Improving overhead position

Often we are restricted with overhead movements as it is an action we don’t use often enough. Try these exercises to increase movement if your tight reaching above your head.

So from the last blog we’ve learnt there are 4 positions of high torque when we wind up the shoulder capsule and surrounding muscles. By utilising these positions they will produce better pathways to move from and minimise the risk of injury.

We’ll start off with the over head positions. In every day life we don’t take our hands above our shoulders often enough. It’s understandable the shoulder will feel tight in these positions. But with a little regular mobilising we should be able to feel more comfortable holding our arms up there.

In the shoulder we have big internal rotators and some small external rotators which can cause a bit of an imbalance. Both internal and external rotation needs to be stretched to achieve full over head movement.

The other thing restricting our overhead movements is thoracic mobility. Another area that often gets stiff with a sedentary life. Additional extension at the Thoracic region without hyper extending at the lower back will give us better shoulder flexion.

Below are some basic mobility drills to improve Thoracic extension.

Foam Roller – Slowly moving over the foam roller, trying to extend over the top, keeping steady breathing throughout. Try to keep the neck in a stable position avoiding hyper-extending, also avoid rolling into the Lumbar spine.  Try this for up to 2 minutes. Once you find some stiffness, stay on that point and lift your arms straight above your head. 1 minute.

https://www.instagram.com/p/BT2yyupFzCP/?taken-by=fundamentalphysio

T spine extension – Kneeling, put both elbows up on the step/box. Drop the chest down to the ground. Feeling a stretch at the Thoracic spine and lats. Hold the stretch for 2 minutes. Try to stay strong at the lumbar spine avoiding extending.

https://www.instagram.com/p/BT2zxQgFaYu/?taken-by=fundamentalphysio

Below are just some stretches you can do to access both the internal and external rotation restrictions at the shoulder.

Pec major stretch – Using a resistance band, taking up the slack with the hand behind, turn your body away, producing a large stretch in the chest. Hold for 2 minutes.

https://www.instagram.com/p/BT20WulFJyD/?taken-by=fundamentalphysio

Under arm stretch – Attach a light resistance band to the opposite frame. Hold the other end with your hand behind the neck, pull into the opposite rack and drive the armpit into the poll. You’ll get a good triceps and lats stretch. 2 minutes.

https://www.instagram.com/p/BT20x4YFGYp/?taken-by=fundamentalphysio

Infraspinatus LaX ball smash – Direct the ball into the shoulder blade. With the pressure, take the hand across the body and over head. 1 minute each direction.

Trigger points – what are they?

Trigger points are the most common source of muscle pain. There are many factors that affect a trigger point and for best results they should all be identified.

I’m going to put a wild bet out there that everyone has a trigger point in at least one muscle of their body. Some have more than others. Who of you are regularly rubbing their shoulders or elbows? More and more we are sitting at the computer or looking down at our phones (sorry for writing this blog) causing prolonged tension on muscles around the neck and shoulder, resulting in the development of trigger points.

What is a Trigger point?

It is defined as a hypersensitive palpable nodule in taut bands of muscle fibers. Meaning very small bundles of muscle fiber have become contracted/”knotted” due to a chemical imbalance within the tissue.  The area is very painful and can cause you to jump or cramp on palpation. It can cause referred pain, weakness and restriction through movement. Which makes doing normal activities and training difficult.

Triger Point diagram
Diagram of trigger points within a muscle

Trigger points of individual muscles have a very specific referred pain pattern and can mimic other problems. For example pain in the forearm and wrist can be referred from Infraspinatus, a shoulder muscle. Without a detailed assessment and clearing other areas this could be misconceived as a tennis elbow.

What causes a trigger point?

A TP can be brought on in a number of ways. 

  • Poor postures held for a prolonged period, causing certain muscles to work harder while trying to support structures like the head, eventually causing TP’s.
  • Repetitive strain on muscles from overuse over multiple days, weeks and months. How many clicks of the mouse or typing are your doing? How much swiping of the smartphone? These repetitive movements take their toll.
  • Emotional stress and poor sleep can cause muscle tension. Particularly the neck and shoulder muscles.
  • A lack of movement will develop TP’s when sitting or on bed rest for a prolonged time.
  • Heavy lifting can cause the development of TP’s when the muscle is placed under excessive loads which it is not familiar with.
  • Trauma to a muscle, either as a reflex to pain or overcompensating for the weak and injured structure. This is quite common with car accidents or sports injuries.

