A systematic review and meta-analysis of the effects of foam rolling on range of motion, recovery and markers of athletic performance

Myofascial release induces declines in heart rate and changes to microvascular reactivity in young healthy adults

OBJECTIVES

The purpose of this study was to compare physiological responses to myofascial release (MFR) and passive limb movement (PLM).

DESIGN

Nineteen (23 ± 2.6yrs) adults (10 men and 9 women) completed two experiments on separate days: MFR and PLM. Participation included collecting ultrasound images, blood pressure, and heart rate (HR) as well as performing a vascular occlusion test (VOT). The VOT assessed muscle tissue oxygenation (StO2) with near-infrared spectroscopy. Experiments consisted of moving the upper limb to release subtle barriers of resistance in the muscle/fascia (MFR) and passive, assisted range of motion (PLM).

RESULTS

There was a significantly (p = 0.012) greater decrease in HR following MFR (-7.3 ± 5.2 BPM) than PLM (-1.3 ± 0.9 BPM). There was an equivalent change in brachial blood flow (-17.3 ± 23.0 vs. -11.9 ± 14.9 mL min-1; p = 0.37) and vascular conductance (-19.3 ± 31.1 vs. -12.4 ± 15.3 mL min-1 mmHg-1; p = 0.38). Microvascular responses differed between the experiments such that MFR exhibited greater area under the curve (AUC, 1503 ± 499.1%∙s-1 vs. 1203 ± 411.1%∙s-1; p = 0.021) and time to maximum StO2 (40.0 ± 8.4s vs. 35.8 ± 7.3s; p = 0.009).

CONCLUSIONS

As evidenced by HR, MFR induced greater parasympathetic activity than PLM. The greater AUC and time to StO2max following MFR suggested a spillover effect to induce prolonged hyper-saturation. These results may be of interest to those investigating possible MFR-related rehabilitative benefits.

Self-Massage Acute Effects on Pressure Pain Threshold, Muscular Electrical Activity, and Muscle Force Production: A Systematic Review and Meta-Analysis

ABSTRACT

Furlan, MR, Machado, E, Petter, GdN, Barbosa, IM, Geremia, JM, and Glänzel, MH. Self-massage acute effects on pressure pain threshold, muscular electrical activity, and muscle force production: a systematic review and meta-analysis. J Strength Cond Res 38(3): 620-635, 2024-Self-massage (SM) is often used in physiotherapy and sports training programs. However, the SM acute effects on pressure pain threshold (PPT), muscle electrical activity (MEA), and muscle force production remain unclear. A meta-analytical review was performed to verify the SM acute effects on neuromuscular responses in healthy adults or athletes. The review (CRD42021254656) was performed in the PubMed, Web of Science, and Embase databases. A synthesis of the included studies was performed, and both the risk of bias and the evidence certainty level were assessed through the PEDro scale and Grading of Recommendations Assessment, Development, and Evaluation approach, respectively. Nineteen studies were included, 5 evaluated the PPT, 7 the thigh muscles' MEA, and 15 the lower-limb strength. The SM application induces moderate increases in quadriceps' PPT (5 studies; standardized mean difference [SMD]: 0.487; 95% CI 0.251-0.723; p < 0.001; I2 = 0%). We found no SM effects on the hamstrings and plantar flexors' MEA. Also, we observed small increases in knee extensors' concentric torque (2 studies; SMD: 0.288; 95% CI 0.088-0.489; p = 0.005; I2 = 0%), without effects in isometric muscle strength, eccentric torque, and rate of force development. Grading of recommendations assessment, development, and evaluation analysis showed high and low certainty levels for the SM effects on quadriceps' PPT and muscle strength, respectively. Self-massage pressure-volume application seems to be a determining factor in inducing changes in these parameters, and it may vary among the treated muscles, where a higher pressure-volume application is required for increasing knee flexors and plantar flexors' PPT and strength. Thus, new studies with better methodological quality should be performed to strengthen this evidence.

Effects of foam roller on pain intensity in individuals with chronic and acute musculoskeletal pain: a systematic review of randomized trials

OBJECTIVE

To analyze the effects of using foam roller on pain intensity in individuals with chronic and acute musculoskeletal pain.

METHODS

This systematic review was registered in the National Institute for Health Research's prospective online registry of systematic reviews (PROSPERO) under CRD42023456841. The databases Pubmed, Medline (via Ovid), Embase, BVS, and PEDro (Physiotherapy Evidence Database) were consulted to carry out this systematic review. Notably, the records of clinical trials characterized as eligible were manually searched. The search terms were: (foam rolling OR foam rolling vibration) AND (acute musculoskeletal pain) AND (chronic musculoskeletal pain). The search was performed until August 22, 2023. For the analysis of the methodological quality, the PEDro scale was used for each of the manuscripts included in the systematic review. Due to the heterogeneity in the studies included in this systematic review, performing a meta-analysis of the analyzed variables was impossible.

RESULTS

Only six manuscripts were eligible for data analysis. The type of FR used was non-vibrational, being applied by a therapist in only one of the manuscripts. With an application time ranging from at least 45 s to 15 min, the non-vibrational FR was applied within a day up to six weeks. Using the PEDro scale, scores were assigned that varied between 4 and 8 points, with an average of 6 ± 1.29 points. Only two randomized clinical trials found a significant benefit in pain intensity of adding FR associated with a therapeutic exercise protocol in individuals with patellofemoral pain syndrome and chronic neck pain.

CONCLUSION

The results of this systematic review do not elucidate or reinforce the clinical use of FR in pain intensity in individuals with chronic and acute musculoskeletal pain.

