Trainers need to adapt their technique when working with the connective tissue of older adults.
The condition of our connective tissue depends on two factors—how old we are and what we have done in our lives to keep our tissue healthy, hydrated and flexible.
The health of connective tissue is a serious concern for older people, as movement restrictions can make it hard for them to perform simple activities of daily living. While personal trainers often develop flexibility programs and modify exercises to help senior clients succeed, there is another valuable technique to improve seniors’ range of motion.
That technique is self myofascial release, or SMR, which works with clients of all ages and simply needs to be modified for older adults to address the physical changes of aging. For example, a typical SMR technique for the hamstrings involves resting the backs of the thighs on a foam roller and using the upper body to pull the legs across the roller. This works fine for clients with strong upper bodies, good core strength, adequate wrist flexibility and good shoulder stability, but it is not a viable option for many older adults.
A Closer Look at the Fascial Network
Our fascial network is a system of fascia and connecting ligaments, tendons, organ bags, muscle envelopes and aponeuroses that provide movement and stability to our bodies (Earls & Myers 2010).
Connective tissue has three cell types—fibroblasts, adipocytes and mast cells, embedded in an extracellular matrix, or “ground substance.” Depending on the makeup of the cells within the matrix, connective tissue is classified as either dense or loose.
Ligaments and tendons are dense connective tissues that contain mostly collagen fibers. Dense tissues are strong and “rubbery.” Fascia, meanwhile, is a loose connective tissue. It has a woven appearance and contains all three types of fibrous cells: collagen, elastin and reticular fibers. Loose connective tissue will “squish” under pressure (King 2013).
Fascia is highly adaptable, and although adaptations take months and years, they eventually change the architecture of the tissue. For example, someone who walks upright has considerably firmer fascia on the lateral side of the thigh than on the medial side. Someone who uses a wheelchair, however, has no discern- able difference between the medial and lateral fascia, because fascia responds to strain and dominant loading patterns. Regardless of whether a force is caused by everyday strain or specific training, it is the fibroblasts (cells that secrete collagen, elastin and reticulum) that respond to the force by remodeling the arrangement of the collagenous fiber network (Schleip & Müller 2013).
A recent study looked at frailty from the perspective of myofascial structure and functional mobility. The researchers concluded that the key to understanding the aging of the myofascial structure lies in the extracellular matrix (ground substance), which “tends to dehydrate in inactive or strained body regions and to store additional collagen,” thus reducing elasticity (Sölch 2013).
Research suggests that aging and sedentary living cause collagen fibers to become condensed through a process called cross-linking. In young people, fascial fibers are two-directional: vertical and horizontal. As we age, the fascial architecture becomes more haphazard and multidirectional. Lack of movement speeds up the cross-linking process. Fibers lose their elasticity, flatten out and stick to one another, rather than glide across one another. Eventually, they can become matted together (Schleip & Müller 2013).
Fascia is a “renewable tissue that is made up of nearly 70%–80% water,” says Sue Hitzmann, creator of the MELT Method® of self myofascial release. Hitzmann suggests that dehydration of the fascia may be at the root of chronic pain, fatigue, bloating, headaches, muscle aches and even some psychological disorders.
SMR Techniques for Older Adults
The goal of SMR with older adults is to rehydrate fascia and “unstick” collagen fibers. SMR is based on the concept that connective tissue is interspersed with mechanoreceptors that respond to external pressure, creating potential for preventive and therapeutic interventions (Sölch 2013).
Effective self-myofascial-release work combines pressure and movement. SMR is often done with a firm roller that can be moved across sections of the body to help “release” the myofascial tissue below the skin. Research suggests that using a rigid roller and applying strong pressure to an isolated contact area can be helpful for younger exercisers (Curran, Fiore & Crisco 2008). Senior clients with fragile tissues and bony structures have much more potential for injury, however, so trainers need to adjust their methods, favoring lighter pressure over a wider contact area and using a soft foam roller.
Applying too much pressure causes muscle contractions that affect fascia and restrict the effectiveness of SMR, according to Dana Rutt, a certified sports massage therapist at Podium Sports Therapy Massage in Minnetonka, Minnesota. The key is applying just enough pressure—similar to the amount used when kneading bread—so the muscle remains pliable, and making sure movements are slow and controlled.
Modifications For Older Exercisers
Trainers need to modify SMR techniques to account for weakness, injuries and chronic conditions. SMR should not be used with clients experiencing the inflammatory phase of an autoimmune disease such as rheumatoid arthritis or lupus. Be cautious with clients who take blood-thinning medications, and watch for bruising.
Bones of the rib cage and spine may be fragile because of osteoporosis or osteopenia. To avoid the risk of fractures, use one or two fingers in the spaces between the ribs for SMR techniques on the chest; use a soft ball or roller with light pressure when working in the midback region.
SMR techniques require clients to push or apply force to an area of the body, increasing blood pressure. Instruct clients to breathe normally throughout the movement. They should feel an “Ooohh” as they perform an exercise, not an “Ow!”
Be careful with techniques that require the head to be lower than the heart. Check for signs of dizziness, and if it occurs, stop the exercise.
When possible, perform SMR in a seated position. On a floor or bench, accommodate limitations by using cushions to support joints. Small malleable balls and soft foam rollers can provide adequate pressure. For midback work, place a ball in a sock to allow for easier placement.
Creating Modifications Without Compromising Safety
Self-myofascial-release work is a useful way to help our older clients regain or maintain movements that allow them to live a more active lifestyle. With careful consideration of the limitations many older adults face, we can develop creative modifications that allow them to reap the benefits of SMR without compromising safety and effectiveness.