Pain originating from muscles and fascia (myofascial pain) is one of the most commonly encountered problems seen in physiotherapy practice. Furthermore, myofascial pain is among the most common chronic musculoskeletal conditions. Myofascial pain often originates from 'trigger points' - palpable, irritable bands within a muscle that are painful on compression and may limit range of movement by increasing a muscle's sensitivity to stretching. Trigger points may also refer pain to sites away from their location through neurological pathways. With the adverse symptoms and commonplace occurrence of myofascial pain and trigger points, it has become a topic of heavy interest - and there are several opinions on how it can or should be managed.
One approach that can help to reduce muscle tension and improve movement is to employ deep pressure over sites of pain and restriction, combined with active contraction and lengthening of the muscle through range. This is sometimes referred to as a functional release or mobilisation with movement. When properly executed this can lead to immediate improvements in range of movement and reductions in pain. However, there is still debate as to how long these effects last, and such therapeutic techniques need to be a part of a comprehensive program for addressing a myofascial condition.
In our blog video this week we present a short routine for performing muscle release techniques on the lower limb using a trigger ball ( lacrosse ball, tennis ball or hand ball makes a good alternative). We often see patients who complain of lower limb muscular tightness, pain or restriction as a limiting factor in their running, gym programs or sport. The release techniques shown can allow improved range of motion and movement control in your hips, knees and ankles when employed before activity. The video shows 5 techniques. In the order they appear they are - a calf release, fibularis release (side of calf), vastus lateralis release (outside of thigh 'ITB'), rectus femoris/vastus intermedius release (front of thigh), proximal hamstring muscle release (back of thigh below pelvis) and a gluteal muscle release (bottom muscles).
In each case the trigger ball is positioned over the area of pain and tension in the muscle, then the individual moves the muscle through range under pressure with the movements shown. Stronger release can be added by attempting to push your body off the ground by directing pressure into the ball through the affected region. This is repeated for ~ 2 mins until a sensation of relief is felt. Importantly, do not push through intense pain (moderate pressure accordingly) and do not position the trigger ball over bony prominences. If adverse symptoms such as pins and needles occur do not persist.
It is worth noting that for the hamstring release a tool is used made of 4 tennis balls taped into a pyramid - this allows a nice stable base for a trigger release to be performed. It can also be used on a variety of other body areas and is a very handy tool! See the picture below to make your own for a few dollars with some tennis balls and strapping tape. Specific self applied tools can also be purchased online for trigger point therapy if budget is not an issue.
If you are experiencing muscle tightness, pain and restriction that is limiting your movement and exercise talk to your physio about how to manage this. Employing some of these muscle release techniques may assist you in returning to exercise pain free and with improved mobility and movement control. A short article on the physiology and management of myofascial trigger points is listed below for further reading and to improve your knowledge of this topic.
Until next time, have a ball with these muscle release techniques!
The Gap Physio
Lavelle ED, Lavelle W & Smith HS 2007, 'Myofascial Trigger Points', Anesthesiology, Vol.25, pp. 841-851.