The Effects of 2 Different Soft Tissue Mobilization Techniques on Delayed Onset Muscle Soreness in Male Recreational Athletes: A Single-Blinded Randomized Controlled Trial

CONTEXT

Soft tissue mobilization is frequently employed for delayed onset muscle soreness (DOMS) management. Foam roller and percussive massage are 2 popular soft tissue mobilization methods preferred by various professionals. However, their effects on DOMS symptoms are controversial and there are no studies comparing these 2 methods. The aim of the present study was to compare the acute effects of soft tissue mobilization with a foam roller or a percussive massage device on DOMS in young male recreational athletes.

DESIGN

A parallel, single-blinded, randomized controlled trial.

METHODS

Thirty-six participants (median [interquartile range 25/75]; age: 20.0 [19.3/21.0] y) were randomly allocated to percussive massage group (n = 12), foam roller group (n = 12), and control group (n = 12). First, a fatigue protocol targeting quadriceps femoris was performed. Then, participants received soft tissue mobilization with foam roller/percussive massage or rested for 10 minutes according to their groups. Pain and fatigue were evaluated by a visual analog scale, and the skin surface temperature of over the quadriceps femoris was measured with thermal camera imaging. Evaluations were performed at baseline, following fatigue protocol, at 24th hour, and at 48th hour. Changes from the baseline at 24th and 48th hours were compared between groups.

RESULTS

No significant between-group differences were observed at the assessments performed at 24th or 48th hour regarding the changes from baseline in pain (P value for 24th hour = .905, P value for 48th hour = .733), fatigue (P value for 24th hour = .895, P value for 48th hour = .606), or skin surface temperature measurements (P values for 24th hour = between .300 and .925, P values for 48th hour = between .311 and .750).

CONCLUSIONS

Soft tissue mobilizations applied with foam roller or percussive massage device do not seem to be superior to passive resting in alleviating DOMS symptoms in recreational athletes.

Fundamentals or Icing on Top of the Cake? A Narrative Review of Recovery Strategies and Devices for Athletes

The sport and athletic performance industry has seen a plethora of new recovery devices and technologies over recent years, and it has become somewhat difficult for athletes, coaches, and practitioners to navigate the efficacy of such devices or whether they are even required at all. With the increase in recovery devices and tools, it has also become commonplace for athletes to overlook more traditional, well-established recovery strategies. In this narrative review, we discuss recovery strategies in relation to the hierarchy of scientific evidence, classifying them based on the strength of the evidence, ranging from meta-analyses through to case studies and reports. We report that foam rolling, compression garments, cryotherapy, photobiomodulation, hydrotherapy, and active recovery have a high level of positive evidence for improved recovery outcomes, while sauna, recovery boots/sleeves, occlusion cuffs, and massage guns currently have a lower level of evidence and mixed results for their efficacy. Finally, we provide guidance for practitioners when deciding on recovery strategies to use with athletes during different phases of the season.

Effects of foam rolling on vastus intermedius and lateralis microvascular blood flow

INTRODUCTION

Foam Rolling (FR) as a technique of self-massage has become a widely used intervention in clinical and sports practice. It is assumed that FR leads to an increased intramuscular microvascular blood flow (MBF), and therefore is commonly recommended as a warm-up or regeneration method. However, no data validate the effects of FR on MBF. This study aimed to assess whether FR increases intramuscular MBF using contrast-enhanced ultrasound (CEUS).

METHODS

Ten healthy athletes performed a standardized FR intervention applied to the lateral thigh (3 sets: 45 s FR, 20 s rest). Intramuscular perfusion was determined by CEUS under resting conditions (t0), immediately (t1), and 30 min (t2) after the intervention. Peak enhancement (PE), wash-in rate (WiR), and wash-in perfusion index (WiPI) were evaluated as quantitative perfusion parameters in vastus lateralis (VL) and intermedius (VI) muscle separately via regions of interest mapping.

RESULTS

Immediately after the intervention (t1), perfusion parameters showed a non-significant decrease in VL (p = 0.3; PE: -32.1%, WiPI: -29.6%, WiR: -50.4%) and VI (p = 0.4; PE: -10.3%, WiPI: -6.4%, WiR: -35.6%). A non-significant decrease was found at t2 in VL (p = 0.2; PE: -34%, WiPI -33.9%, WiR -61.2%) and VI (p = 0.2; PE -17.6%, WiPI -13.8%, WiR -43.2%).

CONCLUSIONS

The common assumption of intramuscular MBF improvement due to FR could not be confirmed for up to 30 min after the intervention. If an increase in intramuscular metabolism or MBF is intended, we recommend that alternative methods (i.e., traditional warm-up) should be preferred.

Immediate Effects of Foam Roller and Stretching to the Lead Hip on Golfers Swing: A Randomized Crossover Trial

Golfers with decreased range of motion (ROM) of their leading hip internal rotation (IR) have increased lumbar rotation ROM and load. This study investigated the effects of foam roller (FR) applied to their leading hip muscles combined with stretching to the leading hip together with lumbar rotation ROM during the golf swing. The study design was a crossover design. Subjects were allocated to one of two groups comprising FR and dynamic stretching (FR + DS) or practice swing. Motion analysis was used to evaluate hip and lumbar angles during the golf swing. Data were compared using analysis of variance with Bonferroni correction using paired t-test's post hoc. The association between lead hip IR angle and lumbar spine left rotation (Lrot) angle was investigated using correlation analysis. Lead hip IR ROM during the golf swing was significantly greater in the FR + DS group (p = 0.034). The FR + DS group showed a moderate negative correlation between lead hip IR ROM and lower lumbar spine Lrot ROM during the golf swing (r = -0.522). The application of FR + DS might be useful to increase lead hip IR angle during the golf swing. Moreover, the application of FR + DS improves lead hip IR angle and may decrease lumbar spine rotation.

Acute effects of foam roller or stick massage on indirect markers from exercise-induced muscle damage in healthy individuals: A systematic review and meta-analysis

BACKGROUND

This systematic review and meta-analysis examined the effects of foam roller or stick massage performed after exercise-induced muscle damage protocols on indirect markers of muscle damage compared to a non-intervention control group in healthy individuals.

