Body Tempering: A New Approach for Myofascial Specific Technique?
Tyler J Gerds, M.S., Emily Dunlap, P.T., and Hirofumi Tanaka, Ph.D.
Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX
Running Head: Body Tempering
Correspondence:
Hirofumi Tanka, Ph.D.
Department of Kinesiology and Health Education
The University of Texas at Austin
2109 San Jacinto Blvd, D3700
Austin, TX 78712
Phone: 512-232-4801
Email: htanka@austin.utexas.edu
Abstract
Background: Body Tempering is an increasingly popular technique used to accelerate functional performance and recovery in athletes by combating soft tissue restrictions utilizing tools such as steel rollers ranging in weight based on an individual’s perceived pain threshold.
Objective: To critically assess the current literature on the potential effectiveness of body tempering.
Methods: A variety of databases, including PubMed, Biomed Central, and Google Scholar, were searched. In spite of the increasing popularity of the technique, no systematic research on the specific method of body tempering was found. Accordingly, the relevant literature that could provide potential insight into the efficacy of body tempering was reviewed and included.
Major Findings: Body Tempering has not yet been systematically evaluated. However, it may serve as a legitimate myofascial specific technique for the heathy athletic population to improve range of motion and manage recovery pain based on its similarity to myofascial specific techniques. Although it remains unknown whether the amount of force applied during roller massage may induce greater gains in flexibility, there appears to be a trend favoring more intense methods of roller massage for a greater reduction in pain of myofascial trigger points.
Conclusion: Body tempering is a promising technique as a myofascial specific procedure. However, further specific research studies evaluating the impact Body Tempering has and the mechanisms by which this technique acts is needed.
Keywords: fascia; myofascial release; injury recovery; flexibility
Introduction
Body Tempering is a new method, developed in 2014, used to accelerate functional performance and recovery in athletes by combating soft tissue restrictions utilizing tools such as steel rollers. Tempering is the process by which something is made stronger, harder, and more durable. This concept has been used for thousands of years to prepare martial artists and various athletes for competitions and to desensitize certain areas of the body to better prepare them for competition. Body Tempering can be viewed as a form of myofascial specific training.
Body Tempering can be done individually or with a partner and involves different tempering methods that include static, dynamic, or targeted tempering of selected muscle groups. All of these different Body Tempering techniques involve different pieces of equipment varying in weight and size. The most common piece of equipment being used is a steel roller ranging in weight based on an individual’s perceived pain threshold.
Static Body Tempering involves constant pressure being applied with the steel roller to the selected muscle group. Dynamic Body Tempering is similar to roller massage with a significant amount of force being applied to the selected muscle group in a rolling fashion. Targeted Body Tempering involves applying force directly to spots of specific tension in the tissue with a heavy, dense tool such as the corner of the heavy steel roller.
Currently, there is no systematic research on the specific method of Body Tempering. However, there is research available on other myofascial specific techniques that share common characteristics to Body Tempering. In particular, the underlying principle is similar to other myofascial specific techniques, but with a different method of applying pressure. As with other myofascial specific techniques, an external load is applied to the tissue eliciting physiological responses. Regardless of how the external load is applied, receptors sense changes in tension and length under the stress of the chosen myofascial specific device. For this reason, research previously conducted on myofascial specific techniques are applicable to understand the rationale for utilization of the newly-developed treatment method of Body Tempering. The mechanical and neurophysiological effects that these techniques ellicit will be analyzed in order to gain insight into Body Tempering as a legitimate myofascial specific technique and recommendations will be made for safe application.
Historical perspective
Acknowledgment of muscle pain disorders have been around for thousands of years (Shah et al., 2015). However, the terminologies of “myofascial pain’ and the physical finding of “myofascial trigger point” are not found in the literature until the 1950’s (Travell & Rinzler, 1952). Ida Rolf created a myofascial specific training approach called Structural Integration or Rolfing. Rolf applied manual pressure to facial sheets and explained how changes in myofascial density and arrangement in response to manual pressures could follow a gel-to-sol model. In this model, fascia can be changed from a “gel” like state to a more fluid “sol” state because it is a colloidal substance that can be modulated by the application of energy (heat or mechanical pressure) (Schleip, 2003).
Myofascial specific training approaches, often described as myofascial release techniques, have been researched extensively over the past two decades. These techniques often utilize specifically-guided mechanical forces to manipulate and reduce myofascial restrictions of various somatic dysfunctions (Meltzer et al., 2010). Fascia is a sheath, a sheet, or any number of other dissectible aggregations of connective tissue that forms beneath the skin to attach, enclose, and separate muscles and other internal organs (Stecco et al., 2007). Alterations in fascial pliability have been thought to lead to poor muscular biomechanics, altered structural alignment, and decreased motor coordination and strength (Langevin et al., 2011). Accordingly, restoration of fascial pliability is thought to increase the efficiency of the musculotendinous junctions and enhance functions and athletic performance. Additionally, through restoring the length and health of restricted connective tissues, pressure may be relieved and pain sensitive structures can be desensitized (Ajimsha et al., 2015).
