Abstract

When examining the critical factors that contribute to high level athletic performance, flexibility is one of the key items. It has been hypothesized that improving an athlete’s flexibility may allow them to be more successful in their chosen athletic endeavor. More specifically, speed, the most vital determinant of athletic success, may be significantly improved by incorporating some form of flexibility enhancement into an athlete’s training program.

Recently, a scientific study was conducted to examine whether or not including a specific form of flexibility training in an athlete’s daily training routine would improve sprint performance. In this study, 30 men age 20-35, who exercised an average of 7.5 hours per week during the six months prior to the study served as subjects. Their preferred modes of training were free weights and cardiovascular machines (Stairmaster, stationary bicycle etc.). Fifteen individuals included twice daily, five minute flexibility sessions into their exercise routine, thereby acting as the treatment group. The second group served as the control and did not incorporate any additional flexibility training into their pre- existing training program. Flexibility was assessed by a sit and reach test, power through a vertical jump test and speed by a 40 meter dash. The results, expressed as percent improvement from the pre test to the post test, are as follows:

Percent Improvement from Pre Test to Post Test

These results indicate that supplementing an athlete’s daily training routine with flexibility training is a promising way to increase athletic performance. In essence a cascade of events is set into motion. Flexibility improves, which in turn positively affects power generation, thereby augmenting speed.

In this study, the Intracell Stick was used by the treatment group as the flexibility enhancing modality that was added to their training program. The Intracell Stick is a 24 inch instrument, containing 14, one inch free-moving spindles that rotate around a semi-flexible core. By applying rolling pressure to muscles following a workout, blood flow is increased. As a result, waste products from various metabolic processes are removed, recovery is enhanced and soreness reduced. An additional benefit of using The Intracell Stick is that it allows the user to locate and treat specific tender areas in the musculature. This allows the user to give attention to both the weakest and strongest regions of each muscle, promoting development of the entire range of motion.

The results of this study demonstrate that the Intracell Stick has the potential to improve athletic performance through increasing muscle flexibility, thereby improving power, speed and the ability to recover faster from intense training.

THE FLORIDA STATE UNIVERSITY

COLLEGE OF EDUCATION

THE EFFICACY OF THE ROM DEVICE

AS AN ERGOGENIC AID

WITH RESPECT TO SELECT MEASURES OF

POWER GENERATION, FLEXIBILITY AND SPEED

BY

BRIAN MATTHEW HICKEY

Fall, 2000

TABLE OF CONTENTS

LIST OF TABLES…………………………………………………………………….ix

LIST OF FIGURES……………………………………………………………………x

ABSTRACT……………………………………………………………………….…xi

CHAPTER 1 INTRODUCTION ……………………..……………………………….1

Purpose of the Study.…………..…………. . . .……………… . . . . …………2

Research Questions…….. ………………………………………………..….2

Significance of the Study………………………………………………………3

CHAPTER 2 REVIEW OF LITERATURE……..……………………………………..4

Power in the Athletic Arena…………………………………………………….4

Flexibility Enhancing    Modalities……………………………………..…….6

Ballistic Stretching………………………………………………..……9

Passive Stretching………………………………………………..……9

Static Stretching……………………………………………….……..10

Proprioceptive Neuromuscular Facilitation……………………….…10

Active Isolated Stretching………………………………………..…..11

Massage………………………………………………………..……..12

The ROM Device: An Eclectic Modality…………………….………13

The Benefits of a Flexibility Enhancement Program…………..…….15

Time Course of Adaptation to Training Stimuli……………………………..17

Periodization Overview………………………………………………18

Time Necessary for Adaptation………………………………………19

Literature Void…………………………………….……………………….20

Research Hypotheses and Rationale…………… .…………………………23

Research Question 1…………………………………………………23

Research Question 2…………………………………………………23

Research Question 3…………………………………………………24

CHAPTER 3 METHOD……………………………………………………………..25

Research Design…………….………………………………………………25

Participants…………………………………………………………………27

Test Battery………………………………. ……………………………..27

Sit and Reach Test……………………………………………………28

40 meter Dash Testing…………………………………………….…29

Vertical Jump Testing………………………………………………..29

Intervention Procedures……………………………………………………30

Statistics……………………………………………………………………30

CHAPTER 4 RESULTS…………………………………………………………..32

Descriptive Data…………………… . .……………………………………32

Data Analysis by Hypothesis………………………………………………33

CHAPTER 5 DISCUSSION AND CONCLUSIONS…………………………….…36

Research Question 1: 40 Meter Dash Performance……………………….…36

Research Question 2: Vertical Jump Performance…………………………..38

Research Question 3: Sit and Reach Performance…………………………..39

General Discussion………………………………………………………..41

Hemodynamic Factors…………………………………………….…42

Temperature Dependant Effects……………………………………..44

Trigger Points………………………………………………………..45

Delimitations of the Study……………………………………………………46

Future Directions……………………………………………………….…47

Summary and Conclusions……………… .………………………………..49

APPENDIX A Training Program Survey and Log….………………………………..50

APPENDIX B Informed Consent Form…….…………………………………….…51

REFERENCES………………………………………………………………………55

BIOGRAPHICAL SKETCH…………………………………………………………60

LIST OF TABLES

Table 1. Age of Subjects in the Treatment and Control Groups……………………..33

Table 2. Hours Trained Per Week for the Treatment and Control Groups……..……33

Table 3. Test Battery Results…………………………………………………………35

Table 4. Paired Sample t-test Results………………………………………………..35

LIST OF FIGURES

Figure 1. The Effects of the ROM Device on 40 Meter Run Performance……………37

Figure 2. The Effects of the ROM Device on Vertical Jump Performance……….….38

Figure 3. The Effects of the ROM Device on Sit and Reach Test Performance………40

Figure 4. The Ergogenic Cascade for the ROM Device……………..……………….41

CHAPTER 1

INTRODUCTION

Power is often the deciding factor in athletic performance. This explosive strength becomes especially critical in anaerobic events. Essential considerations in the generation of highly explosive power are muscle structure and the rate at which muscles can generate force. The velocity of contraction, with respect to maintaining a high degree of force output, further moderates top anaerobic performance (Kraemer & Newton, 1994).

The manifestation of power in the running gait is speed. Sprinting speed is a function of biomechanical form, maintenance of maximal velocity, improved acceleration to maximum velocity and an increase in both stride length and stride frequency (Dintiman, Ward & Tellez 1997).

As delineated by the five components of fitness, muscle flexibility is an integral component of optimal human performance. Athletes possessing a high degree of flexibility traditionally demonstrate an increased proficiency in movements which are fundamental to athletic performance, and are able to perform at the zenith of their potential without injury, when contrasted with their less flexible counterparts (Bonci & Belcher, 1994). Furthermore, the inflexible muscle is predisposed to injury (Wang, Whitney, Burbett, & Janosky, 1993). Consequently, athletes who exhibit reduced levels of flexibility are at risk for experiencing the negative duality of reduced performance and increased risk of injury. With respect to ergogenic properties, stretching, a modality for flexibility enhancement, prepares the muscle for vigorous activity (Liston, 1999).

A sure fire way to improve power generation, hence athletic performance, is through the implementation of a flexibility enhancement program (Girouard & Hurley, 1995). Hamstring flexibility may be significantly improved in as little as three weeks via a passive stretching program (Godges, MacRae, & Engle, 1993). Daily employment of either static, dynamic or proprioceptive neuromuscular facilitation stretching modalities has been shown to improve flexibility and associated measures of localized muscular strength and endurance in less than two months (Kokkonen & Lauritzen, 1995; Lucas & Koslow, 1984). Additionally, benefits from the long run augmentation of flexibility include the prevention of sprains and strains (Bonci & Belcher, 1994).

Purpose of the Study

The purpose of this study is to investigate the effects associated with the employment of a self massage program using the ROM Device on anaerobic sprint performance, and field tests of flexibility and power.

Research Questions

In order to examine the efficacy of employing the ROM Device as an ergogenic aid, with respect to flexibility, power and speed, the following questions needed to be addressed:

1. Does implementation of a self massage program utilizing the ROM Device improve 40 meter dash performance?

2. Does implementation of a self massage program utilizing the ROM Device improve vertical jump performance?

3. Does implementation of a self massage program utilizing the ROM Device improve sit and reach test performance?

Significance of the Study

The results of this study may impact anaerobic performance in a variety of ways. First and foremost, an absolute improvement in 40 meter dash performance may indicate that regular use of the ROM Device could improve linear, anaerobic sprinting performance. Second, an absolute improvement in vertical jump may indicate that regular use of the ROM Device could improve the development of lower limb muscular power. Third, an absolute improvement in sit and reach score may indicate that regular use of the ROM Device could improve hamstring and lower back flexibility.

Significant results from this study may lend credence to the belief that improved flexibility is an integral component in enhanced power, which in turn may positively affect running speed. Furthermore, this study may demonstrate that a commitment to a flexibility enhancement modality could serve as an ergogenic aid with respect to anaerobic activities.

CHAPTER 2

REVIEW OF LITERATURE

In providing a theoretical and practical basis for this study, this review of literature will address four areas. First, there will be an examination of the paradigm of power generation as it applies to anaerobic athletic events. Second, flexibility enhancing modalities which are currently accepted as ergogenics within the context of the athletic arena will be discussed. Third, the time course of adaptation to training stimuli will be discussed. Last, the void in current literature as it pertains to aforementioned topics will be scrutinized.

Power in the Athletic Arena

In short duration activities, the ability to develop force very rapidly is a key determinant to success. However, the ability to develop a high level of force is not as important as the ability to develop a high level of force in a very small time frame. The development of muscle mass and absolute strength are the foundation of power generation, but in isolation possessing a high degree of these qualities may actually hinder athletic performance (Staley, 2000). In light of the pre-existing limits of human physiology, the sport sciences are challenged with the formidable task of continually unearthing ways in which to shift the force – velocity curve to the left. Such a transition will reduce the time frame necessary to generate performance specific force. Hence, an increase in power will follow. By improving an athlete’s flexibility, it is intuitive that range of motion will be improved. It is hypothesized that an increase in flexibility will lead to an improvement in power and a resulting leftward shift of the force – velocity curve (Gordon, Huxley & Julian, 1966).

Power may be defined as the greatest possible neuromuscular impulse generated over a given time period (Schmidtbleicher, 1992). Maximal rate of force development, explosive strength, is the neuromuscular system’s ability to produce a contraction at very high velocities. Power is further moderated by the initial rate of force development. This construct can best be described as starting strength, or the amount of power generated when a movement pattern is initiated. As the interval of the force producing cycle decreases to a duration below 250 ms per cycle, maximal rate of force development and initial rate of force development are the main determinants of success. The dominant factor in actions lasting in excess of 250 ms per cycle is maximal strength (Schmidtbleicher, 1992).

Power production in the running gait, or similar short duration cyclical activities, is typified by a small angular displacement and a high degree of intermuscular coordination. Generation of such power is dependent upon the following mechanisms. Prior to ground contact, the extensor muscles are activated in accordance with the central motor program. Cross bridge formation inhibits elasticity, thereby reducing muscle length at the point of initial ground contact. Simultaneously, a segmented stretch reflex ensues to augment muscular force development so that elastic energy can be stored in the tendons of the main extensor muscles. This process creates a powerful push off phase of the running gait. A lower level of neural activation characterizes the concentric phase of the running gait (Schmidtbleicher, 1992).