Our muscles sit within a biochemical “soup” of  hormones, nerve transmitters and chemicals, all affecting the PH and Oxygen levels of the tissue. Your body knows the perfect recipe to keep everything balanced, but when we overload it with one or more of the above, it causes changes to the recipe, resulting in a drop in PH (becoming more acidic) and reduces the oxygen supply. This leads to the development of TP’s.

How do we treat a trigger point?

Your desire to change must be greater than your desire to stay the same. 

The following treatments for trigger points will help settle them down, but if we provide the same environment they will return.

  • Trigger point release – sustained manual pressure applied to the trigger point causes increased blood flow to remove toxins from the area, interrupts the pattern of pain and spasm and encourages the production of natural pain relieving endorphin’s.
  • Trigger point dry needling – There is a growing evidence base for trigger point dry needling. The needling causes local twitch responses which are a central nervous system reflex. This helps disrupt the pain feedback loop but also reset the acidic biochemical “soup” the muscle is sitting in, back to its normal levels.
  • Myofascial release – the surrounding tight myofascial tissue that feeds into and over the trigger points could also be restricted, causing further exacerbation of the area. Using this technique will give some length back to these structures and can alleviate the trigger point.

Once the hands on therapy has been applied it is not the end of treatment. The muscles with the TP’s will need to be stretched to help prevent their return. Postural correction and stability exercises for surrounding muscles may need to be followed. Changes ergonomically may need to be enforced to prevent falling back into poor habits. Also looking at ways of alleviating stress through improved sleep, meditation, breathing techniques and increase of general exercise.

All of these factors will need to be considered to provide long lasting benefit and avoid their return.

  1. Travell & Simon (1999). Myofascial Pain and Dysfunction: The Trigger Point Manual
  2. Shah et al (2008) Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: An application of muscle pain concepts to myofascial pain syndrome. Journal of Bodywork and Movement Therapies
  3. Simons, (2008), New Views of Myofascial Trigger Points: Etiology and Diagnosis, Archives of Physical Medicine and Rehabilitation

Does your shoulder get the green light?

Are you able to achieve full shoulder range and move efficiently with speed and load. Essential to preventing injury and getting the most out of your training.

The shoulder is such an interesting part of the body. It’s a joint that’s suspended by muscles and fascia and its only point of contact with the rest of the skeletal system is a dinky little joint at the collar bone. Which means that our musculature is doing all the work to maintain stability while moving through huge ranges.

Underneath the layers of muscle, the shoulder has a capsule and it has four positions where it winds up and reaches its highest levels of tension and stability. If we can achieve these positions from start to finish when transitioning through movement, particularly under load we’ll have less chance of injury.


  1. The first movement being overhead a combination of external rotation and flexion at the shoulder and protraction of the scapula (moving forward around the rib cage). Examples of this being the start position of chest to bar pull up or end position of push press. Our arms should get past our ears with the elbow pits facing each other.
  1. Next the front rack position is also flexion and external rotation of the shoulder. Obvious examples are a front squat or the bottom of a hand stand push up. This is elbows up to shoulder level, with the hands outside the shoulders and palms turned up.
  1. Hang position is a full internal rotation of the shoulder. This can be seen when we clean or Snatch. Elbows out to the side at shoulder level and hands down to floor, aiming for the forearms to be in line with the body.
  1. The press position consists of internal rotation and extension. Seen with the start of a bench press or bottom of a ring dip. The elbows are taken past the body as far as possible with hands at chest level.

Failing to maintain shapes of stability becomes more difficult to transition and finish safely to the next position. Make sure you have competency in all 4 positions. If you’re struggling with a position you need to be mobilising. If you’re having pain with these positions you should have it assessed to avoid being side lined.

 

Myofascial Release

Myofascia interweaves through our muscles and takes up to 80% of muscle mass. Consider this when you’re doing your stretching and but not getting the results you wanted, it’s possibly due to fascial restrictions.

What is Myofascia?

Fascia is the largest system in the body with the appearance of spider’s web. Fascia is very densely woven from the top of the head to our toes, covering and interpenetrating every muscle, bone, nerve, artery and vein, all our internal organs including the heart, lungs, brain and spinal cord. In this way, you can begin to see that each part of the body is connected to every other part by the fascia, like a fitted suit.

How would it affect me?

Myofascia interweaves through our muscles and takes up to 80% of muscle mass. Consider this when you’re doing your stretching and but not getting the results you wanted, it’s possibly due to fascial restrictions.

