“No Pain, no gain” is the perhaps the most popular catch phrase of the sporting world. This verbal expression which gained popularity for its motivational intention within the fitness world is commonly used to explain a powerful ideology – Pain produces gains. In other words, painful or discomforting experiences incurred by an individual is necessary to yield positive results, which can also be described as gains. The sentiment behind this cliche is so popular, and reflective of the human experience that similar inferences be found in ancient literature dating back to the early ages. For the human being searching for growth and development, pain appears to be intrinsically valued for its ability to produce positive results in the future.
This mindset, however, is one we must carefully consider when it comes to making long term improvements in the health and performance of athletes. Identifying, understanding and treating pain (or injury) is an important and necessary step towards making gains towards improving athletic potential. Thus, a more appropriate catchphrase for the mentality of those attempting to boost performance within the sport’s training environment should be “Break the chain of pain for potential gain.” Once we understand this perspective, we may be able to shift our behavior toward performance producing strategies that focus on the appropriate treatment on the incidence of pain as well the occurrence of injury within our athletes.
One particular strategy that provides potential for improving factors related to athletic performance, is managing neuromusculoskeletal pain and injury through the treatment of myofascial trigger points. In part 2 of “The Extra Work you need for Athletic Success” we learned that myofascial trigger points are commonly understood as hyper-irritable spots in skeletal muscle that can produce specific regional pain or altered sensation in particular areas (Simons, 2002). In addition, trigger points are linked to motor, sensory and/or muscle dysfunction (McPartland, 2004). Despite an awareness of this affliction in the athletic arena , authors note that treatment of myofascial abnormalities are commonly overlooked (Simons, 2002).
Although the collective consciousness attributed to myofascial treatment continues to grow it is important to appreciate how remarkably common myofascial trigger points are within the athletic space and how often they are a major cause of a patient’s musculoskeletal pain complaint. In fact, some researchers note that this particular abnormality impacts more than just the population of sport athletes. It is understood that a significant number of adults have latent trigger points that elicit pain on direct compression (Sola, 1990). Thus, this widespread condition deserves attention and understanding not only for the benefit of athletic populations but adults in general. Gaining insight to the prevalence of myofascial trigger points and associated treatment, management and prevention strategies can help to translate movement limitations from pain into movement potential gain for all populations
The first step in treating myofascial trigger points is to acknowledge its etiology and the physiological consequences associated with it. Dr. David Simons, leading expert on myofascial trigger points describes them as hyper-contracted sarcomeres or excessively bundled units of muscle when viewed underneath microscope. These tightly collected units of tissue can create a cascade of effects to the muscle fiber in which they inhabit. The surrounding structural units of muscle or remaining sarcomeres of the involved muscle fiber are noticeably stretched to compensate for the missing length of the shortened sarcomeres or trigger point (Simons, 2002). Researchers attributed this bundling of muscle to the properties of sarcomeres such as titin ( a spring-like molecule that functions in holding the elements of sarcomeres in place (Simons, 2002). The “sticking” properties of titin can influence these maximally contracted sarcomeres, allowing them to become stuck and shortened (Simons, 2002). The effect of these shortened and stuck sarcomeres can result in increased tension to the involved muscle fiber (Simons, 2002). This tension can manifest itself as muscle stiffness and/or pain resulting in muscle and movement dysfunction.
Clinicians have recognized for more than a century that effective treatment of painful, tense, tender muscles includes stretching the involved muscle fibers, either locally in the region of tenderness or by lengthening the muscle as a whole (Resteghini, 2016). Likewise, treatment of myofascial trigger points centers on disrupting, lengthening or releasing of certain structural musculoskeletal units. To treat trigger points it is important to understand the characteristics of titin. Titin is a particularly important and frequent element within the musculoskeletal system. It is a protein which functions in providing architectural support and maintaining sarcomeric organization during muscle contraction (Gigli et al., 2016). More importantly, this protein is known for it’s role in the generation of stiffness within muscle tissue and functions in developing passive tension during muscle stretching (Gigli et al., 2016). Because of the particularly “unyielding” or stiff characteristics associated with titin, releasing accumulated sarcomeres or muscle can take time and effort. However, clinical experience shows that there are effective methods that can be used to release the structural units that lay the foundation and/or development of myofascial trigger points.
In fact, researchers confirm that employing a strategy which centers on producing slowly sustained stretches are an effective method for releasing myofascial trigger point tightness (Simons, 2002). It is believed that the action of slow sustained stretches is effective at lengthening shortened sarcomeres. Again, the effectiveness of this mode of treatment may be due to the properties of titin. Several studies have uncovered the basic elements of how titin proteins respond to a stretching force and it has been found that titin changes structure in a time and force dependent manner (Rivas-Pardo et al., 2016). Understanding the influence of time and force to the disruption of muscle tissue units is critical for treating myofascial trigger points. Applying force over time to myofascial trigger points can result in the lengthening of potentially shortened sarcomas, diminish muscle fiber tension and reduce excessive energy consumption within the muscolskeletal system. Strategies which employ a measure of force over time can be useful in treating muscle tissue and improving factors related to athletic potential.
