Following the principles of SFMA, we use rolling patterns in our treatment and assessment. Rolling patterns are performed from prone to supine and supine to prone. Rolling demonstrates neuromuscular and movement control in an unloaded position, and also assess as well as treat the coordination of the extremities and the core.
To perform a successful rolling as an adult, healthy parts and muscles are required, as well as sufficient motor control over the parts and muscles in an unloaded position. With an injury, physical components of muscles and/or joints are injured, they heal and get treated and ultimately gets fixed as much as possible. However, some neuromuscular control may be lost as well.
Purpose of rolling
Neuromuscular control is stored in our nervous system and not in our joints or muscles as the term “muscle memory” suggests. This means, even when the parts such as muscles and joints recover, it does not dictate that the neuromuscular control has recovered.
For example, many people get ankle sprains, some would recover with no issue when the ankle recovers. Others would have some other aches and pains they did not have before – for example calf pain on the opposite leg when running. When the ankle is injured, the neuromuscular control is affected, even higher up – the hip control is lost and the other leg is compensating for the lack of power in the affected hip and as such overloading the calf muscles on the uninjured leg. We use rolling to address this neuromuscular control issue.
As also mentioned previously in our posts about the SFMA and regional interdependence, we use rolling not to look at individual parts, but to look at the interaction of the parts and how it communicates with its other counterparts.
Neuromuscular control is very important in any physical activity – running, lifting, sports, throwing. Symmetrical rolling demonstrates a state of optimal muscle recruitment, coordination and function. An assymetrical rolling pattern demonstrates unacceptable outputs of all moving parts of the system, such as poor reflex-driven stability and motor control. (Even assymetrical athletes should NOT have an assymetrical rolling pattern when compared bilaterally).
Requirements for rolling
As mentioned in our assessment using the SFMA, we might find mobility restrictions in a client. Majority of our clients have mobility issues and are not able to roll because they do not have the freedom of movement to roll.
The rolling patterns require sufficient mobility and strength (the parts) and sufficient coordination and control at the core and extremities; in particular - at least 45-50 degrees of thoracic rotation. For some people, they would be unable to perform the rolling patterns simple because of a mobility dysfunction. In such a case, mobility dysfunction (e.g. stiffness) needs to be addressed with a mobility treatment which may include mobilisation, stretches, massage, manipulation etc. Rolling is not used to treat a mobility problem, but it may expose it.
As such, rolling is generally preferred only after major mobility restrictions are cleared. The exception would be when there are medical and structural reasons that certain mobility restrictions cannot be removed, such as metal plates and pins in joints or bone/joint anomalies.
Performing the roll
Rolling patterns are performed from supine to prone and prone to supine while leading with the upper body or the lower body with either left or right side. This gives us the rolling matrix of 8 different patterns to assess. The movement should be “clean and easy” with minimum compensations when neuromuscular control is intact. We also want to look at some form of separation between torso/trunk and pelvis and also the freedom of movement.
The first time a rolling pattern is performed, minimum cues and assistance is given as it is an assessment. When the pattern is dysfunctional and no mobility issues are identified to be a limitation, then we give cues and assistance to promote a functional rolling pattern. These cues can be verbal, visual or tactile and assistance tries to promote certain muscular activation/relaxation by compressing/distracting extremities.
These forms of assistance are then slowly reduced until you are able to perform a functional rolling pattern with no assistance. Only when you are able to perform the rolling patterns well do we progress you forward. Rolling gives a safe and stable position for us to engage the neuromuscular control and training.
Clinical application of the roll
The roll can be used as a basic rehabilitation program to enhance and maintain basic movement quality, integration and control. Rolling can be used as a simple home exercise, without the need for extra equipment.
However, because rolling is a safe neuromuscular control training, it also serves very well to warm up the system before more challenging tasks and we strongly advocate it.
Next time your therapist asks you to roll around on the floor, you’ll know why! Here are a few examples of rolling.
Hoogenboom, B. J., Voight, M. L., Cook, G., & Gill, L. (2009). Using Rolling to Develop Neuromuscular Control and Coordination of the Core and Extremities of Athletes. North American Journal of Sports Physical Therapy : NAJSPT, 4(2), 70–82.
Hoogenboom, B. J., & Voight, M. L. (2015). ROLLING REVISITED: USING ROLLING TO ASSESS AND TREAT NEUROMUSCULAR CONTROL AND COORDINATION OF THE CORE AND EXTREMITIES OF ATHLETES. International Journal of Sports Physical Therapy, 10(6), 787–802.
Rolling for Neuromuscular Control "Workshop", Greg Dea