Jul 12, 2017In Full Swing
One, two, three – harder, stronger, hold, hold. Okay, now relax.” We’ve all seen proprioceptive neuromuscular facilitation (PNF)-assisted stretching start this way: An athlete lies down with their foot on the athletic trainer’s shoulder, pushing with all of their strength, grimacing, and holding for a count of 10. Recently, an alternative type of stretching has gained traction that builds on the foundation set by this conventional method — but with some important differences.
Called fascial stretch therapy (FST), this technique moves and stretches the body’s fascia and joint capsules, rather than focusing on the muscle as traditional static stretching or PNF-assisted stretching does. As such, FST allows the clinician to find any problem areas more quickly and make changes in the tissue that provide longer-lasting results. Based on scientific research, FST has proven to have many advantages beyond those of conventional stretching, such as decreasing pain, reducing injury risk, and increasing performance.
Although FST got its start in 1996, it has really taken off over the past few years. When I became FST certified in 2010, there were only 200 other practitioners in the world. Now, that number is at 2,000 and counting.
The rise could be due to the fact that FST can be just as beneficial to the clinician as the athlete. Doctors, physical therapists, chiropractors, massage therapists, and strength coaches have all turned to FST to expand their practices, and athletic trainers are doing the same. By learning this new stretching therapy, athletic trainers can open up new doors in the sports medicine profession and even earn supplemental income. And as FST continues to grow, now is the perfect time for athletic trainers to get on board.
FST PRIMER
In order to understand FST, you have to understand fascia first. Fascia is one of those terms that athletic trainers might hear once or twice in their undergrad programs but don’t focus their studies on. For me, it wasn’t until I did my own research that I truly understood how important fascia is and why we need to pay more attention to it.
Because the fascia links everything, putting tensional strain on one part of the body in FST ultimately has an impact on other areas. In this way, FST engages the whole neuromyofascial system.
Fascia is one sheath of fibrous tissue that connects every muscle, tendon, ligament, and organ in the body from the top of your head to the tips of your toes. I explain it to athletes by having them visualize a piece of sausage — the casing is the fascia, and the meat is the muscle. This is the main reason why athletes don’t get any long-standing results with traditional stretching — it only focuses on the muscle, while FST focuses on the fascia that encases it all.
Because the fascia links everything, putting tensional strain on one part of the body in FST ultimately has an impact on other areas. In this way, FST engages the whole neuromyofascial system. This comprehensive approach brings the body back into homeostasis by unlocking and activating any areas that are restrained. It removes restrictions from movement, stimulates lubrication, and causes a more drastic and longer-lasting change in the tissue than traditional stretching methods. Remember that as athletic trainers, we should be treating the problem, not just the symptom, and FST allows us to do that.
Additional benefits can include:
• Improved performance and recovery
• Relieved pain and tight muscles
• Released endorphins
• Increased body awareness
• Increased balance and symmetry in the body
• Reduced injury risk
• Reduced muscular soreness
• Improved posture and muscle function
• Increased speed and power.
There are perks for FST practitioners, as well. It’s much easier on the clinician’s body than traditional stretching techniques because the ergonomics are far better. When I used conventional or PNF-assisted stretching in the past, I would be exhausted after one session with an athlete. But with FST, I can do six straight hours of stretching and still have plenty left in the tank to do more.
To date, the biggest athlete I’ve practiced FST on was 7 feet tall and weighed 440 pounds. This goes to show that no matter your size — or the athlete’s size — any athletic trainer can do this work.
IN SESSION
Whether you’re treating a large football player or a petite gymnast, a FST session is typically performed on a massage therapy table using straps. While straps are not necessary, they are a signature of FST.
That being said, there are no facility constraints when it comes to performing FST on an athlete. FST is really about the technique, so it can be utilized anywhere — on a massage table, bench, or even lying on a field.
Regardless of location, as part of FST, the clinician pulls and pushes an athlete’s arms, legs, spine, and neck through various planes of movement. Athletes undergoing FST often feel a lot of decompression throughout their hips and spine, which helps relieve tension in these areas.
In addition, FST includes a synchronized breathing component. The breathing techniques can be altered to fit an athlete’s desired results. Some support the parasympathetic nervous symptom, which helps the athlete relax and reduces the stress on their body, allowing for a deeper stretch. Other breathing techniques awaken the sympathetic nervous system, like in weight training.
A full FST session usually lasts an hour. The first 15 minutes are spent discussing the athlete’s goals and completing an assessment, while the remaining 45 minutes are focused on increasing flexibility. When developing an FST program for a specific athlete, I consider their structural makeup, injury history, and physical goals. Sessions can be adapted to meet different needs, such as rehabilitation, a pregame stretch, or recovery.