The magnitude and quality of power generated is a function of the muscle’s innervation pattern and the functional strength of the muscle – tendon system with respect to its contractile and elastic capacities. Besides concentric and isometric contractions, power generation is further moderated by the eccentric component of contraction (Schmidtbleicher, 1992). Consequently, when seeking to design and implement a training program with increased sport specific power generation as its specific goal, the three critical considerations are: (a) the prevention of reflex inhibition, (b) an increase in neural activation, and (c) the selection of modalities which will promote structural changes in muscle and associated tissues in a minimal time frame (Hutton, 1992).

Flexibility Enhancing Modalities

Flexibility, an essential quality of the muscular system, is critical for athletic performance. A lack of flexibility predisposes the athlete to injury, especially strains. A complete range of motion is necessary for the successful execution of athletic skills. When the muscle exhibits a high capacity to move through a complete range of motion in a minimum time frame, there is an increased protection against injury (Roy & Irvin, 1983).

When examined in the context of the athletic arena, the interaction of the muscle – joint complex may be viewed as a physiologic torque generating system. As specified by the muscle architecture, assuming uniform moment arms, a joint capable of a larger range of motion will produce greater torque than a joint with a more limited range of motion (Hoy, Zajac and Gordon, 1990). The negative correlation between speed of contraction and torque generation lies at the crux of power development. Specifically, maximal athletic performance hinges on the athlete’s ability to produce an optimal contractile force relative to the rate of change in the joint angle.

In general, the plasticity of the myogenic component plays a critical role in determining muscular pliability (Noth, 1992). Consequently, the more an individual participates in repetitive motion activities, the greater the risk of developing tightness in the musculature that generates these movements. As the range of motion becomes increasingly constricted, the biomechanical efficiency is compromised and injury risk escalates. In order to prevent the onset of these negative qualities, flexibility needs to be maintained or improved (Roy & Irvin, 1983).

The mobility of an articulation is defined as the amount of motion experienced before being restricted by the surrounding tissues. Mobility, dictated by the articulation’s total range of motion, is typically expressed in degrees of flexion and quantifies flexibility. Since flexibility is specific to each joint, its range of motion is influenced by the shape of the articulation, and the tightness of the bones and ligaments that encapsulate the joint. Flexibility exercises are designed to enhance the “stretchability” of the ligaments and tendons. An enhanced range of motion allows for a more flexible articulation to move safely into positions which an inflexible one cannot achieve. Consequently, flexibility is an important factor in the performance of motor skills and the prevention of injuries (Kreighbaum & Barthels, 1985).

When examining joint mobility, four factors create resistance to motion. These constraints may be either neurogenic, myogenic, joint or frictional in nature. With respect to joint capacity being restrained neurogenically in a voluntary muscle, as neural activation increases so does tonicity. As a result, the muscle becomes resistive to stretch (Hutton, 1992). At the myogenic level, thixotropic bonds between actin and myosin filaments play a role in limiting flexibility. Thixotropy, the viscosity of a gel, is altered with activity. Consequently, when the muscle is exposed to a pre-stretch condition that reduces the viscosity of the actin-myosin complex, range of motion about the joint will increase (Hutton, 1992). The limitations placed upon flexibility by joint architecture include: (a) bone articulation and physical structure, (b) joint capsule composition, and (c) ligament and tendon attachment (Hutton, 1992). Frictional constraints are concerned with lubrication, contact area and the coefficient of friction (Kreighbaum & Barthels, 1985). These conditions are in turn linked to joint architecture, the supply of synovial fluid, and thixotropic response (Hutton, 1992).

In an acute setting only the neurogenic and myogenic constraints are subject to voluntary control. In general, emphasis has been placed on the neurogenic component via employing stretching techniques that presumably enhance the level of inhibition to the muscle experiencing treatment (Hutton, 1992). It is theorized that reflex control is the predominant component of flexibility enhancement (Sherrington, 1906). The primary flexibility enhancement modalities are: (a) ballistic stretching, (b) passive stretching, (c) static stretching, (d) proprioceptive neuromuscular facilitation, (e) active isolated stretching, and (f) massage therapy (Chaitow, 1980; Hutton, 1992; Mattes, 1995).

Ballistic Stretching

A ballistic stretch may be characterized by the application of a stretch torque through a movement which is both dynamic and rapid. The extreme limits of the range of motion are explored. This modality has come under criticism since it has been shown to aggravate the muscles and associated connective tissues. Additionally, the production of small muscle tears and a resulting generation of inflexible scar tissue may result. Last, a stretch reflex may be initiated, causing a rapid contraction of the muscle. This may, in turn lead to spasms and the creation of an over tight, rather than relaxed, muscle (Chaitow, 1980; Hutton, 1992).

Passive Stretching

The passive stretching modality is usually employed when an individual is paralyzed, or when the agonist muscle group is injured. In these instances it is crucial to maintain joint range of motion. If the musculotendon unit is not activated on a regular basis, it will permanently shorten and joint motion will be lost. Passive stretching requires assistance from an individual who provides a continuous resistance which is just below the pain threshold. The duration of each stretch may last up to one minute. It should be a slow steady force, that gently lengthens the isolated muscle. This modality has several drawbacks. First, it is dependant on the assistant and their judgment. Therefore, an error could easily reverse all benefits or initiate the onset of a stretch reflex. Additionally, this type of stretching may be painful and there is no motor learning or improvement in active range of motion. It fails to activate or strengthen the weak, overstretched agonist muscle. Consequently, there is no enhancement of a coordinated movement pattern (Mattes, 1995).

Static Stretching

The static stretch has been used for centuries as a modality to increase range of motion (Mattes, 1995). It is characterized by placing a joint in the outer limits of its present range of motion and then subjecting it to a stretch torque (Hutton, 1992). This torque may be passively induced or enhanced through the application of weights. A drawback to this protocol is the potential for overstretch, a risk of damage to the muscle or its associated tendons and the plausible initiation of a stretch reflex. In some instances pre-workout stretching, employing a static based protocol, may lead to a higher incidence of injury (Liston, 1999).

Proprioceptive Neuromuscular Facilitation (PNF)

Kokkonen and Lauritzen (1995) have demonstrated that Proprioceptive Neuromuscular Facilitation is a viable modality for increasing localized muscular strength, endurance and flexibility. Using a repeated measure design with a control group, the following results were reported. In the male experimental group, flexibility increased 38%, strength 17.2% and localized muscular endurance 35.6%. The female experimental group exhibited the pursuant gains: a 23.2% increase in flexibility, a 16.8% increase in strength, and a 35.5% increase in localized muscular endurance. Furthermore, the control group made no significant improvement during the intervention period.

Proprioceptive neuromuscular facilitation uses a maximal pre-contraction of the muscle group about to undergo elongation (Hutton, 1992). Its theoretical underpinnings may be linked to the theory of successive induction, whereby the agonist is successively excited to induce less reflex activity (Sherington, 1906). This modality may be subdivided into: (a) contract relax, and (b) contract relax – agonist contract. In a contract relax stretch, the muscle is first maximally contracted then subject to a static stretch. The contract relax – agonist contract stretch also begins with a maximal contraction. At this point however, there is an accompanying contraction of the agonist. In both modalities, the stretch torque is usually enhanced by a second party. As with passive stretching, success or failure is linked to the individual assisting in the process. Furthermore, it is time consuming and dependant upon sustaining exertion while providing a graded resistance to the movement (Mattes, 1995).

Active Isolated Stretching (AIS)

Many stretching modalities are characterized by an isometric, eccentric muscular contraction. Active Isolated Stretching (AIS) is rooted in the belief that these techniques, which work muscles and connective tissue while they are actively contracting, makes the reduction of muscle tension highly unlikely. Additionally, soreness or injury may result. Furthermore, AIS does not employ assistance from others since outside forces may move joints too far. The AIS method uses a contraction of the agonist muscle followed by a relaxation of the antagonist. As with the other modalities, AIS claims to enhance recovery, create soft pliable scar tissue following injury, prevent and eliminate trigger points, reduce swelling, edema and bruising, activate the lymphatic system, enhance lung ventilation, promote the removal of toxins and acids, augment capillary growth, and nourish and lubricate the musculature (Mattes, 1995). The primary drawback to this modality is the time commitment. In general, the program takes 30 minutes, excluding warm up. Furthermore, AIS stretches last no longer than two seconds (Liston, 1999). To this end, this modality appears to be a derivative of ballistic stretching, and when used inappropriately, may actually damage the muscle. Specifically, predisposition to injury is highest when a thorough warm up does not precede the implementation of a flexibility enhancement protocol (Coe, 1996).

Massage

Massage, as a therapeutic and flexibility enhancing modality, dates back to Hippocrates. The underlying goal of massage therapy is to allow for body-mind reintegration and balance via the creation of a therapeutic experience which affords an individual the opportunity to release their physical and emotional tensions (Long, 1996). The aim is to remove the substances trapped in the muscles which are not dispelled by exercise. By dispersing these toxins, it is hoped that the signs and symptoms of fatigue are also eliminated. The benefits of massage exist within the physical, physiological and psychological realms. In general, massage seeks to reduce the perception of localized muscular pain, mobilize and enhance ranges of motion, improve blood and lymph circulation, sedate the nervous system and eliminate or prevent trigger points. Additionally, chest massage has been shown to enhance lung tidal volume (Wood & Becker, 1981). Following a massage treatment, hemoglobin levels and red blood cell count have been shown to improve (Schneider & Havens, 1915). Massage tends to open sebaceous and sweat glands, thereby improving their function (Krusen, 1941). Psychologically, a massage treatment often results in soothing feeling characterized by reduced stress levels (Wood & Becker, 1981). Two primary drawbacks to massage therapy are time investment and monetary factors. In order for this to be a viable therapeutic modality, treatment sessions need to occur 2-3 times a week. Often a massage session will last upwards of one hour, with fees typically starting at $50 (Long, 1996).

The ROM Device: An Eclectic Modality

For many years a debate has raged over the foremost way to enhance flexibility. Some claim that static stretching produces the best results, while others argue for activated isolated stretching or proprioceptive neuromuscular facilitation (Mattes, 1995). Still other factions believe that massage is pre-eminent in terms of its benefits (Chaitow, 1980). Despite these polarized opinions, there is not one, clear cut, optimal technique. Consequently, in order to maximize the gains from a flexibility enhancement program, an eclectic tact should be taken. The key features of each method may be incorporated into a progressive system designed to maximize gains within a minimum time frame.

Recently, the ROM (Range of Motion) Device has been developed as a tool which allows the user to passively enhance their flexibility through the implementation of a self massage technique (Bonci & Belcher, 1994). The tool measures 24 inches in length. It contains 14 one inch free moving spindles which rotate independently around a semi rigid plastic core. Ease of use is enhanced by handles on either end (Bonci & Belcher, 1994). By applying deep rolling pressure to the muscles a stripping massage is facilitated. The effect of this procedure is to relieve intramuscular pressure and increase localized blood flow (Bonci & Belcher, 1994).

The basic premise of how the ROM Device enhances flexibility is as follows. An inactive muscle is characterized by a low degree of pliability. Additionally, during inactivity, metabolic wastes tend to become trapped in the muscle, further reducing fluidity. A sudden loading of a cool muscle may cause extensive stretching of the muscle fibers. This overstretch tends to place an adverse strain on the localized muscular system, thereby negatively impacting musculoskeletal flexibility and providing an ideal medium for the formation of trigger points. Implementation of a self massage program utilizing the ROM Device has shown a propensity to dilate blood vessels. Consequently, trapped metabolites are removed, circulation is increased and the muscle is prepared for loading (Bonci & Belcher, 1994).

