by Dr. Lisa Goodman, DC, CCSP, CACCP
In last week’s blog I introduced the concept of joint mobility and how many crossfitters and other athletes can find very significant improvements in flexibility with simple chiropractic adjustments. It astounds me daily just how much improvement in movement and performance can happen with changes in joint mobility. Joint mobility is not really affected by stretches or foam rolling. It is nearly completely improved by adjustments or mobilizations. Once established, it can be aided by traction (utilizing bands) and by improving overall, global mobility. Yoga and Crossfit are a great example of how to maintain joint mobility once you have solved it.
The Tight Muscle Misconception. Ok, so what about muscle, ligament and connective tissue movement? What about flexibility? We tend to overuse the word TIGHT. Manily in the form of “tight hamstrings”, “tight lower back”, “tight pecs” and my current favorite “tight hips”. What does tight mean? I don’t completely hate the word, because it is pretty descriptive. To the person with tight muscles, it means that they most likely feel tight, or like they cannot stretch as far. So in that way, I generally know when someone says they are tight, that they mean they are having trouble moving a muscle as far as they think it should be able to go. The problem with the word TIGHT, is that it doesn’t really describe anything fixable. In other words, the opposite of tight is LOOSE, and while I do want more flexibility and more mobility in my muscles, I definitely do not want loose muscles. If you aren’t sure yet why loose muscles would be a bad thing let’s revisit our problem areas above. Loose hamstrings, lower back, pecs or hips would mean a total imbalance to the stability of the body. Those muscles are all really important stabilizers to keep up strong, standing and upright. In other words - we don’t want loose muscles, but we do want more movement and more control in these otherwise ‘tight’ muscles.
How NOT to Fix Tight Muscles
Step one. Do not stretch.
Step two. Do not foam roll.
How to Fix Tight Muscles.
Myofascial Release. This can be done by a sports professional (chiro or PT) and concurrently or eventually it can be done to yourself to maintain mobility. There are a lot of versions of myofascial release (Active Release Technique, Graston Technique, Myofascial Release, FAKTR, Pin and Stretch, etc.) but they are all based around one goal - to release myofascial adhesions that may form between layers of muscle, ligament, fascia or other soft tissue.
What is a Myofascial Adhesion? I just showed you the answer before describing the problem! Going to make this really simple. Layers of muscle and ligaments are long, strong and flexible and designed to smoothly and easily glide and stretch around each other. When those muscle or ligament fibers are injured or damaged, they form adhesions as part of their natural, healing process. This is really similar to how a cut on your skin heals - a disproportionately large scab forms around a cut to stop the bleeding. Over a process of weeks the skin under the clot remodels to form rather normal looking skin...and a scar. So think of a myofascial adhesion as a scar that forms in the tissue between layers of muscle, fascia or ligament. Now back to our list of how NOT to fix a tight muscle. None of those three will resolve a scar. Stretching and foam rolling a myofascial adhesion does not efficiently or meaningfully resolve a myofascial adhesion. Another good visual is thinking about a rope tied in a knot, if you pull both ends (ie. stretch) the rope the knot gets tighter. If you first until the knot, it is much easier to pull both ends. So we can think of the myofascial adhesions as the knot in the rope. This explains why many times stretching a tight muscle can make it feel tighter!
How does Soft Tissue Injury Happen? To summarize, myofascial adhesions result from inappropriately healed soft tissue (muscle, ligament, tendon, fascia) injuries. We are talking about three basic types of injury:
Sudden, traumatic injury - severe sprain / strain (ie. ankle sprain)
Slow, but instantaneous seemingly minor injury - muscle pull (sprinting groin pull)
Repetitive stress - ‘tight’ muscles (pecs, hips, hamstring, lower back......)
Myofascial Release to Regain Mobility and Strength. Resolving myofascial adhesions can be really simple and this brings us back to our second part of mobility...soft tissue. If you have a myofascial adhesion (ie. scar) between layers of muscle, ligament or fascia, you really have to resolve it before the injured muscle can be trained to be strong, flexible or supportive. Myofascial release is a way of breaking up the adhesion in the injured muscle so that your body and immune system can absorb the broken down adhesion and re-heal the muscle. Essentially, we use either our hands or metal instruments to hold or pin down the adhesion while moving the muscle through a range of motion.