Leading experts have address several methods aimed at treating myofascial trigger points and/or optimizing sarcolema length. The most common approach to myofascial treatment occurs through the action of compression. Over twenty years ago, researchers Dr. David Simons and Dr. Janet Travell first devised a method to treat myofascial trigger points by applying heavy thumb pressure on trigger points. This strategy employs the use of a force (expressed through the thumb) over a certain time to produce ischemic compression over an afflicted area. Treating myofascial trigger points by compression is an approach most commonly seen in the athletic arena through the use of foam and stick rollers. Athletes will use these rollers in effort to compress adhesions within muscle fibers and return structural units to their appropriate length. Over the last few years, however, experts have devised new methods for treating myofascial tissue.
For instance, the “press and stretch” technique is believed to be a more effective strategy in restoring abnormally contracted muscle units to their normal resting length. Specifically, this technique is thought to disrupt trigger points by mechanically disuniting the tethered muscle structural unit myosin from actin. This is a process that normally requires energy from the body, therefore the press and stretch technique helps to conserve energy by it’s ability to uncouple contracted pieces of muscle. Experts suggest that the press and stretch may also help release the “sticky” characteristics reflective of the titin connections in myofascial trigger points. (McPartland, 2004). This relatively new approach to myofascial treatment can be a valuable resource for movement specialist, performance coaches and athletes looking to rediscover lost potential.
The tools currently utilized within the athletic space provide a one dimensional approach to treating fascia. These application devices have been invented and marketed to roll and apply pressure to the muscles to disrupt adhesions in fascia. However no device has been able to both apply pressure to the skin and also pulls the skin to further disrupt fascia – Until now. It is for this reason that I have designed a new tool aimed at both applying compressive and stretching forces to tissue. The “Rattle Stick” roller is a tool which emphasizes compressive and traction forces in effort to better disrupt trigger points.
The Rattlestick is a one piece roller device layered with suction cups which allows the application of force in a multiple dimensions. With the Rattlestick, a person conducting the myofascial treatment firmly presses cups and the body of the roller against the skin of the area to be treated. The application of firm pressure provides a disruptive force to collagen fibers and enables the suction cups to adhere to the skin of the area being treated. Gentle, but firm repeated rolling of the roller over the area to be treated first causes a row of suction cups to adhere to the patient’s skin and then continued rolling removes that row of suction cups. This repetitive action of compression and traction forces along muscle tissue over a periods of time can help to improve blood flow and mechanically disrupt the connection between “sticky” structural units that compose myofascial trigger points.
The Rattlestick represents one approach to myofascial care for our athletes. The stick roller can be part of the ethereal “Extra work” that we all search for in order to gain a competitive edge. Most of us should know the importance of tissue care by now. And a lot of us understand that myofascial treatment is a process that needs to be performed consistently over a long period of time to maximize gain in movement and performance. The number of devices attributed to myofascial care that are currently on the market reflect this common understanding. However, the “Rattlestick” roller is a step forward. It is simply better, because we now have the opportunity to apply compressive forces and traction forces on muscle fascia more efficiently and over a greater amount of tissue at relatively low energy costs. Simply put, The Rattlestick is the tool that will help to limit your pain in effort to produce gains.
Gigli, M., Begay, R. L., Morea, G., Graw, S. L., Sinagra, G., Taylor, M. R. G., … Mestroni, L. (2016). A Review of the Giant Protein Titin in Clinical Molecular Diagnostics of Cardiomyopathies. Frontiers in Cardiovascular Medicine, 3, 21.
Sola, A. E., Bonica, J. J., (1990). Myofascial pain syndromes. In: Bonica J J, Loser J D, Chapman C R, Fordyce W E, editors. The Management of Pain. 2nd edition. Philadelphia: Lea & Febiger; .352-367.
Dan Liburd is in his ninth season as a NFL Strength and Conditioning Coach. Liburd has experience in designing, implementing and supervising strength and conditioning programs for various athletic populations. Liburd also has experience in designing and overseeing team nutrition and dietary programs. Liburd is a Certified Strength and Conditioning Specialist who earned his Bachelor degree in Exercise Science from Boston University. He has a Master of Science degree from Canisius College in Health and Human Performance and is currently working towards his Ph.D. in Health and Human Performance at Concordia University Chicago. Liburd holds a variety of certifications in Health and Sport Nutrition, Olympic Weight Lifting and Movement Assessment. These certifications include Precision Nutrition Level I and Level II as well as USA Weightlifting and Functional Movement Systems. Liburd also has a great deal of experience in Health, Fitness and Sport Strength and Conditioning. Liburd has worked with several professional teams such as the Buffalo Bills and the Pittsburgh Steelers. Liburd has also held various positions in Collegiate Strength and Conditioning programs. He has worked with the Boston University Terriers, Springfield College Pride, American College Yellow Jackets and held positions at Mike Boyle Strength and Conditioning as well as Peak Performance Physical Therapy.