Today I had my good friend Dr. Perry Nickelston write about how he utilizes rolling patterns in his practice. Enjoy!
In my sports medicine pain laser center I typically see the worst of the worst; people from all levels of athletics and fitness who are suffering with chronic pain. One moment I can see a high end athlete ailing from an injury which is keeping them from game time, and the next I will be with the fitness enthusiast who simply wants to take an exercise class without wincing in pain. Most of them have been through the normal channels of traditional physical therapy, medicine, chiropractic, and just about anything else you can name. They had little or no long lasting improvement and no answers as to why they still get pain when they resume exercise and movement.
This is where assessing rolling patterns comes into play. In order to determine the real reason ‘why’ they are in pain as opposed to just chasing their symptoms, we must look at core function and dysfunction combined with assessing movement patterns. Every single one of the people I evaluate has some type of inner core dysfunction and abnormal movement pattern. The number one rule in my assessment is: if you have pain, you have a movement problem! Knowing how to discover that problem begins with assessing inner core function.
What is the inner core? People mistakenly think that all ‘core’ is created equal. Not so. You actually have an ‘Inner Core’ and an ‘Outer Core.’ What’s the difference between them? The inner core is like a cylinder made up of the pelvic floor as the base, the diaphragm as the top, the tranverse abdominis (TrA) muscle as the anterior border and the lumbar multifidus (LM) muscles as the posterior border. 1mThe function of the inner core is both physiological and mechanical as its main role is to provide the muscle activation required to sustain respiration, continence, and segmental spinal stabilization. Think of the inner core as your ‘reactive core’, meaning it should engage without thought in order to support outer core function. It acts as a stabilizer. Very critical point here, the inner core must engage, activate, or ‘fire’ prior to outer core or abnormal compensation patterns develop in movement resulting in possible injury.
What is the outer core? The outer core is what most fitness professionals usually think of when talking about core training. The outer core is comprised of large multiarticular muscles such as the erector spinae, rectus abdominis, and the external oblique. The outer core provides postural stability, produces movement and resists external loads. What happens is that most people train there outer core without giving any attention to the inner core. If there is an altered firing pattern and the outer core is overloaded, then the body reaches a ‘High Threshold Strategy’ (HTS). A response by the CNS central nervous system to increase activation to the outer core, which leads to 24/7 muscle activation and the propensity for trigger points, muscle fatigue and fascial restriction issues. That’s not good. When nothing seems to alleviate soft tissue and movement problems, stop chasing the pain and look deeper inside at the core.
So, how does assessing and training these rolling patterns enhance core function? Well, movement dysfunction is usually a problem with sequence and stabilization rather than a deficiency in strength of a prime mover. It stands to reason that we should address muscle sequencing.
The rolling patterns can function as a basic assessment of the ability to shift weight, cross midline, and coordinate movements of the extremities and the core. Abnormalities of the rolling patterns frequently expose proximal to distal and distal to proximal sequencing errors or proprioceptive inefficiency that may present during general motor tasks. Many adults have lost the ability to capture the power or utilize the innate relationship of the head, neck, and shoulders to positively affect coordinated movements.
Rolling patterns should be assessed after ensuring proper mobility exists in the thoracic spine. Why? Because stability exercises will not correct a mobility problem and adequate t-spine rotation is a must for rolling. If it comes out decreased do some foam rolling, soft tissue mobilization or the tennis ball technique and then retest. If during assessment the different rolling tasks are not symmetrical and equal, then you should consider that foundational mobility or neuromuscular coordination may be compromised.
The wonderful thing about rolling is that the test is also the corrective. If a client has difficulty rolling, the way to improve it is to have them do more rolling. How easy is that? However, we will give them some ways to make it a bit easier to train these rolling movements until they can do a full functional quality roll. You do not want to make it too difficult for them to complete. Make it challenging, but not difficult. Too much struggle or too much rolling at once can overwhelm the neurological system and the client may fall back on bad movement patterns. Start with 5 rolls on either side listed below.
The types of rolls are:
- Supine to prone upper extremity driven
- Prone to supine upper extremity driven
- Supine to prone lower extremity driven
- Prone to supine lower extremity driven
- Hard roll (knee to opposite elbow)
Initial evaluation for rolling capacity should be with the HARD ROLL. If unable to complete the HARD ROLL even with assistance, move to the normal SOFT ROLL.
***Assistance may be given with:
(Not to be used during initial assessment. Only during correction rolling)
Wedging underneath the upper torso to assist initial direction.
Tubing assistance with proprioceptive input.
Cuing may be given:
• Look with the eyes and head
• Reach arm across body and turn head into shoulder
• Elongate the axis:
-Make the axis (left) leg long – “reach”
-Make the axis (right) arm long – “reach”
-Stay long through the axis
- Verbal sequence: “Reach-lift arm-look into shoulder-roll”
Key Component: Turning and using the head is the secret to completing a successful rolling pattern. You cannot power this movement. It must be a neurological corrective. Clients will notice an immediate change in ease of movement when they stress the eyes and neck turning.
What to look for if they have difficulty rolling:
They may suffer from decreased mobility in the cervical spine, hip, shoulder or thoracic spine. Try some soft tissue techniques such as foam rolling or trigger point rolling using a tennis ball and recheck the patterns for improvement. If you find improvement in rolling in regards to effort of movement and overall increased motion, work on the soft tissue prior to rolling.
Rolling patterns are a great way to teach an athlete to feel disassociation from the upper and lower parts of the body. This is vital in relationship to sports performance. Make this part of every client assessment to take your training results to new heights. You do not want to build fitness on top of dysfunctional movement and this is a simple and effective way to get a baseline evaluation. For your clients that cannot move, this drill will be a workout. They will sweat and use muscles they never knew existed. That’s a good thing.
Perry Nickelston, DC, SFMA
- Cook Gray, Kiesel Kyle, Plisky Phil. The Selective Functional Movement Assessment: An Integrated Model to Address Regional Interdependence. 2010
- Gill Lance, Cook Gray, Voight Michael, Hoogenboom Barbara. Using Rolling to Develop Neuromuscular Control and Coordination of the Core and Extremities of Athletes. NAJSP Volume 4 Number 2. May 2009 Pg. 70-82
- Cech DJ, Martin S. Functional Movement Development Across the Lifespan, 2nd Edition. Philadelphia, PA: WB Saunders; 2002.