Foam Roller

A newly discovered muscle: The Tensor of the Vastus Intermedius (TVI)

A group of researchers in Switzerland and Australia have identified a new muscle in the thigh.  Part of the quadriceps, this muscle attaches to the upper outside of your thigh, near the Tensor Fascia Latae, and runs down to your patella.  It's called the Tensor Vastus Intermedius (TVI). 

Looking at the left anterior thigh, (from the front) 1-  Tensor Vastus Intermedius  (TVI)  2-  Vastus Lateralis  (VL)  3-  Vastus Intermedius  (VI) 4-  Tensor Fasia Latae  (TFL)  5-  Rectus Femoris  (RF)  6-  Vastus Medialis  (VM) _Picture from research article Grob et al

Looking at the left anterior thigh, (from the front) 1- Tensor Vastus Intermedius (TVI)  2- Vastus Lateralis (VL)  3- Vastus Intermedius (VI) 4- Tensor Fasia Latae (TFL)  5- Rectus Femoris (RF)  6- Vastus Medialis (VM) _Picture from research article Grob et al

The researchers made the discovery after examining 26 cadavers.  They found the TVI combined with an aponeurosis merging separately into the quadriceps tendon and inserting on the medial aspect of the patella.  Essentially, they found an additional muscle belly between the vastus lateralis and intermedius.

Reference: Netter, Atlas of Human Anatomy

Reference: Netter, Atlas of Human Anatomy

Implications

Like the TFL the TVI likely carries a lot of tension from repeated hip flexion and knee extension. 

This could have implications in particular for:

  •  runners, cyclists and athletes in involved in kicking sports such as soccer and football

Dr. Ed Wittich from BAT Logic says:

"The new discovery of the TVI will not have a large impact on clinical approaches but may indeed make us think differently about the forces on the patella and the way that the quadriceps group works together. This is not just a slip but in fact an actual muscle belly, with independent nerve and vascular supplies. The mechanical model for force production and function of the quads may indeed be adjusted based on this addition to the known attachments and line of pull on the patella and even if it doesn’t, in effect it should create a change for the name for the Quads - Quins maybe?!"

If you've ever foam rolled the upper part of the quads towards the outside, you've probably experienced a lot of tightness/pain here (along with the other superficial muscles in the region). If you've had knee pain/patella tracking issues, the TVI could be playing a role in the dysfunction.

Whilst it's exciting to find a 'new muscle', much of the rehabilitation these days is focused on functional movement patterns and thinking more broadly.  Osteopath Bill Adamson from Errol Street Osteo in Melbourne states:

"Movement patterns are still the main issue facing knee joints the world over.  When addressing the knee we will still look at the hip and the ankle as well as the low back to make sure movement/load is evenly distributed across them.  The great thing with running and cycling coaches is they look at all overall movement efficiency. Which is the even spread of load across the body.  When there is a gross error in the way that an athlete moves then a manual therapist or movement specialist may regress the athlete to incorporate a specific muscle activation.

 

Summary

  • The discovery of this new muscle confirms the complexity of the human body and our knowledge base is still a 'work in progress'
  • I think rolling the lateral upper quads is way underutilized and can help a lot with ongoing knee pain especially in runners and cyclists
  • Deep trigger point dry needling may have more of a role to play to release this newly discovered muscle

Stay tuned to find out more!

 

Get To Know Your Muscles - TFL (Tensor Fasciae Latae)

Author: Daniel O'Grady is a Physiotherapist in Adelaide, Australia.

Most people know about their ITB (Ilio Tibial Band)  that runs on the outside of the thigh; but not as many are familiar with the strip of muscle that joins the upper part of the ITB to the pelvis. 

This small muscle is known as the TFL (Tensor Fasica Latae). 

If you’ve ever had problems with your knee, hip, lower back, calf or achilles, chances are you have some unresolved tightness in your TFL.

