Don't forget about the muscles

To some this may seem like a silly concept, but I’ve noticed that many patients and clinicians aren’t giving muscles their due attention. Pain can be generated from a variety of structures in the body, and I often see that one structure is blamed while an entirely separate structure actually generates the pain. This is particularly true with muscles.

Take the low back, for instance. The public has a tendency to blame the intervertebral disks between the bones for their low back pain. Yes, the disks tend to degrade with age, but that is no guarantee of pain. Many times, we are trying to find a single structure to blame for what is really a long-term problem that stems from a lack of activity and poor postural habits that weaken and stress the spine’s stabilizing muscles.

Another issue to consider is that structures can interact to cause pain. At the low back again, consider that increased muscle tension will change how the spine’s joints move and will change the stress on the nerves that exit out of the spine. In this instance it may be necessary to treat multiple structures. Both the muscle and the nerves could be causing pain. Also, weak spine and hip muscles may have led to premature wear and tear on the spinal joints and disks. There can be a lack of overall stability in the hip and low back region. Treating one area is insufficient.

Trigger point Pain referral pattern from a single hip muscle, image courtesy of

Trigger point Pain referral pattern from a single hip muscle, image courtesy of

I expect we partly have an educational bias to blame for this issue. If instructors didn’t spend time describing muscle pain and appropriate treatments, then it must not happen that much, right? Unfortunately that's not true. Prior to the work of Drs. Travell and Simons in the 1940s, few practitioners cared about “myofascial trigger points” or muscle pain referral. And perhaps it’s difficult for the medical profession and the public to accept that a muscle generated or trigger point pain isn’t going to produce an extraordinary finding on an MRI, CT or X-ray image. And no matter what tissue it is, imaging does not guarantee pain in the presence of a damaged structure. Sometimes people have pain with little to no visible tissue damage.

Often there are patients who do have a good understanding of the underlying problem because they are able to touch the affected tissue and have figured out that massaging or placing pressure on the correct muscles makes them feel better for a while. That’s a good sign that soft tissue treatment techniques would be effective. A good exam and assessment all of the appropriate structures is the key here. Physical Therapy and certain types of massage therapy would be excellent methods to treat this type of muscle pain. Following up the hands-on soft tissue work with strengthening exercises is a great option to prevent recurrence.

Please let me know if you have any questions about muscle pain identification and treatment at

Footwork Friday - Foot muscle rolling

Welcome to Footwork Friday where we will be introducing agility drills, strengthening, and muscle care techniques for the athlete who understands how important their feet are in carrying them through to the next step in their active lifestyle. While you are beating the heck out of your feet out there, think about the health of your feet every so often. Our feet can be very resilient, but when they start to go south then bad mechanics tend to snow ball, leading to other leg and hip injuries. Take care of them before they head south. 

Today's topic is simply about rolling the muscles of the feet. It seems simple but I want you to do it correctly. Sure, it's fine if you sit in a chair and roll a golf ball up and down the length of the bottom of the foot. Many people do this and that's great and easy to do. I just want you to realize that you may be neglecting two of the most important muscles: abductor hallucis and flexor hallucis brevis. This is because they are on the inside of the foot. And they do a ton of work stabilizing your inner arch. 

To get to them you have to pick up your foot and roll the inside of the arch and heel with a massage stick, golf ball, dowel rod, etc. I've colored the abductor hallucis muscle in red and flexor hallucis brevis muscle in purple in the photo below. Don't roll onto the bones.

Abductor hallucis (red), flexor hallucis brevis (purple)

Abductor hallucis (red), flexor hallucis brevis (purple)

If you want a primer on my version of proper rolling altogether, see my earlier post here

As an aside, if you are having pain more toward this inner side on the bottom of your foot then there's a good chance it can come from these muscles, not the plantar fascia that is often blamed. 

How to effectively roll and loosen muscles for soft tissue maintenance and athletic success

It seems that several people know they should be foam rolling or doing their soft tissue maintenance but few are actually doing it or know how to do it. The video is much more detailed and I use two areas for examples though the techniques could be used on most muscles in the body. Be warned that the more aggressive the technique then the more likely you are to get sore.

***Not to be taken as medical advice. Techniques are intended for healthy, uninjured, active individuals.***

Consider the following tips:

  • Your best location is on a carpeted floor, larger rug, or a yoga mat to provide just a little cushioning but otherwise is very firm
  • Proceed more conservatively until you realize how your body is going to react
  • Only roll or release the same area once every 2 days until you see how sore you are going to get and then you could do it daily
  • It should be uncomfortable, maybe 5/10 on the 0-10 pain scale but will improve with consistent work.
  • The most tender areas tend to need the most attention but don’t overdo it
  • The steady holding techniques should noticeably improve in a matter of minutes.
  • Steady pressure techniques should be maintained until the muscle progresses from tender and uncomfortable to not tender and a sense of pressure only
  • You will have to shift your body weight to vary the pressure
  • It’s ok to have referral discomfort from the muscle which would be an aching, not a pins and needles or tingling sensation
  • Be cautious of numbness or tingling sensations further away from the area you are working on as you could be compressing fragile nerve structures
  • Start with shorter bouts of rolling or pressure and go longer or aim for more reps when it becomes harder to find involved areas
    • beginner 10 reps or 20-30 seconds of rolling
    • advanced 40-50 reps or 2-3 minutes of rolling

The main techniques, regardless of device are:

  • BEGINNER: strictly rolling up and down the full length or partial length of the muscle while the muscle is more relaxed
  • BEGINNER to MODERATE: rolling up and down the full or partial length of the muscle while the muscle is under a stretch
  • BEGINNER to MODERATE: moving the local joint through motion while you sustain a pressure on a specific tighter area in the muscle
  • MODERATE to ADVANCED: placing a sustained pressure on the muscle at a specific tighter, tender area in the muscle and waiting until it doesn’t feel tender any longer
  • SUPER ADVANCED: placing a sustained pressure on the muscle at a specific tighter, tender area in the muscle while it is under stretch and waiting until it doesn’t feel tender any longer