Preliminary anecdotal results show that the ROM Device has a profound effect on muscle flexibility, strength, endurance and recovery from intense exercise bouts (Bonci & Belcher, 1994). Significant changes in trigger point pressure threshold measures following the use of the ROM Device have been found (Belcher, 1993). Furthermore, the use of the ROM Device has significantly altered the pressure threshold values of fibromyalgia patients (Masengale, 1993).

Endurance, strength and flexibility are three of the basic components of physical fitness. During intense exercise, all three factors are compromised by the accumulation of lactic acid. As this by product of anaerobic metabolism accumulates in muscle tissue, functioning is significantly compromised, contributing to fatigue. The ROM device may be employed during intense physical activity in an attempt to rid muscles of metabolic waste and enhance energy stores. Following activity, use of the ROM Device for stripping massage may decrease recovery time (Bonci & Belcher, 1994).

In general, the body contains many multi-joint muscles, ones which cross more than one joint. Consequently, flexibility of the entire muscle is difficult to attain. Furthermore, uniform, in vivo stretching is difficult to assure since a muscle is typically lengthened across one joint while it is simultaneously being shortened across another. The ROM Device solves this specificity dilemma. Via employing this tool, the user can locate and treat specific tender areas in their musculature thereby eliminating any segmentally shortened muscle (Bonci & Belcher, 1994).

This technique provides the benefits of massage without the associated time or cost. Specifically, myofascial trigger points are eliminated thereby returning the muscle to its optimal length. Via regular application of this technique, cumulative muscle trauma may be prevented. With respect to the time commitment for the user, the entire body can be treated in less than 10 minutes (Belcher, 1993). In comparison, other total body techniques take up to 45 minutes to complete (Long, 1995).

When assessing flexibility, it is of critical importance to note that all individuals have unique and diverse needs. Pain and weakness may occur at any point in an individual’s range of motion. In deference to this existence of different areas of inflexibility within a given range of motion, there arises a need for a program which isolates tender points while simultaneously positively affecting the entire muscle. This ideal program is not limited to enhancing the weakest point in the range of motion. Instead, it accommodates the stronger regions as well, promoting a faster development of the entire range of motion. To this end, the ROM Device serves to meet these demands.

The Benefits of a Flexibility Enhancement Program

Upon assessing the benefits of a flexibility enhancement program it is key to note that both chronic and acute adaptations exist. Immediately following the completion of a stretching program, the muscle’s core temperature has been shown to increase. There is an increase in the blood flow to the working muscles which positively alters the body’s blood distribution to cope with the increasing demands placed on the musculature. Consequently, the body’s ability to deliver hemoglobin, hence oxygen, to the working muscle is enhanced. There is also an increase in the interactions of the muscle’s actin and myosin filaments which increases the speed and force of each muscular contraction, thereby improving performance. A relaxation of the antagonist muscles is promoted. This reduces the resistance to movement and decreases the risk of muscle and tendon injuries, such as strains and sprains. As muscle tension is reduced, the body becomes more relaxed and coordinated. This, in turn promotes joint movement and enhances range of motion (de Swardt, 1995).

According to Mattes (1995), the implementation of a flexibility enhancement program provides the following long term benefits. The complete range of motion of the joint tends to be increased and maintained. Additionally, there has been shown to be a decrease in muscle soreness and a resulting increase in functional activity from the employment of a flexibility enhancement program. Furthermore, an inverse relationship has been exhibited between neuromuscular tension and musculotendon extendibility.

Improving flexibility reduces the likelihood of strains, tears and tightness that may result in muscular pain, spasm and cramping. In the event of acquiring one of these ailments, range of motion enhancement techniques play a central role in the recovery process. Moreover, a flexibility enhancement program tends to lengthen the fascia, which supports and stabilizes the muscles, organs and most body tissues. The underlying tenant of a flexibility enhancement program is the generation of a medium, which provides an ideal environment for the relaxation of the musculature (Wood & Becker, 1981).

Time commitment to a flexibility program should be equal to one fourth of the total training time. For instance an individual who runs 35 miles per week, with a total training time of 245 minutes, needs to devote approximately 10 minutes per day to flexibility enhancement. (Dellinger & Freeman, 1984; Ebbets, 1993). These sentiments are echoed by Kokkonen and Nelson (1996) who conclude that flexibility enhancement must be sufficient in nature as to facilitate a full range of motion. They continue that modalities seeking the aforementioned end may be over utilized in the acute context when duration for an isolated bout approaches or exceeds 20 minutes. From the physiological standpoint, this ergolytic effect may be traced to an inhibition of the spinal cord neurons by the Golgi tendon organs following an overly aggressive acute application of a given flexibility enhancing modality.

Time Course of Adaptation to Training Stimuli

When examining the effect of an ergogenic aid, with respect to the time course of a given intervention, periodization theory forms the theoretical basis for determining the length of the intervention. In light of the training principle of individual response, athletes with similar characteristics, for example: (a) training density, (b) current level of performance, and (c) current preparedness, will generally adapt to an identical stimulus within a reasonably similar time frame. This adaptation is afforded by adhering to the training principle of variation and the training program design framework of periodization.

Periodization Overview

Periodization refers to the different phases of training an athlete is exposed to over the course of a competitive season. In general, how far in advance an athlete wants to initiate preparation for specific competition delineates the duration of each phase of training. Each training block is rooted in the training principle of individual response in order to meet the needs of the individual athlete. To this end, each period seeks to addresses a specific issue as to eliciting maximal performance (Graff, 2000).

With respect to the process of training for athletic competition, a well organized, scientifically based program must be implemented it order to maximize adaptation and performance. To this end, emphasis should be placed on rhythmical achievement (Bompa, 1989). Via this process, performance objectives and training factors are established at the outset of a specific training period and are used to dictate the design of each specific training bout. This framework, termed periodization, ensures that the athlete peaks for the most important competitions (Bompa, 1989).

Periodization is driven by the training principles of variation and long term training. The systematic application of different training stimuli is necessary to facilitate optimal physiologic functioning. Furthermore, the sequential approach to training that is the backbone of periodization provides the athlete with every opportunity to perfect their biomotor ability and hone its associated metabolic demands (Bompa, 1989). In this framework training progresses from general preparation to specific preparation and ultimately peak competition.

Periodization divides training into distinct segments or training blocks. This framework is comprised of three distinct divisions: (a) the macrocycle, (b) the mesocycle, and (c) the microcycle. The macrocycle may encompass the general training plans for an entire year or a competitive season. The mesocycle is a subdivision of the macrocycle that typically lasts 4 weeks. These segments are designed address the loading of the athlete as a function of frequency, intensity and duration of the application of training stimuli (Bompa, 1989).

The ultimate component in the periodization framework is the microcycle, which lasts 1-2 weeks maximum. This short duration allows for adequate recovery between strenuous training sessions while simultaneously achieving a balance between the steadiness of a training stimulus and variability of the training parameters: frequency, intensity and duration. The crux of the microcycle is to promote adaptation while avoiding premature accommodation and staleness. It is the most important and functional tool in training program design and implementation since its structure and content determines the quality of the training process (Bompa, 1989).

Time Necessary for Adaptation

With respect to the time necessary for the human body to initiate a response to a given training stimulus, short term physiologic improvements in performance have been exhibited in as little as three days (Noakes, 1986). Moreover, at the level of the muscle tissue, alterations in function typically begin manifestation within seven days. After three weeks of exposure, the stimulus no longer overloads the system. Consequently, in order to maximize adaptation, an overloading stimulus should be applied approximately every 14 days (Noakes, 1986).

Literature Void

Upon examination of the various flexibility enhancing modalities currently being employed in the athletic arena, it has become clear that an eclectic technique may be used to maximize the benefits of a flexibility enhancing program. The protocol associated with the ROM Device serves to fill this void. The theoretical basis of this modality is consistent with that of the Active Isolated Stretching technique in that the muscle must be relaxed during the stretch (Mattes, 1995). Conversely, the static stretching modality subjects the muscle to high tension and active contraction while attempting to improve the pliability of the muscle and its associated connective tissues (Mattes, 1995). An anatomical contradiction results, creating a situation where injury may result.

Protocol associated with the use of the ROM Device borrows heavily from massage theory. Both techniques seek to remove substances which have become embedded in the muscle and are detrimental to performance. Benefits include, but are not limited to, a decrease in localized muscular pain, an enhancement in joint specific range of motion, and improved circulation of the blood and lymphatic systems. Additionally, these procedures allow for the isolation and removal of specific tender points within a muscle. In general, massage techniques have been shown to be more specific than traditional stretches in the development of localized muscular flexibility (Bonci & Belcher, 1994; Wood & Becker, 1981).

Treatment via the ROM Device is self administered. This eliminates the need for partners or professional therapists. This call for self administered programs has been championed by Mattes (1995) as a vital component of the Active Isolated Stretching program. Through the elimination of an assistant who serves to facilitate implementation of the modality, risk of injury is substantially reduced and convenience enhanced. Furthermore, the absence of a second party eliminates communication problems associated with conveying where trigger points are located in the muscle.

In contrast with other flexibility enhancing modalities, certain aspects of the ROM Device protocol are original in application. The most prominent of these factors is the time commitment necessary for implementation of the program. In general, the entire body can be treated by the ROM Device in 10 minutes. This time frame contrasts favorably with those associated with Active Isolated Stretching and massage. In these instances, 45 to 60 minutes is necessary to effectively treat the entire body (Bonci & Belcher, 1994; Mattes, 1995; Wood & Becker, 1981).

Another crucial aspect of flexibility physiology addressed by the ROM Device is that of specific needs. Since a large proportion of the body’s muscles span more than one joint, traditional flexibility enhancing modalities have difficulty in assuring that flexibility of a specific muscle is uniform. Most modalities incorporate a non-specific approach, in that as a muscle is shortened across one joint, it is lengthened across another. However, ROM Device techniques are to be implemented only on the relaxed muscle. This allows the user to identify and treat trigger points which result from the muscle being segmentally shortened during exercise (Bonci & Belcher, 1994).

Despite all the theorized benefits associated with the implementation of a flexibility enhancement program utilizing the ROM Device, there is a virtual dearth of scientific data in which to support its claims. This is due in part to the subjective nature of flexibility assessment, since it is highly dependent upon subject discomfort. Upon the implementation of a flexibility enhancement program, improved flexibility may result. However, it may be difficult to delineate between improvements in stretch tolerance and actual range of motion. Another factor hindering the scientific assessment of flexibility and its associated improvements is the lack of a scientifically based protocol. Notwithstanding, a lack of flexibility is most frequently exhibited in linear activities, specifically running (Gleim & McHugh, 1997). This may be attributed to the highly specific range of motion dictated by activities of this nature. There is a chronic regulation of activity specific muscle length. Due to this constant repetition of a sub maximal range of motion, a permanent compromise in the integrity and pliability of the musculature and its associated structures results (Hutton, 1992).