 

QUICK ANATOMY REVIEW:

As you can see in the picture, the ITB has upper attachments to both the gluteals and the TFL.  Any dysfucntion/weakness in the glutes means that the TFL needs to work proportionally harder.  Gluteal inhibition is common - especially if you spend a lot of time sitting.

 

PALPATE THE TFL ON YOURSELF:

To feel the TFL, place your finger on your front of your pelvic bone.  Slowly move down and to the outside of the thigh until you feel a ropey muscle that is the the width a finger.  It may be tender to touch.

 

FUNCTION:

The TFL is a hip flexor, abductor and internal rotator.  It works in conjunction with the gluteus medius and gluteus maximus to stabilise the leg during the stance phase of walking and running.  The TFL anteriorly rotates your pelvis.  Functionally, the TFL is part of the Lateral Line and the Spiral line, according to Thomas Myers in his book Anatomy Trains.

The Lateral Line

The Lateral Line

The Spiral Line

The Spiral Line

 

SYMPTOMS:

Overload of the TFL can lead to pain and tightness in the front of the hip.  Very common is also pain and tightness in the outer part of the knee and into the ITB.  This is most noticeable when walking or up and down stairs/hills. 

Other symptoms:

  • knee and hip pain (especially outside)

  • the lower back and SIJ

  • upper back

  • calf and achilles

As the TFL pulls the head of the femur bone forwards, chronic increased tone is one of the prime causes of hip osteoarthritis and degeneration. 

HOW THE TFL BECOMES OVERLOADED:

The TFL becomes overloaded with repeated use in the following situations:

  • excessive sitting, driving, kicking

  • walking and running (especially uphill and downhill)

  • cycling, swimming, kayak/canoe

  • meditating crossed legged in lotus position

  • sleeping in the fetal position

  • standing with a swayed back and wearing high heels too often

TREATMENT:

Physiotherapy assessment will involve a comprehensive movement assessment to determine the cause of your TFL issue.

Short term treatment such as soft tissue massage and dry needling is very helpful, while long term building gluteal and core strength is critical to prevent a relapse.

 

TRIGGER POINT DRY NEEDLING:

Tightness and shortening of the TFL responds well to dry needling, which can de-activate the trigger points (knots in the muscle) that can form in chronic cases.  The benefit of dry needling is that it can reach the deep fibers of the muscle and lead to a quicker resolution of symptoms.  Dry needling is certainly an unusual feeling, but definitely beats 15 minutes of deep painful massage in that area.

 

SELF-CARE TIPS:

  • apply heat to the front of your hip 10 minutes each day

  • avoid sitting cross legged

  • avoid walking and jogging uphills and on sloped surfaces in the short-term

  • ensure your shoes are not overly worn

  • sleep on stomach or side with pillow between knees

  • when running - avoid over-striding and endure proper warm up and cool down

  • use cruise control on long car trips to stretch the legs

 

GRADED EXERCISE PROGRAM TO ADDRESS TFL OVERLOAD:

PART 1 STRETCHES:

FOAM ROLLER ITB  Regulate the pressure with your arms and top leg, so pain is less than 5/10.

FOAM ROLLER ITB

Regulate the pressure with your arms and top leg, so pain is less than 5/10.

FOAM ROLLER QUADS  Go harder along the quads. Keep breathing!

FOAM ROLLER QUADS

Go harder along the quads. Keep breathing!

