Treatment for Sports Performance

Timothy Hodges, LMT, JSCCI, CACI, CSC I Counterstrain Portland
Portland, Oregon

The Athletic Edge  

There are a few things rarely disputed about what gives athletes an edge over their opponents.  Speed, strength and endurance are often touted as the most important of these. Taking it a step further, one's speed-endurance, quickness and explosive capacity can often be the difference in a game. The higher the level of competition the smaller the differences are going to be. So the importance of being able to extract as much as possible from your athletes is paramount. What do you do when training, nutrition and standard manual therapies have been exhausted in the attempt to find that little edge over your opponents? Is there anything else that can improve the capacity of an athlete to run faster, jump higher and go farther and to do so with substantially less pain and discomfort? And more importantly, is it possible to do this and stay in accordance with modern performance enhancing drug rules and substance use guidelines? The short answer is yes. But to fully understand how, it is necessary to explore how the body's protective reflex system works, what it perceives as a potential threat and what makes it resort to protecting itself in the event of any injury or overuse situation. This includes the rigors of weekly athletic performance and the typical soreness guided recovery that we all assume is standard and normal. To better understand the relationships between wellness and athletic performance it helps to define the primary categories. Though there are likely many more categories than are listed here, I see 5 pillars of health as being the most important within the big picture of wellness: 1. Medical health and well-being. The first and perhaps the most important in terms of injury/condition diagnostics. Does the athlete have a serious injury, tissue failure or inflammatory condition? Though the process of arriving at a complete medical diagnosis can often take days, weeks or even longer, it is the absolute most important component. If it cannot be shown that there is any true tissue failure or pathological condition that is creating pain or dysfunction, move to the next category. 2. Diet and nutrition.  Dietary and nutrition issues can cause pain, systemic inflammation and dysfunction from undiagnosed food sensitivities or allergies. And of course eating for sports performance is well documented, though experts are constantly tweaking their recommendations. If this catagory is well cared for and ruled out as being a potential issue, move to the next category. 3. Mental/Emotional state. This is of particular interest to athletes who are in a constant state of training/performing. Tuning this system can produce a competitive edge and it is frequently provided by professionals working in both sports psychology and coaching/training. If it's not an issue, we move to the next category. 4. Physical fitness, strength and conditioning. This fourth main pillar of wellness is the current, undisputed king. All athletes perform in this category even though some find it difficult to deal with the demands of sports performance and constant preparatory exercise without succumbing to the strain of this grueling schedule. It is prescribed for everything from general fitness to very specific rehabilitation efforts following injury or surgery. Professionals in this field use the process of mechanotransduction to alter cell function and improve physical strength, speed and endurance. This is usually where the majority of attention is focused by training staff when the chronic condition fails to respond to the standard approach to injury treatment of rest, ice compress and elevate. Huge amounts of time are devoted to strength training and conditioning protocols all aimed at alleviating the symptoms of dysfunction. The problem is that many of these persistent problems have nothing to do with the actual strength, tissue flexibility or conditioning levels of the athlete. Failure to recognize this makes everyones job miserable. 5. Function of the Protective Reflex System. This brings us to the last main pillar which is truly the functional state of the body's Deep Fascia. Dysfunction of the body's connective tissues is by far the least recognized, most poorly understood and yet perhaps one of the more important categories of wellness, as it is capable of directly affecting all other categories. Strength, speed, endurance, flexibility and comfort in ones body can all be directly affected with techniques aimed at improving the normal processes of circulation, nerve conduction and arthrokinematics etc. within the human body. What's with the excitement over Fascia?   The topic of connective tissue, or fascia as it is more commonly known, has recently taken center stage in the field of manual therapy and manual medicine. While many of us immediately associate this substance with myofascia or the connective tissue of the muscular system, that is merely the tip of the iceberg in the expanding field of manual therapy. Our perception of what role this tissue plays in our everyday lives has gone through some serious change in the past 15 years. In school we learned that connective tissue, while obviously pervasive throughout the entire body, did little more than hold tissue together. It was referred to as inert (inactive) and just a type of body glue that kept us from being a giant pile of ectoplasmic goo. And then we moved on to the next system. That was it. Nothing more was spoken about this tissue, though we were expected to know all of its many variations and what to call it when it surrounded an organ, a vessel or muscle tissue. Histologically speaking, it is the same tissue throughout the body. Early Fascial Research   In the early 1990s, in an attempt to establish the threshold at which the human thoracolumbar fascia begins to fail when subjected to long term strain, Yahia et. al. stumbled upon a previously unknown characteristic of fascia, contraction! Not