METHODS

PubMed, Biblioteca Virtual em Saúde, Scopus, Google Scholar, and Cochrane Library database were searched in August 2, 2020, with last update on February 21, 2021. Were included clinical trials involving healthy adult individuals who received foam roller/stick massage versus a non-intervention group and evaluated indirect markers of muscle damage. Risk of bias was assessed by the Cochrane Risk of Bias tools. Standardized mean differences with 95% confidence intervals were used to measure the foam roller/stick massage effect on muscle soreness.

RESULTS

The five included studies investigated 151 participants (136 men). Overall, the studies presented a moderate/high risk of bias. A between-groups meta-analysis showed no significant difference between massage and non-intervention control groups on muscle soreness immediately after (0.26 [95%CI: 0.14; 0.65], p = 0.20), 24 h (-0.64 [95%CI: 1.34; 0.07], p = 0.08), 48 h (-0.35 [95%CI: 0.85; 0.15], p = 0.17), 72 h (-0.40 [95%CI: 0.92; 0.12], p = 0.13), and 96 h (0.05 [95%CI: 0.40; 0.50], p = 0.82) after an exercise-induced muscle damage protocol. Moreover, the qualitative synthesis showed that foam roller or stick massage had no significant effect on range of motion, muscle swelling, and maximal voluntary isometric contraction recovery.

CONCLUSION

In conclusion, the current literature appears to not support the advantage of foam roller or stick massage to improve recovery of muscle damage indirect markers (muscle soreness, range of motion, muscle swelling, and maximal voluntary isometric contraction) compared to a non-intervention control group in healthy individuals. Furthermore, due to the heterogeneity of the methodological designs among the included studies, making it difficult to compare the results. In addition, there are not enough high-quality and well-designed studies on foam roller or stick massage to draw any definite conclusions.

REVIEW PROTOCOL NUMBER

The study was pre-registered in the International Prospective Register of Systematic Review (PROSPERO) on August 2, 2020, with last update on February 21, 2021. Protocol number: CRD2017058559.

Response to Mechanical Properties and Physiological Challenges of Fascia: Diagnosis and Rehabilitative Therapeutic Intervention for Myofascial System Disorders

Damage to the fascia can cause significant performance deficits in high-performance sports and recreational exercise and may contribute to the development of musculoskeletal disorders and persistent potential pain. The fascia is widely distributed from head to toe, encompassing muscles, bones, blood vessels, nerves, and internal organs and comprising various layers of different depths, indicating the complexity of its pathogenesis. It is a connective tissue composed of irregularly arranged collagen fibers, distinctly different from the regularly arranged collagen fibers found in tendons, ligaments, or periosteum, and mechanical changes in the fascia (stiffness or tension) can produce changes in its connective tissue that can cause pain. While these mechanical changes induce inflammation associated with mechanical loading, they are also affected by biochemical influences such as aging, sex hormones, and obesity. Therefore, this paper will review the current state of knowledge on the molecular level response to the mechanical properties of the fascia and its response to other physiological challenges, including mechanical changes, innervation, injury, and aging; imaging techniques available to study the fascial system; and therapeutic interventions targeting fascial tissue in sports medicine. This article aims to summarize contemporary views.

Foam Rolling Acute Effects on Myofascial Tissue Stiffness and Muscle Strength: A Systematic Review and Meta-Analysis

ABSTRACT

Glänzel, MH, Rodrigues, DR, Petter, GN, Pozzobon, D, Vaz, MA, and Geremia, JM. Foam rolling acute effects on myofascial tissue stiffness and muscle strength: a systematic review and meta-analysis. J Strength Cond Res 37(4): 951-968, 2023-Foam rolling (FR) is widely used in rehabilitation and physical training. However, the effects of FR on myofascial tissue stiffness and muscle strength remain unclear. This study aimed to perform a systematic review with meta-analysis of trials that tested the FR acute effects during warm-up on the myofascial tissue stiffness and muscle strength in healthy adults or athletes. This systematic review (CRD42021227048) was performed according to Cochrane's recommendations, with searches performed in PubMed, Web of Science, Embase, and PEDro databases. Syntheses of included studies' data were performed, and the PEDro scale was used to assess the methodological quality of the studies. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluations approach. Twenty included studies assessed trunk and thigh fascial tissue stiffness, and thigh and calf muscle stiffness, whereas muscle strength was assessed in the knee extensors and flexors, and plantar flexors muscles. Qualitative analysis showed decreases in fascial ( n = 2) and muscle ( n = 5) stiffness after FR. However, the meta-analysis showed no effects of FR on myofascial tissue stiffness. Both qualitative and quantitative analyses showed no effects of FR on isometric muscle strength, eccentric torque, and rate of force development. However, the knee extensor concentric torque increased after FR. Foam rolling increases the knee extensor concentric torque, but it does not acutely change the myofascial tissue stiffness and isometric muscle strength. However, evidence of these studies provides low certainty to state that FR does not change these parameters. Therefore, high methodological quality studies should be performed to better ascertain the effects of FR on the myofascial tissue stiffness and muscle strength.

Nutritional priorities, practices and preferences of athletes and active individuals in the context of new product development in the sports nutrition sector

Introduction

Sports nutrition is a rapidly growing sector with increasing demand for evidence-based nutritional products to support competitive and healthy lifestyles. The product development process for novel foods should rely heavily on end-user engagement to facilitate future success, however there is a dearth of published information available. An understanding of the practices and self-reported nutritional priorities of athletes and active individuals is required for the development of new food products, facilitating evidence-based product formulation.

Methods

Participants were at least 18 years of age, actively participating in competitive sport or structured physical activity on at least two occasions per week. Participants were asked to undertake a comprehensive online survey assessing their nutritional practice, perceived nutritional priorities and preferences for product characteristics. Questions were developed on the basis of critical evaluation of the current scientific literature and the hosting of two scoping focus group sessions with prospective end-users.