I’d like you to try something. Reach behind your back with your right hand, grab a handful of the shirt/top in the middle of your back. Now try and lift your left hand above your head, it will likely be restricted and wind up in certain areas. Think about the tightness and restriction you might feel doing an overhead lift or in the back when squatting, it could be the fascia pulling on these areas.

One study has shown that tightness in the posterior neck muscles can cause a significant decrease in hamstring length and strength. (1)

What causes it to get tight?

Postural adaptations, trauma, inflammatory responses, and surgical procedures create myofascial restrictions that can produce tensile pressures of approximately 2,000 pounds per square inch on pain sensitive structures that do not show up in many of the standard tests (x-rays, MRI scans, etc.)

What does Myofascial release involve?

The MFR technique appears quite light as it puts a slow sustained shearing force on the superficial layer of fascia that lies beneath the skin. The superficial layer taps into other deeper structures within muscle and other systems of the body. There is no oil used as it allows for more feedback detecting for fascial restrictions into the therapist’s hands. There is extensive evidence that shows myofascial release is an effective tool in improving flexibility and reducing pain (2,3,4,5)

How does it differ from a deep tissue massage?

With DTM this is more directed to muscle tissue that has adhesions or is tightened and needs deep pressure to bring back some length and lower its tone. Although the deep pressure can be painful depending on how sensitive the tissue is and pain tolerances of the individual.

 

  1. McPartland et al (1996) Rectus capitis posterior minor: a small but important suboccipital muscle, Journal of Bodywork and Movement Therapies
  2. Hsieh et al,  (2002) Effectiveness of four conservative treatments for subacute low back pain: a randomized clinical trial. Spine.
  3. Wong, K.-K. et al, (2016) Mechanical deformation of posterior thoracolumbar fascia after myofascial release in healthy men – a study of dynamic ultrasound. Physiotherapy
  4. LeBauer et al, (2008) The effect of myofascial release (MFR) on an adult with idiopathic scoliosis. J Bodyw Mov Ther.
  5. Ajimsha et al (2012) Effectiveness of myofascial release in the management of lateral epicondylitis in computer professionals. Arch. Phys. Med. Rehabi.
  6. Ajimsha, M.S. et al, (2014) Effectiveness of Myofascial release in the management of chronic low back pain in nursing professionals Journal of Bodywork and Movement Therapies

Back Pain Myth Busting Part 5

This series of blogs is to help bring some clarity with what to expect with back pain and what the evidence is telling us.

And the final part of this Lower back pain blog is regarding factors in our life that we wouldn’t think influence our pain. Also, there is hope for people dealing with persistent back pain.

 

9 Sleep deprivation, stress, low mood and worry influence back pain

Some people feel that pain can only be mechanical, but there are a few other factors that affect our pain perception when we have lower back pain. Life events that cause increased levels of stress or depression can enhance the pain we feel. Understanding these factors and trying to take control of them will help. Studies have shown that with a cognitive approach dealing with stress’, fears relating to the injury and of movement will help lower pain scores and result in good outcomes (1)

 

10 Persistent back pain can get better

As previously noted in the last point and the other parts of this blog, there are many factors influencing back pain and not every individual is the same, requiring a tailored treatment plan to match their needs. Most people with persistent back pain will likely need to address non-physical factors as mentioned in the last point (2).

It is very common as most treatments only address one factor, if someone goes for a massage for their sore muscles, but fails to address their stress at work or fitness levels. You can understand why problems likes this become an “on + off” issue throughout life.

Identifying the different contributing factors for each individual and trying to address them, pain can be greatly reduced and people can live a happier and healthier life.

 

1.     O’Keeffe et al, (2015) Individualised cognitive functional therapy compared with a combined exercise and pain education class for patients with non-specific chronic low back pain: study protocol for a multicentre randomised controlled trial, BMJ Open

2.     O’Sullivan, P. (2012) ‘It’s time for change with the management of non-specific chronic low back pain‘, British Journal of Sports Medicine, 46(4), 224-227.

Back Pain Myth Busting Part 4

This series of blogs is to help bring some clarity with what to expect with back pain and what the evidence is telling us.

Next up are two biggies. How should I sit and can I lift with a spinal injury? Posture is an important factor with both positions but it’s understanding how it can be effective while recovering.

 

7 The perfect sitting posture may not exist

The body is designed to move. If we sustain a position for too long, we end up loading an area more than it’s designed for. This can either be in a slouched position or even sitting erect. It’s important to alternate our sitting positions to avoid pain and adaptations (1). This can be done with changing sitting positions, getting up regularly and doing tasks in standing that you would normally do sitting (i.e. taking phone calls). Try to change position every 20minutes.

