The Importance of Fascial Home Interventions Part 3
Part 3: How to Read Your Body and Help the Release While Performing Home Interventions
by Derrin Kluth, PT, DPT, RMT
In the last couple of instalments in this series, I discussed how a Fascial Home Intervention Program differs from a more traditional Home Exercise Program, and then further discussed different types of Fascial Home Intervention Exercises. In this post I will address a common problem that every recovering chronic pain patient runs into: How do I know what to do moment by moment based on what I feel as I am doing these interventions at home? While this could be a discussion for how to read your pain in activity more broadly, I wanted to shrink it down for now specifically for several types of interventions described earlier in this series. Hopefully this will help those of us who are attempting their own self treatment based on that information!
So you’ve been prescribed a Fascial Release technique for home by your practitioner! They’ve probably discussed with you what you’re feeling for and how to achieve it given whichever tool or technique they’ve selected for you. Maybe a rubber ball, maybe a tool like the Theracane, or maybe some fascial stretching, among other possibilities. Whatever it is, you go home and give it a try, and here’s where the hard part can start. Sometimes you might not feel like you’re able to do what your practitioner seemed to do so easily with their experienced hands, and feel inadequate or frustrated. Sometimes it hurts or feels uncomfortable and you’re not sure if you’re supposed to stop or keep going. Sometimes it feels great and you start moving around after and it feels like the pain has moved to another area. And sometimes you feel great and you’re just not sure what to do next at all! Let’s take time to discuss each of these in turn.
Scenario 1: “I don’t feel like I’m doing anything at all.”
The most common mistake in the beginning is to give up too quickly. Once a person starts to try to hold a position with a tool for 5-10 minutes, they start to realize that it’s one thing to say to hold that long and quite another to actually do it! Sometimes we get impatient, or our mind starts racing to the next thing we have to do, or the kids or the dog come in and start running around, or the phone goes off and what if it’s work calling and you need to get it! For these and many more reasons, beginners in these techniques oftentimes find that they aren’t able to hold the entire duration to get a release to start.
If this is the case, there are a few simple tricks we can do. The simplest trick is simply to actively budget the time out beforehand. Plan into your day 10-20 minutes (or more if desired) of uninterrupted time and it’s harder to let other things creep in and sidetrack your releases. A second and related idea is to find a private space, close the door, and inform anyone around not to disturb you unless it is an emergency. The less distraction around you the more likely you will be able to focus on the task at hand. A third simple technique is to set a watch or phone for the minimum time you are aiming for and dedicate your attention to not wandering to see how long it has been until the alarm goes off. And finally, if you are finding it hard to even begin to achieve a release, ask your practitioner to teach you some focused breathing and active visualization techniques to help the “rest and digest” part of your nervous system to counteract the “fight or flight” protective portion. These techniques are subtle but incredibly powerful in helping the release move along when utilized correctly.
Giving yourself adequate time to work on a fascial release is key.
So you’re holding for at least 10 minutes and you still don’t feel anything. The next thing to adjust is the force you’re putting into the trigger point area. There are two major ways you can misjudge how much pressure the trigger point your are releasing needs to begin the process. The first one is not putting enough pressure in. If you’re holding for 10 minutes and don’t feel anything at all, including pain, tightness, or muscle guarding, then you probably have to either put more pressure through the tool, make it more firm (i.e. by blowing air into a rubber ball), or make the surface more firm (like moving from your nice feather bed onto a yoga mat). The other option is that you may have too much pressure and the nervous system is too hesitant to let go because it feels like it’s under attack. If you’ve been holding 10 minutes and it’s very painful, tight, tender, or guarded, this probably means you’re trying to do too much too fast. In this case, back off and try using less pressure, softening the tool (i.e. by letting air out of a rubber ball or putting a towel between your skin and the tool to cushion it), or making the surface less firm (move from that yoga mat to the feather bed instead!). As we’ll discuss next, pain doesn’t automatically mean stop, but you can do too much and in this case the old saying “no pain, no gain” definitely does not apply. Importantly, you can’t hurt yourself but you can make the tissue not let go, which means that you are just wasting your time.
Scenario 2: “I feel something but it starts to hurt or feels uncomfortable so I back off and don’t feel much change after.”
In this case, you’re doing what most of us with chronic pain have been very well trained to do by our habits – avoid the pain because that must mean you’re hurting it! Right? Well, believe it or not, many times that’s actually wrong. The second most common mistake is giving up because we’re afraid we are causing damage somehow and making things worse if it feels unpleasant, even temporarily. This happens because we confuse the two very different kinds of pain. The first is what we call “acute pain.” This is the pain felt when some tissue has been damaged, whether it’s as simple as a paper cut or as elaborate as a broken bone. This kind of pain is saying to us, “GET OFF ME I NEED TO HEAL AND YOU’RE MAKING IT WORSE!” In the beginning of healing and while the tissue is repairing itself (sometimes up to a few months later), it actually is fairly wise to read our pain this way and avoid provoking it, at least in general. We can go too far the other way sometimes and be too careful which sometimes actually triggers a chronic pain episode, but that’s another topic for another time. In general, this pain means leave me alone or don’t push me any further.