In general, most evidence regarding the efficacy of the ROM Device is anecdotal. Furthermore, the generalizability of previous scientific data is limited due to characteristics associated with the sample population. In one instance, a convenience sample of 20 subjects, with low back pain resulting from trigger points, was treated via the ROM Device (Belcher, 1993). These results may be confounded due to the fact that the population was heterogeneous in nature and the study lacked a control group. A similar study employed 12 volunteer subjects with a clinical diagnosis of fibromyalgia (Massengale, 1993). In this instance, the condition was not isolated in one region of the body. Instead, this condition was located throughout the body. Furthermore, the subject pool was heterogeneous in nature. Last, since all subjects were volunteers, they may have exhibited characteristics which could differ from the population at large (Leavitt, 1991). It is important to note that in both instances, the ROM Device was used in an attempt to alleviate symptoms associated with various clinical maladies. Consequently, in order to support the claims made that the ROM Device is effective in injury prevention, flexibility enhancement and strength improvement, a homogeneous population of athletes should be examined.

Research Hypotheses and Rationale

The ensuing hypotheses are rooted in the aforementioned literature and derived from the research questions.

Research Question 1

1. Does implementation of a self massage program utilizing the ROM Device improve 40 meter dash performance?

Hypothesis 1. It is hypothesized that following a 14 day intervention employing the ROM Device, there will be a statistically significant improvement in 40 meter dash performance.

Research Question 2

2. Does implementation of a self massage program utilizing the ROM Device improve vertical jump performance?

Hypothesis 2. It is hypothesized that following a 14 day intervention employing the ROM Device, there will be a statistically significant improvement in vertical jump performance.

Research Question 3

3. Does implementation of a self massage program utilizing the ROM Device improve sit and reach test performance?

Hypothesis 3. It is hypothesized that following a 14 day intervention employing the ROM Device, there will be a statistically significant improvement in sit and reach test performance.

CHAPTER 3

METHOD

This chapter will describe the research process of the study. Specifically, research design, participants, test battery, intervention procedures, statistics and issues of reliability and validity will be delineated.

Research Design

This study utilized two groups of 15 subjects each. Subjects were randomly assigned to either the treatment or control group. The experimental group received the intervention, while the control group did not. The specifics of the time course of the study were as follows. Each subject was exposed to the test battery on two occasions over a 14 day span. Pursuant to completion of the initial testing, the intervention period commenced. During this two week phase, subjects in the treatment group incorporated a passive flexibility enhancement program implementing the ROM Device into their training routine. These subjects received a ROM Device following their first exposure to the test battery and were instructed on proper usage. They administered two treatments per day of 50 strokes on the quadriceps, hamstrings and calves and lumbar back. Treatments occurred upon waking and after the daily training session, or during the evening if no training was scheduled for the day. Members of the control group did not include any additional flexibility enhancing modality in their training program. At the conclusion of the 14 day intervention period, subjects were tested for a final time.

Prior to initiating the test battery, subjects were instructed to use their own, personal warm up routine, as employing a uniform warm up may have interjected a confounding variable into the process. Each participant’s pre test warm up was observed and documented.

In order to minimize any skewing of the data via a training effect, a 14 day intervention period was selected. An intervention duration of this length was sufficient as to generate a deviation from the subject’s homeostatic state (Noakes, 1986). However this two week period did not allow for complete adaptation to the new stimulus. With respect to the other facets of training program design and implementation, subjects were instructed to continue training as per their current mesocycles, with the only change being the incorporation of the ROM Device into one microcycle. Prior to initiation of the study, subjects completed a survey outlining their current training. Additionally, all subjects kept a training log for the 14 day intervention period in order to insure that no radical departure from recent training levels occurred (Appendix A). Subjects specified the duration and nature of workout conducted each day i.e. resistance training, cardiovascular training, interval running.

Participants

This study utilized 30 adult males between the ages of 20 and 35 as subjects. Subjects were residents of the metropolitan Tallahassee, FL area. They were recruited for participation from the membership of the Westside Athletic Club, located in Tallahassee, FL. Subjects were recreationally active, in that they viewed their training as an end to itself, rather than a means to an end, such as preparation for athletic competition. In order to be considered for the subject pool, individuals must have averaged at least 5 hours of training per week for the past six months. Subjects were randomly assigned to the treatment and control groups.

Test Battery

With respect to assessing the effect of flexibility on athletic performance, the following field tests were identified as both reliable and valid: (a) sit and reach test, (b) vertical jump, (c) 40 meter dash (Coast & Herb, 2000; Dawson, 2000; Dintiman, et al, 1997; Kipp, 2000; Mikesky, Bahamonde, Stanton, Alvey & Fitton, 2000; Wilson, 2000). All timing and measurements were administrated by an individual certified in exercise testing and prescription. To alleviate any inter-rater reliability issues, the same individual timed, measured and recorded every trial for every subject. The researcher was present at all testing sessions in an observational capacity to insure that each test was conducted properly.

Within the context of each test battery exposure, each subject was given three trials on each of the field tests. The best score was then recorded.

Following the subject’s personal warm up, tests were administered in this order: sit and reach test, vertical jump test, 40m run. All three trials of one test were completed before progressing to subsequent tests. Subjects were given two minutes recovery between sit and reach and vertical jump trials, while five minutes was given between 40 meter run trials. Additionally, five minutes was provided to allow subjects to move between testing stations.

Testing was conducted throughout the month of September 2000 on an individual basis. For instance, one subject completed the pre test battery on September 7, had an intervention period lasting from September 8 through 22, and was tested again on September 23. Another subject had their initial exposure to the test battery on September 11, with the subsequent 14 day period lasting from September 12 to 26 and the post test being administered on September 27.

Sit and Reach Test

Flexibility was measured via the sit and reach test. This test was chosen as the assessment for flexibility since it targeted the lower back and hamstrings. These muscle groups are essential contributors to lower limb force and power generation, hence athletic performance. Based on a plethora of relevant literature, this test is both a reliable and valid measure of hamstring flexibility (American College of Sports Medicine, 1991; Dintiman, et al, 1997; Kipp, 2000; Wilson, 2000).

The protocol for the sit and reach test was as follows. To insure reliability, a steel measuring tape was used for measurement. The tape was marked from a zero point with markings extending 60 cm fore and 40 cm aft. The marking was done in this way as to accommodate an individual low in flexibility, as ascertained by this test. Subjects were instructed to remove their shoes prior to this, and only, this test. Then, the zero point of the tape was placed at their heels. The subjects leaned as far forward as possible, toward their toes, without bouncing. Once the maximal reach was attained, the test administrator placed a thin, rigid plastic ruler perpendicular to the measuring tape. The intersecting point was then rounded to the nearest half centimeter and recorded. Scores beyond the subject’s heels were recorded in positive numbers, while scores before the subject’s heels were assigned negative values.

40 meter Dash Testing

The stationary 40 meter dash was ideally suited for evaluating sprinting speed, explosive leg power and quickness, including start and acceleration. (Coast & Herb, 2000; Dawson, 2000; Dintiman, et al, 1997; Kipp, 2000; Mikesky et al, 2000; Wilson, 2000). Within the context of this test battery, the 40 meter dash was used to evaluate running speed and to estimate power (Dintiman, et al., 1997; Kipp, 2000). This test was conducted on a standard running track in an environment devoid of wind assistance. Timing was done manually. In order to eliminate subject’s reaction time to an audible starting signal, elapsed time started upon the subject’s first perceivable motion and concluded upon completion of the run (Kipp, 2000).

Vertical Jump Testing

Lower limb power was evaluated via the vertical jump test. In each exposure to the testing battery, the subjects were allowed three trials, with the highest value being recorded. The difference in height between the subject’s maximum overhead reach while standing, and the apex of their jump marked by their outstretched hand, was used to measure vertical jump (Coast & Herb, 2000; Dawson, 2000; Dintiman, et al, 1997; Igna, Wygand & Otto, 1996; Kipp, 2000; Mikesky et al, 2000; Wilson, 2000).

Intervention Procedures

Subject usage of the ROM Device was verified as follows. Following the first exposure to the test battery, each subject in the treatment group received a ROM Device and was instructed on proper use. Additionally, proper use was initially verified at this point. On day 3 of the intervention a phone call was made to each subject to verify proper use of the ROM Device and to address any questions or concerns that may have arisen. On day 7 of the intervention, each subject met with the researcher in person to verify that the ROM Device was being used properly. A phone call with identical scope and purpose to that made on day 3 was be made on day 11. Additionally, at this time, arrangements were made for the subject’s second exposure to the test battery. The post test was administered on the 14th, and final day of the intervention. Subjects were allowed to keep the ROM Device that they used over the course of the intervention.

Statistics

Tests and measurements are permanent ways to evaluate performance. These techniques may be used for a variety of reasons, including but not limited to assessing: (a) preparation for beginning a particular phase of training, (b) the effectiveness of a completed phase of a training program, (c) talent, and (d) the efficacy of a training modality. Evaluation is also necessary to determine the success of a given training program and its associated performance aims. Pursuant to this end, the data was analyzed via paired samples t tests.

CHAPTER 4

RESULTS

The purpose of this study was to investigate the effects associated with the employment of a self massage program using the ROM Device on anaerobic sprint performance, and field tests of flexibility and power.

A total of 30 recreationally active males between the ages 20 and 35 participated as subjects. The participants were randomly assigned to either the treatment and control groups. This study was approved by the Human Subjects Committee of The Florida State University, and each subject provided written consent (Appendix B). This chapter details the data collected and associated statistics, for this investigation.

Descriptive Data

The initial step in the investigation process was to describe the subjects as a group, ensuring that they met the specifications with respect to age and number of hours trained per week. As outlined in Tables 1 and 2, the intervention and control group were similar with respect to age and hours of training per week. Additionally, resistance training was the predominant training modality for all subjects.

Table 1.

Age of Subjects in the Treatment and Control Groups

Hours Trained Per Week for the Treatment and Control Groups

Data Analysis by Hypothesis

This section will report the analysis of data for each of the hypotheses outlined in the previous chapter. In all cases, an alpha value of .05 was used.

Research Question 1 was, “Does implementation of a self massage program utilizing the ROM Device improve 40 meter dash performance?” The hypothesis for this question is:

H1. It is hypothesized that following a 14 day intervention employing the ROM Device, there will greater improvement in 40 meter dash performance for the treatment group, than the control group.

Research Question 2 was, ” Does implementation of a self massage program utilizing the ROM Device improve vertical jump performance?” The hypothesis for this question is:

H2. It is hypothesized that following a 14 day intervention employing the ROM Device, there will greater improvement in vertical jump performance for the treatment group, than the control group.

Research Question 3 was, ” Does implementation of a self massage program utilizing the ROM Device improve sit and reach test performance?” The hypothesis for this question is:

H3. It is hypothesized that following a 14 day intervention employing the ROM Device, there will greater improvement in sit and reach performance for the treatment group, than the control group.

Paired samples t-tests were executed to evaluate whether the change performance between the pre tests and post tests were statistically significant. The mean and standard deviation for both groups of subjects, of the pre and post tests results, for all components of the test battery are reported in Table 3. The results of the paired samples t-tests are reported in table 4. In all conditions, the degrees of freedom was 14.

When examining the change in performance between the pre test and post test, statistical significance was achieved by the treatment group over the entire test battery: (a) 40 meter run, (b) vertical jump test, and (c) sit and reach test, (t = 4.79, p = .000), (t = -4.34, p = .001) and (t = -7.05, p = .000), respectively. Furthermore, in all instances, t-test results were not statistically significant for the control group over the entire test battery: (a) 40 meter run, (b) vertical jump test, and (c) sit and reach test, (t = -0.73, p = .477), (t = 0.07, p = .942) and (t = -1.35, p = .198), respectively.

