Pain - Part 3

Well I hope you were able to try out the Myofascial Compression Techniques on your Soleus muscles over the past few days, and you were able to see what an amazing difference there was during the reveal tests.

I have been using Self Myofascial Release (SMR) techniques for years, on myself and my athletes with great success.  These techniques have been applied using foam rolls and tennis balls...not the TP Therapy products...and I can honestly say that I have seen far better results in increased mobility, pain reduction, and improved muscle elasticity by using the Trigger Point products.

This is not to say that the 'standard' SMR techniques do not provide benefit...I just feel as though there is significantly more benefit gained through the use of the TP products.

Today, we are going to explore the Quadriceps muscle group which, as most of you know, makes up our 'thigh' muscles.

The Quadriceps muscle group is made up of the Vastus Lateralis, Vastus Medialis, Vastus Intermedius, and the Rectus Femoris.  The quadriceps are primarily responsible for knee extension, but just as with the calf muscles, the quads have other functional responsibilities such as knee joint stabilization, hip-complex stabilization, and the deceleration of knee flexion.

Remember, the Trigger Point system was developed around six distinct areas...The Ultimate 6 Areas for improved biomechanics.  The first area we worked on was the Soleus muscle, and today we are going to work on both the medial and the lateral aspects of the Quads - targeting the Rectus Femoris and the Vatsus Lateralis muscles of the thigh.

Before we do that however, lets gain a little deeper understanding of each muscle.

Rectus Femoris

The Rectus Femoris (RF) is positioned down the center of the thigh.  This muscle originates from the anterior-inferior iliac spine of the pelvis.  This means that it attaches to the pelvis itself, thus having some degree of control over our hips.  The RF inserts at the base of the patella, at the tibial tuberosity on the anterior tibia.  As the RF crosses over the knee joint, it also has some degree of control over the knee.  

Muscles that cross two separate joint articulations are often referred to as bi-articulate, meaning they control movement at two joints.  In comparison, the Soleus muscle is considered a mono-articulate muscle as it only crosses the ankle joint, and is only responsible for movement of foot-ankle complex.

RF's isolated, or primary function, is two-fold (remember, it's bi-articulate)...Knee extension and hip extension, through concentric contraction.  The integrated function of the RF is also two-fold, as it decelerates (slows) the extension of the hip, and flexion of the knee, via eccentric contraction.  The RF also stabilizes both the lumbo-pelvic-hip complex (LPHC) and the knee through isometric contractions.

Rectus Femoris muscle in red

 Vastus Lateralis

The Vastus Lateralis (VL) is positioned laterally along the thigh, hence the name lateralis.  The VL originates from the anterior and inferior border of the greater trochanter, the lateral region of the gluteal tuberosity, and the lateral lip of the linea aspera of the femur.

What?

Basically, the VL's attachment is confined to points below the pelvis, so it is a mono-articulate muscle.  The VL inserts at the base of the patella, and the tibial tuberosity - the same insertion points as the RF. 

Vastus Lateralis muscle is outer portion in red, not the inner portion

OK, now let's learn a little about what the VL does.  In an isolated manner, the VL is responsible for knee extension, and knee extension only.

Pop Quiz time!

Why isn't the VL responsible (like the RF) for action at the hips?  HINT:  the answer is right above!

Excellent!  Because it does not cross or attach to the pelvis.  Very Good!

Alright, back to it's functions.  The VL does have integrated functions...both eccentrically, and isometrically.  Eccentrically, the VL is responsible for the deceleration of knee flexion, while isometrically, it stabilizes the knee, along with it's counterpart - the Vastus Medialis Oblique (VMO).  The VMO is the inner muscle that is highlighted in red, in the illustration above.

Now that you have gained an understanding of the functional anatomy of the Quadriceps (or at least some of the quad muscles), let's talk about why we should be applying Trigger Point Therapy's Myofascial Compression Techniques (or other forms of self myofascial release) to this area.

Many athletes, young or old, are quad-dominant.  This means that the normal patterns of muscle recruitment have been altered, and have resulted in movement dysfunction.  This can be the result of injury, chronic overuse, or pattern overload.

As I have mentioned in previous posts, we spend a great deal of time sitting.  Our muscles adapt to this position, through the process of adaptive shortening, and over time, the normal firing patterns of our muscles become altered.  

Overuse is another reason for these alterations in normal movement, and serves as justification for employing myofascial release techniques.  Take for instance, my sport of cycling.  During a typical three hour road bike ride, I usually average a pedal cadence of 85 RPM.  This means that, on average, I complete 15,300 pedal revolutions during a typical three hour training session.  

That's overuse.  That's pattern overload. 

Applying the principle of adaptive shortening as a result of chronic overuse/pattern overload...when the hip flexors are tasked repeatedly, or placed in a shortened position for extended periods of time (such as sitting), they tend to adapt by remaining in a shortened position.  This occurs even after we have stood up, or stopped the incessant pedaling.  

The position of the pelvis is controlled, in great part, by the hip flexors and hip extensors.  The hip flexors are positioned anteriorly, while the hip extensors are along our backside.  Proper positioning of the pelvis is dependent upon the harmonious relationship between these agonist and antagonist muscles...basically, balance between these muscle groups must exist for the pelvis to remain properly positioned.

A battle (of sorts) ensues when the hip flexors become adaptively shortened.  The battle takes place between the flexors and extensors, and is more often than not, won by the smaller, weaker hip flexors.  You see, our most powerful muscles - the gluteals, tend to give up the fight to the smaller, weaker hip flexors.  This results in an anteriorly tilted pelvis, a condition which is often referred to as Lower-Crossed Syndrome (LCS).  