Knowing that movement through range in sitting is necessary to gain confidence in your spine instead of being rigid/protective. (2)

 

8 Exercise and resistance training

Lower back pain can cause people to fear and avoid certain activities that involve bending, lifting and twisting (3). However, it is important that we encourage this within a safe environment, to gain confidence and reach better outcomes.

Initially it may be sore practising these movements, but as mentioned previously it’s about understanding the type of pain you feel. This will help strengthen the spine and supporting structures, getting you back to lifting, running and jumping.

Studies have shown great benefits and long-term safety of various types of exercises (4) including high load resistance training (5).

 

1.     Zemp et al, (2013) In vivo spinal posture during upright and reclined sitting in an office chair. BioMed Research International.

2.     Baumgartner et al, (2012) The spinal curvature of three different sitting positions analysed in an open MRI scanner. The Scientific World Journal.

3.     Thomas et al, (2008) The relationship between pain-related fear and lumbar flexion during natural recovery from low back pain. Eur Spine J.

4.     Steele et al (2015) A Review of the Clinical Value of Isolated Lumbar Extension Resistance Training for Chronic Low Back Pain; American Academy of Physical Medicine and Rehabilitation

5.     Pieber et al (2014) Long-term effects of an outpatient rehabilitation program in patients with chronic recurrent low back pain; Eur Spine J

Back Pain Myth Busting Part 3

This series of blogs is to help bring some clarity with what to expect with back pain and what the evidence is telling us.

You may have heard of the phrase, Pain doesn’t hurt. In some cases, it doesn’t. Also, the urgency for having spinal surgery may want to be reconsidered based on the research.

 

5 More pain does not mean more damage

As mentioned previously the spine is a complexed structure with many different factors effecting it from a physical, mental and environmental perspective. You could have two individuals with the same injury, but can feel different sensitivities of pain (1).

Our nervous system has an influence on the pain we feel and can sometimes get stuck in a loop if the injury is poorly managed. So, even once it has healed we can still experience discomfort.

Our coping strategies vary depending on different types of pain. Once we understand that some pains are not causing damage, our quality of life can be drastically improved. (2,3)

 

6 Surgery is rarely needed

There are only a small proportion of people with back pain that need surgery. Following clear guidance from your physio or Dr by staying active with exercise, manual therapy when needed, positive reinforcement of movement, understanding your injury and good pain management we see excellent results.

The statistics for successful outcomes following surgery vary from one country to another and between surgeons. But there is evidence showing that the outcomes after having surgery are similar to non-surgical treatments over a span of 1-2 years (4,5).

 

1.   Vernon H, (2010) Historical review and update on subluxation theories. J Chiropr Humanit.

2.   Taylor et al (2014) Incidence and risk factors for first-time incident low back pain: a systematic review and meta-analysis: The Spine Journal October

3.   George et al, (2012) Predictors of Occurrence and Severity of First Time Low Back Pain Episodes: Findings from a Military Inception Cohort. PLoS ONE 7(2): e30597

4.   Brox et al, (2010) Four-year follow-up of surgical versus non-surgical therapy for chronic low back pain Annals of the Rheumatic Diseases

5.   Wynne-Jones et al, (2014) Absence from work and return to work in people with back pain: a systematic review and meta-analysis. Occupational and environmental medicine

Back Pain Myth Busting Part 2

This series of blogs is to help bring some clarity with what to expect with back pain and what the evidence is telling us.

Moving on from part 1 are some misunderstandings of an old medical phrase and some advice that should only be left to the most severe of cases.

 

3 Back pain is not caused by something being “out of place”

There is literally no evidence of joint subluxations of the spine when under X-ray, MRI or any other type of imaging (1). Yet the phrase of the spine being “out of place” is still used and that it needs to be realigned like pieces of Lego.

As humans, we are not symmetrical and there are slight discrepancies, more so with scoliosis, Scheunemann’s etc. But we adapt to these changes throughout life.

It is worth noting a popular treatment for being “out of place” are joint manipulations. This is not relocating the joint, but causing cavitation (the formation of gas bubbles within the joint causing an audible sound). This is however effective in providing short term improvements to pain, muscle tone/tension and lowering fear.

