. In so many places nerves actually pierce through muscles and travel through the smallest of spaces. What if nerves are being impinged and lose their ability to glide, will this display as tightness? You betcha, and it may even have some type of neurological pattern, such as numbness and tingling. Some common areas are the sciatic nerve at the sacrotuberous ligament, piriformis, superior gemmelus, and between the medial and lateral hamstrings.
Sciatica just means you have specific symptoms but there is no specific location of injury yet uncovered.
The diagnosis of sciatica is a bit lazy in my opinion. This means you may feel radiating symptoms, numbness or tingling anywhere from the lower back, gluteals, posterior thigh, through the bottom of the foot. Do you know how many structures can affect the sciatic nerve from its course starting as a nerve root at the spine to the plantar aspect of the foot? So many!! As I stated above it can be one of so many areas that are actually causing the problem without any resolution because the cause isn’t pinpointed. If this is your diagnosis, I would ask for more answers.
Plantar fasciitis is a blanket term which refers to foot pain and it may not even be the fascia itself.
The plantar aspect of the foot is full of tons of different tissues in a small area. As you can see from the pictures, the plantar fascia is only a small part of what lies within the foot. Are your symptoms caused from an intrinsic muscle, an extrinsic muscle, the plantar aponeurosis, plantar fascia, a nerve being impinged, or a restricted joint? Don’t think rolling on a golf ball, stretching the calf, and anti-inflammatories are going to resolve your issue if it’s not actually the plantar fascia itself.
Chronic ‘tendonitis’ has been found to lack inflammation. Then what’s the ‘itis’?
Research has shown that many of these tendonitis diagnoses actually lack inflammatory cells when extracted and studied. So what is the actual issue? Could the problem be scar tissue build-up or a disorganized fiber alignment? Could it be adjacent structures lacking their relative motion and pulling on the affected tissues? I don’t know exactly, but all I know is it isn’t inflammation or some type of ‘itis.’ This is just some word that was thrown at your injury to make you feel like it will get better from ice/heat, stretching, and rest, when in reality a form of soft-tissue treatment may be your best bet.
By: Garrett McLaughlin, MS, ATC, CSCS, ART
As the weather starts to warm-up there are a lot more races for runners happening on a weekly basis. This is great for distance runners and the community, as it promotes exercise and living a healthy lifestyle. I do credit runners for their training discipline and being active on a consistent basis, which sets them apart from other exercise-goers. However, an area I see that is commonly neglected is properly recovering from the high mileage demand of distance running. Sports involving high volume, repetitive motions can cause significant wear and tear on your soft-tissue, which increases the chance of injury. In this post I will discuss the process of muscle repair, and why the soft-tissue should be treated regularly.
How Do Muscles Repair?
When you strain a muscle, new muscle forms in its place, correct? Not exactly… During muscle repair following injury or repetitive stress, your body actually lays down different substances which are weaker and less elastic in nature, called scar tissue. Just think about that for a minute… After injury, your soft-tissue just isn’t the same. That is why it’s essential to not just rest completely following soft-tissue injury, but gradually stretch, strengthen and re-align the tissues manually. Once the scar tissue is laid down, it happens in almost a haphazard fashion. These new substances that fill in to repair the tissue need to be aligned in the same direction as the original muscle fiber, or the muscle will not function optimally and the incidence of future injury is high.
Do you have tight muscles? Have you ever considered that the tightness may be a protective mechanism by the brain to prevent further damage? Take a peek at the diagram to the right. Stress can start a vicious cycle, which if not treated properly can lead to injury. Even the low intensity, but repetitive running motion can cause microtrauma to the muscles. In some instances there might not even be a pain response, but often an increased level of soreness for the next few days that people usually disregard as having a great run or workout. This is all it takes on a weekly basis to increase your likelihood of muscular strain, tightness, compensation, and injury.
Maintaining the resiliency of your soft-tissue is key if you want to excel in running, prevent adhesion/scar tissue build-up, and thus prevent injury. And, the great thing about soft-tissue treatment is there are tons of methods out there. Foam rolling may be the cheapest, do-it-yourself form of self-myofascial release (SMR). A foam roller costs anywhere from $15-$30 and is a must have for all runners. Although there is still some research needed on what exactly foam rolling is doing, there is no doubt that it makes you feel better after and allows greater improvements in flexibility. Other SMR techniques include using tennis balls, lacrosse balls, a theracane, etc. Whichever one you choose is fine with me, as long as you are making an attempt of improving tissue quality. Here is a quick video on foam rolling the Iliotibial Band.
Another great method is massage. It is definitely sufficient to maintain tissue quality with a foam roller, but the direct, hands-on application of a massage therapist is far superior. To manually palpate, and find specific restrictions within the soft-tissue will provide a better outcome. And, you usually don’t have to do a thing. Unlike a foam roller, which usually takes a little bit of work, a message will have more improvements than just to the soft-tissue. By improving lymphatic drainage, increasing blood flow, decreasing pain, and causing a longer lasting state of relaxation, I highly recommend this method once in a while.