Results

405 individuals (29 ± 9 years) completed this questionnaire. 295 participants reported active participation in competitive sport while the remaining 110 participants undertook structured physical activity exclusively. When asked to rank their top three most sought-after product claims in sports nutrition, "enhanced muscular recovery" was the most prioritised receiving 101 first choice preferences (25%) and 295 top 3 preferences. Fifty-eight percent of participants reported taking nutritional supplements. Caffeine containing functional foods (excluding caffeine supplements) were the most commonly used functional food group. A very low incidence of functional food usage was reported otherwise. When asked to rank the importance of various food product attributes, "nutritional profile" was ranked as the most important with rating of 3.37 ± 0.7 out of 4 followed by "taste" and "accessibility". Whole food nutritional products received the most first preference selections and most top 3 selections when presented with a number of popular performance and recovery products on the market.

Conclusions

The transition towards a food first approach in sports nutrition is vital for athletes and active individuals to achieve their goals; with the development of evidence-based functional foods, particularly with a focus on muscle recovery, endurance, and strength enhancement at the forefront for new food product design and innovation.

Does Vibration Foam Roller Influence Performance and Recovery? A Systematic Review and Meta-analysis

Background

Foam rolling has been extensively investigated, showing benefits in performance and recovery. Recently, vibration has been added to foam rollers, with hypothesized advantages over conventional foam rollers. However, there is no systematic evidence in this regard.

Objective

To carry out a systematic review and meta-analysis about the effects of vibration foam roller (VFR) on performance and recovery.

Methods

A systematic search was conducted in PubMed/MEDLINE, Web of Science and SportDiscus according to the PRISMA guidelines. The outcomes included performance (jump, agility and strength) and recovery variables (blood flow, pain and fatigue) measured after an intervention with VFR. The methodological quality was assessed with the PEDro scale. A random-effects model was used to perform the meta-analysis.

Results

Initially, 556 studies were found and after the eligibility criteria 10 studies were included in the systematic review and 9 in the meta-analysis. There was no significant effects on jump performance (SMD = 0.14 [95% CI − 0.022 to 0.307]; p = 0.101; I² = 1.08%) and no significant beneficial effects were reported on isokinetic strength (SMD = 0.16 [95% CI − 0.041 to 0.367]; p = 0.117; I² = 9.7%). Recovery appears to be enhanced after VFR interventions, but agility does not seem to increase after VFR interventions.

Conclusion

This systematic review and meta-analysis suggest that VFR could have great potential for increasing jump performance, agility, strength and enhancing recovery. Further research is needed to confirm the effects of VFR on performance and recovery.

Trial Registration This investigation was registered in PROSPERO with the code CRD42021238104.

The Application of Recovery Strategies in Basketball: A Worldwide Survey

The purpose of this study was to assess the perceived usefulness, actual use and barriers to the implementation of recovery strategies among basketball practitioners. 107 participants (strength and conditioning coaches, sport scientists, performance specialists) from different countries and competitive levels completed an online survey. Most participants rated recovery strategies as either extremely (46%) or very important (49%). Active recovery, massage, foam rolling, and stretching were perceived as most useful (80, 73, 72 and 59% of participants, respectively) and were most frequently adopted (68, 61, 72 and 67%, respectively). Participants mentioned lack of devices and facilities (51%), excessive cost (51%), lack of time (27%), players’ negative perception (25%) and lack of sufficient evidence (16%) as barriers to the implementation of recovery strategies. The present findings reveal that some dissociation between scientific evidence and perceived effectiveness was present among the study participants. A possible solution would be to ensure that scientific evidence-based guidelines are followed when considering the application of recovery strategies. Regarding actual use, participants favored easily implementable strategies (e.g. active recovery, stretching), rather than evidence-supported, but expensive and/or impractical strategies (e.g. whole-body cryotherapy). Possible solutions may include the use of practical tools that don’t need specific facilities, the development and validation of new low-cost recovery devices, the promotion of players education regarding recovery strategies, and conducting further research to increase the scientific knowledge in the area.

Why Percussive Massage Therapy Does Not Improve Recovery after a Water Rescue? A Preliminary Study with Lifeguards

The aim of this study was to analyze the effects of percussive massage therapy (PMT) on lifeguards’ recovery after a water rescue, in comparison with passive recovery. Methods: A quasi-experimental crossover design was conducted to compare passive recovery (PR) and a PMT protocol. A total of 14 volunteer lifeguards performed a simulated 100 m water rescue and perceived fatigue and blood lactate were measured as recovery variables after the rescue and after the 8-min recovery process. Results: There were no differences between PMT and PR in lactate clearance (p > 0.05), finding in both modalities a small but not significant decrease in blood lactate. In perceived fatigue, both methods decreased this variable significantly (p < 0.001), with no significant differences between them (p > 0.05). Conclusions: PMT does not enhance recovery after a water rescue, in comparison with staying passive. Despite PMT appearing to be adequate for recovery in other efforts, it is not recommended for lifeguards’ recovery after a water rescue.

Chronic Effects of Foam Rolling on Flexibility and Performance: A Systematic Review of Randomized Controlled Trials

The purpose of this study is to review the existing literature on chronic effects of foam rolling (FR) on flexibility and performance. Electronic databases were searched during January 2022 for topics related to FR. Included studies met the following criteria: (a) peer-reviewed articles written in English; (b) FR intervention of at least four weeks; (c) non-motorized FR device during intervention; (d) randomized controlled trial with existence of a control group; and (e) any lower body parameter related to flexibility, recovery, and performance. Nine studies met that criteria. Results revealed that chronic FR demonstrated conflicting results for improvement of flexibility. On the other hand, a majority of the articles in this review showed no beneficial effects of FR on performance. Lastly, the effect of FR on recovery is unclear. These findings suggest the need for further studies to establish the consensus about the long-term application of FR in flexibility, recovery, and performance.