Myofascial release has been shown to be a valid procedure for improving recovery from an injury. Following repetitive motion strain of connective tissue, myofascial release treatment resulted in normalization of apoptotic rate and cell morphology (Meltzer et al., 2010). Other benefits of myofascial release include enhanced muscle recovery post trauma and increased range of motion in affected joints alongside reductions in edema and inflammation (Meltzer et al., 2010). This scientific evidence for myofascial specific techniques improving the function of fascia is the same proposed benefits of Body Tempering.
Physiological changes with myofascial techniques
Myofascial techniques elicit both acute and chronic physiological effects although the exact mechanisms underlying these effects are unknown (Beardsley & Skarabot, 2015). It is known that fascia is heavily innervated with sensory nerves (Stecco et al., 2007), contains mechanoreceptors (Yahia et al., 1992), and displays piezoelectric effects alongside changes in water content and pliability (Fukada & Yasuda, 1957). Myofascial specific techniques decreases the tonic state of tissues and impacts mechanical properties of the fascia through a complex interaction of both mechanical and neurological mechanisms (Bialosky et al., 2009). The models to explain mechanical changes in the fascia include: 1) the fascial adhesions model where fascial layers, which normally glide about each other, become stuck together, and myofascial specific techniques un-stick these layers returning to normal function (Hedley, 2010), 2) the thixotropy models in which heat and pressure makes fascia less dense and more fluid (Schleip, 2003), 3) the cellular responses model in which fascia responds to mechanical loading at the cellular level (Chen & Ingber, 1999), 4) the fluid flow model in which fascial pliability is restored through rehydration of the tissues (Chaitow, 2009), and 5) the fascial inflammation model in which myofascial specific techniques increase blood flow to damaged tissue and decrease inflammation making the fascia less tight (Bednar et al., 1995). Most likely, a combination of these models rather than a single model proposed would explain the impact of mechanical changes in the fascia. Neurological components that myofascial specific techniques influence include the Golgi reflex arc, Ruffini and pacini corpuscles and potentially interstitial mechanoreceptors (Beardsley & Skarabot, 2015). It is likely that Body Tempering impacts the tissues through similar mechanisms to that of the aforementioned intervention protocols in other myofascial specific techniques previously shown in the literature. However, there is no research study to support such notion at present.
Myofascial techniques and flexibility: pressure and force variability
A common myofascial specific technique for the purpose of improving flexibility is foam rolling. Body Tempering is similar to foam rolling; the difference can be seen through the participant’s role in each technique. In foam rolling, the participant puts pressure into the roller in order to create tension on the myofascial tissues, while in Body Tempering, the participant relaxes as the Body Tempering device is rolled over the intended area. One potential limitation with a highly compressible foam roller is that as it deforms under the participant’s body weight, less pressure may be applied to the targeted soft tissue and the roller becomes a more superficial tool. This could be one potential reason why Body Tempering may be suggested to be a more effective method, as the amount of pressure does not change and the participant is able to remain relaxed.
In a study that examined the pressure differences in two different foam rollers: a normal flat foam roller and a rigid foam roller (Curran et al., 2008), normalized pressure data for contact area was significantly higher for the rigid foam roller. Utilizing the rigid foam roller allowed the participants to apply more pressure to the soft tissues of their lateral thigh, providing a more targeted and potentially deeper fascial contact. The authors postulated that deeper therapies brought about by increasing localized pressure may yield higher therapeutic benefits. In regards to Body Tempering, the assumption is that a 135 pound piece of steel being rolled over soft tissue is going to yield more pressure than a rigid foam roller. If the enhanced benefits are a result of increased pressure created by the rigid foam roller, the use of a steel Body Tempering device could potentially be even more effective.
A recent study investigated the effects of variable roller massage forces (50-90% of maximum discomfort) on range of motion, muscle strength, and depth drop vertical jump performance (Grabow et al., 2018). The intervention included 3 sets of 60 seconds roller massage at 50, 70, and 90% of the participants maximum (10/10) rating of perceived pain applied using a similar constant pressure roller apparatus. No significant differences were noted from pretest to posttest for strength and drop jump. Results did indicate significant improvements from pretest to posttest for active and passive range of motion. However, this was independent of the roller massage forces (Grabow et al., 2018). One limitation to this study is that the loads used in that study were 15, 21, and 27% of total body mass. Although it provided varying loads between the groups, the amount of variation between lightest and heaviest loads was only a 12% difference in body mass, which may not have been enough variation to elicit any further gains in range of motion, strength, or performance. These loads are significantly less than those that would be expected from a Body Tempering protocol where loads commonly exceed 50% of total body mass.
