Soft Tissue Therapy, Movement and Charlie Weingroff

I have worked with a number of clients over the past two weeks, each with different problems and issues.  One thing that I feel is incredibly important is not just performing soft tissue therapy, but getting the clients up and moving and developing some sort of capacity to function.  In addition to that, performing some exercises following soft tissue work can be a great time to ensure that the soft tissue re-models, deforms and complies properly so that you can start to normalize the areas that feel “unhealthy” or “not normal” (which I realize is somewhat subjective to the therapist; however it can also be confirmed by the clients feedback as to how the tissue feels – tender, painful, referral pain, etc…)

My last post on Movement in Athletics got some great comments and I thought I would touch on the idea of preparing the tissue to move first and then developing the pattern.

There are basically two types of people that come into my office:

1) People that need a whole lot of soft tissue work (their tissue quality is really poor or they may have a lot of pain and soft tissue dysfunction) followed by a little bit of movement re-education

and

2) People that need a little bit of soft tissue work (just to get mobility) and then a lot of movement training (basically we are getting them back to function or reconditioning them to prepare for a more specific training program).

Obviously the goal is to progress from group 1 to group 2, as group 2 is moving towards developing their overall capacity to a much greater extent.

Soft tissue therapy is great for helping us to achieve mobility.  We free up the soft tissue, then apply a stretch and/or some sort of joint mobilization (either manual or self-mobilization) and regain or re-develop joint mobility.  Once mobility is gained, it is then time to train for stability and make sure that the joint is stable in its new range of motion.  Physical therapist Gray Cook uses the analogy of “giving you WD-4o to loosen up the joint (IE, manual therapy) and then duct tape to fasten it down (IE, training/corrective exercise).”

I had the pleasure of meeting Charlie Weingroff, a physical therapist and strength coach from New Jersey, this weekend.  We talked shop for a good 3 or 4 hours.  It was awesome.  One of those real “wow” type of moments.  Charlie was giving me some ideas and concepts he uses in the treatment room to assess athletes and determine where their limitations lie.  He then talked about gaining mobility first followed by stability.

Basically, he looked at my hip joint and determined that my hip mobility was poor (which it was…horrible actually).  Then, he asked if I was satisfied with this amount of mobility and if it was something that I could live with.  Obviously I said “no”, since I am not a 90-year old man who doesn’t care about being active (no offense to any extremely mobile 90-year old men out there).  What he told me was that if I was satisfied with my (poor) hip mobility then we could go ahead and train for stability in that (poor) range of motion.  However, since I wasn’t happy with that range of motion, the goal would be to first go and get more mobility, and then once that has been gained, start to train for stability.  That sequence would basically continue on until I was at a range of motion that was adequate enough to meet my activity level and training goals.

There was obviously a lot more to the discussion and Charlie had a ton of great info on assessments and determining where dysfunctions lie.

The idea of doing soft tissue work followed by some movement/exercise is the way that I always set up my sessions – and that mantra should be nothing new to those who are regular readers of this blog.  The take home message is more about coming up with a systematic way to evaluate your clients in order to get an understanding of where the greatest restrictions are.  By correcting those first you can sometimes correct a lot of other issues that may be going on.

So to recap:

1) Assess

2) Get mobility where range of motion is restricted

3) Once mobility is gained, make the joint stable in the new range of motion

4) Rinse and repeat until satisfied

One thing I would add is to try, as hard as you can, to not bias your assessment in anyway.  We often get so caught up in things like weak glutes, anterior pelvic tilt, overpronation of the foot, etc., that we expect to see it with everyone that walks in the door and sometimes this expectation almost forces us to see things that may not actually be there.  I try and approach each client with the mentality that they have no issues and I am hoping to not find anything majorly wrong.  This (hopefully) allows me to treat each person as an individual and determine where their individual dysfunctions lie, and not just lumping them into the mold of what we typically see or what is common.

Patrick

patrick@optimumsportsperformance.com