Table 3.

Test Battery Results.

Paired Sample t-test Results.

* = results are statistically significant (p<.05)

CHAPTER 5

DISCUSSION AND CONCLUSIONS

This study investigated the effect of a 14 day passive flexibility intervention using the ROM Device on performance of 40 meter dash, vertical jump and sit and reach tests. Results showed a significant improvement in all three tests for the group of subjects who received the treatment. Meanwhile, subjects in the control group did not display any statistically significant improvements in any of the components of the test battery.

This chapter will discuss the results of the study as they apply to each research question. Additionally, limitations of the study will be discussed and recommendations for further study will be made.

Research Question 1: 40 Meter Dash Performance

The first research question of the study was: Does implementation of a self massage program utilizing the ROM Device improve 40 meter dash performance? Based on the results of the statistical tests, it may be concluded that the results of this study support an affirmative answer.

Figure 1. The Effects of the ROM Device on 40 Meter Run Performance.

Sprinting speed is the product of stride length and stride frequency. Maximum speed is produced only when these factors are in optimal proportion. Essentially, sprinting is a series of jumps: from one foot to the other. Stride length may be improved by increasing the athlete’s power at push off in the stride cycle and jumping farther without touching the lead foot down ahead of the center of gravity. In essence, stride length is increased by exerting more force during this high speed movement, which in turn demands improved strength, power and flexibility (Dintiman, et al, 1997).

During the running gait cycle, the leg passes through three distinct phases: (a) the drive phase – when the foot is in contact with the ground, (b) the recovery phase – when the leg swings from the hip at the foot clears the ground, and (c) the support phase – when the runner’s weight is on the entire foot (Dintiman, et al, 1997). An increase in flexibility of the hamstring muscle group will directly impact the gait cycle as the lever arm in the recovery phase will be reduced, thereby decreasing the time necessary to cycle through this phase. Improved flexibility and power generation may also impact the drive phase via a decrease in the amount of time the runner spends in the support phase, and the resulting transition to the drive phase.

Research Question 2: Vertical Jump Performance

The second research question of the study was: Does implementation of a self massage program utilizing the ROM Device improve vertical jump performance? Based on the results of the statistical tests, it may be concluded that the results of this study support an affirmative answer.

Figure 2. The Effects of the ROM Device on Vertical Jump Performance.

The quadriceps and hamstrings play an integral role in extension at both the hip and knee joints. To this end, these muscles play a major role in the development of power by the lower extremities due to their ability to generate large amounts of force, hence power. The vertical jump test may be employed as a modality for assessing an athlete’s power (Dintiman et al, 1997).

Within the context of this study, the improvements exhibited by the group which received the intervention, relative to the control group, lends credence to the conclusion that employment of a flexibility enhancing protocol employing the ROM Device may increase an athlete’s ability to generate power. Furthermore, this improvement in power is more than likely attributable to a decrease in the time component of the power equation, rather than an increase in force development. This holds true since, in accordance with periodization theory, the intervention was not long enough as to elicit a significant increase in the subject’s ability to generate force.

Research Question 3: Sit and Reach Performance

The third research question of the study was: Does implementation of a self massage program utilizing the ROM Device improve sit and reach test performance? Based on the results of the statistical tests, it may be concluded that the results of this study support an affirmative answer.

Figure 3. The Effects of the ROM Device on Sit and Reach Test Performance

The inherent structural elements of muscle resist lengthening. Over time bonds may develop between the actin and myosin filaments, thereby increasing the muscle’s resistance to stretch. Employment of a flexibility enhancing modality such as the ROM Device may serve to decrease the muscle’s overall stiffness by reducing the aforementioned bonding of the actin and myosin. Within the context of this study, the improvements exhibited by the group which received the intervention, relative to the control group, lends credence to the conclusion that employment of a flexibility enhancing protocol employing the ROM Device may increase an athlete’s lower body flexibility, as evaluated by the sit and reach test.

This increase in flexibility by the intervention group is consistent with the other improvements in the test battery exhibited by this group. In essence, it is the improvement in flexibility that triggers increased power generation, which in turn plays a role in enhancing running speed. This may be termed the ergogenic cascade for the ROM Device. It is interesting to note that the control group, as a whole, demonstrated much greater flexibility, as measured by this test. This may be attributed to the fact that the control group contained two outlier points, both located above the mean.

Figure 4. The Ergogenic Cascade for the ROM Device.

General Discussion

This study has attempted to investigate the effects of a short term flexibility enhancing program employing the ROM Device. The improvements exhibited by the intervention group on the measures of sit and reach, vertical jump and 40 meter run may be attributed to alterations in: (a) hemodynamic factors, (b) muscle temperature, and (c) trigger points.

Hemodynamic Factors

Blood flow is a function of muscle tension, arterial inflow and venous outflow. It is limited by: vessel elasticity, actin – myosin overlap, movement resistance, blood stream resistance and blood mass (Bendel, 1998). When blood flow is increased via augmented vessel dilation there is an associated increase in capillary recruitment. This vasodilation acts as a hypersensitive feed forward mechanism, preparing the associated musculature for an increase in metabolic demand (Joyner & Halliwill, 2000; Murrant & Sarelius, 2000)

Intramuscular flow of blood is controlled by four factors: (a) myogenic components, (b) flow dependent vasodilation, (c) metabolic responses, and (d) neurogenic reflexes. With respect to the myogenic response, a change in pressure in a distensible vessel results in a change in flow. There is a time lag associated between metabolic response and the associated change in flow. Furthermore, a venous-arterial reflex may influence the autoregulatory response. In essence, the effect of flow is noticeable and serves to modulate the effect of pressure. Flow dependent vasodilation mirrors myogenic response with respect to the time parameter involved. When muscle metabolism increases there is an accompanying vasodilatory response, whereby acute blood flow is increased (Bendel, 1998; Gladden, 2000; Joyner & Halliwill, 2000). Following an acute training bout, when localized blood flow is already elevated, employment of the ROM Device may serve to further elevate this value. In essence, the fatigued muscle may become deluged with nutrient and oxygen rich blood while simultaneously promoting the venous return of blood high in carbon dioxide and metabolic waste products.

There is a physiologic trend for the smaller and more distally positioned transverse arterioles in skeletal muscle to develop a higher threshold to dialation than the more proximal arterioles. This distinct response produces higher tonicity in transverse arterioles (Murrant & Sarelius, 2000). Twice daily use of the ROM Device may serve to reduce this threshold via the repeated process of vasodilation and the accompanying increase in metabolism.

A moderating parameter of the four previously mentioned factors is metabolic demand. In the rest to exercise transition, a potential limiting factor in muscle performance is imposed by oxygen diffusion. At the onset of activity, the limited oxygen supply results in a slower conversion from anaerobic to aerobic pathways. This prolonged reliance on anaerobic metabolism may serve to limit the duration of the activity (Hughson, & Tschakovsky, 1999). Additionally, blood flow regulates lactic acid uptake and consumption. Via optimal blood flow to the working muscle, there is a maintenance of an ideal lactic acid and hydrogen ion concentration between the environment outside and inside the muscle (Gladden, 2000). During peak effort, blood flow to the working muscle is 100 times greater than it is at rest. The time lag between maximal blood demand and the point in time where peak blood flow is achieved ranges between 10 and 150 seconds (Saltin, Radegran, Koskolou and Roach, 1998). To this end, the ROM Device may be used prior to an exercise bout as part of a warm up routine as it may promote vasodilation, thereby inundating the soon to be stressed muscle with oxygen rich blood and setting in motion the aforementioned processes.

A central theme with respect to increased blood flow and enhanced athletic performance is that of improved nutrition at the cellular level. Frequently, the limiting factor in the refueling process is the existence of trigger points. Extremely prevalent in athletes, these isolated bands of hypertonicity restrict blood flow due to abnormally high internal muscle pressure. Additionally, in order to alleviate the pain associated with trigger points, the nervous system will increase the tension and decrease the sarcomere length of associated normal myofacsial bundles (Bonci, 2000). This chronic ischemic state will: (a) decrease the muscle’s ability to generate force, (b) disrupt intracellular homeostasis, and (c) disrupt intracellular oxygen tension thereby disrupting aerobic metabolism (Hogan, Gladden, Grassi, Stary & Samaja; 1998). Consequently, a key to optimal muscle performance is an unrestricted blood supply. To this end deep massage, as included in the ROM Device use protocol, provides a mechanical mechanism for the break up of trigger points (Bonci, 2000).

Temperature Dependant Effects

As muscle temperature increases, several discernable ergogenic changes are evidenced. First, there is an increased rate of tension development within the muscle associated with an increased muscular temperature (Wakeling & Johnston, 1998). At the sub cellular level, this temperature – tension relationship limits the transition of the actin – myosin complex into force generating states via the hydrolysis reaction, specifically in the phase of cross bridge detachment. As the muscle becomes progressively warmer, cross bridges detach more freely, thereby reducing the likelihood of generating myo-fascial trigger points. Furthermore, as temperature decreases, there is a reduced availability of excitable Na(+) channels due to the channels being in an inactive state while at the resting membrane potential (Ruff, 1999). Consequently, an increase in muscular temperature will increase the number of Na(+) channels available for activation, thereby increasing the efficiency of muscular contraction.

Within the context of an acidic intra muscular environment, the following changes are magnified with decreasing temperature: (a) reduction in force production, (b) a greater amount of time needed for actin-myosin relaxation, and (c) a decrease in shortening velocity (Westerblad, Bruton & Lannergren, 1997). In the acidic intra muscular environment produced by anaerobic activity, an increase in temperature serves to markedly diffuse the ergolytic effect of decreased intracellular pH on muscle performance. As muscular temperature increases, there is an increase in time to fatigue for the maximally contracting muscle. This positive influence may be traced to an improved interaction between actin and myosin as a result of a favorable intracellular chemical environment (Wakeling & Johnston, 1998).

In an acute context, the ROM device may be employed as a modality to increase local muscular temperature. The result of this process would be the creation of an enviromnent which is conducive to repeated muscle contraction (Murphy, Zhao & Kawai, 1996).

Trigger Points

Fitness is positively correlated with performance (Bonci, 2000). In order to elicit top athletic performance, an athlete must possess a high degree of flexibility and strength, as these two factors create the foundation of power. Power generation is drastically compromised via the presence of trigger points. Furthermore, muscles rife with trigger points lack compliance and resiliency, are more susceptible to injury and have a decreased pain threshold (Bonci, 2000). These isolated bands of hypertonicity restrict blood flow, create an abnormally high internal muscle pressure and impair nutrient delivery (Bonci, 2000).

The ischemic state created by trigger points decreases muscular force production, disrupts intracellular homeostasis and disrupts intracellular oxygen tension (Hogan, Gladden, Grassi, Stary & Samaja, 1998). Employment of the ROM Device may serve to mechanically breakup trigger points, thereby allowing ample blood flow and ensuring a homeostatic environment within the muscle conducive to optimal performance.

Delimitations of the Study

In an attempt to explore the effects associated with the employment of a program using the ROM Device on anaerobic sprint performance, and field tests of flexibility and power, it is essential to discuss the limitations of the study. These include limitations of the subjects, testing procedure and test order.

With respect to the limitations imposed by the subjects, the operational definition of the population examined limited the subject pool to recreationally active males between the ages of 20 and 35. Consequently, the results of this study may only be generalized to members of this population.