Myofascial techniques and flexibility: duration variability
Doubling the duration of a foam rolling session from 5 to 10 seconds produces a greater increase in sit-and-reach range of motion (Sullivan et al., 2013). There is also a study in which the myofascial specific technique intervention protocol consisted of roller massage applied to the quadriceps muscle groups at 25% of body weight on a custom-made plate-weighted foam roller (Bradbury-Squires et al., 2015). The first condition was rolling the quadriceps for 5 repetitions of 20 seconds, the second condition was 5 repetitions of 60 seconds, and the third condition was the control condition in which no roller massage was applied. The roller massage caused moderate pain in both roller conditions but the pain was 21% greater at 60 seconds of duration. Biceps femoris EMG activity was 110% higher in the 60-second condition than in the 20-second condition. A trend was noted in knee-joint range of motion being higher in the 60-second condition than in the 20-second condition. The prolonged rolling duration may have enhanced range of motion to a greater extent potentially due the greater amount of time that mechanical force was applied to the muscle groups (Bradbury-Squires et al., 2015). This increase in duration or rolling would in turn alter the viscoelasticity and thixotropic properties of the fascia. This study sheds light on the impact that duration of roller massage has on range of motion enhancements.
Comparison to Body Tempering for gain in flexibility
In Body Tempering, the amount of total load that is applied is a combination of intensity and duration. The variation in intensities shown in the aforementioned studies is much less than those typically used in Body Tempering. For improvements in flexibility, it is still unclear how much pressure should be applied to the tissues and there is not enough research to support that an increasing the amount of force that is applied will enhance flexibility gains (Beardsley & Skarabot, 2015). If the amount of force applied during foam rolling does not significantly enhance range of motion, then one could propose that Body Tempering with extreme loads may not be necessary to further enhance flexibility. However, this hypothesis has yet to be examined and is worthy of future study.
Myofascial techniques for Trigger Points and Pain Pressure Thresholds
Body Tempering has been proposed to increase tissue pliability and reduce edema in bodily tissues. In the trigger point release research, the impact trigger point release has on pain pressure thresholds (PPT) has been studied extensively. If Body Tempering were to affect perceived pain, applying direct pressure to particular myofascial trigger points should desensitize targeted areas. Sustained manual pressure has been advocated to be an effective treatment for myofascial trigger points. Continual manual pressure applied to myofascial trigger points by a clinician at a pressure scale of 7 out of 10 has shown to produce significant and immediate decreases in sensitivity of myofascial trigger points (Fryer & Hadgson, 2005). It is important to note that the pain level reported during the 60 second treatment in this study was shown to diminish to a level of 3-4 after 40 seconds and the clinician was required to increase pressure as the 60 seconds concluded. The acute desensitization of the myofascial trigger points could be a result of the pressure applied lengthening the targeted sarcomeres (Fryer & Hadgson, 2005). Sarcomere lengthening has been postulated to reduce the energy consumption and cease the release of noxious substances that are potentially causing the perceived pain of myofascial trigger points (Simons, 2002). Static and targeted Body Tempering of myofascial trigger points could potentially have a similar impact in acutely reducing pain levels as long as the right amount of consistent pressure was applied to the myofascial trigger points.
In another study, patients with myofascial pain dysfunction syndrome were enrolled into a specific myofascial specific technique protocol (Chan et al., 2015). The self-massage protocol required patients to take a baseball to the determined myofascial trigger points and apply direct pressure on them following a short stretch of the muscle groups in which the myofascial trigger points were present. This was done for multiple sessions a week for 6 weeks. The self-massage protocol produced reductions in autonomic nervous system dysfunction as assessed by the heart rate variability and decreases in pain in myofascial trigger points. This study sheds lights on the value of applying direct pressure and stretching to myofascial trigger points and their respective muscle groups in order to reduce pain and autonomic dysfunction in patients with myofascial pain dysfunction syndrome. Although the degree of pressure applied in the self-massage therapy was unidentified in this study, Body Tempering protocols are similar in regards to applying direct pressure to myofascial trigger points.
