KIN 4200 | EXERCISE PRESCRIPTION FOR CLINICAL

POPULATIONS
ROBERT GUMIENIAK, PhD.
 PLAN FOR THE DAY…

1. Re-cap last class/lab

2. Interesting read…I know this is your favourite
part of the week.
3. Corrective exercise -ya you know me.

https://lifespanbook.com/
 KEY QUESTIONS
• What is the knowledge and rationale for the use of the inhibitory technique of self-
myofascial release within a corrective exercise program?
• Following this, the health and fitness professional will be able to:
- Understand and explain the rationale for the use of self-myofascial release techniques.
- Be familiar with different self-myofascial release modalities and their uses.
- Apply self-myofascial release techniques to assist in inhibiting overactive myofascial tissue.
 1. What are examples of transitional
movements/assessments?
2. What are examples of compensations to the
rotation test?
3. While performing an overhead squat, the client’s
feet turn out. Which muscle(s) is most likely
underactive?
Review questions 4. Which muscle(s) is considered underactive if there
is an increased lordotic curve?
5. If a client’s foot moves into excessive pronation
while walking, which muscle(s) is overactive?
6. How will elevating a client’s heels impact an
overhead squat assessment?
7. While performing a single-leg squat assessment,
the client’s knees move into a valgus position.
What factors can cause this deviation?
 THE CORRECTIVE EXERCISE The premise of NASM
approach to correcting
CONTINUUM movement impairments

NASM Essentials of Corrective Exercise Training, 1st Edition. NASM, 2014 © Jones & Bartlett Learning
 THE CORRECTIVE EXERCISE CONTINUUM
• Step 1: Inhibiting overactive tissue
- The term inhibit refers to decreasing overactivity of myofascial tissue.
- The primary technique used here is self-myofascial rolling.

NASM Essentials of Corrective Exercise Training, 1st Edition. NASM, 2014 © Jones & Bartlett Learning
 MYOFASCIAL ADHESIONS AND MOVEMENT IMPAIRMENT
• Muscle trauma leads to inflammation and muscle spasm
(protective mechanism to prevent more damage).
• Increased activation in areas of adhesion = increased reciprocal
inhibition of functional antagonist.
• Multiple adhesions result in less elastic tissue properties and
formation of collagen fibers.
• Adhesions, altered reciprocal inhibition, increased collagen
content, leads to compensated movement pattern and further
injury.

NASM Essentials of Corrective Exercise Training, 1st Edition. NASM, 2014 © Jones & Bartlett Learning
 CAUSES OF ‘TRIGGER-POINTS’
• A MTrP is described as the most irritable location in a taut band of muscle. Fibrous
adhesions can be painful, prevent healthy muscle mechanics (i.e. altered muscle strength
and activation, endurance and coordination) and decrease soft-tissue extensibility
impairing joint ROM and muscle length.
• Several mechanisms, acting individually or in concert, may trigger stiffness increases of
the connective tissue:
1. Sustained volume changes of the muscle, e.g. following hypertrophy or hypertonicity,
2. In some areas, skeletal muscles present direct fiber insertions into the surrounding deep
fascia, which allow for selective tensioning.
3. Contraction of myofibroblast cells, can lead to long-term increases of fascial tone,
particularly in the presence of psychological stress.
4. Fascial hydration changes occur in response to mechanical stimuli such as stretching
exercises.

Do Self-Myofascial Release Devices Release Myofascia? Rolling Mechanisms: A Narrative Review. Behm and Wilke. Sports Medicine (2019) 49:1173–1181
SELF-MYOFASCIAL ROLLING (SMR)-THEORY
• Manual pressure on muscle may lead to pull on the tendon and activation
of GTO (golgi tendon organ).
• Activation of GTO may lead to inhibition of neural drive to muscle =
relaxation
• Intended to help break up microspasms in traumatized tissue which may
lead to reduced reciprocal inhibition of functional antagonist.
RESULT
• Produces an inhibitory or relaxation response to the muscle by inhibiting
the muscle spindle.
• Decreased muscle activation, in turn, may lead to improved ability of tissue
to lengthen when stretching and increasing joint range of motion.
HOWEVER,
• While the term self-myofascial release is often used in the literature and by
practitioners, evidence that myofascial release is a predominant
mechanism permitting the augmentation of flexibility, pain suppression or
performance enhancement is quite scant. [Behm and Wilke, 2019]
This Photo by Unknown Author is licensed under CC BY-SA-NC
 DEVICES USED FOR
SMR
• Self-Myofascial Rolling (SMR) with
Massage Ball
• SMR with Handheld Roller – Two Hands
• SMR with Vibrating Roller
• Cupping
• Voodoo Flossing
• SMR to Neck Region with Instrument-
Assisted Device

