Rolling…rolling…really? This is something that I have done enough times that I have seen great responses with. It has a purpose and if done and followed through with can be very beneficial. Even though I have done this several times I still continue to get questions and stares in clinic from both physical therapists, students and patients.
When do you decide to roll?
In the SFMA course that I took, the instructor (Greg Rose DC) referred to it as turning the switch on. For whatever reason, your “switch” has been turned off and we need to turn it back on. This “switch” is the motor control switch. Usually, in more chronic or longer lasting issues (pain or faulty movement patterns) there is this global motor control issue.
So, when you test functional movements and then break it down into individual segments there are many deficits. Each time you test a passive vs active ROM there is this overwhelming amount of full PROM and limited AROM. Also, the AROM looks “dirty” as in they compensate greatly to achieve a desired outcome. I will test rolling when someone has asymmetrical global weakness (such as in the hips or shoulder), when they show me poor movement patterns in deep squat/backward bend/full body rotation/lumbar flexion and/or they can’t activate their glutes (with prone hip extension they say they feel it in their hamstrings and/or they have a lot of compensations to get the leg smoothly up).
Why do you roll?
It is actually quite simple. If someone can’t roll correctly then how can they possibly perform exercises in any other position such as half/tall kneeling and standing? The way we develop, we start by rolling and then crawling then standing. We can’t skip steps!
The reason why we can’t roll?
I really think, from seeing the patients who fail at it, that we develop faulty movement patterns over the course of time. This could be a result of a previous injury years ago, our very sedentary lifestyles/jobs or the result of our chosen sport. The longer we go with a poor movement pattern then the more engrained into our nervous system that pattern becomes. Rolling is just the first step.
How do you test rolling?
There are four quadrants in both supine and in prone. I usually start in supine. You want to move one body part only and attempt to roll using that one body part. If you are going to use the upper body then the lower body is paralyzed and not allowed to help at all. If there is any activation then that attempt doesn’t count and they should redo it. The patient has to be honest with you and usually after seeing a couple good movements then most times you can see the compensation. Once the upper body is tested in supine then you test the lower body when the upper body is paralyzed.
Supine right shoulder flexion -> supine right leg flexion -> supine left shoulder flexion -> supine left leg flexion
Prone right shoulder extension -> prone right hip extension -> prone left shoulder extension -> prone left hip extension.
How do you treat rolling?
Most often times you will see one area that is especially dysfunctional though there may be multiple areas that need to be worked on. Say the right hip extension is dysfunctional. In order to treat that (this way is easier so that they can replicate it at home versus using a sport cord) dysfunction you place a pillow under there right hip/torso (decreases difficulty by 25%). If they still can’t do this properly you add another pillow to make it 50% easier and so on until they can easily roll.
Once they accomplish the rolling task with, let’s say two pillows, then you want to take one pillow out and make them work for the 25%. Once they pass a step I would make them do a bunch of reps first before increasing the difficulty. Do this at each stage until they are able to roll successfully from the floor.
What can it help clear up?
Remember, whenever you want to make a quick fix always have that movement or test that they failed and retest after they perform the intervention to see if it helped clear anything up. So, if they failed prone hip extension because of both poor active ROM and excessive hamstring activation then you want to go back to that test and see if it is better. It may not be an excellent grade after but you should see a considerable change. This change should be enough to allow you the “in” to start working on those individual motor control deficits.
Sometimes over the course of the session they still aren’t able to roll without assistance. That is okay! That would be there HEP and to progress to the floor. You can give a few small, simple motor control exercises after rolling but I would make their HEP following their initial evaluation focused on the rolling. The changes should maintain and stay as long as they are consistent with working on the movement at home. Most likely these patients will have a lot of deficits to slowly work on because their entire system has been shut off for so long. Those inhibitory muscles, overtime, can become actually weak as well.
What patients will this help?
Most athletes and people who have sedentary jobs where that extension mechanism is just lost. Chronic pain patients where the general programs just haven’t work to decrease their pain or improve their function.
Runners: usually their injuries are a lack/loss of active hip extension when running. This hip extension needs to be from the glutes and not the hamstrings or lower back. Ankle injuries/shin splints fall in line with this as well. Activate the glutes and entire posterior chain extension mechanism.
Swimmers: who have been using their shoulders/neck/lower back and hamstrings for long periods in the water will sometimes just need that relearning of proper muscle activation to go with all that motion.
Baseball players: Like swimmers, upper/lower body sports require better movement patterns
Golfers: they lose that motor control with rotations which can translate up/down the chain
Flexion based activities: just because they can’t reach down and touch their toes doesn’t mean tight hamstrings or lack of mobility. Often times they have impaired whole body movement patterns.
TJ Slowik PT DPT