Core Muscle Activation With Foam Rolling and Static Planks

The objective of this study was to compare the activation of the core (trunk) musculature during quadriceps and hamstrings foam rolling (FR) vs. prone and supine/reverse static planks to determine if FR is a viable means of training the core musculature. Using a randomized allocation, nine recreationally trained, young adults (18-26 years) performed two sets each of quadriceps and hamstrings FR as well as supine/reverse and prone static planks for 30-s each with 1-min rest between sets and 5-min rest between exercises. Electromyographic (EMG) activity of the lower abdominals (LA), external obliques (EO), lumbosacral erector spinae (LSES), upper lumbar erector spinae (ULES) muscle groups were normalized to a maximum voluntary contraction and analyzed. Quadriceps FR exhibited a very large magnitude greater LA activity compared to reverse plank (p = 0.033, d = 4.42) and hamstrings FR (p = 0.020, d = 3.49), respectively. The prone plank demonstrated very large magnitude higher EO EMG activity compared to reverse plank (p = 0.001, d = 9.17), hamstrings FR (p = 0.002, d = 8.14), and quadriceps FR (p = 0.011, d = 5.97). Reverse plank (p = 0.003, d = 12.06), and quadriceps FR (p = 0.002, d = 7.84) induced greater ULES activity compared to the prone plank and hamstrings FR, respectively. Reverse plank also exhibited very large magnitude higher LSES activity compared to the prone plank (p < 0.001, d = 7.68), hamstrings FR (p = 0.002, d = 4.11), and quadriceps FR (p = 0.005, d = 2.34), respectively. In conclusion, whereas reverse plank was the most effective activator of dorsal core muscles, quadriceps FR may also be a time efficient alternative exercise to activate back (ventral core) muscles. The prone plank is effective for ventral core muscles activation.

Chronic and Residual Effects of a Two-Week Foam Rolling Intervention on Ankle Flexibility and Dynamic Balance

Background

Foam rolling has been shown to acutely improve joint range of motion (ROM). However, limited knowledge exists on the chronic and residual effects. The primary purpose of this study was to examine the chronic and residual effects of a 2-week roller–massager intervention on ankle dorsiflexion ROM and dynamic balance.

Methods

Forty-two participants (24.3 ± 2.5 years, 33 males, 9 females) were randomly assigned to either roller-massage (RM) or control group (= no intervention). Ankle ROM was assessed with the weight-bearing lunge test (WBLT) and dynamic balance with the Y-Balance test for both limbs. The RM group was instructed to roll their calf muscles for three sets of 60 s per leg on 6 days a week over 2 weeks. Acute effects were measured during baseline testing for dorsiflexion ROM and dynamic balance immediately after foam rolling. Chronic and residual effects were measured 1 day and 7 days after the intervention period. Multivariate ANOVA was performed for post-hoc comparisons to determine acute, chronic, and residual effects.

Results

Significant acute and chronic foam rolling effects (p <0.05) were found for ankle dorsiflexion ROM. The chronic increase in ROM slightly decreased 7 days post-intervention but remained significantly above baseline (p < 0.05). Regarding dynamic balance, there were no acute but chronic (p < 0.05) and residual (p < 0.05) effects.

Conclusion

Using a roller–massager for a 2-week period chronically increases ROM and dynamic balance. These increases are still significant 7 days post-intervention emphasizing the sustainability of foam rolling effects.

Myofascial Tissue and Depression

Background

The myofascial system plays a fundamental role in the mechanics of the body, in body tension regulation and the etiology of pathological states like chronic pain. Moreover, it contains contractile elements and preliminary evidence suggests that its properties are linked to psychological factors. The aim of the present research was to investigate characteristics of the myofascial tissue in patients with Major Depressive Disorder (MDD) and to examine whether the state of the myofascial tissue causally affects pathopsychological processes in MDD.

Methods

In Study 1, stiffness and elasticity of the myofascial tissue of 40 inpatients suffering from MDD measured with a tissue compliance meter were compared with those of 40 matched never-depressed participants. In Study 2, 69 MDD patients were randomly assigned to single-session self-myofascial release intervention (SMRI) or a placebo intervention. Effects on memory bias and affect were investigated.

Results

Results showed that MDD patients displayed heightened stiffness and reduced elasticity of the myofascial tissue and that patients in the SMRI group showed a reduced negative memory bias and more positive affect compared to patients in the placebo condition.

Conclusions

The preliminary results of our studies indicate that the myofascial tissue might be part of a dysfunctional body-mind dynamic that maintains MDD.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10608-021-10282-w.

Sex Differences in the Mechanical and Neurophysiological Response to Roller Massage of the Plantar Flexors

Self-massage using foam rollers, sticks, or balls has become a popular technique to enhance joint range of motion (ROM). Although increases are reported to be larger in females than males, the mechanisms of this observation are unclear. The present study aimed to investigate the effect of roller massage (RM) on ROM, passive tissue stiffness, and neurophysiological markers as a function of sex. Males (n = 15, 22.8 ± 2.9 yrs.) and females (n = 14, 21.1 ± 0.7 yrs.) performed three 60-second bouts of calf RM. Outcomes assessed pre-, and post-intervention included passive dorsiflexion (DF) ROM, passive tissue stiffness, passive torque, DF angle at the first stretch sensation, shear elastic modulus, and spinal excitability. DF ROM (+35.9 %), passive torque at DF ROM (+46.4 %), DF angle at first stretch sensation (+32.9 %), and pain pressure threshold (+25.2 %) increased in both groups (p<.05) with no differences between males and females (p > 0.05). No changes were observed for passive stiffness, shear elastic modulus, and spinal excitability (p > 0.05). Roller massage may increase ROM independently of sex, which, in the present study, could not be ascribed to alterations in passive stiffness or neurophysiological markers. Future studies may further elucidate the role of sensory alterations as possible factors driving RM-induced changes in flexibility.

