Does IASTM and Cupping need to leave bruises?!

I'm a little worried about this one! This is a topic that has brought up some pretty deep emotional stuff with some clients and practitioners who have used these therapies with some success. But the therapies themselves also have some deep seeded roots in cultural and spiritual aspects for some people. So we'll see how this goes!

Lets start with cupping, because I think it'll help lead us into IASTM/Graston/Gua Sha. Cupping has been around for a very long time! They used to use bamboo cups or clay cups before we moved to glass, then plastic and silicon. The idea was that you had to bring sickness to the surface in order to get rid of it. Think like blood letting or using leeches to suck out tainted blood. Chinese medicine had the element of helping with stagnant Chi flow (our life energy that flow through our body).

As we got into more modern times though we learned that we have natural cleaning systems like our kidneys, spleen, and lymph nodes that are constantly working to clean out any problematic things in our body. The idea of needing to bleed out toxins gets voided out by this knowledge. Now, we do have superficial lymph vessels that help clear things out so this is some peoples attempt to justify the idea of needing to bring stuff to the surface, but we also have lymph vessels all throughout the different layers of our body so that doesn't apply either.

The next step was to try and integrate Eastern and Western medicine and say that instead of working with Chi flow we're gonna work with blood flow, so cupping helps "stagnant blood". Again, based on modern information we have a closed system of blood vessels where blood is continuously pushed through the system. You shouldn't have stagnant blood anywhere, unless you have a blockage which leads to tissue death like in a heart attack. There goes that idea too.

So now onto the bruises! People who are deep into cupping will usually make the claim that they're not bruises, it's different. Well it's not. Its actually another form of stagnant blood because the cup has ripped the blood out of the vessels into the intercellular spaces to form a bruise. Instead of preventing or helping stagnant blood they've actually created it. Now the body has to deal with whatever the original complaint of the client was plus it has to clean up the spilled blood. Which leads us to the next part where people will claim that the process of cleaning up the bruise has medicinal effects. There is an enzyme called Heme oxygenase 1 or HO-1 for short. It's job in this scenario is to help clean up the mess. Studies have found that there may be an analgesic effect of Ho-1 or even possibly it's counterpart that shuts down HO-1. But in those studies they are doing injections of massive amounts of HO-1 into an injured area, way more than would be present in a cupping bruise. Not only is it still theoretical and being studied but the dosing would be wrong anyway.

This leads us back to our question of does cupping need to leave a bruise. My opinion is absolutely not. The focus should be on the decompressive effect of the cupping and the neurological stimulus it provides. If during that time the client/patient has a bruise appear then oh well. But the focus shouldn't be on creating a bruise. The amount of suction seems to be directly related to how dark and full the bruise becomes, but a high amount of suction isn't required to have the effects we want. a low to moderate amount is plenty depending on if its static cupping or if you need a little more because you're going to have your client move around while they have the cups on.

Hopefully that makes sense. We need to shift our mindset since we've learned a lot about the human body and it's physiology so the narrative of what the therapy is doing needs to be updated.

Same goes for IASTM/Graston/Muscle Scraping/Gua Sha. Gua Sha is the chinese medicine version of the modern Graston or IASTM. The belief is similar to that of cupping where you have to cause bruising in order to help people clear out the toxins or sickness. The biggest difference between scraping(lets use that term to cover all the different names) and cupping is that is compressive versus decompressive. But the same effect can happen, it forces blood out of the vessels and capillaries into the intercellular space leaving a visible bruise. "It's not a bruise, it's petechiae!" They say. It's blood that is no longer in the vessels. Same argument as cupping, same HO-1 enzyme brought up for the same reason, same logic to refute it. But this time I don't think it's ok to leave a bruise. You can provide someone a scraping treatment and stop if things look like they're starting to bruise. Cupping its a little more of a guessing game. Scraping can be a lot more controlled so there's no reason to leave marks on someone. Treatment philosophy is similar with cupping, the reason the treatment works isn't because we are changing the anatomy of what's going on in the area but its a physiological response to the stimulus you're providing. Because of that you don't have to go crazy on someone in order to get the response we want, which means no bruises.

If you are a practitioner, give it a try for yourself. Think of it as providing the minimal amount of of stimulus to create a change. Don't go overboard "just in case". I think you'll find like I did that we can get the exact same response without being as aggressive. Give it a go and let me know!

Changing the language in rehab

17 years ago I started massage school. It was a family run school with numerous campuses around the surrounding states. They had built a name for themselves so when I graduated I had job offers from all around the country.

Over ten years later I went to work at that same school and found that the curriculum hadn't changed at all! Pretty scary to me considering how quickly the world of physiology is changing! I only lasted at that school for one term.

