A question about assisted fascial stretching
June 29th, 2008Posted by chris @ 12:34 pm | No Comments
Question excerpt from one of my Stretch to Win Institute students:
Dear Chris and Ann,
I have an unusual situation with a client arise, I thought you might have some advice….
When doing the “sack of potatoes” stretch with this gentleman last week there was a loud crack during the stretch phase of the work. It sounded just like scar tissue… at the time he had pain in the lateral aspect of the joint. It lasted for three days, getting progressively better each day (again, just like scar tissue). All special tests for the knee clear ligaments, tendons, and meniscii. There are no ROM limitations. In addition, he tolerates all weight bearing exercise, including change of direction and heavy squats without difficulty.
However, when I bind the fascia for the sack of potatoes stretch and also for the gluteus maximus position, he experiences pain in the medial/anterior aspect of the tibia (no where near any ligamentous or muscular attachments and beneath the meniscus). There are no other subjective complaints except in those two positions (he is even able to perform a glut stretch in sitting and supine without symptoms, full range). Again, there are no significant objective findings.
There are restrictions in the gluteus maximus and the hip, so ideally I would be able to work with this fascial train. I’m not sure how to proceed and also have no idea exactly what happened. Do you have any advice or have experienced a similar situation???
Answer:
I discussed your case with Ann and we both have not had this experience nor have we ever heard of any others experiencing what you describe.
While seeing a video of you performing the moves would also be helpful, we’ll just work with your descriptions and offer you my thoughts:
Since you say that all tests and FWB functional movements screens are clear then all that remains is either a trigger point referral or a cruciate ligament trigger point vs scar tissue lesion.
a) there is possibility that your client is experiencing what Travell calls a “shortening activation” which basically means that the antagonist to the muscle being stretched reacts by contracting. In the case of the positions you mentioned, it’s plausible that the adductors may by reacting this way to the glutes and other lateral structures under increasing tension. Solution: search & deactivate TPs in antagonists.
b) in the sack the anterior cruciate is under the most tension, since there also occurs some tibial IR therefore if there is any defect or scar tissue in the ACL, the stretch may stimulate this & cause pain in the antero-medial aspect. Solution: if you believe the cruciates to be hypomobile from a scar or whatever then it is probably safe to explain to the client what you are doing and get a verbal OK to proceed. If not, then use the upper hand wrapping around the outside of the thigh, fingers coming underneath to control & direct traction and even rotation, thus greatly reducing or even eliminating any traction with rotation to the knee joint. If no pain with this modified move then you will have no more pain in the knee using this technique (but it suggests that there is a lesion in the knee that needs separate treatment). This effect may also occur in the glute stretch because of the long lever force pushing the knee into a slight anterior draw position with a slightly internal rotated knee (no problem for a normal knee but stressful to other knees). Another solution: try varying the leverage angle & while simultaneously reducing the IR.
Let us know how it works out or if you need more direction.
Dear Chris,
Thanks again for taking the time to respond… I found a major trigger point at the Gracilis origin and after releasing it was able to perform both the sack and glut max stretch! I’m very excited 1) to have learned something new and 2) to be able to assist this gentleman with his martial arts work.
Thanks again for taking the time to respond… I found a major trigger point at the Gracilis origin and after releasing it was able to perform both the sack and glut max stretch! I’m very excited 1) to have learned something new and 2) to be able to assist this gentleman with his martial arts work.
You are making a difference! 
Laura