 

4 Bed rest is not helpful

If we were to take a trip back to the 80’s you’d likely get told by the Dr to have a few weeks of bed rest and if you’re lucky be prescribed a corset.

We now know with strong evidence that gentle movement and trying to maintain normal activities as comfortably as possible will improve the rate of recovery (2,3).

 

  1. Vernon H, (2010) Historical review and update on subluxation theories. J Chiropr Humanit.
  2. Wynne-Jones, G. et al., 2014. Absence from work and return to work in people with back pain: a systematic review and meta-analysis. Occupational and environmental medicine
  3. Malmivaara et al, (1995) Treatment of acute low back pain: bed rest, exercises, or ordinary activity? N Engl J Med

Back Pain Myth Busting Part 1

This series of blogs is to help bring some clarity with what to expect with back pain and what the evidence is telling us.

This week I wanted to pull out some facts regarding back pain and the public perception of the most prevalent musculoskeletal injury. The idea is to give you more confidence in using your back during injury but also trying to clear the stigma associated with this condition.

 

1 Back Pain is normal factor in life

Up to 84% of people will have some form of back pain in their lifetime (1). It has become inevitable that this will happen at some point unless you’re a hermit. The good news is that only a small percentage that don’t fully recover.

Most acute back injuries are the result of a simple strain or sprain and expected recovery is excellent. Within the first two weeks of an acute episode of pain, most people will report a significant improvement in their symptoms with up to 90% full recovery within 6 weeks. Only 2-7% of people develop chronic, disabling problems (2).

2 Scans are rarely needed – be careful what you wish for

This one is great, if you put the people of Newmarket through an MRI scan about 60% will have some abnormality even if they don’t have pain. (3, this wasn’t a study of the Newmarket population) (4)

Wait, so if an MRI scan can show a disc prolapse without pain, could that mean the pain may not be associated to the disc identified? Some of us need a “label”, once being diagnosed with a disc prolapse it becomes easy fall back into the “what can I do? I’ve got a disc prolapse”. This can cause a heightened fear of moving normally and exercising, which happens to be the opposite approach to rehabbing this condition. (5)

Consider this, only 5% of lower back strains are the direct result of a disc herniation (6). It’s not to say they can’t be the cause of pain but there are many other structures and factors involved with lower back pain.

  1. Balagué et al, (2012) Non-specific low back pain. Lancet.
  2. Kinkade, (2007) Evaluation and treatment of acute low back pain. Am Ac of Family Phys
  3. Jensen et al, (1994) Resonance Imaging of the Lumbar Spine in People without Back Pain, N Engl J Med
  4. Teraguchi et al, (2013) Prevalence and distribution of intervertebral disc degeneration over the entire spine in a population-based cohort: the Wakayama Spine Study.
  5. Shnayderman et al, (2013) An aerobic walking programme versus muscle strengthening programme for chronic low back pain: a randomized controlled trial. Clin Rehabil.
  6. Lateef et al, (2009): What is the role of imaging in acute low back pain? Curr Rev Musculoskelet Med

Hold the Ice – in RICE

Questioning the reasoning of using ice when injured. A lot of current evidence shows that ice may hinder the recovery of an injury.

Changing brings difference, difference brings progress and if progress was easy to achieve it would not be so hard to accomplish. 

This is always going to be a difficult topic to discuss when dealing with an acute injury. The knee jerk reaction is to apply the ice to the sprained ankle or twisted knee as it’s something commonly used in general practice for over 40 years. This is not me condoning the use of the ice if you’ve had good experiences with it in the past, just providing another way of approaching the recovery of an injury with current literature and using clinic reasoning.

Most of us have been familiar with R.I.C.E. (Rest, Ice, Compression, Elevation) for the initial treatment of acute injuries, which was first published in sports medicine book by Dr Gabe Mirkin in 1978. The acronym was easily remembered and became engrained in all environments with little to no challenge of its overall effectiveness. In the last 7-8 years, there has been more evidence published to question inclusion of ice as an essential tool for an acute injury. In fact, Dr Mirkin has reviewed the current research and done a complete turn on his own recommendation of using ice.

Why use Ice?

The whole idea of icing was to restrict blood flow to the damaged structure, to minimise swelling and bleeding. This was to be applied at regular intervals for the first 2-3 days. It was believed that the swelling restricts range of motion and delays the overall length of recovery. Also, it works as a natural numbing agent to help with pain relief

What’s happening when we get injured?