In deference to Occam’s Razor, Field tests were selected as the criteria for evaluation due to their economical nature and ease of administration. However, equipment such as force plates, electric goniometers and kinematic cinematography may have provided additional data and further insight into the effects of the ROM Device on flexibility, power generation and running speed.

Last, the ordering of each field test within the test battery may have had some impact on the results. To this end, the sit and reach and vertical jump tests may have served as further warm up for the 40 meter run. In the future, a larger sample size may be employed in conjunction with a Randomized Solomon design. In this instance, twelve groups of subjects would be employed, six treatment groups – one group for each possible permutation of the ordering of the test battery, and a corresponding control group.

Future Directions

The results of this study, in conjunction with current literature related to this topic present some interesting avenues for future research. First and foremost, subsequent studies could be conducted using the same methodology, but examining other populations such as recreationally active females and elite athletes. Additionally, the efficacy of the ROM Device may be compared to other flexibility enhancing modalities. Last, the aforementioned Randomized Solomon design may be employed as a way in which to diffuse any potential ordering effect of the test battery.

Another avenue to consider would be employing a matched pair design. Subjects would be matched based on their pre test results. Subsequently, one member of the

matched pair would be assigned to the treatment group, and the other to the control group. One subject of the pair would be assigned to the treatment group and the other to the control group. This process would serve to make pre test means on the components of the test battery similar across the treatment and control the treatment and control groups. Additionally, significant post test departures from the pre test mean would become more robust and salient.

By using a protocol of ROM Device utilization in conjunction with kinematic cinematography, with respect to the gait cycle, it would be possible to examine the impact this intervention has on the individual components of stride length and stride frequency. Additionally, via this process, improvements in economy of motion may also be investigated.

The employment of the ROM Device as a modality for, or component in, an acute warm up program may be examined.

Last, the implications for use of the ROM Device as a component in a post exercise recovery program are promising, and deserving of examination. Following a training bout and re-feeding, liver glycogen increases, but not muscle glycogen (Edwards, McMurtry & Vasilatos-Younken, 1999). However, if insulin levels were elevated in response to a surge in blood glucose uptake of carbohydrate fates by the recovering muscle, maintaining blood flow, via a massage modality, to this area may enhance absorption. This process may allow for the rapid re-synthesis of muscle glycogen (Burke, 1997; Cotright & Dohm, 1997). In the case of the aerobic athlete, massage coupled with mild static stretching and carbohydrate replacement immediately following a training bout, may trigger insulin to be released and glucose uptake enhanced, thereby improving recovery.

Summary and Conclusions

This study examined the effects associated with the employment of a self massage program using the ROM Device on anaerobic sprint performance, and field tests of flexibility and power. The results showed a statistically significant evidence of improvement on these tests by the group of subjects using the ROM Device, while no significant difference was exhibited by the control group. These results support the claim that employment of the ROM Device may improve flexibility, power and running speed.

The limitations identified included the population examined and test battery used for evaluation. Future research on this topic may proceed in a myriad of directions including, but not limited to: (a) different populations, (b) biomechanical avenues and (c) warm up and recovery processes.

Although certain, distilled measures of athletic performance may have been improved to the level of statistical significance by employment of a self massage program utilizing the ROM Device, an important caveat needs to be elucidated. That is: the only true measure of athletic performance is that specific and particular athletic feat itself. Consequently, improving an athlete’s power and flexibility may improve their performance in a competitive setting. However, as with all things in life, there are no absolute guarantees.

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ABSTRACT

Objective: The Intracell is a timely device that purports to decrease trigger point pain and sensitivity. Therefore the objective was to find an answer to the question, “Can the Intracell significantly reduce trigger point pain and sensitivity in patients who suffer with trigger points?”

Design: A convenience sample of 20 subjects, diagnosed as having low back pain of trigger point origin, were selected. A pre-test / post-test design was employed whereby each subject could serve as their own control. For the purpose of this study, 8 of the 20 subjects applied the therapeutic intervention to themselves, while the remaining 12 subjects had a trained therapist apply the Intracell. Correlated t-tests were used to analyze the data for significance.

Setting: The study was conducted in a private clinical environment.

Intervention: Testing for pain and sensitivity was taken pre- and post- intervention by means of pressure threshold measures over primary trigger points. Immediately following the pre-intervention pressure threshold measures Intracell procedures were administered to the trigger points as described above. Immediately following the intervention with the Intracell, post-intervention pressure threshold measures were taken.

Results: The volunteers in this study demonstrated significant gains in pressure threshold measures immediately following intervention with the Intracell. It is interesting to note that the subjects who self-administered [t=6.3, p=0.0004] demonstrated slightly greater improvements than did their counterparts [t=4.5, p=0.0009].

Conclusion: The results of this study indicate that the deep, massaging action of the Intracell will immediately and significantly reduce the pain and sensitivity of trigger point activity. It is apparent that the Intracell can have a significant impact on the modulation of myofascial back pain, both in the industrial and clinical setting.

RAW DATA

Therapist-Administrated Intervention

Self-Administered Intervention

DESCRIPTIVE STATISTICS

INFERENTIAL STATISTICS

Therapist-Administered Intervention                 Self-Administered Intervention

Therapist-Administered Intervention                 Self-Administered Intervention

Therapist-Administered Intervention                 Self-Administered Intervention

T-Value : 4.5 T-Value: 6.3

^ DF: 11 DF: 7

2-Tail Prob.: 0.0009 2-Tail Prob.: 0.0004

LEGEND: The measures are in the following units: Age is in years • HT [height] is in inches •

WT [weight] is in pounds • PRE and POST measures are in kilograms

Human Performance Laboratory

Mission, Kansas

Abstract

This is an initial study designed to determine if Intracell Technology, which employs the application of a novel device called the Intracell, can immediately increase grip strength. It has been suggested that stretching muscle tissue can result in increased strength according to the length-tension principle. Grip strength of the experimental group was significantly increased, whereas grip strength of the control group was not.

Introduction

The Intracell ErgoGenic 2250 model, was selected for the study because it is currently being used to counteract the effects of repetitive strain injuries and cumulative trauma disorders such as carpal tunnel syndrome. The State of Georgia selected the ErgoGenic 2250 for employees working with visual display terminals to help stem the tide of repetitive strain injury to the carpal tunnel. The ErgoGenic 2250 [RPI of Atlanta, Atlanta, GA] contains a 22 inch semi-flexible, Delrin rod around which 12 independent spindles freely rotate. This device comes with handles and a seat plate that allows for efficient self-therapy.

A feature of carpal tunnel syndrome is progressive loss of grip strength with eventual numbness and tingling throughout the wrist, hand and fingers. Grip strength can be efficiently measured with a standard grip strength dynamometer.

It was proposed that increases in grip strength may have a protective effect against repetitive strain injuries such as carpal tunnel syndrome. To investigate this hypothesis pre and post grip strength measures were collected on volunteers. This study was designed to quantify immediate changes in grip strength following application of the ErgoGenic 2250. This favorable preliminary study lays fertile ground for large scale investigations of the ErgoGenic 2250 regarding the prevention of repetitive strain injuries such as carpal tunnel syndrome.

Materials and Methods

Thirty professional students ranging in age from 22 to 58 years were randomly divided into two groups of 15. A baseline grip strength measure was collected on the dominant hand of each volunteer. For the control group, a latency period of 5 minutes was allowed to elapse before a follow-up grip strength was collected. Using the ErgoGenic 2250, the experimental group self-applied 30 deep strokes to the flexor mass and 30 deep strokes to the extensor mass of the dominant forearm. Following the prescribed application, the experimental volunteers performed a follow-up grip strength measure.

All subjects were required to be pain-free on their dominant side and without a diagnosis of wrist injury or carpal tunnel syndrome.

Results

The volunteers serving in the experimental group demonstrated the following grip strength measures: [mean +/- SD]

Initial Measure: 56.0+/-9.7 kg

Final Measure: 58.5+/-9.1 kg

The calculated t-value for paired data was 3.54 with 14 degrees of freedom resulting in a p-value of 0.003. These data demonstrate that grip strength significantly increased after intervention of the ErgoGenic 2250.

The volunteers serving as controls demonstrated the following grip strength measures: [mean +/- SD]

Initial Measure: 50.8+/-13.9 kg

Final Measure: 52.3+/-14.3 kg

The calculated t-value for paired data was 1.46 with 14 degrees of freedom resulting in a p-value of 0.1662. These data demonstrate that, without intervention of the ErgoGenic 2250, grip strength did not significantly increase.

Discussion

The ErgoGenic 2250 proved to increase grip strength of the volunteers in the experimental group. This result may serve as strong evidence for its use as a preventive and therapeutic modality for repetitive strain injuries and cumulative trauma disorders. The ErgoGenic 2250 is designed for self-application of therapy, which makes it cost effective and time efficient. Preventive and therapeutic application can be applied whenever and wherever the subject finds it necessary.

It is noteworthy that minimal instruction was required by the study subjects. A simple and brief explanation and demonstration of the method of application of the ErgoGenic 2250 was sufficient to train each study subject. While observing and supervising the study subjects, there were no instances when subjects deviated from the prescribed protocol.

Conclusion

A cardinal sign of carpal tunnel syndrome, grip strength weakness, may be modulated by a novel device called the Intracell ErgoGenic 2250. In this study of normal healthy volunteers, grip strength was significantly and immediately increased following a single therapeutic application. This study opens the door for additional research into the application of devices, such as the ErgoGenic 2250, in regard to their preventive and therapeutic value for repetitive strain injury and carpal tunnel syndrome.

©1996

Brian M. Hickey, Ph.D.

The Florida State University,  College of Education

Introduction

The foot is the foundation of the human body. Only spanning approximately 12 inches, its key responsibilities include bearing the body’s entire weight and acting as both fulcrum and lever during the gait cycle. Consequently, a rich blood supply and a high degree of flexibility are essential for proper functioning of this vital component of the lower limb.

The muscles of the arches create the foot’s posture and are responsible in part for supporting the foot’s architecture, which is created by the bones. The plantar fascia is critical to the performance of the foot, as this tissue envelopes the bony, muscular and ligamentous structures, contributing to proper function and nutrition. In addition to meeting the nutritional needs, a rich blood supply to the foot insures that metabolic wastes will be swiftly removed and a constant flow of oxygen maintained.

Foot Performance and The Foot Wheel

Over time, foot performance may be compromised via reduced blood flow and decreased flexibility. In an attempt to counteract these forces, the Foot Wheel was developed. Comprised of three plastic disks separated by two plastic beads, the Foot Wheel’s ergogenic effects are felt when the user rolls it on the plantar surface of the foot. Optimal effects result when the user stands, holding an immovable object for support, and places the foot wheel between the plantar aspect of one foot and the ground while allowing the other leg to bear the majority of the body’s weight. As the wheel is rolled along the entire plantar surface of the foot, the user should experience a high pressure sensation at the point of contact. The duration of Foot Wheel treatment should last 60 to 90 seconds. Each foot should be treated at least twice per day.

Competitive athletes, or individuals involved in highly structured exercise programs, should use the foot wheel before each training session as part of their warm up and include it in their cool down routine. The Foot Wheel also provides benefit to individuals who spend a large portion of the day on their feet.

