Soft tissue work is Still Critical

Many blogs and articles continue to insist that foam rolling is an insignificant part of mobility training, as we don’t know exactly how or why it works. I too don’t believe that foam rolling mechanically breaks down scar tissue and fascial bind, but it certainly does transiently reduce stiffness. People continue to move and feel better after they do it, and most importantly, it always improves the quality of mobility tasks that take place post intervention.

Does this mean that any physical therapist shouldn’t adjust/manipulate a spinal or peripheral joint because we don’t have a complete physiological reason/knowledge as to why we get a reduction in pain and improvement in range of motion post intervention?

Breathing is Essential to Quality Core stiffness and Thoracic mobility!

As an example, take deep squat breathing with lat stretch:

We constantly see shoulder flexion range of motion improve 10-25 degrees without stretching or mobilizing the shoulder girdle itself or anywhere near its end range of motion, ultimately minimizing risk of aggravating the capsule or surrounding ligaments.

Alternating between cueing a downward pull of the lats and a light shrug and protraction through the Scapulothoracic joint, inducing upward rotation can bring about benefits during this exercise. The muscles of your anterior core are incredibly important for getting air out!  Staying in deep inhalation, with each faulty breath creates unnecessary accessory tone (scalenes, lats, SCM, Pec minor etc). Shall we use our diaphragm instead perhaps?

Step 1 is to get the ribs down and pelvis into some posterior tilt to re-establish a Neutral Zone.

Step 2 is to learn how to Breathe in this position, emphasizing full Exhalation.

Step 3 is to strengthen these “newly rediscovered” patterns with good anterior core training (Resisting extension, dead bug, rollouts, fallouts etc)

Not everyone conforms to the joint-by-joint approach

Gray Cook (FMS/SFMA) and Mike Boyle first brought the approach to the fore, and whilst for the majority of the population, the concept is exceptionally consistent, there is never a one size fits all approach. Ultimately, they looked at the body and saw a common theme, the joint systems from toe to head alternate between requiring a greater amount of mobility and a greater amount of stability. The ankles require mobility, the knees require stability, the hips require mobility, the lumbar spine needs stability, the thoracic spine needs mobility, the scapula needs stability, etc. However, there are individuals with hypermobile hips, excessively stiff lumbar spines and extremely flat and extended thoracic spines. You can’t use a one-size fits all approach, and thus you need to have a baseline assessment in the gym facility, or have a physical therapist whom you trust and communicate with regularly and refer them off! 

Mistaking laxity for mobility

Physical Therapist assessments are gradually becoming more and more aware and considerate of congenital laxity. These individuals’ mobility training should focus on soft tissue quality and high volume stability training in all planes. Instead of simply testing them in mobility drills, it may be wise to team the mobility drill with a stability-based task to test their mobility under unstable demands.

Instability however, is an acquired, excessive joint range of motion. The individual can go beyond the realms of their normal anatomy to get into a desired position. Just because you can get to a position does not mean that you are stable in that position!

Mobility is a bank account

Maintaining mobility is easier than losing it and getting it back. If you excessively withdraw from your account, such as direct trauma to tissue, alcohol and tobacco use, faulty movement patterns or sitting at your desk for 5-8 hours, 5 days a week, you will lose all your deposits made from an early age. Deposit regularly and save smart.