Check out this example... Two Crossfit Case Studies (and I am one!)
I am no exception to injury - over the last few weeks I have had a handful of minor muscle pulls at both Crossfit and soccer. My injuries have occurred in my lower back, inner thighs (adductors), pecs and quads. As an expert in soft tissue and myofascial release, I was able to resolve these within a day or two with the help of my chiropractor, Dr. Jace Buzek. And again, I know I am biased, but had I let them go untreated, I know these minor but significant injuries could have ballooned into a chronic issue.
Among my crossfit patients, I have come across some really perfect examples of minor to moderate muscle injuries that were not treated appropriately initially. Let’s highlight hip injuries as they are really common in this group. One competitive female patient, Brittney Gaillot, in particular has extremely ‘tight’ hips. Pain worse at the deepest part of a squat and even worse upon standing from that position. We determined that his injury happened months ago, seemed minor at first and gradually compounded into a moderate to severe adhesion. My approach in this case is to restore joint mobility (see part 1 of this blog from last week) as making sure that her pelvis and SI joint mobility is optimal will help in reducing stress from her hips. The next step is determining exactly where her hip ‘tightness’ or adhesion is coming from. With pain in the front of the hip/groin we look at three prime suspects: hip flexors, quadriceps, adductors. In our patient it is all three. We can determine this with muscle strength testing (weak in all three) and with palpation (feeling tender areas in all three) but most importantly, with what actions cause pain. With our style of myofascial release - we utilize the position of pain (deep squatting) and treat her while bearing weight in that position. While it’s pretty uncomfortable, it is actually really cool. Treating the myofascial adhesion for about 3-5 minutes in a weight-bearing position while using the injured muscle can produce immediate improvement in mobility. The main side effect: bruising. This is not our main objective, but it is common. Common results: if an injury is new (ie. pulled muscle) it can resolve in one quick treatment. If an injury is months old and has become a daily issue or is getting worse, it may take 4-8 treatments to make significant progress, but there is still an immediate effect after just 1-2.<
How to do Myofascial Release to Yourself. All of the balls, bands, rollers and sticks at my office and at the gym can be effectively used to maintain mobility and attack new, mild muscle pulls. There are about 10+ videos on our instagram page @washparkchiro that go over how to use them most effectively. We are always adding new videos and come up with them on an individual, patient basis!
My last two blogs were SO technical - but hope they help answer some questions about how to improve your mobility at Crossfit (and with other sports/workouts). Chiropractic adjustments and myofascial release can quickly and efficiently improve strength and mobility. I really do think everyone should have a good sports chiro in their life because injury is part of progress. It just is.
Washington Park Chiropractic is the only practice in Denver, Colorado specializing in Sports Chiropractic, Prenatal Chiropractic and Pediatric Chiropractic. Our Wash Park Doctors are expert certified and trained in Sports, Pediatrics and Prenatal Care including massage, acupuncture, Webster Technique, Graston Technique, Laser, K-Laser, Kinesiology Tape, RockTape and Normatec.
Lisa Goodman, DC, CCSP, CACCP is a Certified Chiropractic Sports Physician (CCSP) and Certified Prenatal and Pediatric Chiropractor (CACCP). She is a CrossFit L1 and CrossFit Kids Certified Trainer. Dr. Goodman founded Washington Park Chiropractic in 2006 in Denver, Colorado. Dr. Goodman incorporates sports chiropractic techniques with prenatal and pediatric patients, she teaches mobility and taping classes locally, and is a contributor to POPSUGAR, Urban Life Wash Park and DC Aligned. She is a committee member on the boards of the ACA Pediatrics Council and the ACA Sports Council. Areas of special interest include prenatal care, ankle and wrist injuries, instrument assisted soft tissue techniques, strength training, and pediatric fitness. Stay connected with Dr. Goodman on Instagram @washparkchiro or @lisakgoodman