NASM Essentials of Corrective Exercise Training 2nd ed. Edited by Rich Fahmy. Copyright 2022 Jones and Bartlett Learning
PRECAUTIONS AND CONTRAINDICATIONS FOR SMR
Self-Myofascial Roller Contraindications
Skin rash, open wounds, blisters, local
tissue inflammation, bruises, or tumors
Bone fracture of myositis ossificans
Acute or severe cardiac, liver, or kidney
disease
Bleeding disorders
Connective tissue disorders
Direct pressure over surgical site or
hardware
Pregnancy (consult MD)
Sever scoliosis or spinal deformity
Deep vein thrombosis or
Osteoporosis
osteomyelitis
Cancer or malignancy Hypertension (uncontrolled)
Acute infection (viral or bacterial), Neurologic conditions resulting in loss
fever, or contagious condition or altered sensation
Systemic conditions (e.g., diabetes) Recent surgery or injury
Peripheral vascular insufficiency or Medications that thin the blood or
disease alter sensations
Direct pressure over face, eyes,
Chronic pain conditions (e.g.,
arteries, veins (e.g., varicose veins), or
rheumatoid arthritis)
nerves
Direct pressure over bony
Extreme discomfort or pain felt by
prominences or regions (e.g.,
client
lumbar vertebrae)
Reproduced from Cheatham, S. W., & Stull, K. R. (2018c). Roller massage: A commentary on clinical standards and survey of
physical therapy professionals: Part 1. International Journal of Sports Physical Therapy, 13(4), 763–772.
https://doi.org/10.26603/ijspt20180763
 GUIDELINES FOR SMR
• Current research indicates that if maintaining pressure for only 30 sec. has to be
performed at pain threshold.
• Lower pressure intensity requires longer pressure application (up to 90-120 sec.).

Hou CR, et al. 2002. Immediate effects of various therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Arch Phys Med Rehabil. 83: 1406-14.
NASM Essentials of Corrective Exercise Training 2nd ed. Edited by Rich Fahmy. Copyright 2022 Jones and Bartlett Learning
Postural exercises on the foam roll. Craig Liebenson. Journal of Bodywork & Movement Therapies (2010) 14, 203-205
Postural exercises on the foam roll. Craig Liebenson. Journal of Bodywork & Movement Therapies (2010) 14, 203-205
 Key points:
1. FR did not improve athletic performance, but at the same time, FR did not impede various force and power outcome
measures.
2. FR appears to be a good tool to use for or during a warm up to increase flexibility but it is advised to be used in
combination with DS and active warm-up.
3. Foam Rolling seems beneficial for recovery from DOMS and its physical performance decrements.
4. SMR through FR does lead to an acute increase in ROM.
5. FR may have an effect on ROM by reducing neural inhibition (pressure-pain threshold) of the connective tissue.
6. Foam rolling seems to reduce stress, but no more so than passive rest.

Effects of foam rolling on performance and recovery: A systematic review of the literature to guide practitioners on the use of foam rolling
Hendricks, Sharief et al. Journal of bodywork and movement therapies, 2020-04, Vol.24 (2), p.151-174
 LENGTHENING
TECHNIQUES

NASM Essentials of Corrective Exercise Training, 1st Edition. NASM, 2014 © Jones & Bartlett Learning
IS STRETCHING SPECIFIC TO
THE MUSCLES BEING
LEGTHENED?
• To identify the effects of upper body
stretching on lower body mobility.
• Improved ROM can be observed at
other joints, not only the one being
lengthened.
• Effects are global in nature.
VOLUME

• Foam rolling seems to produce similar

benefits as static stretching, but without
the temporary adverse effects on
performance.
• Does increasing the number of bouts of
foam rolling or the duration of each set
had any effects on the temporary
change in mobility?
• The duration of each set seemed to
have a bigger impact than the number
of sets performed in total.
TRAINING
MOBILITY
 SAMPLE PNF EXERCISES

NASM Essentials of Corrective Exercise Training 2nd ed. Edited by Rich Fahmy. Copyright 2022 Jones and Bartlett Learning
 • Stand tall
• Step back with your right leg
• Perform reverse lunge to increase
your stride length. Perform on the
balls of your rear foot
- Notice how the front of your right
thigh is beginning to feel a
gradually stronger stretch the
more you step back
• Step even further and then raise
your right arm overhead
- Push the toes on your back foot
into the floor and feel how your
heel rises up.
- At the same time notice how
when you push off the floor that
the front of the right hip stretch
increases.
• Key Point: If you are having trouble
balancing place your left hand on a
counter or other surface for
support.
Hip mobility training. Craig Liebenson. Journal of Bodywork & Movement Therapies (2012) 16, 555-556
• Resistance training with external loads can improve range of
motion to a moderate magnitude.
• Improvements in range of motion are not significantly
different between resistance training and stretch training.
• Additional stretching prior to or after resistance training may
not be necessary to enhance flexibility.
• Stretch training can still be advocated as a fitness and training
component for much of the population and included as a
component of a warm-up prior to competition.
 SUMMARY
• Phase 1 has a goal to inhibit or modulate the nervous system that innervates the
myofascia. SMR is the preferred technique.
• The SMR guidelines and acute variables proposed by NASM provide a starting point for
professionals.
• SMR is safe for most clients. Professionals should screen for precautions or
contraindications prior to starting a program.
• Phase 2 has a goal to lengthen inhibited neuromyofascial tissues through different types
of stretching.
• The client’s goals and assessment results should determine which stretches are chosen
for their program.
• Static, neuromuscular, and dynamic stretching are all effective at producing favorable
changes in flexibility and muscle extensibility.
NEXT CLASS…

Now that we have introduced inhibition and lengthening, what is next?

- Topic: Activation and Integration
- Chapter: 5-6
- See also: CourseLink