Fast forward again to four months ago when I hired a therapist who had just graduated from that school. In talking with him I found out that the curriculum still hadn't changed! So in over 20 years of that school being open they hadn't updated their information. Come to find out though this is very common in the world of rehab. We are taught the same old info and processes with the same theoretical info but as if it was fact. That's the part that bothers me the most.

When we don't understand something we try and come up with an explanation that makes sense to us. "The reason for thunder and lightning is because Thor is striking his hammer." Right? How well do you think it went over when the first person suggested a more scientific explanation. Well, we do this a ton in the rehab world. We massage, scrape, cup, adjust, mobilize, whatever to a client/patient and when their range of motion improves we say it's because we released tight muscles, broke down scar tissue/adhesions, or we put things back into place. But research has been done and none of that has been found to be true. The amount of force it takes to deform tissue even 1% is way beyond what a massage therapist, cup, or scraping tool could provide. Sorry, but look it up.

We're way overdue for a language refresh in our rehab world. There are so many claimed benefits out there that need to be thrown out. So start with yourself. Listen to the way you speak to your clients/patients and double check what you are saying to them. Google is so easy, but you just have to find reliable sources instead of sales pitches. One of my favorite companies has continued to do this, Rocktape has come out numerous times to update their following and say that what they had said is wrong. No shame in it, its built a following of practitioners in chiropractic, physical therapy, athletic training, massage and personal training/strength coaching. I have a ton of respect for someone who can admit a mistake and then show or explain how they're going to fix it. My clientele have appreciated it as well, it shows them that I am continuing to learn to improve my craft.

Give it a go, be prepared for some butt hurt as you learn that what you thought and believed in so strongly has been clarified and it's not what you thought it was. But then continue on and find out how you can use this new knowledge to improve the lives of others. Just because you may not be breaking up scar tissue doesn't mean you're not doing anything at all. The change in range of motion is still real, but what happened to make that change isn't what we originally thought.

Want to Increase Your Overhead Press?

The wise-man built his house upon a rock, right? Why? Because if he built it on sand the house wouldn't have the required support to stay strong. Simple concept. So how do you build a strong foundation for your shoulders?

Your shoulder joint, or your glenohumeral joint, is controlled and moved by numerous muscles which are your deltoids, pec major, lats, rotator cuff, bicep brachii, tricep brachii, coracobrachialis and teres major. Some of those muscles will play a role in creating the movement that makes up the movement path of an overhead press. What we are concerned with though are the muscles that will help stabilize your "scapulothoracic joint" however.

I put that in quotation marks because it's not your typical joint consisting of two bones held together by ligaments. The scapula isn't connected to your ribcage by ligaments, but they interact so it's called a joint.  In order to generate a decent amount of force in our glenohumeral joint we need to have our foundation that is our scapulothoracic joint to be held solid. What can make this complex is that we still need our scapula to move as our arm moves upward. Upward rotation of the scapula makes up one-third of the required movement needed to get our arm up overhead. We need to have stability throughout the entire movement path. The scapula typically wants to tip, or flair out to the sides, or people try to squeeze them together which prevents the upward rotation. We need a nice controlled upward rotation.

The starting point for this control starts with strengthening the middle back (i.e. middle trap and rhomboids) and external shoulder rotators (infraspinatus and teres minor). That combination of weakness and imbalance is a common pattern caused by postural distortions. We slouch, we constantly work with our hands out in front of us, and we care more about our bench press numbers than we do about how much we can row. That is where my first recommendation comes in, check-in with your row. Can you pull what you can push? There are recommendations out there that take it steps further and recommend that you can pull more than you can push, even well beyond 150% of what you can bench press. I'll leave that to you. My experience has shown that clients can pull a fraction of what they can push, so that's why I start there and ask you to do a quick check-in.

Next step is to strengthen the support muscles while introducing the movement. There are two ways you can do this. One way is the Prone Military Press- use a light enough weight that you can keep form- we want you to be able to keep your arms in line with your body, which means not allowing your arms to internally rotate and your humerus from horizontally abducting.

 

The other way is a banded military press with the resistance coming from the front. In this video I also add in an external rotation at the start.

Once you feel like you have good control of this movement you can progress to the next step which is adding some resistance in the actual press. Keep the weight light enough that you can still keep the control you felt in the earlier versions.

Everyone is going to need a different amount of time to progress so I can't give a good general recommendation on how long you should do this. Listen to your body and don't let your ego get the best of you. Do your sets until you feel like you did every rep with quality, not just until you can do 1 decent rep out of the set. Continue your pressing program so you don't lose ground, but add this in as a finisher or as a reminder to your system before you start your sets.

Good luck, I hope to hear about your new found gains and PR's!

Lift You Should Be Doing - Front-Racked Step-Ups

This weeks "Lift you should be doing" is the Front-Racked Step-Up. Step-ups are a great way to target your legs in general. They call on your Quads and Glutes/Hamstrings to give you the normal squat motion of knee extension and hip extension. By only using one leg you can call the stabilizers into a bigger role to create a well-balanced and strong system.