The second kind of pain is, of course, what we call “chronic pain,” and the type that most of our readers are probably experiencing. The key difference, though, is that chronic pain is not warning us to stay away. Indeed, believe it or not it’s actually guiding us and telling us some very valuable information for how to help our pain complex! This may sound confusing, but understand that this kind of pain is saying, “Hey, there’s something here you need to work on to help my body recover!” It can be hard to unlearn the habits that our reaction to chronic pain have instilled in us over the years and “trust the pain” in the short run to make long term gains, but in time and with enough practice, a chronic pain sufferer can do just that.
Sometimes our pain acts as a beacon.
What this means during your releases is that oftentimes if you “hang through the pain” for a few more minutes you will begin to feel the release and your symptoms will ease and oftentimes feel even better than they did before! The only time to actually stop is if you’re experiencing pain with a lot of tightness and guarding as described above, and should soften your pressure to allow the tissue to stop guarding. Otherwise, in all my years of helping chronic pain patients I have never once had someone cause actual tissue damage (like tearing a muscle, severing a nerve, or breaking a bone) with a rubber ball or other tool used in home releases. I can assure you that you would stop a long time before any actual damage did happen as your body wouldn’t let you willingly hurt yourself. Another feeling that can be quite intensely uncomfortable sometimes but is actually slightly different than frank pain is an intense feeling of itchy/prickly/slight burning that I like to call the “skin-rippy feeling.” If you feel this during your releases it means hold on a bit longer even if it’s unpleasant because a big release is probably at most only a few minutes away.
Scenario 3: “I did the release and the area feels great! But now the pain moved a little (or sometimes a lot!).”
Now we understand from the last scenario a bit more clearly that understanding our chronic pain is a signal that can guide us. If you’re the kind of patient who can feel the melting, heat, and/or just general sinking in feeling of a release and feels better in that area afterwards, but then feels pain somewhere else when you start moving around, then congratulations, you’re actually successful! The problem is that sometimes we misinterpret the moving pain in a negative way as a worsening situation. In actuality, when you’ve released one area of tight and hypersensitized tissue, then sometimes the chronic pain will bring other areas to your attention that are connected to but had been covered up by the pain in the area you just released! What this means is that you should simply do another release in the area that you are now feeling the symptoms in. And if you feel different pain after that, do the release there. And so on and so forth. In this way you will find that, probably contrary to how you felt about your pain before, it can actually be an incredibly useful guide and instructor in how all your different pain areas are connected and train us in what we need to do to make each area feel better! Sometimes we can feel frustrated if our pain “goes around in circles,” but if we are patient and follow the body’s wisdom to sink through a few layers at a time in each spot we can finish and be fairly surprised at how much of an improvement we feel.
Follow where your pain leads you, treat there.
Scenario 4: “I did the release and I feel great! There’s no more pain, but now I’m not really sure what to do next. . .”
For our final scenario, your practice is making your technique so perfect that you’ve gotten good at doing the releasing and reading the body’s signals to improve the pain in all the different areas and the connections between them. Is there more you can do to help? Actually, yes!
Oftentimes the dedicated practitioner of home interventions will become skilled at taking care of their pain at baseline and being able to control flareups, but they assume that because their pain is under control there isn’t more that they can do. In actuality, most people don’t know that chronic pain is actually the most intense of a range of signals along a spectrum that your body uses to try to signal to you as it tries to protect and guard the tissue. The spectrum actually begins with what I like to call “twitching,” or the small “jumpy” muscle sensations that in chronic pain usually precedes a feeling of increasing tightness which further progresses to increasing pain the tighter and more guarded the tissue becomes.
Understanding that, and by utilizing the increased sense of body awareness that a successful student of fascial release interventions usually develops, many times a person can continue the work of not just controlling their pain once flared up but also following the body’s more subtle signs to be led to the places that need to be released. This may actually prevent the pain from being provoked and make it harder to even begin an episode of pain in the first place! This is where the techniques move from intervention to what I like to call “fascial maintenance.” It’s up to the person but if they utilize the techniques in this way, I like to think of it like performing regular maintenance on your car – that is, the more you take care of it the more miles you get out of it, the better it runs, and the longer it lasts!
Fascial Maintenance is an important piece of long-term pain relief.
In conclusion, I hope the reader finds themselves more confident with this information as they are performing the various home interventions we have previously outlined. Feel free to ask your practitioner if you find that you are fitting in to one of the above scenarios, and we can help fine tune your home interventions to be the most efficient and effective that they can be! Future instalments of this series will focus on ways fascial therapies can be applied to different types of specific patient problems, among other topics.
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