Effects of Foam Rolling Duration on Tissue Stiffness and Perfusion: A Randomized Cross-Over Trial

Despite its beneficial effects on flexibility and muscle soreness, there is still conflicting evidence regarding dose-response relationships and underlying mechanisms of foam rolling (FR). This study aimed to investigate the impact of different FR protocols on tissue perfusion and tissue stiffness. In a randomized crossover trial, two FR protocols (2x1 min, 2x3 min) were applied to the right anterior thigh of twenty healthy volunteers (11 females, 25 ± 4 years). Tissue perfusion (near infrared spectroscopy, NIRS) and stiffness (Tensiomyography, TMG and Myotonometry, MMT) were assessed before and after FR application. Variance analyses revealed a significant interaction of FR duration and tissue perfusion (F_[1,19] = 7.098, p = 0.015). Local blood flow increased significantly from pre to post test (F_[1,19] = 7.589, p = 0.013), being higher (Δ +9.7%) in the long-FR condition than in the short-FR condition (Δ +2.8%). Tissue stiffness (MMT) showed significant main effects for time (F_[1,19] = 12.074, p = 0.003) and condition (F_[1,19] = 7.165, p = 0.015) with decreases after short-FR (Δ -1.6%) and long-FR condition (Δ -1.9%). However, there was no time*dose-interaction (F_[1,19] = 0.018, p = 0.895). No differences were found for TMG (p > 0.05). FR-induced changes failed to exceed the minimal detectable change threshold (MDC). Our data suggest that increased blood flow and altered tissue stiffness may mediate the effects of FR although statistical MDC thresholds were not achieved. Longer FR durations seem to be more beneficial for perfusion which is of interest for exercise professionals designing warm-up and cool-down regimes. Further research is needed to understand probable effects on parasympathetic outcomes representing systemic physiological responses to locally applied FR stimulations.

Expert Consensus on the Contraindications and Cautions of Foam Rolling-An International Delphi Study

Background: Foam rolling is a type of self-massage using tools such as foam or roller sticks. However, to date, there is no consensus on contraindications and cautions of foam rolling. A methodological approach to narrow that research gap is to obtain reliable opinions of expert groups. The aim of the study was to develop experts’ consensus on contraindications and cautions of foam rolling by means of a Delphi process. Methods: An international three-round Delphi study was conducted. Academic experts, defined as having (co-) authored at least one PubMed-listed paper on foam rolling, were invited to participate. Rounds 1 and 2 involved generation and rating of a list of possible contraindications and cautions of foam rolling. In round 3, participants indicated their agreement on contraindications and cautions for a final set of conditions. Consensus was evaluated using a priori defined criteria. Consensus on contraindications and cautions was considered as reached if more than 70% of participating experts labeled the respective item as contraindication and contraindication or caution, respectively, in round 3. Results: In the final Delphi process round, responses were received from 37 participants. Panel participants were predominantly sports scientists (n = 21), physiotherapists (n = 6), and medical professionals (n = 5). Consensus on contraindications was reached for open wounds (73% agreement) and bone fractures (84%). Consensus on cautions was achieved for local tissue inflammation (97%), deep vein thrombosis (97%), osteomyelitis (94%), and myositis ossificans (92%). The highest impact/severity of an adverse event caused by contraindication/cautions was estimated for bone fractures, deep vein thrombosis, and osteomyelitis. Discussion: The mechanical forces applied through foam rolling can be considered as potential threats leading to adverse events in the context of the identified contraindications and cautions. Further evaluations by medical professionals as well as the collection of clinical data are needed to assess the risks of foam rolling and to generate guidance for different applications and professional backgrounds.

Effects of Different Tissue Flossing Applications on Range of Motion, Maximum Voluntary Contraction, and H-Reflex in Young Martial Arts Fighters

The purpose of this study was to investigate the effects of tissue flossing applied to the ankle joint or to the calf muscles, on ankle joint flexibility, plantarflexor strength and soleus H reflex. Eleven young (16.6 ± 1.2 years) martial arts fighters were exposed to three different intervention protocols in distinct sessions. The interventions consisted of wrapping the ankle (ANKLE) or calf (CALF) with an elastic band for 3 sets of 2 min (2 min rest) to create vascular occlusion. A third intervention without wrapping the elastic band served as a control condition (CON). Active range of motion for ankle (AROM), plantarflexor maximum voluntary contraction (MVC), and soleus H reflex were assessed before (PRE), after (POST), and 10 min after (POST10) the intervention. The H reflex, level of pain (NRS) and wrapping pressure were also assessed during the intervention. Both CALF and ANKLE protocols induced a significant drop in H reflex during the intervention. However, the CALF protocol resulted in a significantly larger H reflex reduction during and after the flossing intervention (medium to large effect size). H reflexes returned to baseline levels 10 min after the intervention in all conditions. AROM and MVC were unaffected by any intervention. The results of this study suggest that tissue flossing can decrease the muscle soleus H reflex particularly when elastic band is wrapped around the calf muscles. However, the observed changes at the spinal level did not translate into higher ankle joint flexibility or plantarflexor strength.

Comparison of Immediate Effects of Foam Rolling and Dynamic Stretching to Only Dynamic Stretching on Flexibility, Balance, and Agility in Male Soccer Players

CONTEXT

Dynamic stretching (DS) is typically suggested during warm-up protocols. Also, foam rolling (FR), which is applied with a foam cylinder, has increased popularity in recent years. However, the combined effects of DS and FR in improving flexibility, dynamic balance, and agility performance are unclear in current literature. Therefore, this study aim to evaluate and compare the acute effects of DS as well as DS followed by FR (DS + FR) on flexibility, dynamic balance, and agility in male soccer players.

DESIGN

This study was a crossover study with a within-subject design.