The addition of the barbell in a front-racked position will call on your spinal stabilizers and erectors, the erector spinae group, to keep you from bending over forward. As you start to step up onto the box, your torso will naturally lean forward, but your erectors will have to contract isometrically (without movement) to keep you upright.

This "anti-flexion" movement is argued as the better, or at least the preferred way to strengthen the erectors, specifically in the lumbar region. We used isometric holds regularly in physical therapy to help strengthen any muscle that needed it- it was an important component to the strengthening process. Give it a try when it fits into your workout and let us know what you think!

Advanced Foam Rolling Techniques - Part 2

Our next advanced technique is called Active Lengthening. It combines the pressure of normal foam rolling with a muscle contraction. Because we have a muscle contraction involved we can achieve a much deeper release of the connective tissue.  "As the muscle fibers naturally broaden and lengthen during the contraction, pressure of the friction stroke intensifies these movements to release any restriction between fibers. ... The technique also causes a reflexive reduction of muscle tension, presumably by stimulating the muscle spindle and Golgi tendon organ(GTO) with intensified lengthening and tension output" (Archer, 2007)

The GTO causes a reaction called the inverse myotatic reflex- skeletal muscle contraction causes the antagonist(opposite) muscle to simultaneously lengthen and relax. So by contracting the hamstrings, we are using the nervous system to help us relax the quads. It's not a perfect system, but you get the idea. By combining a nervous system reflex, the stimulus from rolling, and the mechanical friction on the muscle we can get a better response to your foam rolling.


The video example is of foam rolling the quads, our knee extensors. We start by putting the muscle in a shortened position, in this case by extending the knee. Then as we apply pressure just above the kneecap we slowly flex our knee as we roll up the thigh. 

**As always, remember to roll toward your heart as you roll out your arms and legs. Visit the post Foam Rolling Techniques from a Massage Therapist and refer to Rule #2.


Work Cited
Archer, P. (2007). Therapeutic massage in athletics. Philadelphia: Lippincott Williams & Wilkins.

Advanced Foam Rolling Techniques - Part 1

You don’t have to look hard to find someone talking about the benefits of using a foam roller/lacrosse ball. They’re a great example of how something so simple can cause a great change. But people have barely scratched the surface of the potential within these little tools, we can use them to mimic so many massage techniques that can have an even greater effect.

In the injury rehab world these techniques are known by many names- Active Release Technique, Active Myofascial Release, Osteokinematics and Active Assistive Release. Each of these techniques incorporate contraction of correlating muscles while work is being done. They are using neuromuscular theories to help the muscles relax through getting the nervous system involved at a higher level. The nervous system has many ways of getting a muscle to relax, often those ways prove to have more permanent effects.

Inside each of your muscles you have proprioceptors that tell your brain what’s going on with your muscle- amount of stretch or lengthening and the amount of contraction or tension. By adding in movement to your foam rolling you are incorporating these senses into the treatment and allowing their signaled responses to help cause change.

The first technique that I’d like to show you is one you may have already done briefly without noticing- the Pin and Stretch. Just like the name implies, you pin down the muscle and then stretch (lengthen) it out. This is going to require that you have some kind of muscular knowledge, which I’m sure you’ve been paying attention to what muscles activate with what movements. But, this is info that you can easily find online on any kind of anatomy or kinesiology website. Below is a quick example of the Pin and Stretch with the hamstrings.

As you can see, the ball isn’t rolling it’s just providing some pin-point friction to my hamstring. I’m contracting my quads which is causing my hamstrings to lengthen and move across the ball. Instead of moving the ball or roller along the muscle we’re doing the opposite and having the muscle do the moving. By having my quads contract we’re using the ideas behind reciprocal inhibition to help cause further change to our hamstrings. You will have to move the ball or roller around after a few contractions, but I’m positive that you will feel the difference in the technique.

One more example using a foam roller on the lats

Give it a try on your stubborn areas and see if the extra involvement causes some changes for you. As always- the deeper you go, the slower you should go; If it’s painful it’s probably too much; and don’t do any deep/corrective work postworkout.

How Athletes Can Benefit from Massage Therapy

*** As seen on Fitocracy's Knowledge Center ***

*Reduced muscle tension ^{1, 2, 3}

*Reduced muscle hyper-tonicity ^{1, 3}

*Increased range of motion ^{1, 2, 3, 4}

*Improved soft tissue function ^{1, 2}

*Decreased muscle stiffness and fatigue after exercise ^{2, 3, 5}

*Improved exercise performance ^{2, 3, 5, 6}

*Decreased delayed onset muscle soreness ^{1, 2, 7, 8, 9, 10, 11, 12}

*Reduced swelling/edema ^{2, 10}

Each time we exercise we hope we are stressing our muscles enough to cause a change. That change doesn’t come without a price though. Muscle stiffness, soreness, micro-trauma, inflammation, joint disorders, all start to take their toll on our bodies. Massage can be the solution to both the physical and mental strain we endure for our healthy lifestyles. 