HIP FLEXOR STRETCH  Feel the stretch in the front of your hip as you tuck the pelvis under gently

HIP FLEXOR STRETCH

Feel the stretch in the front of your hip as you tuck the pelvis under gently

FOAM ROLLER TFL  Angle your body across the TFL and roll it with medium to light pressure

FOAM ROLLER TFL

Angle your body across the TFL and roll it with medium to light pressure

PRONE EXTENSION COBRA DECOMPRESSION  Relax on your forearms, let your hips release at the front. Breathe through the diaphragm

PRONE EXTENSION COBRA DECOMPRESSION

Relax on your forearms, let your hips release at the front. Breathe through the diaphragm

PART 2 STRENGTHENING:

The goal is to strengthen and support the muscles around the TFL

BRIDGE  Feel a stretch in the front of your hips while your glutes activate in the back of the hips

BRIDGE

Feel a stretch in the front of your hips while your glutes activate in the back of the hips

CLAM SHELL  Ensure hips stay facing the front and you feel the gluteus medius (back of the hip) activating

CLAM SHELL

Ensure hips stay facing the front and you feel the gluteus medius (back of the hip) activating

SINGLE-LEG BRIDGE  Keep the bridge high as your transfer your weight to each side. Keep activation through the glutes

SINGLE-LEG BRIDGE

Keep the bridge high as your transfer your weight to each side. Keep activation through the glutes

PUSH-UP TO SIDE-PLANK  Activate the obliques as you twist into side plank. Try x3 on each side.

PUSH-UP TO SIDE-PLANK

Activate the obliques as you twist into side plank. Try x3 on each side.

PLANK  Feel the abdominals support your body. Hold 30 seconds. Keep breathing!

PLANK

Feel the abdominals support your body. Hold 30 seconds. Keep breathing!

 

PART 3: POSTURE / NEW MOVEMENT PATTERNS

For many people, the TFL becomes the muscle that is always switched on and over-active.

Try these movements, focusing on keeping your core and gluteals engaged.
STANDING PELVIC-TILTS  Use the abdominals to gently tuck the pelvic under. Keep the shoulders relaxed and breathe through the diaphragm. x10 per hour.

STANDING PELVIC-TILTS

Use the abdominals to gently tuck the pelvic under. Keep the shoulders relaxed and breathe through the diaphragm. x10 per hour.

STANDING HAMSTRING CURLS  Keep the pelvis tucked under and abdominals engaged as you bend the knee by activating the hamstring. Keep the knees aligned during the entire exercise. 3 x10 each side.

STANDING HAMSTRING CURLS

Keep the pelvis tucked under and abdominals engaged as you bend the knee by activating the hamstring. Keep the knees aligned during the entire exercise. 3 x10 each side.

REVERSE LUNGE  Feel the stretch in the front of your left hip as you stretch back and drop the knee towards the ground. Keep your spine straight while gently tucking your pelvic under. x10 each side.

REVERSE LUNGE

Feel the stretch in the front of your left hip as you stretch back and drop the knee towards the ground. Keep your spine straight while gently tucking your pelvic under. x10 each side.

SIT TO STAND SQUATS  Focus on activating the glutes and core as you come up into standing by gently pulling your pelvis under.

SIT TO STAND SQUATS

Focus on activating the glutes and core as you come up into standing by gently pulling your pelvis under.

Stick your butt out as you slowly sit down, keeping your feet and toes in contact with the ground. Repeat 3x10

Stick your butt out as you slowly sit down, keeping your feet and toes in contact with the ground. Repeat 3x10

How Foam Rolling Can Help With Headaches

Many headache sufferers we see in the physio clinic have a very stiff Thoracic spines.

This is the part of the back that runs from your upper shoulder blades down to the upper waist line. 

**The thoracic spine is designed to move and be mobile**

spinal-canal-spinal-cord.jpeg

Unfortunately for many of us - through excessive sitting, driving and generally poor posture, this part of the spine has lost its flexibility. 

In particular the upper back starts to round over time.

index.jpg

This stiffness then leads to compensations - commonly tightness felt in the neck, shoulders leading to chronic headaches. 

These foam roller exercises are designed to improve your posture, increase mobility through the thoracic spine and decrease the pressure on the head and neck.

If you are a headache sufferer, please give these exercises a try and let me know in the comments how you get on.

FOAM ROLLER EXERCISES FOR.png

Research Update - Benefits of Foam Rolling

What is the Evidence for using a Foam Roller?