Individuals with LCS often complain of low back pain.  This is a result of the compressive forces being applied to the intervertebral discs of the lumber spine...which result from the severe curvature created in the low back, as we instinctively stand up straight.

Let me explain...

Our spine attaches to our pelvis.  When we tip our pelvis forward (anteriorly), our spine naturally follows, resulting in a forward lean at the hips.  Instinctively however, we upright ourselves so that we are not leaning forward.  This creates a greater-than-normal curvature in our lumbar spine - usually L3-L5.  Over time, the compressive forces created, coupled with athletic activity, can cause the disc to bulge.  When this happens, the nerves that emanate from within this region of the spine, can become compressed - which ultimately causes pain and numbness in the low back, buttocks, and the back of our legs.  If left unaddressed, these bulging discs can rupture, creating a host of more severe problems.

How's that for a reason to employ these Trigger Point techniques?!

To restore proper positioning of the pelvis, the over-active flexors must be relaxed, and allowed to return to their normal resting length.  Additional, work needs to be performed to 'retrain' the gluteals as well, however, this post will only be addressing our work on the hip flexor muscles.

Now let's take a look at how we will use the Trigger Point Therapy products to help restore proper biomechanics in the knees and hips.   I will warn you...there is a fair amount of discomfort associated with this manipulation...it is similar that which you experience while getting a deep tissue or sports massage.  With the Quadballer however, you control the amount of pressure applied to the tissues, thus placing you in control!

The video below briefly describes the Quadriceps manipulation, and provides a little video demonstration.  Unfortunately, it may be a little vague for some, so I will walk you through the steps.

Click here to see the video demonstration

The photo below shows the proper body position when performing the Quadriceps manipulation.  The Trigger Point team refers to this as the "GI Joe" position.  As this blog is directed toward aging athletes, I am sure all of you understand the GI Joe reference...right?

 

Here we go...grab your Quadballer (you have purchased a TP Therapy kit by now haven't you?) and place it on the floor in front of you. The easiest way to position yourself correctly is to kneel on the floor, placing the Quadballer (QB from here on out) directly in front of your left thigh, so that it actually makes contact with your leg.  Next, lean forward, placing your hands on the floor, allowing your body to settle comfortably (HA!) with the QB positioned about 1-2 inches above your knee.  Extend your left leg, and bend your right leg as shown above...the GI Joe position.

You will feel an immediate sensation of discomfort...the tell-tale sign that you really need to be doing this!  Similar to the Soleus manipulation, there are multiple passes that are going to be made, each of which will focus on a different area of the muscle group.

The first pass will remain centered on the thigh, the second pass will be approximately 45-degrees off center, laterally...and the final pass can either be performed on the IT Band, or run the reverse direction along the lateral aspect of the thigh.  Due to the fact that I believe the IT Band can benefit significantly from SMR techniques, this description will include it in the third pass.

Keeping the hips low creates more pressure on the thigh...which is exactly what we want, so do your best to maintain a position with your hips low to the ground, and your foot slightly elevated.  While pushing through your elbows, begin your first pass by moving your body downward...this rolls the QB upward toward your hips.  Your first pass will consist of four incremental movements, whereby you will roll up one inch, and down one-half inch.  Each incremental movement is then followed by two Cross Friction moves.  To perform the cross friction, maintain pressure on the QB while quickly moving your thigh back and forth, laterally on the QB.  Perform two cross friction passes.  Next you will perform two leg bends by flexing your knee and bringing your lower leg up, approximately 45-degrees.  Perform two leg bends.  This completes the first pass.  The QB should be roughly 1/4 of the way up your thigh.

Perform one more series of incremental movements, cross-friction passes, and leg bends with the QB aligned along the center of your thigh.  When finished with the second pass, the QB should be located close to the midpoint of your thigh.  

The third pass will focus on your Vastus Lateralis, so you will need to rotate your foot internally, which causes the femur (and thigh) to internally rotate, positioning the VL directly on the QB.  Do not lift your leg off of the QB when rotating it inward!  The goal is to maintain constant pressure on the thigh throughout the entire manipulation.  

Now that the QB is positioned on the VL, perform two more series of passes, working your way to the upper end of the thigh.  When you are finished with the last pass, the QB should be located directly on the Tensor Fascia Latae (TFL).  The TFL is point of origin for the IT Band, and must (for best results) be released prior to rolling the IT Band (ITB), which is exactly what your last pass did.  

Now it's time to work the IT Band.  Again, do not ease up on the pressure while repositioning...simply rotate your foot inward even more, and shift your weight to the left to direct the pressure onto the ITB.  Your hips will be opened up significantly, in this position, as it is not necessary to keep the hips low and level to the floor for this series of passes.  You will be working your way back down towards your knee, performing the same series of incremental passes, cross-friction, and knee bends.  The only difference is that now you will be rolling down one inch, and back up one-half inch.

Once you have completed the entire series for the left leg, switch sides with the QB and perform the series for the right leg.  The video below provides a brief demonstration of the incremental pass, the cross-friction technique, and the knee bend.

Click here to see the video

Thanks for reading, and as always...please leave me a comment about this blog.  And...if you have not yet purchased your Trigger Point Therapy kit, and  you are an athlete (aging or not), you don't know what you are missing!  I can honestly say that over the course of my 15 years within the sports performance industry, this is the best tool I have come across for performing self-myofascial release techniques.  This could be a game changer for you!

Yours in Health and Performance!

John