Foot Wheel Study

Recently an investigation was conducted that examined the perception of foot fatigue and soreness before and after Foot Wheel use. Participants in the study held jobs where at least 50% of the day was spent standing and/or walking. Twenty individuals whose occupations included hospital emergency room personnel, store clerks and teachers, were asked to rate how sore/tired their feet were on a scale of 1-5.

Before use of the Foot Wheel, the average fatigue perception was 4.2. Immediately following a 60 second use of the FootWheel, the rating dropped to 2.9. One hour later, average foot fatigue was still moderate (3.2).

These results demonstrate that the Foot Wheel is an effective tool in combating sore feet, which are frequently associated with periods of prolonged standing and activities that place a high demand on the foot.

Discussion

When the foot becomes fatigued, efficiency of the musculature, with respect to providing for support and/or locomotion, becomes compromised. The muscles of the foot become tight, reducing blood flow and taxing the plantar fascia. Consequently delivery of nutrients and oxygen and removal of metabolic wastes is curtailed. This, in turn, accelerates fatigue. Furthermore, an environment ripe for the creation of trigger points is generated. These knots in the muscle tissue are the result of decreased oxygen and pooled metabolic wastes. Trigger points chronically shorten the muscle, thereby decreasing flexibility, hampering performance and increasing sensations of discomfort and fatigue. One of the main effects of treating the weary foot with the Foot Wheel is increasing blood flow during this time of need, thereby decreasing the likelihood of the aforementioned maladies. Also, as evidenced in the study, the perception of fatigue is decreased. Further investigation is warranted to examine the physiological effects of the Foot Wheel.

Foot Fatigue Chain of Events

1. musculature becomes fatigued as a result of prolonged standing, walking or other activity and tightness develops

2. blood flow is reduced, accelerating fatigue and promoting trigger points

3. performance is compromised

4. massage based modality increases blood flow

5. removal of metabolic wastes and delivery of oxygen and nutrients is accelerated

6. foot performance is enhanced and potential for trigger points is reduced

A. A chronic pain disorder characterized by diffuse, muscular aching and stiffness. Non-restorative sleep is thought to contribute significantly to this complicated syndrome that is in evolution. There are [3] types: primary [idiopathic], secondary [associated with another disorder] and post-traumatic [onset initiated following bodily injury].

Q. What causes Fibromyalgia Syndrome? [FMS]

A. FMS is a very complicated condition that appears to have more than a single cause. FMS can be activated by a physical or emotional injury or can follow an illness like the flu. To date, the underlying true etiology remains a medical mystery.

Q. Is FMS inherited or contagious?

A. Recent studies suggest genetic predisposition could play a role in the condition. There is no evidence to suggest that FMS is contagious.

Q. Who does FMS target?

A. The condition strikes 8 times as many women as men and mid-life is the targeted age group, but it can occur at any age to either sex.

Q. How severe is the pain?

A. A medical research team from Finland has reported that the pain intensity from FMS is twice that of rheumatoid arthritis.

Q. How is FMS diagnosed?

A. Laboratory or x-ray findings are not needed to diagnose FMS, however, often times numerous tests are conducted to rule out other conditions. According to the American College of Rheumatology the 1990 criteria requires a history of widespread pain [minimum 3 months]. The pain pattern must include both right and left sides of the body, be located above and below the waist and also include the axial skeletal region. On digital examination pain must be noted in at least 11 of 18 characteristic tender point sites.

Q. What aggravates FMS symptoms?

A. The symptoms of pain, stiffness and soreness are often aggravated by cold or damp weather, anxiety or stress, over-use or repetitive activity and poor sleep. Long periods of inactivity will also activate symptoms.

Q. What treatment is recommended?

A. Treatment is aimed at reducing symptoms not curing the underlying condition because the etiology at present is not known. FMS has no well defined or universally accepted therapy regimen. A combination of massage, exercise, stress manage- ment techniques and medication are considered the most effective treatments now available.

Q. How about exercise?

A. When muscles are inactive they become shorter and weaker. Also, tendons, ligaments, bones and cartilage are more prone to injury. FMS patients MUST get at least a few minutes of exercise each day despite the pain. Stretching, strengthening and cardiovascular are 3 forms of needed and recommended exercises.

Q. Does stretching help?

A. The muscles of FMS often feel tight, stiff and ropelike. Both stretching and massaging the involved muscles brings relief. The Intracell Stick provides the benefits of stretching and massage. I use it before and after exercise. It is extremely helpful during sudden flare-ups.

Q. What about nutritive supplements?

A. I know of no controlled studies evaluating a nutritive supplement’s effectiveness for FMS. Yet there is a metabolic hypothesis that MIGHT offer relief. This includes CO-Q-10, Magnesium and Malic Acid . . . ask your doctor.

Q. Does massage help?

A. Research suggests that fibromyalgic muscles fail to receive adequate oxygen. Massage increases circulation and augments the uptake of oxygen. It is better, however, to have several short massage sessions than to have a single extended session. When it comes to therapeutic massage the answer is MORE OFTEN not just more. This is why I prefer the Intracell Stick muscle device.

Q. How is sleep involved?

A. Most people with FMS fail to achieve restful, restorative sleep. If you feel sore, stiff, tired and unrefreshed upon waking, you have typical symptoms of FMS. The quality (depth) of sleep is more important than the quantity (hours) of sleep. Most FMS people are deprived of an adequate number of deep [Delta] sleep stages.

Q. What about FMS research?

A. In 1993 the US government spent 3 cents per patient on FMS research but lobbying efforts increased that figure to 28 cents per patient in 1994. Recent Senate Subcommittee testimony estimated fiscal impact on the US economy to be $9.2 billion per year.

Intracell Technology engages the use of a simple, easy to use tool called the Intracell®. The Intracell® is a non-motorized device that is composed of a semi-rigid core around which independent, 1 inch spindles freely spin. This instrument was engineered to assist healthcare providers in the deep manipulation of soft tissues such as muscle.

The Intracell® has proved to be highly effective at its intended function, but new evidence strongly suggests that the benefits of Intracell Technology™ far outpace its original intentions. Following is a synopsis of these benefits which were researched by Dr. Andrew Bonci of the Sport Biomechanics Laboratory in New York.
The Q-10 Effect
Warm muscles perform better than cool muscles. Traditionally, athletes would have to do light exercise to raise muscle temperature and enhance enzyme activity. This came at the expense of energy stores that could make the difference between first place and second place. Intracell Technology™ allows an athlete to warm-up without expending energy reserves.
Speed, Strength and Endurance
Emphasis on flexibility training by most athletes is almost non-existent. However, flexibility is crucial for developments in speed, strength and endurance. The usual approach to flexibility is less than optimal since muscle rarely stiffens uniformly. Typically, isolated segments of muscle become chronically shortened. Intracell Technology™ allows an athlete to perform general stretching as well as segmental stretching procedures with a high degree of precision.
Barrier Trigger Points
Barrier trigger points are inflexible bands of muscle containing knots. These barriers set an artificial ceiling on muscle performance by restricting blood flow to the muscle. And, unrestricted blood flow is vital for both high performance and full recovery from exercise. Intracell Technology™ lifts the ceiling on performance by extinguishing barrier trigger points.
Growth, Repair and Glycogen
Restricted blood flow to the muscles following exercise hinders muscle growth, muscle repair and glycogen repletion. Blood flow restrictions are due to generalized muscle tightness and barrier trigger points. Intracell Technology™ relaxes tight muscle which enhances muscle growth, repairs tissue and augments glycogen repletion following heavy exercise.
Enhanced Lactic Acid Removal
During exercise, lactic acid can build to critical levels where optimal performance is sacrificed. Intracell Technology™ expedites the discharge of lactic acid from your muscles and encourages its conversion into glucose by the liver.

Q: What is Fibromyalgia Syndrome (FMS)?

A: The condition can affect people in many different ways, however the major symptoms include diffuse muscular pain, ache, soreness and stiffness. Frequently waking during sleep and rising unrefreshed are companion symptoms. Memory loss and irritable bowel complaints are other symptoms that often accompany fibromyalgia syndrome.

Q: Why is syndrome used in the diagnosis?

A: Syndrome is used because the condition presents as a constellation of symptoms to the patient. Fibromyalgia is a syndrome in evolution. What a doctor or patient learns this year about Fibromyalgia Syndrome may be placed in disrepute next year. At least a recognized diagnostic criteria of the condition has now been established. This occurred in 1990 when The American College of Rheumatology developed the classification criteria.

Q: What is the cause of FMS?

A: The etiology remains a mystery despite the research. Some authorities propose deprivation of specific growth hormones produced during stage 4 sleep. Other studies point to poorly conditioned muscles and their failure to store adequate glycogen, as an underlying cause. The truth is no one really knows.

Q: Since the etiology is unknown are there any episodes that may trigger its onset?

A: There are many events that propose to trigger the syndrome. A few examples would be infection, sudden trauma [emotional or physical], or the development of a primary disorder such as rheumatoid arthritis, lupus or hyperthyroidism.

Q: Is FMS a form of arthritis?

A: Some research experts in the past have referred to the condition as nonarticular rheumatism or fibrositis. To date no inflammatory process has been documented and this has caused the scientific community to drop the suffix “itis” and replace it with “algia”. By the way, for those of you who think fibromyalgia is a new term, history indicates that it was first used by Sir William Gowers in 1904.

Q: Is there more than one type of FMS?

A: Some authorities classify the syndrome as primary or secondary and others include post-traumatic as a third classification. It is very difficult to classify the syndrome and most diagnoses simply omit same.

Q: Is FMS difficult to diagnose?

A: Since the official criteria for diagnosis were established in 1990, it is said that FMS can be identified with an 88% accuracy.

Q: How does the healthcare practitioner diagnose FMS?

A: By performing a thorough history and examination. The diagnosis of FMS does not rely on laboratory findings or radiographic studies, but on a physical examination that must demonstrate diagnostic pain in at least 11 of 18 characteristic tender point sites. The tender point locations are actually 9 on each side of the body to total 18. The patient history must document widespread pain of at least 3 months duration. Widespread refers to right and left side of the body, above and below the waist, including the anterior and posterior axial skeleton.

Q: What is meant by diagnostic pain?

A: As the examiner presses or palpates the tender point site, diagnostic pain will occur with roughly 4 kilograms of pressure. If you press down with your thumb until you notice a blanching of your nail, then you have applied roughly 4 kilograms of pressure. This is known as the “Yunus Rule of Thumb”, from Muhammad Yunus, MD who published the first controlled study on Fibromyalgia in 1981.

Q: Are tender points and trigger points the same thing?

A: A safe and easy way to differentiate between the two is by pain patterns. Remember, the pain of fibromyalgia syndrome is widespread, hence the tender points will also be widespread. Trigger point pain is found in a condition known as myofascial pain syndrome which may be highly localized or regional. An active trigger point will also refer pain when deeply palpated, while a tender point is more likely to just cause more pain at the local site. Also, the prognosis for trigger points is more favorable than tender points.

Q: Do muscle spasms occur in Fibromyalgia Syndrome?

A: When examining muscles of the FMS patient they often feel tight and like a rope that is twisted and knotted. These shortened muscles and twisted fascia biomechanically compromise blood supply to the area. Remember that fascia has a tensile strength of 2000 pounds per square inch; it’s no wonder noncompliant muscles feel so tight when they are palpated. Without a copious blood supply muscles can not relax enough to recover, therefore the FMS patient exhibits a persistent low energy level regardless of their dietary habits. Remember it takes as much energy to relax a muscle as it does to work a muscle.