The benefits seen above only scratch the surface as research attempts to prove the validity of the claims the massage industry has made for years. The benefits that I hope will stick with you are related to helping you function better and prevent future injuries. The main concern sports therapists and structural bodyworkers have is to help the body realign itself so the musculature can work better as a team in supporting our bodies against gravity. As the body shifts out of alignment the joints are stressed in a different way than they were intended for and muscles are recruited for motions they weren’t designed for. Often we think that stretching or foam rolling will help us achieve the muscular balance we need, but only if you know what muscle(s) or fascial sheets are the exact cause. 

            One of the best examples I can think of relates to shoulder imbalances. Many posts in forums will talk about how someone can’t get into the front rack position, or maybe they have shoulder pain during bench press. These can be complicated issues that a general stretching or foam rolling program won’t work for. A qualified massage therapist can assess which muscles are tight because they are short (concentrically loaded), and which muscles are tight because they are locked long (eccentrically loaded). An example of this would be in a person who has the sloucher’s posture from working at a desk all day. Their Pectoralis Minor and the lower head of their Trapezius is tight. Which one do we want to lengthen and which one do we want to strengthen? Your massage therapist has the tools to read posture and determine those types of patterns. They could then give personalized exercises, stretches, and muscles to roll out that will fit their exact need, not the general populations.

There are many types of massage that can assist you in your training, some to consider are

Deep Tissue – lengthens short muscles, helps restore blood flow to restricted areas, and relieves pain.

Trigger Point Therapy – Those fun knots/tender points that cause random pain in other parts of your body. “Where you think the problem is, it ain’t” – Ida Rolf

Structural Integration/Rolfing – Alignment therapies. That dropped arch in your foot might be what causing your neck pain.

Thai Massage – The lazy man’s yoga. All the benefits of yoga, without having to do the work!

1- Brukner, P., and Khan, K., with colleagues. (2009). Clinical Sports Medicine. Sydney, Australia: The McGraw-Hill Companies.

2- Fritz, S. (2005). Sports & Exercise Massage: Comprehensive Care in Athletics, Fitness, & Rehabilitation. St. Louis, Missouri: Elsevier Mosby9

3- Archer, P. (2007). Therapeutic Massage in Athletics. Philadelphia, Pennsylvania: Lippincott Williams & Wilkins.

4- Crosman, L.J., Chateauvert, S.R., Weisberg, J. (1984). The effects of massage to the hamstring muscle group on range of motion. J Orthop Sports Phys Ther, 6(3):168-72

5- Ogai, R., Yamane, M., Matsumoto, T. Kosaka, M. (2008). Effects of petrissage massage on fatigue and exercise performance following intensive cycle pedaling. BR J Sports Med, 42(10):834-8

6- Brooks, C.P., Woodruff, L.D., Wright, L.L., Donatelli, R. (2005). The immediate effects of manual massage on power-grip performance after maximal exercise in healthy adults. J Altern Complement Med, 11(6):1093-101

7- Farr, T., Nottle, C., Nosaka, K., Sacco, P. (2002). The effects of therapeutic massage on delayed onset muscle soreness and muscle function following downhill walking. J Sci Med Sport, 5(4):297-306.


8- Hilbert, J.E., Sforzo, G.A., Swensen, T. (2003). The effects of massage on delayed onset muscle soreness. Br J Sports Med, 37(1):72-5.


9-Smith, L.L., Keating, M.N., Holbert, D., Spratt, D.J., McCammon, M.R., Smith, S.S., Israel, R.G. (1994). The effects of athletic massage on delayed onset muscle soreness, creatine kinase, and neutrophil count: a preliminary report. J Orthop Sports Phys Ther, 19(2):93-9. 

10- Bakowski, P., Musielak, B., Sip, P., Bieganski, G. (2008). Effects of massage on delayed-onset muscle soreness. Chir Narzadow Ruchu Ortop Pol, 73(4):261-5.

11 - Frey Law, L.A., Evans, S., Knudtson, J., Nus, S., Scholl, K., Sluka, K.A. (2008). Massage reduces pain perception and hyperalgesia in experimental muscle pain: a randomized, controlled trial. J Pain, 9(8):714-21.


12- Zainuddin, Z., Newton, M., Sacco, P., Nosaka, K. (2005). Effects of Massage on Delayed-Onset Muscle Soreness, Swelling, and Recovery of Muscle Function. J Athl Train, 40(3): 174–180.