By: Courtney Edgecomb, DPT, PHRC Los Angeles
The very first time I came across a foam roller was in high school when I went to physical therapy for back pain. At that time, the main product was simply a long, circular white piece of soft foam. It wasn’t special but it certainly helped me continue playing soccer without pain. Fast forward into my college years and I found myself in physical therapy for back pain again after running a half marathon. That time around, foam rollers came in different colors and a couple different densities. Massage balls (and double massage balls!) were even coming around to the market, which made getting to the glutes and lower back a PT’s dream! I have to give a ton of credit to my PT after working with him for 2 years, but using a foam roller and massage balls regularly has been a critical part of my self-care routine to be pain-free and even run a marathon. But foam rollers have a greater purpose than pain relief, they also assist with posture, mobility, flexibility, blood flow, releasing trigger points and tight muscles, and decreasing delayed onset muscle soreness (DOMS).1-5
“Foam rollers are used to restore alignment, improve body awareness, posture and flexibility, challenge neuromuscular control and alleviate muscular tension and pain” – Feldenkrais, 2009
It’s basically an all-in-one tool! So as we near 2020, there are even more products to choose from that you can conveniently pick up at Target along with your groceries. Foam rollers vary from light to extra firm, smooth to pointy bumps, small to large diameters, and cheap to expensive. Some vibrate, heat up, or even collapse to become travel-friendly (another PT’s dream). However, with all of the options it sometimes becomes tricky to find the one for you. Personal preference does play a factor in choosing a foam roller, but in general you want a foam roller that is dense and can provide a deep, focal pressure that can release trigger points and relax muscles.1-5 A foam roller should be generally uncomfortable, but tolerable. You should be able to breathe and not tense everything up while still feeling a deeper massage. I call this the “it hurts so good” tolerance level. My personal favorite and recommendation to every patient is the IntelliRoll because of a groove built for the spine and curves on each end that contour around the body. The grooves improve the comfort of foam rolling and allow great access to tissues around the spine and tailbone – a HUGE bonus for our pelvic pain patients.
The research on dosage for foam rolling is limited and varied, but using a foam roller for 30-60 seconds, 1-2x/day per muscle group or body area is effective.1-5 Those who are new to foam rolling or have poor tissue quality may need a bit longer. Changes in flexibility and range of motion were greater when combining foam rolling with stretching.2,5 Additionally, foam rolling before or after workouts has shown to reduce DOMS and improve muscle activation.1,2,5
While the pelvic floor muscles are generally the focal point of pelvic pain or dysfunction, they are usually not the only culprits. External muscles and fascia surrounding the pelvic girdle including the iliopsoas, adductors, quadriceps, iliotibial band, gluteals, piriformis, and hamstrings commonly have a relationship to hip, buttock, back, groin, and thigh pain. Since foam rolling can directly reach these muscle groups, it is a very effective part of a home exercise program for those with pelvic pain or pelvic floor dysfunction. By reducing tightness and trigger points, improving flexibility, and increasing blood flow, a foam roller will minimize impairments from the big muscle groups. Another benefit of the IntelliRoll is the ability to perform mobility exercises along the spine and tailbone, which improves posture and alignment to restore optimal muscle function. So follow along with the videos below to see how you can begin feeling better today by foam rolling!
Conclusion
Hopefully by now I have convinced you enough that whether or not you are in pain, recovering from an injury, or simply want to improve self-care, then foam rolling is your next best move. If you are experiencing symptoms of pelvic floor dysfunction including pelvic girdle pain, groin pain, vaginal/penile/testicular pain, low back pain, pain with sex, urinary urge and frequency, constipation, and prolapse (to name a few), I highly recommend that you try out the IntelliRoll as demonstrated in the videos above. Don’t have one? No problem, use the code PHRCROLL on the IntelliRoll website for a 10% discount today! You have the choice of three different versions, but at PHRC we find that the IntelliRoll Sport is the most preferred by our patients for its light to medium pressure on sensitive tissues. For more information about foam rolling, watch my webinar on YouTube. But most importantly, schedule an appointment to see a pelvic floor physical therapist to discuss your symptoms and get a full treatment plan tailored to your needs – and to have a foam rolling buddy.
References
- Aboodarda et al. Pain pressure threshold of a muscle tender spot increases following local and non-local rolling massage. BMC Musculoskeletal Disorders (2015) 16:265
- Beardsley et al. Effects of self myofascial release: A systematic review. Journal of Bodywork and Movement therapies (2015) 19, 747-758
- Curran et al. A comparison of the pressure exerted on soft tissue by 2 myofascial rollers. Journal of Sport Rehabilitation (2008) 17, 432-442
- Griefahn et al. Do exercises with a foam roller have a short term impact on the thoracolumbar fascia? A randomized control trial. Journal of Bodywork & Movement Therapies (2017):21, 186-193
- Kalichman et al. Effect of self-myofascial release on myofascial pain, muscle flexibility,and strength: A narrative review. Journal of Bodywork & Movement Therapies (2017):21, 446-451
FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.
Comments
Great article!
Excellent exercises! Thank you!
You are welcome!