Q: What does noncompliant muscle mean to the FMS patient?

A: In order to understand the role of noncompliant or unhealthy muscle it is necessary to discuss complaint or healthy muscle. Compliant muscle can be stretched, shortened, twisted or compressed without restriction or pain. It exhibits good circulation, flexibility, strength and endurance. On the other hand non-compliant tissue is stiff, tender and sore with a feeling of painful knots or tight bands in the muscle. Noncompliant muscle also exhibits poor circulation, reduced flexibility, weakness and it easily fatigues. It is susceptible to injury in the same way a worn tire invites a blowout. Remember, the way we diagnose the FMS patient is by compressing noncompliant muscle at characteristic spots.

Q: Does therapeutic massage or myofascial release help the FMS patient?

A: Frequent use of myofascial release or therapeutic massage is the secret to the management of symptoms. The Intracell Stick allows the FMS patient to self-manage symptoms, between clinic visits, with a high degree of accuracy. Waiting for an appointment to get help, often triggers an unnecessary flare up for the patient.

Q: What sex is most prone to FMS?

A: The condition strikes 8 times more women than men. Mid-life is the targeted age, however it does occur at any age.

Q: Can Fibromyalgia Syndrome be cured?

A: At present there is no cure for the syndrome. Dr. Stuart Silverman is quoted as saying, “Tricyclic drugs can be used to improve the quality of sleep or reduce pain sensitivity, but they are only mildly effective in alleviating the symptoms.” On the brighter side, Dr. Andrew Bonci, Professor, Department of Diagnoses at Cleveland College states,” advances in exercise science and manual medicine are evolving practical and promising solutions for the fibromyalgia patient.”

Q: How does the healthcare practitioner attract FMS patients to his or her office?

A: One of the best ways is to contact a local support group and request to speak at one of the meetings. If you don’t speak, go listen . . . you can learn a great deal about this condition from the ones who have it.

Q: Is FMS a workers’ compensation issue?

A: Most of the time when we think of compensable muscular injuries we associate them with an acute onset, however an exception we now see is carpal tunnel syndrome which of course is a chronic manifestation. According to noted ergonomist and chief editor of Occutrax magazine, Patrick Venditti, “fibromyalgia syndrome may be the next industrial epidemic.”

By Dee Clement, M Ed, MA
Exercise Physiologist

The plantar fascia is a tough thick band. Its 3 fibrous structures help hold up the arch – from the heel to the ball of the foot. A rich blood supply and high degree of flexibility are essential for proper functioning. A minor tear or pull in the fascia can painfully hamper daily activities. Plantar fasciitis is also known as calcaneal spur syndrome. It can mimic the pain of a stone bruise in the heel.

“If heel pain is felt during the first few steps after sleep – I immediately think of a problem with the plantar fascia”, says Dr William Hamilton, Orthopedic Surgeon for the N Y City Ballet.

Some Common Causes

• Over training
• Constant contact with hard or irregular surfaces
• Structural / biomechanical abnormalities
• Repeated stress to the foot
• Improper footwear
• Obesity

Dr Perry H Julian, foot specialist for the 1996 Olympic games, states, “One of the most common causes of plantar fasciitis is tightness of the calf and achilles tendon.” I agree with Dr. Julian. More importantly muscle tightness is usually traced to trigger points! And, that’s where my approach is focused.

Trigger Points

When the foot becomes fatigued the musculature becomes compromised. Muscle support and locomotion are hampered. An environment ripe for the creation of trigger points is generated. Trigger points are knotty, involuntary contractions of muscle bundles. They prevent the host muscle form relaxing and recovering. Trigger points are painful. The foot contains 126 ligaments, muscles and tendons, so there is plenty of hiding places for trigger points. These aggravating little knots can be found in any muscle. In fact, trigger points in the calf often refer pain directly to the bottom of the foot. Therefore, trigger point therapy of the lower leg and foot is essential in the successful management of plantar fasciitis.

Common Trigger Points of the Foot

Common Trigger Points of the Lower Limb

Leg Management Regimen

I like to start the treatment with the lower leg. I recommend and use a trigger point therapy product called the Intracell Stick. TOf the several different models, I prefer the short length with good flexibility. The Intracell Stick compresses and stretches muscle. It simultaneously moves fluids. The Stick performs trigger point therapy and myofascial release – with virtually no effort.

Step 1 – [about 30 seconds]

• Place the hands close together for better control and easier use of the Intracell Stick.
• Begin by rolling the muscles outside the shin bone – use short, specific, back-and-forth strokes
• Roll lengthwise, starting at just below the knee to immediately above the ankle
• Search for trigger points [ouch pain] and roll with a progressively deeper pressure. When found … roll trigger poonts an additional 10 – 15 seconds

Step 2 – [about 45 seconds]

• Follow the same procedure for the calf muscles as you did in step 1
• The area between the two large muscles of the calf, downward to the heel cord, usually needs special attention
• I always end the session on the calf with several long back-and-forth rolling strokes

The Foot Regimen

Treatment to the bottom of the foot has always presented a problem for me. In the past I’ve massaged my own feet with coke bottles, frozen cans of juice, golf balls – you name it. Recently I discovered a simple, yet very effective, body tool that absolutely eliminates shortened, tight plantar fascia. It’s called a FootWheel. The FootWheel easily compresses and stretches the complex musculature of the plantar fascia. This process increases circulation and rapidly permits chronically shortened muscles to relax and recover. The 3 treating surfaces of the FootWheel are designed to target the 3 major support muscles of the foot.

Step 3 – [about 45 seconds] Procedure

• Place the FootWheel on a thick carpet or heavy towel – always stand
• Support your weight on the opposite side, and begin rolling the bottom of the foot. Use gentle, pleasant pressure
• Roll the 3 therapeutic wheels to locate and destroy trigger points
• Trigger points will be recognized as tight, knotty, tender bands of muscle
• When trigger points are located [ouch pain] – continue rolling for 15 / 20 seconds
• Move slowly and be gentle. Use specific, short, back-and-forth movements
• Be sure to tilt and roll the foot – on both the inside and outside – before completing the session.

The foregoing is an amazingly effective procedure to prevent or manage plantar fasciitis. It takes about 3 minutes. Use the techniques at least twice per day – namely before and after a night’s sleep. Use more often if needed. Keep the sessions short and gentle to avoid soreness. Progress is gauged by the way you feel and the number of trigger points you extinguish. Healthy, happy feet are free to tenderness, soreness & pain … even during rollouts.

Good luck and keep on rolling!

REMEMBER, this is an article based on the empirical findings of the author. The suggestions, procedures and ideas are not intended to replace or substitute the medical advice of the readers’ healthcare provider. Please consult your personal healthcare practitioner before adopting any of the suggestions.

I’ve had a twinge in my right shoulder when bench pressing lately, but I wouldn’t say I have a problem.

Or I wouldn’t have said so before fulfilling an assignment to visit Rockford chiropractor R .G. Hotchkiss, who wrote to the Register Star a couple of weeks ago commending a treatment he’s found for nonspecific shoulder pain.

Hotchkiss’ treatment uses two tools developed by Atlanta, Ga. – based researcher Pat Belcher – the Trigger Wheel (registered trademark), a small metal wheel about 1/4-inch thick that rotates on a plastic grip and the Intracell (registered trademark), a row of hard plastic rings strung on an approximately 2-foot long flexible rod with plastic grips at either end.

“I had used so many different things for people with shoulder problems over the years,” said Hotchkiss, who added that pain is sometimes attributable to arthritis, frozen shoulder or a torn rotator cuff and other times no cause can be identified. “This has been so successful that I’ve thought of giving up the chiropractic end of it and just doing this treatment.”

The Trigger Wheel and Intracell were developed to treat complaints of unspecified muscular pains and that’s what Hotchkiss used them for until about four years ago, when a patient with shoulder pain said several doctors had been unable to find its cause.

“He indicated that there were areas of muscular soreness, but that he could feel the results of the Intracell in his fingers and arm on the same side as the shoulder complaint,” Hotchkiss said.

“The initial treatment resulted in a reduction of the shoulder pain, plus increased mobility. Continued treatment led to full relief and no return of the symptoms, and similar results have been repeated with hundreds of patients,” Hotchkiss said.

Here’s what he showed me.

We performed a test in which I pressed the tips of my thumb and pinkie finger together with palm up, palm perpendicular to the floor and palm down positions. I resisted as much as I could while Hotchkiss tried to pull the fingertips apart.

In the palm down position on my right hand, the fingertips came apart easily, leading Hotchkiss to believe I had a problem with two small muscles in my rotator cuff.

After having me lie face down, he rolled the Trigger Wheel across my left shoulder blade -no problem. The same action on my right shoulder blade produced shooting pains throughout my shoulder area.

He had me stand with my left shoulder against a wall and place my right hand atop my head. He rolled the Intracell across the shoulder blade and produced more pain. It took a couple more tries before the pain subsided and my shoulder felt better.

“I’ve never had this take fewer than five or more than 14 visits,” said Hotchkiss, adding that he wants a patient three times a week for each of the first two weeks. “The progress after the second week will determine the number of remaining visits. I want to make sure the ligaments and muscles are all in balance before I release them.”

The Trigger Wheel and a nonexclusive to healthcare providers version of the Intracell, called The Stick (registered trademark), also can be bought and used for self-massage of sore muscles, Hotchkiss said.

For more information, contact Hotchkiss at Metro Health Center, 461 N. Mulford Road, 815-227-1600 or Belcher at 800-554-1501 or online at www.intracell.info.

Nearly 80% of all pain syndromes originate in muscle. Thankfully, there is no pain in healthy muscle tissue. Also, healthy muscle can be stretched, contracted, twisted and compressed without pain or restriction. Management of healthy muscle requires an adequate pre-activity warm-up, stretch and cool-down period. This article features the warm-up and is part one of a three part series that deals with feeling good.

Unlike most workers, athletes of all ages and skill levels, have learned that increasing body temperature before the activity will elevate performance. Pre-activity warming of muscle prepares athletes and workers both physically and mentally. Muscle warming elevates body temperature, increases blood circulation and speeds muscle contractions. A good pre-activity warm-up helps prevent joint sprains and muscle strains. This is especially true with the priority muscles that are always under greater stress.

Enzymes are substances in muscles that allow them to contract and relax. Enzymes allow muscles to convert food to energy and help expedite the conversion of waste products. When enzymes are warm, they are dramatically more effective and efficient. An added bonus is recognized by Covert Bailey who states, “A warm muscle burns more fat than a cold muscle.”

Following are three pre-activity warm-up techniques:

1. Passive Warm-up involves raising body temperature with external sources such as hot baths, saunas, heating pads or by simply warming in the sun. Passive warm-ups are effective for superficial muscles and require virtually no depletion of food reserves in the muscle cells.
2. General Warm-up elevates both superficial and deep muscle temperatures through active movements. Jogging in place, jumping rope or stationary bicycling are effective ways to elevate temperature of deep and superficial muscles. General warm-ups, however, deplete vital stores of muscle energy.
3. Specific Warm-up is directed primarily to muscles that will be used most during specific activities. A good way to warm these priority muscles is by increasing localized circulation. I have talked with numerous companies over the past several years that use the Wellness Stick for this purpose. The Stick allows for both superficial and deep warming of muscle and can be used at the workstation. This wellness technique increases vital food reserves in the muscle cells.

Next time we will discuss general and segmental stretching in part two of this three part series.