I read with interest a recent article entitled 'Iliotibial Band Syndrome: Please do not use a foam roller!' from esteemed sports physician Andrew Franklyn-Miller. I moved away from using foam rolling some years ago, so it was interesting to see this. There is some data to support the efficacy of self massage using a foam roller to improve range of motion and other functional measures. However, by its nature the foam roller is a blunt tool. Applying compression over such a large area, the foam roller is too imprecise to be useful for self-myofascial release via trigger point therapy. Morever, excessive and non-selective use of foam rolling has the potential to cause more trauma to the tissues than good. This discussion also prompted the topic of this two-part post - if not the foam roller, which of the growing array of self-therapy and recovery tools on the market is worth the investment and space in the athlete's kit bag? In part two, we will explore in more detail how to best use those tools that make the cut, with some examples.
Item #1 - 'Back Balls' (featuring a lacrosse ball or similar)
The first item for the kit bag is commercially available as a single piece of kit that comes under a variety of names and different suppliers, the best established of which being Bakballs. The use of this self-therapy device has become quite widespread in recent years, but was originally pioneered in Australia by sports physiotherapist Mark Alexander, and has won the endorsement of the Australian Physiotherapy Association. In part two of this post we will explore in detail the different applications, but briefly this device is used to mobilise adjacent vertebrae and release surrounding structures by lying supine atop it, so that pressure is applied using the athlete's own weight. The device is positioned at the junction between each vertebrae, moving in turn from S1/L5 to upper thoracic/lower cervical region (stopping at C7-T1).
Whilst this equipment can be bought as a prefabricated single-piece device, a do-it-yourself version can be made very simply and inexpensively - quite literally comprising two balls in a sock. When trying this out for the first time, you might want to use relatively softer and more compressible balls - tennis balls or similar. However, most athletes who are accustomed to deep tissue massage and performance therapy will soon graduate to something harder and less easily compressed. I favour lacrosse balls as they are very firm but have a thin rubber outer shell which makes it less uncomfortable against the skin.
Aside from being less costly - a legitimate factor in itself for many athletes - the DIY option has the advantage of being easily disassembled to provide the athlete with another self therapy tool. The balls themselves can be employed to great effect for self-myofascial release or trigger point massage. Once more the lacrosse ball is superior for this application, being firm but with an outer coating that is 'nonslip' - almost as if it was designed for the purpose. Likewise due to its shape the ball provides a focal point that can be easily manoeuvred to apply pressure to the precise region of the myofascial trigger point. This is clearly not something that can be achieved with a foam roller. Using this simple tool, the athlete can also replicate modified versions of active release techniques.
Item #2 - Yoga Strap
The second piece of kit that makes the cut is the humble yoga strap. This is another very inexpensive, light and very portable piece of equipment that can be employed for a variety of uses (as we will explore in more detail in part two of this post). One such application is as a tool for various mobility and assisted flexibility exercises for upper and lower limb.
The fact that the strap is made of inelastic material, and can be easily adjusted and fastened in a loop, also allows it to be employed to provide static resistance for isometric efforts (both submaximal and maximal). This application is particularly useful for the muscles of the hip. Similar 'activation' exercises for the gluteal muscles has been documented to serve an apparent potentiating effect when employed prior to dynamic activities such as jumping. For instance, a study by Crow and colleagues employed exercises recruiting the gluteal muscles in a group of elite team sports athletes alongside vertical jump testing and reported improved jump scores immediately following. Isometric exercises using the yoga strap such as a resisted clam shell might therefore be employed in a similar way to serve an 'activation' and potentiation function prior to training and competition.
Item #3 - Heavy Resistance Band
The heavy resistance band is a slightly more specialised piece of kit, but it is equally widely available from a host of different training equipment suppliers. To be used most effectively the band needs to be anchored to something immovable, such as a post or some wall bars - generally something suitable can be found at the training or competition facility. That said, there are also partner-assisted variations that can be employed with the help of a coach, therapist or training partner.
One of the major applications of the heavy resistance band from a self-therapy viewpoint is to provide traction to restore more normal joint function and mobility. For instance, conservative treatment modalities described in the sports medicine literature for hip impingement syndromes include exercises that involve 'distraction' applied using a belt - or in this case the heavy band.
For athletes who require a high degree of hip mobility (hurdlers, jumpers, racquet sports players, ice hockey players), band distraction mobilisation techniques can be used in a preemptive fashion as a normal part of athletes' mobility work. For instance, I observed these techniques employed with athletes in the hurdles and jumps squads particularly on a recent visit to AltisWorld.
(Extra) Item #4 - Gua Sha Stone Tool
Finally, an 'extra' item for the athlete's kit bag is a Gua Sha acupressure tool. These tools come in different shapes and are made with different materials, including plastic, jade and stone. Gua sha is a long established acupressure technique in traditional medicine from the Far East, but is often better known in the West by the more recent rebranded (and trademarked) titles, such as Graston therapy (involves the use of a set of specialised tools) and FAKTR. Gua Sha tools can be purchased easily and inexpensively online or from your local chinese medicine store. Alternatively, a ceramic (or plastic) chinese soup spoon offers an even cheaper and more readily available substitute.
The Gua Sha technique simply involves 'scraping' or grooming the fascia using the blunt tool directly on skin lubricated with massage oil or aqueous cream. Despite being long-established this technique has been subject to minimal study in the sports medicine literature. The limited study that has been undertaken does however indicate that these acupressure techniques may have some efficacy and more importantly attest to the safety of this method.
Myofascial structures are rich in both blood supply and afferent receptors; and Gua Sha or derived techniques appear to stimulate both. These factors are likely to underpin the acute effects observed with this form of treatment in the field. Many practitioners use some variation of these techniques in their treatment and therapy with athletes. Likewise, the athlete can apply this technique on themselves, following instruction by a suitably qualified practitioner.
So there it is, a light-weight, inexpensive, and portable selection of self-therapy equipment that can be carried in the athlete's kit bag each day at training or when traveling to competition. In part two of this post we will describe in greater detail the different applications of these tools, with examples for athletes to try at home...