METHODS

Thirty volunteer male soccer players (mean age 18.80 [0.66] y) were included in the study. Each participant performed the 2 sessions (DS and DS + FR) on separate occasions in a randomized order, with an interval of 72 hours. All sessions were performed in the indoor gym at the sports club. Flexibility was assessed by sit-and-reach test, dynamic balance was assessed by Y balance test, and agility was assessed by t test.

RESULTS

Compared with the pretest results, significant improvement in flexibility was observed in both groups (change = 0.55, percentage change = 2.05, effect size [ES] = 0.15, P = .041; change = 0.64, percentage change = 2.36, ES = 0.20, P = .025; respectively). Balance scores did not significantly improve in either group (change = 0.40, percentage change = 0.45, ES = 0.09, P = .342; change = 0.93, percentage change = 1.02, ES = 0.23, P = .103; respectively). Agility performance significantly improved in both groups (change = -0.12, percentage change = -1.18, ES = 0.19, P = .021; change = -0.21, percentage change = -2.18, ES = 0.38, P = .005; respectively).

CONCLUSIONS

Both DS and DS + FR improved flexibility and agility and did not affect balance. DS + FR was not superior to DS at improving flexibility and agility as compared only with DS. Both methods are effective warm-up protocols to augment factors related to injury risk and performance. It seems that further studies that investigate the combined effects of FR and DS are needed.

Effect of vibration foam rolling on the range of motion in healthy adults: a systematic review and meta-analysis

Professionals use foam rollers to improve range of motion (ROM). Recently, a vibrating foam roller (VFR) that combines the vibration function with a foam roller (FR) has been used. The purpose of this systematic review and meta-analysis was to determine the effects of a VFR on the improvement of ROM in healthy individuals. A systematic literature search was carried out in five international databases: PubMed, Embase, PEDro, Cochrane Library, and Google Scholar. Eight clinical studies, composed of six randomized controlled trials and two randomized crossover trials that involved 230 healthy participants were selected for analysis. Methodological quality was identified using the PEDro scale. The mean scores, 4.75±0.71, of the eight included studies, were classified as fair. The results demonstrated that the VFR achieved better gains than the FR in improving ROM (standardized mean difference [SMD], 0.53; 95% confidence intervals [CIs], 0.29–0.77; I²=55%). The VFR was more effective in improving the ROM than the FR in the hip and knee joints (hip: SMD, 0.56; 95% CI, 0.28–0.85; I²=0%; knee: SMD, 0.86; 95% CI, 0.42–1.30; I²=79%). The VFR may be an additional option to improve the ROM in healthy adults and athletes.

Effects of foam rolling for delayed onset muscle soreness on loaded military task performance and perceived recovery

Objective

The purpose of this investigation was to evaluate the effects of foam rolling (FR) and passive recovery (PR) on symptoms of delayed-onset muscle soreness (DOMS) and military-specific performance.

Methods

Twenty men and women (age: 23.6 ± 4.1 years, height: 176.4 ± 5.6 cm, and body mass: 84.7 ± 13.4 kg) completed a DOMS-inducing exercise protocol (DIP), followed by FR or PR. Four loaded military tasks (LMT) were performed 24 h later. Rating of perceived exertion (RPE) was measured during DIP and after each LMT. Rating of muscle pain (RMP) was measured prior to the LMTs and after the recovery protocols. A repeated measure analysis of variance and partial eta squared were used to compare LMT performance across baseline, FR and PR sessions. Friedman tests compared perceptual variables across baseline, FR, and PR. Wilcoxon matched-pairs signed-ranks test evaluated RPE during DIP, post-DIP, and post-recovery RMP between FR and PR.

Results

LMT performance times were significantly faster after FR compared to PR (stair climb: p = .038, cover position sprint: p = .011, simulated ammunition can carry: p = .003, Shuttle Run: p = .034). RPE measured during LMTs was similar across all data points. Post-recovery RMP for FR (3.0 (2.3, 4.0)) and PR (4.0 (3.0, 6.0)) were not significantly different.

Conclusion

FR reduced the impact of DOMS on three loaded tactical performance tasks without significant reduction in perceived soreness.

Effects of myofascial release or self-myofascial release and control position exercises on lower back pain in idiopathic scoliosis: A systematic review

BACKGROUND

Idiopathic scoliosis is associated, among others, to muscular imbalance, functional limitations, and the most prevalent, back pain. The treatments usually applied are exercise, bracing or surgery. The objective of corrective exercise is to reduce symptoms and improve functional capacity and quality of life. Myofascial release (MFR) or Self-Myofascial release (SMFR) are manual techniques, intended to restore optimal muscle and fascia length, decrease pain, and improve function.

PURPOSE

to analyze the effects of MFR and postural control programs in lower back pain and scoliosis curves.

METHODS

A systematic literature review was conducted in high quality databases to identify the existing evidence of the effects of MFR and postural control on reducing back pain and scoliosis curves.

RESULTS

Seventeen studies met inclusion criteria. 533 subjects and 94 MFR/SMFR applied interventions lasting one to 24 weeks/sessions were identified. Ten studies used MFR, six SMFR and one mixes techniques. Seven MFR and five SMFR studies shown positive result. One study using MFR and one using SMFR applied also postural control exercises. MFR was useful to reduce back pain in all studies included that aimed in that matter. In addition, 12 studies reported improvements in flexibility and/or stiffness reduction, and two studies observed improvements in postural control and balance.

CONCLUSIONS

The combination of MFR and postural control programs might be suitable for reducing scoliosis and back pain. However, due to the reduced number of studies and the relatively small sample sizes used, results may be carefully interpreted, and more studies are needed.

Evaluating the effects of embedded self-massage practice on strength performance: A randomized crossover pilot trial

Background

Self-administered massage interventions with a roller massager are commonly used as part of warm-ups and post-workout recovery routines. There is yet no clear consensus regarding the practical guidelines for efficient embedded interventions.