able to rationalize how the experiment had yielded a shortening of the fascia or why the instruments registered an increase in tone in the fascia, all instruments were re-calibrated and the test was rerun. The second test yielded the same result. So it was run again for a third time, thinking there must be something wrong with the method and the instruments. However, they got the same result! The researchers termed it "ligament contraction" and thus began the research community's newly found interest in connective tissue. New Theories Emerge   Fast forward to the early 2000s and you will find a published German researcher by the name of Robert Schleip, PhD. His research forever changed our understanding of fascia. He was able to determine how fascia contracted by locating a network of myofibroblasts throughout its tissue matrix. Others found a rich vascular supply and a vast neural innervation (Stecco, 2008 & Van Buskirk, 1990). The old theory that this tissue is inert has finally been put to rest. The truth is that fascia is the opposite of inert. It's alive, active, has a blood supply, and is loaded with sensory nerves that detect pain, mechanical strain, thermal changes and even chemical toxicity. And of course it is capable of contracting independently of your conscious thought process as its efferent nerves are 100% autonomic. Let that sink in for a minute to two. This tissue is literally everywhere. It surrounds every organ, every artery, the entire lymphatic system, the veins, ligaments, bones, tendons, muscles, the brain and central nervous system and every nerve in the entire body. And when I say every nerve, I mean every nerve including the nerves of the autonomic system, both sympathetic and parasympathetic. So the big question is why?  What in the world do we need this fascia for? In one word, protection. Without it we would barely survive the birthing process or any fall, whiplash, back strain etc. All of our vital tissues are wrapped in fascia so that in the event of injury or even a serious threat of injury, our bodies can instantly know where the threat is and act to protect us from serious bodily harm. This giant sensory blanket is capable of producing a protective spasm of the structure involved in the injury and any nearby muscle tissue. That's right, your own body can hi-jack your powerful muscles away from your conscious control in order to protect a vital structure from the threat of injury. Wow. That's not simply an interesting fact or observation, its a field altering revelation. It flies in the face of the decades old theory that scar tissue and a pervasive fibrosis is at the root of pain, loss of range of motion and weakness. For example, a nerve that feels threatened can instantly spasm its outer covering (epineurium) and simultaneously evoke a protective spasm of the muscle best suited to prevent further stretch injury to the nerve. Its a perfect system for keeping our vital tissues intact. Recognizing that it is, for all intents and purposes, a communication error that keeps the process active indefinitely means that it likely has a fairly simple off switch. Or numerous off switches considering the complexity of the human body. What are the implications?  After the protective process has been triggered because of injury or the perceived threat of injury, one would think that the end result, after any tissue healing, would be to return to a normal functional level of tone throughout the body. However this is not what actually happens. Instead, this protective reflex can persist due to biochemical responses to the protective reflex. It is then capable of spreading and forming palpable tenderpoints throughout the body. It can create fluid stasis in the venous system, restrict blood supply to working muscles, organs and even the brain in the case of head injury and it can interfere with the neural network and prevent the normal propagation of a nerve signal. This can result in weakness, loss of range of motion and of course pain. In terms of athletic performance it can substantially hinder an athletes ability to maintain a high level of output, both in power and strength endurance. There are few things that are as damaging to an athletes performance as the experience of constant pain. It robs one of strength, sucks the energy out of your game and prevents the possibility of ever realizing ones full potential of athletic performance. What is the end result?   It is commonly believed that this is a normal condition that simply accumulates throughout ones life. It contributes to the typical aches and pains that plague many people, restricting normal freedom of movement and performance as they get older. We often refer to these symptoms of dysfunction as simply The aging process. Most seem quite content to accept that just because they notched another year on the calendar of life, that they will continue to feel worse as time progresses. In fact, this belief is so common that we have come to accept it as fact. In the world of competitive athletics the high level of physical strain and the demands of performance frequently sideline athletes with injuries. Some are definitely worthy of surgical repair, some are career enders. However many are simply odd, puzzling injuries that don't seem to fit in the typical strain/sprain category of injury and are definitely not severe enough to warrant surgery. Most turn into chronic conditions that plague an athlete throughout their career. These would fit in the dysfunctional tissue category and require something entirely different than our typical rest, ice, compress, elevate and the long term care of stretching and exercise. What can be done?   