An extended treatment plan can be developed depending on an athlete’s needs, time frame, and issues that must be addressed. Some athletes will require two FST sessions per week or more, while others who are looking to maintain their current status may see progress with a session once a week or every other week. The beauty of the technique is that you can adjust it to meet the athletes’ physical needs.
As with any bodywork or manual therapy, FST sessions can be catered to specific sports. For example, when doing FST with a golfer, I focus heavily on rotation of the torso, hips, and upper extremities. But when working with a football lineman, I take into consideration which leg is his power leg (the one he pushes off from). This helps me understand where any issues and tightness are emanating from.
Further, if an athlete is looking to increase power and speed, I do a full lower-body evaluation to start. If I find tight hip flexors and glutes, this becomes the focus of my therapy. Increasing hip mobility and unlocking the glutes allows them to fire and activate, which results in increased power from the lower body.
Although it might sound like FST bends athletes in all sorts of uncomfortable positions, it’s a relatively painless technique. I have seen success using FST with athletes at the high school, college, and professional levels. Compliance has been higher than when I used traditional stretching techniques, and feedback has been positive. After an FST session, my clients usually jump off the table, feeling light on their feet and ready for activity. In addition, many of my veteran athletes regret not using FST throughout their careers to shorten recoveries, reduce injuries, and increase overall production.
OPENING NEW DOORS
I’ve experienced my own professional benefits since becoming an FST practitioner, and I’ve been amazed at the opportunities it has presented me. Since I offer FST to clients independently from my position as Head Athletic Trainer at Bergen County Technical Schools in Hackensack, N.J., it’s been a good way to supplement my income while giving me a change of pace from my everyday tasks at school.
For instance, about seven years ago, I was in the process of taking the BOC certification exam and decided to take my first FST class. During the course, I reached out via e-mail to Joe DeFranco, owner of DeFranco’s Training Systems in New Jersey, to see if he would allow me to practice FST on athletes at his gym. Joe was familiar with FST from taking a course on it and using it to relieve his own reoccurring back issues. He agreed to let me come in and do a stretching interview on him and another trainer. It went well, and he offered me a position in his gym shortly thereafter.
Eventually, performing FST on weekend warriors and NFL athletes at DeFranco’s provided me the opportunity to work with Paul Levesque, also known as Triple H, World Wrestling Entertainment’s (WWE) Executive Vice President of Talent Relations and a popular long-time wrestler. Joe had become his strength coach and suggested we work together. From there, Vince McMahon, owner and CEO of the WWE, became a client of mine. Soon, I was working regularly with WWE talent and traveling to the company’s main event, WrestleMania, as their FST therapist.
As a young athletic training student, I had dreams of being an athletic trainer in the NFL and working with professional athletes. Through my experiences with FST, I now realize I am making my mark, just in a slightly different way.
With both athletic training and FST, the relationships I’ve cultivated along the way are the most important things to me. I have built a large network of physicians, athletic trainers, therapists, healers, coaches, and athletes. I constantly strive to get better at what I do, and having this network of brilliant minds just a phone call away enables me to continuously expand my knowledge. One hand feeds the other: My work in athletic training makes me a better fascial stretch therapist, and my FST work makes me a better athletic trainer.
A colleague of mine has a simple motto that holds special meaning for me: “Know what you don’t know.” It drives me every day to improve as an athletic trainer, and it’s what led me to check out FST in the first place. Both the athletic and medical worlds are constantly growing, and if we want to give athletes the best opportunity to thrive, we need to grow with them.
This article first appeared in the May/June 2017 issue of Training & Conditioning.
Sidebar:
BECOMING CERTIFIED
Fascial stretch therapy (FST) got its start in 1996. Founder Ann Frederick originally developed the therapy to treat the USA Men’s Wrestling Team at the 1996 Olympic Games, basing it off of research she conducted as an undergrad at Arizona State University. When Frederick returned, she and her husband Chris Frederick created the Stretch to Win Institute in Tempe, Ariz., so they could teach others about FST.
Today, the Institute is one of two places in the world where practitioners can become certified in FST. Therapy workshops are also offered at a Stretch to Win Institute in Canada.
FST therapy is taught as a full-body course, and there are different levels of certification: Level 1, Level 2, Level 3 Fitness, and Level 3 Medical. The medical track is restricted to professionals with a license or certification in the health care field, such as physicians, physician assistants, nurses, athletic trainers, physical therapists, occupational therapists, chiropractors, and acupuncturists. This is the certification I currently hold.