Foam rolling is a method of self-myofascial release that can be used all over the body to improve flexibility. Research (Junker and Stogg 2015) suggests 4 weeks of foam rolling the hamstring three times per week was enough to produce a significant improvement in hamstring flexibility.

Foam rolling has also been shown to decrease muscle soreness after intense exercise (Pearchey et all 2015). The participants in this study foam rolled for 20 minutes immediately after a bout of intense exercise and then again 24 and 48 hours after. They experienced significantly less muscle soreness compared with a control group. Researchers believe foam rolling may trigger a release of the pain relieving hormone oxytocin.

Chan (2014) found that self-myofascial treatment, in addition to home exercises, was found to reduce cortisol levels and increase heart rate variability. This indicates an activation of the para-sympathetic nervous system, crucial to healing, optimal recovery and decreasing stress.

Conclusion

Using a foam roller regularly will keep your musculoskeletal system healthy.

Aim to use your foam roller on a daily basis, spending 1-2 minutes before a workout and 10-20 minutes after an intense bout of exercise to improve your flexibility, reduce soreness and improve recovery times. Rolling the upper back every day can help maintain spinal flexibility.

The roller helps in 3 ways:
1. improves flexibility
2. improves core strength
3. activates the para-sympathetic nervous system (reduces stress and enhances the body's healing ability).  

Powerful stuff, if you know how to do it right!

 

Research links:

The foam roll as a tool to improve hamstring flexibility - Junker and Stogg

J Strength Cond Res. 2015 May

Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. Pearchey et al (2015) Journal of Athletic Training 

Short-term effects of self-massage combined withhome exercise on pain, daily activity, and autonomicfunction in patients with myofascial paindysfunction syndrome Chan et al 2014

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5 Ways You Could Be Using Your Foam Roller All Wrong

Using a foam roller can be a valuable way to improve your flexibility, athletic recovery and relaxation. (Want to know how to use a foam roller? Start here.) Take care to avoid these common mistakes:

1. Holding your breath

Holding your breath activates the sympathetic nervous system. This sends a message to your brain that there is a perceived threat in your body. Your body reacts by increasing heart rate and blood pressure as well as causing muscles to tighten and constrict — the exact opposite of what we want to happen.

While rolling, keep breathing regularly (breathe in for five seconds and out for five seconds approximately). By focusing on your exhalation, you activate the parasympathetic nervous that activates the body’s healing mechanism.

2. Rolling the IT band too intensely

The iliotibial band (ITB) is a fibrous tendon that runs up the outside of your thigh. Often it becomes inflamed after too much walking, running or hiking downhill. It contains many sensitive nerve structures and does not respond well to heavy, prolonged rolling.

The ITB reacts better to a few quick rolls, with body weight partially supported by your arms and other leg. The fleshy, muscular part of the ITB called the tensor fasciae latae (TFL, which runs up to the front of the hip) can often give you better results, along with rolling the quads, hamstrings and calf muscles.

3. Rolling your lower back

The body contains many joints, each of which has a specific job to do. The lower back is generally designed to be a strong stable core, from which other body movements can take place. There is no need to roll the lower back, as true stiffness is rarely the problem. More commonly the hips and upper back are tight, which then leads to compression through the lumbar spine.

4. Using bad posture

Foam rolling involves lots of different positions. Good body awareness and core stability are important to ensure you don’t injure yourself. In general, try and maintain a neutral spinal zone.

5. Rolling too quickly over major muscle groups

Slow, focused rolling is better for big muscles like the quads, hamstring and calves. Pay attention to your body and if you come across any particularly tight areas you can hold the pressure there for up to 30 seconds, as the muscle slowly releases. If the muscle doesn’t release or you feel any unusual symptoms like pins and needles, it may mean you are compressing a nerve. Please consult with your physiotherapist for further advice.

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