In order to alter a protective reflex you must be able to communicate with the body on the same level as its built in system of protection. You cannot simply apply the same set of tools that you learned in school to deal with scar tissue or fibrosis. Not only that, it is being shown in study after study that manual manipulation of tissue with the intent of directly increasing its yield is not only minimally effective, it is non-effective. Put simply, fascia does not budge when a therapist tries to stretch it. To guarantee success in treatment of fascia, the dysfunctional tissue must be categorized as being of neural origin, vascular origin, visceral origin or muscle-skeletal origin. There are rules that pertain to each subset of the multi-faceted fascial system. Along with a commanding knowledge of human anatomy, these rules help dictate what is necessary to correct these central nervous system dysfunctions. Despite the anatomical differences in our various systems there is a common thread. They respond to shortening of tissue, not stretching. This is the pivotal difference in the application of Fascial Counterstrain (FCS). We stretch nothing. All tissues that we treat, now totaling more than 700 individual fascial releases that span 6 systems (11 if one considers the subsystems within the neural system) respond within 15-30 seconds to a very precise shortening manipulation of the fascial structure. What else is new?   Whether it is a vessel, nerve, organ, ligament, tendon or myofascial structure they all have very specific diagnostic tenderpoints. Combined with a rapid multi-system assessment that uses cranial motion to determine primary system, a Fascial Counterstrain Therapist can answer the question that has evaded manual therapists for ages. What is the causal dysfunction resulting in my pain and inability to perform? This tool is so quick and accurate that it has become an absolute necessity for navigating the many systems and hundreds of diagnostic tender points that can be at the root of an athletes issue. Clinical Application    A therapist that is trained in Fascial Counterstrain begins the session by assessing cranial motion that coincides with systems related to the athletes pain and dysfunction. We ask the body what is the source of the pain? If the area is a lower back for example, we ask:  Is the problem the peripheral nerves of the back? Nerves of the legs? Autonomic nerves of the viscera? Blood supply to the paravertebral muscle? Blood supply to the gluteal region? Blood supply the hip flexors? Or even the blood supply the spinal cord itself? Venous drainage of the spine? Venous drainage of the epidural space? Visceral dysfunction of peritoneum relating to the small intestine? Colon fascia dysfunction? Renal fascia dysfunction? Ligamentous dysfunction of the hip capsule, SIJ or spinal facet joints? Or is the issue with the myofascia of the trunk, spine, hips and legs? That entire assessment can take place in 30-60 seconds. Though the primary system will show up first, it is usually not the case that a person has only one system of involvement. They could have 2-3 systems or all of them depending on the severity of the condition. In the case of major reconstructive surgery, the problem can be even more convoluted. In these cases it is not uncommon to see severe vascular changes, autonomic nervous system dysfunction throughout the body, and even emotional trauma surrounding the difficulty of the situation. The ensuing treatment process is one of elimination. Get the main system and the main culprits. Work through each related system until the process is complete. For acute injuries this can be done in minutes, providing they didn't have the issue to begin with and there is minimal history of pain in the injured region. If it is a chronic condition it is likely to have spread to several or even all systems as the body attempts to balance the level of spasm and spread the load across all related or nearby systems. This is the most common type of injury we see at Counterstrain Portland as we are rarely onsite to do anything at the point of injury. Not to say that it can't be done, it most certainly can! What's The Big Picture?   Of course the question arises, how does this concept fit in the grand scheme of things? To understand what this technology is capable of and how it fits within the landscape of health and wellness the list from above needs to be viewed as a flexible continuum. It is not always best to view this in a linear fashion. Though an injured player may require medical attention before engaging in other forms of therapy, an uninjured player of good health usually doesn't require constant medical care. He/she may on the other hand benefit from regular sessions of FCS to keep the various fascial systems in good working order. A dysfunctional artery will not produce adequate flow as its lumen is reduced by vasospasm. Long term effects of reduced blood supply are well documented and include degenerative pathologies and even neurogenic symptoms like numbness, tingling and loss of coordination. During high level activity arterial dysfunction can produce severe ischemic pain. It is similar for a dysfunctional venous system which carries numerous potential issues, not the least of which is persistent swelling or edema. Nerve dysfunction often presents as weakness and loss of normal ROM and of course significant pain. Visceral dysfunction can produce severe back pain, sciatica, breathing abnormalities, upper back pain and abdominal pain. It is also frequently associated with significant postural deviations in the rib cage, and pelvis. In addition, when it is significant it can appear like actual visceral problems including IBS, GERD, Constipation, apparent food sensitivity and others. Combine any of these systems of dysfunction and it is not difficult to see how the mental state of an athlete can quickly deteriorate under significant stress to perform while dealing with pain/discomfort and an inability to perform at normal levels. It can also interfere with training when the exercise or drill is actually an irritation to a dysfunction. And finally, when an athlete has a significant amount of fascial dysfunction, they will absolutely be more prone to injury due to reduced ROM, loss of tissue extensibility, inhibited strength and general tension within their body as a protective mechanism against further threat.