Objectives

The present randomized crossover pilot trial aimed at examining the effects of a rolling intervention with a roller massager embedded within the rests periods of a resistance training protocol. The rolling intervention targeted quadriceps muscles.

Setting

Participants (n = 14) performed two resistance training protocols expected to elicit momentary muscle failure. The protocol consisted in 10 sets of 10 rest-pause repetitions of back squats, with a poundage set up at 50% of the maximal one-repetition. Two min were allocated to recovery between sets. During the recovery periods, participants completed a rolling routine with a roller massager for 60 s (Roller-massager), or underwent passive recovery (Control). The total workload, concentric power, thigh circumference rate of perceived exertion (RPE) and delayed onset of muscle soreness (DOMS) from 24 h to 120 h after completion of the protocol were the dependent variables.

Results

Roller-massager was associated with a reduction in total workload (-11.6%), concentric power (-5.1%) and an increase in perceived exertion compared to Control (p < 0.05). Roller-massager was also associated with reduced thigh circumference after the resistance training protocol, indicating reduced muscle swelling, and reduced DOMS 24 h to 120 h post-workout (p < 0.001).

Conclusion

These findings support that embedded rolling with a roller massager hinders performance and increases effort perception. Embedded interventions may not be suitable during conditioning periods designed to maximize training intensity.

Effects of Myofascial Self-Release on Range of Motion, Pressure Pain Threshold, and Hamstring Strength in Asymptomatic Individuals: A Randomized, Controlled, Blind Clinical Trial

CONTEXT

Myofascial self-release is performed using a roller to exert pressure on the soft tissues and to promote effects similar to those of traditional massage. However, there is no standardization regarding its application, mainly in relation to time.

OBJECTIVE

To evaluate the effects of myofascial self-release with a rigid roller on range of motion (ROM), pressure pain threshold (PPT), and hamstring strength in asymptomatic individuals following 2 different times of intervention.

DESIGN

Randomized, controlled, blind, clinical trial comparing preintervention and immediately postintervention within 2 groups.

SETTING

Institutional physiotherapy clinic.

PARTICIPANTS

A total of 40 university students (18-30 y), who had no symptoms, participated.

INTERVENTION

Foam roller for 30 seconds and 2 minutes for group 2.

MAIN OUTCOME MEASURES

Hamstring PPT, knee-extension ROM, and peak knee-flexion torque measured before and immediately after the intervention.

RESULTS

Both groups experienced a statistically significant increase in ROM compared with baseline (30 s and 2 min for group 2 P < .024). There were no statistically significant differences comparing peak knee-flexion torque or PPT.

CONCLUSIONS

Hamstring myofascial self-release using a roller for 30 seconds or 2 minutes produced an increase in ROM in healthy individuals. PPT and peak knee-flexion isometric torque showed no effects.

Efficacy of foam rolling with additional vibration stimulation on the mobility of the thoracolumbar fascia. An observational study

INTRODUCTION

Observations show that foam rolling improves joint movements. Likewise, it can be stated that a vibration stimulation of the tissue leads to improved joint mobility.

METHOD

This study investigates whether the combination of foam rolling and vibrations (31 Hz) can influence the sliding of the thoracolumbar fascia more effectively than normal foam rolling. 45 subjects participated in the study and were divided into a foam roll with additional vibration group (FRV), a foam roll group (FR) and a control group (CG). The intervention groups rolled out the gluteal muscles, the lateral trunk and the upper and lower back. Mobility measures were taken pre and post the respective intervention. Subsequent cross correlation software analysis quantified the sliding of the fascia and calculated its shear strain mobility (SSM).

RESULTS

The sliding of the thoracolumbar fascia improved significantly within the FRV by 2.83 mm (SD ± 1.08/p < .001), in the FR by 0.96 mm (SD ± 0.43/p < .001) and in the CG decreased the sliding by 0.1401 mm (SD ± 0.28/p = .076). The fascia/fascia SSM increased in the FRV by 22.61% (SD ± 15.64/p < .001), in the FR by 11.41% (SD ± 20.38/p = .056) and in the CG decreased the SSM by 0.9473% (SD ± 11.35/p < .751). The lumbar movement increased in both intervention groups, but showed no significant result.

CONCLUSION

The use of a foam roll with additional vibration and standard intervention have increased thoracolumbar fascia sliding and lumbar movements. The improved shear strain mobility can be attributed to the multi-activity of mechanoreceptors, such as Pacini- and Ruffini-Bodies.

Selective Effects of Manual Massage and Foam Rolling on Perceived Recovery and Performance: Current Knowledge and Future Directions Toward Robotic Massages

Manual massage and foam rolling are commonly used by athletes for warm-up and recovery, as well as by healthy individuals for well-being. Manual massage is an ancient practice requiring the intervention of an experienced physiotherapist, while foam rolling is a more recent self-administered technique. These two topics have been largely studied in isolation from each other. In the present review, we first provide a deep quantitative literature analysis to gather the beneficial effects of each technique through an integrative account, as well as their psychometric and neurophysiological evaluations. We then conceptually consider the motor control strategies induced by each type of massage. During manual massage, the person remains passive, lying on the massage table, and receives unanticipated manual pressure by the physiotherapist, hence resulting in a retroactive mode of action control with an ongoing central integration of proprioceptive feedback. In contrast, while performing foam rolling, the person directly exerts pressures through voluntary actions to manipulate the massaging tool, therefore through a predominant proactive mode of action control, where operations of forward and inverse modeling do not require sensory feedback. While these opposite modes of action do not seem to offer any compromise, we then discuss whether technological advances and collaborative robots might reconcile proactive and retroactive modes of action control during a massage, and offer new massage perspectives through a stochastic sensorimotor user experience. This transition faculty, from one mode of control to the other, might definitely represent an innovative conceptual approach in terms of human-machine interactions.