As a certified active release techniques provider, I am biased to ART as the most superior method. ART is a diagnosis/treatment technique which takes into consideration not only which way the muscles fibers are oriented, but the movement of the muscle itself. By placing a specific contact on the tissue and then moving it from a shortened to lengthened position, either actively or passively, it allows the therapist to feel and break up any scar tissue/adhesions within the tissue. In terms of tissue repair, this technique makes the most sense by re-aligning the haphazard fibers to regain proper length and function.
Regardless of which soft-tissue method you choose, consider adding something into your maintenance routine. Not only will it allow you to improve flexibility and feel good, but it will reduce your chance of injury. Remember, exercise without proper recovery is like preparing dinner and never putting it into the oven. Why put in all the work if you’re not allowing yourself to reap the benefits. Think of it like getting an oil change for your car, once in a while we need it to continue running at our best. To find a certified active release techniques provider in your area, check out the ART website.
Garrett McLaughlin is a licensed athletic trainer and personal trainer in Nashville, TN. He thoroughly enjoys helping people make improvements within their lives. Aside from one-on-one personal training, Garrett is a certified active release techniques provider. ART is a soft-tissue manual therapy technique to quickly and safely restore the natural function of muscles, tendons, ligaments, nerves, and fascia. Contact Garrett for more information.
When it comes to distance running there are many proper steps that are often overlooked. In my experience I have come across a significant amount of runners who only run. With repetitive task activities, whether that be siting at a computer and typing all day or running, we need to develop an adequate maintenance program to offset the negative effects of these movements. When I say maintenance program, I am not only talking about exercise, but soft-tissue work, movement prep/warm-up, mobility/flexibility, and nutrition. When all of these things are combined in a way to maximize performance, we can reduce the chance of injury, become more efficient, and improve results. Below are a few tips on getting the most out of your runs.
1. Soft-Tissue Work is essential to maintain normal functioning tissue. It is proven that over time doing the same repetitive motions will cause our tissues to breakdown, become adhered to surrounding structures, and lose there proper function which will cause compensation and injury. There are several great soft-tissue treatment techniques out there such as Active Release Techniques (ART), Graston, Myofascial Release, and Sports Massage. My favorite is ART as it allows the practitioner to evaluate tissue tension, texture, function, and movement. Once the dysfunctional tissues are located, it uses specific protocols to regain the tissues natural function. How often does a runner need soft-tissue work you may ask? Well, it all depends. I always recommend that my clients listen to their bodies. Some come to me every few weeks, and others every few months. Another cheaper alternative would be to pick up a foam roller and trying this form of self-myofascial release. It’s not as effective as using a therapist, but it definitely makes a difference. Here is a great site talking about the benefits of ART on runners.
2. Movement Preparation/Dynamic Warm-Up is essential and often an overlooked aspect to most exercise and running programs. Week after week I hear the same complaints of either not knowing what to do or not having enough time. In just several minutes you can adequately prepare the body for what lies ahead and good chance it will even maximize your run. I truly believe a proper warm-up should be based on our weaknesses while also increasing heart rate, muscle temperature, and mentally preparing for the upcoming activity. Check out these two videos for ideas on basic dynamic warm-ups:
3. Completing a Movement Screen is possibly the most important part of exercising properly. Ask yourself, “Is what I do on a daily basis improving my weaknesses, or am I continuing to put fitness on top of dysfunction?” Now, when I say weakness I don’t mean the actual strength of a muscle, but are all parts of the body functioning correctly to put them through the stress you do running each and every time. A movement screen will take a look at the biomechanics of your movement. Are you compensating? Do you have adequate mobility in your joints? Do you have the necessary strength to complete basic movements? Movement screening breaks you down in order to build you back up. Each and every one of my clients completes a movement screen prior to beginning their program. This way I have a baseline of how their body is functioning and can then create a program to improve their mechanics and also achieve their fitness goals. I highly recommend finding a qualified personal trainer, athletic trainer, or physical therapist to assess your movement and develop a plan to improve these things. This will maximize your runs, allow you to become more efficient with less energy wasted, and most importantly reduce the chance of injury.
4. Many runners have trouble finding the time to Resistance Train. Resistance training is essential to distance runners because it provides the opportunity to improve performance, address any dysfunctional areas, and reduce injury. I don’t even necessarily think you need to go to the gym 3-4 days/week, but based on your movement screen what are some exercises you can do at home that will make you better. It is amazing at how many people have lost the natural movement patterns that we were born with. In a society that is becoming less active every year and sitting long hours at a desk, resistance training can help combat those negative effects. For those that spend the majority of their exercise each week running, complete a movement screen, and develop a corrective program that will take only 10-15 minutes per day. Remember, “A chain is no stronger than it’s weakest link, and life is after all a chain.” – William James.