A multitude of things begin to happen in the body when faced with an injury. You may be aware of the three stages of an injury; acute inflammation, proliferation and remodelling. In that inflammatory stage the blood vessels dilate and increase permeability allowing an increased supply of white blood cells (Microphages and leukocytes) to the damaged site. These blood cells will help break down the damaged tissue and to promote healing will produce growth hormones. There is also increased swelling and the joint becomes more restricted and increases sensitivity to pain which both protects the joint from further damage. Our other less known system in the body, the lymphatic system (the “sewerage” system) slowly helps drain the area of fluid and other by-products.

What is the current evidence showing?

If blood flow is restricted through ice, this limits the release of white blood cells to the area. Lu (1) found that with a steady supply of growth hormone soft tissue can heal at a normal rate compared to tissue with limited/no supply of the hormone. Also, when ice is applied it has a longer lasting effect on vasoconstriction even after the ice has been removed (2), meaning the supply of these white blood cells is depleted for a prolonged time.

Also, the lymphatic system that I mentioned which helps draw away swelling and the “junk”, this is assisted by the pumping action of muscle contractions. Bleakley (3) demonstrated that the strength of a contraction is depleted when iced is applied and this would impact on the pumping action to lymph nodes that help draw swelling away from the injured site. Also, icing the injured site causes changes to the permeability of the lymphatic system causing fluid to leak back into the injured site cause more swelling (4 – I know it’s old but it was a foundational study).

Another study in 2011 (5) broke down the stages of healing even further, the soft tissue was sampled physiologically and under a microscope, comparing damaged tissue that had been iced and non-iced.

Time after injury No Icing Group Icing Group
12 hours Macrophages were found within the necrotic muscle fibers (Macrophage migration to an injured site to phagocytose the necrotic muscle fibers is essential for “clean-up”) Less macrophages were found within the necrotic muscle fibers
Day 3 Regenerating muscle cells present Reduced regenerating muscle cells
Day 4 Normal sized muscle cells produced Smaller sized regenerating muscle cells
Day 14 Normal maturation of the regenerating muscle fibers Maturation of the regenerating was visibly reduced
Day 28 Cross-sectional area of the regenerating muscle was 65% greater than the icing group Collagen fibers were seen only among the bundles of muscle fibers as it is seen in healthy muscles Regenerating muscle fibers was significantly less in the icing group (P < 0.01) Abnormal collagen formation where collagen fibers surrounded each muscle fiber

If no ice then what are we left with?

So now we know ice doesn’t need be put on this pedestal of being an essential tool in recovery post injury. It still has its place for pain modulation, but only for short periods otherwise it will cause prolonged vasoconstriction. Also along the lines of avoiding limiting the inflammatory process, we need to refrain from anti-inflammatories and stick to a mild pain killer (ie Panadol) if struggling with discomfort. If this does not control your pain levels, seek your GP for advice on stronger medication

Following an injury, we fear the worst which is understandable, therefore it’s important to have it assessed by a health care professional to determine the degree of the injury and be receive the best advice, treatment and referrals if needed (i.e. X-ray). To kick start the repair process, begin moving the joint or damaged tissue within a comfortable range as soon as possible at regular intervals through the day. When resting consider having the area elevated above the heart and wear some compression. This will all assist with the lymphatic drainage, putting your body in the best environment and allowing it do the work.

Other options worth considering if you have a high pain tolerance and a keen mobiliser. I’ve seen some good results with regular intervals of using voodoo floss recovering from injury. Although there is no literature to support voodoo bands. But in terms of releasing myofascial tissue which is the main structure the band is impacting on, this can improve lymphatic drainage (6).

There is no harm in using ice, as we’ve been using it for a few decades now, but looking at the latest research and its impact on recovery times, you might want to consider your options before chucking on the bag of peas.

  1. H. Lu et al, (2010) Macrophages recruited via CCR2 produce insulin-like growth factor-1 to repair acute skeletal muscle injury. The FASEB Journal
  2. Khoshnevis et al, (2015) Cold-induced vasoconstriction may persist long after cooling ends: an evaluation of multiple cryotherapy units. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
  3. Bleakley et al, (2012) Should Athletes Return to Sport After Applying Ice? Sports Med
  4. Meeusen, R. (1986) The use of Cryotherapy in Sports Injuries. Sports Medicine.
  5. Takagi, R, et al, (2011) Influence of Icing on Muscle Regeneration After Crush Injury to Skeletal Muscles in Rats. J of App Phys
  6. Bruno C, (2016) Lympho-Fascia Release and Viscerolymphatic Approach To Fascia,