The use of pressure algometry to assess pain pressure thresholds has been suggested as accurate and valid for the diagnosis of tender spots and evaluation of assessment results (Linde et al., 2018). One study included 5 different experimental conditions utilizing 2 different methods of massage therapy on the plantar flexors and examined the acute effects the massage had on pain pressure threshold measurements taken immediately after the intervention and 15 minutes post treatment (Aboodarda et al., 2015). The 5 experimental conditions included: 1) heavy rolling massage on the calf that exerted high tenderness (self-perceived pain scale 7 out of 10), 2) heavy rolling massage of the contralateral calf, 3) light stroking of the high tenderness calf with roller (as sham), 4) manual massage of calf that exhibited the high tenderness (combination of compressions and petrissage), and 5) no intervention (control group). The three deep tissue massage interventions were applied by a massage therapist and pain levels were constantly reported by the participants to ensure a consistent level of pain at a 7 out of 10 on the visual pain scale (Aboodarda et al., 2015). Although the Theraband roller massager utilized in this study is different from a Body Tempering device, the amount of pressure applied with this device during the conduction of this study may be comparable to Body Tempering. All 3 deep tissue massage intervention conditions produced significant increases in pain pressure thresholds immediately following treatment (Aboodarda et al., 2015). The favorable effects of acutely decreasing tissue sensitivity may be a result of mechanical or neurological mechanisms in the affected tissues. The mechanical pressure applied during the roller massage and deep manual massage may stimulate the proprioceptors and mechanoreceptors of the affected tissues ultimately providing an analgesic effect. However, the non-localized effect of roller massage on the contralateral limb suggest that other mechanisms such as central pain-modulatory system via the descending anti-nociceptive pathway might be involved. The results of this study are important in understanding how Body Tempering works because heavy massage/roller intervention on the contralateral and ipsilateral plantar flexors increased pain pressure thresholds greater than that of light rolling on the ipsilateral limb indicating a heavy pressure may be needed to produce the desired pain relieving response.
Additional support of this concept can be found in massage therapy as there is a certain threshold level of pressure that must exceed in order to elicit a response in the targeted tissues. Indeed a moderate amount of pressure appears to be more effective in many ways than light pressure during different massage therapy protocols (Field, 2010). If applying more pressure to myofascial tissues induces more favorable responses, Body Tempering could be a valuable myofascial specific technique.
In women with upper trapezius myofascial trigger points, immediate effects of different myofascial release techniques on various parameters including cervical range of motion, pain reduction, and myofascial trigger point sensitivity were investigated (Hou et al., 2002). One of the study’s treatment methods was ischemic compression therapy or “manual pressure release” that applies tolerably painful, consistent manual pressure with the thumb or fingertip against the tissue barrier of myofascial trigger points (Simons et al., 1999). When the higher pressure protocol was applied for a short 30 sec duration, significant changes were induced in all measured areas while the lower pressure protocol did not (Hou et al., 2002). This study is important as the value of an adequate amount of pressure being applied to myofascial trigger points is once again shown in the literature. Similar to other previous studies (Bradbury-Squires et al., 2015), increasing the duration of myofascial release intervention yielded higher increases in range of motion and decreases in pain and myofascial trigger point sensitivity.
Static Body Tempering applies high but tolerable pressure to trigger points and can be compared to ischemic compression myofascial techniques. It is important in ischemic compression techniques to not exceed the patient’s comfort level as it would result in muscular tightening and inhibit the relaxation of the myofascial trigger points. This same concept can be applied to Body Tempering by adjusting the weight of the steel tools so as not to exceed the tolerable pain level to ensure that the musculature can effectively relax.
Perspectives
Body Tempering has not yet been systematically evaluated. However, the anecdotal evidence indicates that it may serve as a legitimate myofascial specific technique for the heathy athletic population to improve range of motion and manage recovery pain based on its similarity to myofascial specific techniques. Body Tempering applies a heavy consistent pressure to targeted myofascial tissues by a predetermined load selected for the participant based on their pain tolerance. Although it remains unknown whether the amount of force applied during roller massage may induce greater gains in flexibility, there appears to be a trend favoring more intense methods of roller massage for a greater reduction in pain of myofascial trigger points. Clearly, extrapolating roller massage research to Body Tempering methods has a number of limitations, but one can appreciate that steel tools utilized in Body Tempering techniques provides more force than that applied by a foam roller. In the myofascial specific techniques, it is evident that there is a certain level of pressure that is required to elicit significant responses in the targeted tissues. The mechanisms of action that Body Tempering effects is currently unknown but could be similar to the same mechanisms of action that other myofascial specific techniques induce. Due to the heavy steel tools used in Body Tempering, it is important to have specific training, anatomical knowledge, and the physical ability to apply these tools safely and effectively. Clearly, specific and systematic research studies evaluating and demonstrating the impact of Body Tempering are needed.
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