5. Just as important as a warm-up, Cooling Down/Stretching is a simple and easy way to recover post-run, prevent muscle soreness, and offset the limitations in flexibility we get from exercising and then sitting down as we cool off. Try adding just a 3-5 minute cool down after your runs. This could be as simple as slowing down to a light jog or walking to allow your heart rate to decrease. Once you finish a brief cool down, run through both lower and upper body stretches to restore the muscles back to their resting length. A lot of research shows that we don’t necessarily gain range of motion while stretching the muscles when they are warm due to their elastic properties, but if we reset back to our “normal” tension we can prevent future tightness from developing. Not only will this prevent tightness but it will allow you to recover quicker and feel better the next day.
6. Let’s be honest, Nutrition is the key to it all. We can exercise all day but still not become truly healthy on a cellular level unless we improve our nutrition in some way. Eating right really isn’t that difficult. Strive to eat every 3-4 hours to increase metabolism, regulate blood sugar levels, and prevent excessive hunger which leads to overeating. Once you get that principle down it’s all about quality of food. This means reading labels, staying away from processed foods, and trying to eat as natural as possible. Yes, obviously this can be a more expensive way, but the results you can see from eating well go beyond just your running performance and impact your whole life. I recommend all my distance runner clients to wear a heart rate monitor. This will give a more exact representation of how many calories they are burning during their runs and throughout the day. Then emphasis can be placed on adequately refueling the body and getting enough proteins to prevent tissue degradation.
Take the time to evaluate your current situation. Are any of the above areas missing in your exercise routine? If you are unsure, find a qualified fitness/health professional to evaluate your program and make the necessary changes to maximize results. Stay tuned until next time for ‘Exercises That All Runners Should Be Doing.’ Safe and healthy running to you all!
Garrett McLaughlin is a licensed athletic trainer, personal trainer, and certified active release techniques provider. He creates fitness and injury rehabilitation programs for athletes and the general population. Aside from achieving the client’s specific goal, Garrett is passionate about making each client move better in the process. With years working in collegiate and high school athletics, Garrett has trained cross-country/track athletes to some of their best times. Contact Garrett for more information on personal training, injury rehabilitation, or active release techniques. You can also check out his wellness page on Facebook for more frequent postings.
Active release techniques is a patented soft-tissue system that treats muscles, tendons, ligaments, fascia, and nerves. It is common through repetitive daily tasks and athletic events that we develop restrictions within our soft-tissue structures which limit blood flow/circulation, cause pain, limit range of motion, and cause compensatory motion. ART is a specific system that allows the provider to use his hands to identify restriction and adhesions within the tissues and treat using specific protocols. These protocols consist of identifying the structure involved, placing that structure in a shortened position, apply a specific contact tension along the tissue, and then actively or passively lengthening the tissue. By doing so, the dysfunctional tissue slides under the contact of the provider causing any restriction or adhesions within the tissue to be broken up resulting in the restoration of normal functional tissue.
Several factors are taken in consideration when it comes to ART and they are: tissue tension, tissue texture, tissue movement, and tissue function. When a tissue doesn’t function properly, pain is often the result within that specific tissue or others, as a compensatory mechanism. Why do some of those factors change within tissue you may wonder? It is usually a result of the everyday stressors we expose our bodies to. For example: An office worker who types for 7 hours a day and reaches in the same direction to pick up the phone. This may not seem like much, but imagine how the body adapts to the same small movements day in and day out for years. It is also common for the athletic population to have some type of soft-tissue dysfunction from the normal wear and tear of the activity.
This past weekend, I had the chance to become a certified ART provider for the upper extremity. This 4-day certification educational program is only offered to healthcare providers such as doctors, chiropractors, physical/occupational therapists, massage therapists, and athletic trainers. It was an amazing educational experience which provided me an additional set of skills in evaluating and treating soft-tissue injuries. It is common for many soft-tissue injuries to be labeled as tendonitis when it is nothing more then adhesions within the tissue that need to be appropriately treated using ART. It can also be used for many postural issues such as forward rounded shoulders and the loss of normal joint range of motion from tissue tightness. I feel ART can have a great impact on not only someone who is injured, but the regular gym-goer or athlete who wants to prevent injury and maintain healthy bodily function.
Garrett McLaughlin is an Athletic Trainer and Personal Trainer in Nashville, TN. He creates personal training and injury rehabilitation programs for the general population and athletes. Garrett is passionate about not only working one-on-one with clients, but educating them on health & wellness so they can continue making positive choices throughout their lives. Contact Garrett with questions or to schedule a session.