Is self myofascial release an effective preexercise and recovery strategy? A literature review

Comparison of the Effects of a Roller Massager Intervention on the Rectus Femoris Between Lengthened and Slack Positions

ABSTRACT

Kasahara, K, Konrad, A, Murakami, Y, Thomas, E, and Nakamura, M. Comparison of the effects of a roller massager intervention on the rectus femoris between lengthened and slack positions. J Strength Cond Res XX(X): 000-000, 2024-A roller massager (RM) is a type of foam rolling device, which previous studies have shown to be effective for acutely decreasing tissue hardness and increasing range of motion (ROM). However, these effects may differ with the RM intervention position (i.e., knee flexion or knee extension). Therefore, this study aimed to compare the acute effects of an RM intervention on the rectus femoris (RF) in the knee flexed and extended positions. The subjects were 14 healthy male college students (age, 22.6 ± 0.8 years). The RF of the dominant leg was tested. Three conditions were compared: a control condition with no intervention (CON), an RM intervention in knee extension (i.e., RM_extension), and a RM intervention in knee flexion (i.e., RM_flexion). The measurements were tissue hardness in the proximal (TH_pro), middle (TH_mid), and distal (TH_dis) portions of the RF, knee flexion ROM, pain pressure threshold (PPT), maximal voluntary isometric contraction (MVC-ISO) torque, and maximal voluntary concentric contraction (MVC-CON) torque in the RF before and immediately after the intervention. There were significant interaction effects of TH_mid and knee flexion ROM. Both RM_extension and RM_flexion conditions showed a significant (p < 0.01) decrease in TH_mid and an increase in knee flexion ROM, but there were no significant differences between conditions. There was a main effect for TH_pro and PPT (p < 0.05) but no significant interaction effect or main effect for TH_dis, MVC-ISO torque, and MVC-CON torque. The results showed that the RM intervention can effectively decrease tissue hardness and increase ROM, regardless of limb position (i.e., knee extension or flexion).

Discussing Conflicting Explanatory Approaches in Flexibility Training Under Consideration of Physiology: A Narrative Review

The mechanisms underlying range of motion enhancements via flexibility training discussed in the literature show high heterogeneity in research methodology and study findings. In addition, scientific conclusions are mostly based on functional observations while studies considering the underlying physiology are less common. However, understanding the underlying mechanisms that contribute to an improved range of motion through stretching is crucial for conducting comparable studies with sound designs, optimising training routines and accurately interpreting resulting outcomes. While there seems to be no evidence to attribute acute range of motion increases as well as changes in muscle and tendon stiffness and pain perception specifically to stretching or foam rolling, the role of general warm-up effects is discussed in this paper. Additionally, the role of mechanical tension applied to greater muscle lengths for range of motion improvement will be discussed. Thus, it is suggested that physical training stressors can be seen as external stimuli that control gene expression via the targeted stimulation of transcription factors, leading to structural adaptations due to enhanced protein synthesis. Hence, the possible role of serial sarcomerogenesis in altering pain perception, reducing muscle stiffness and passive torque, or changes in the optimal joint angle for force development is considered as well as alternative interventions with a potential impact on anabolic pathways. As there are limited possibilities to directly measure serial sarcomere number, longitudinal muscle hypertrophy remains without direct evidence. The available literature does not demonstrate the necessity of only using specific flexibility training routines such as stretching to enhance acute or chronic range of motion.

Deciphering recovery paradigms: Foam rolling's impact on DOMS and lactate dynamics in elite volleyball athletes

This study examines the effects of Self-Myofascial Release (SMR) techniques on post-exercise recovery in elite volleyball athletes. Through a controlled investigation involving eighteen Chinese Men's National Volleyball Team athletes, the research assessed the impact of foam rolling (FR) versus passive recovery (PAS) on blood lactate clearance and Delayed Onset Muscle Soreness (DOMS), as measured by Visual Analogue Scale (VAS) scores. Findings indicated that FR significantly reduces VAS scores and facilitates lactate clearance when compared to PAS, suggesting foam rolling may enhance post-exercise recovery. While confirming foam rolling's benefits, this research calls for further exploration into recovery mechanisms, emphasizing a cautious interpretation of foam rolling as part of a comprehensive recovery strategy.

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.

Effects of Self-Myofascial Release on Athletes' Physical Performance: A Systematic Review

Therapists and strength and conditioning specialists use self-myofascial release (SMR) as an intervention tool through foam rollers or massage rollers for soft tissue massage, with the purpose of improving mobility in the muscular fascia. Moreover, the use of SMR by professional and amateur athletes during warm-ups, cool downs, and workouts can have significant effects on their physical performance attributes, such as range of motion (ROM) and strength. The purpose of this study was to analyse the literature pertaining to these types of interventions and their effects found in different physical performance attributes for athletes. A systematic search was carried out using the following databases: PUBMED, ISI Web of Science, ScienceDirect, and Cochrane, including articles up to September 2023. A total of 25 articles with 517 athletes were studied in depth. SMR seems to have acute positive effects on flexibility and range of motion, without affecting muscle performance during maximal strength and power actions, but favouring recovery perception and decreasing delayed-onset muscle soreness. Some positive effects on agility and very short-range high-speed actions were identified, as well. In conclusion, although there is little evidence of its method of application due to the heterogeneity in that regard, according to our findings, SMR could be used as an intervention to improve athletes' perceptual recovery parameters, in addition to flexibility and range of motion, without negatively affecting muscle performance.

Self-Massage Techniques for the Management of Pain and Mobility With Application to Resistance Training: A Brief Review

ABSTRACT

MacLennan, M, Ramirez-Campillo, R, and Byrne, PJ. Self-massage techniques for the management of pain and mobility with application to resistance training: a brief review. J Strength Cond Res 37(11): 2314-2323, 2023-Fascial restrictions that occur in response to myofascial trigger points (MTrP), exercise-induced muscle damage (EIMD), and delayed onset of muscle soreness (DOMS) cause soft tissue to lose extensibility, which contributes to abnormal muscle mechanics, reduced muscle length, and decrements in joint range of motion (ROM) and actively contributes to musculoskeletal pain. Resistance training and in particular, weightlifting movements have unique mobility requirements imperative for movement efficacy and safety with ROM restrictions resulting in ineffective volume and intensity tolerance and dampened force output and power, which may lead to a failed lift or injury. Self-massage (SM) provides an expedient method to promote movement efficiency and reduce injury risk by improving ROM, muscular function, and reducing pain and allows athletes to continue to train at their desired frequency with minimal disruption from MTrPs-associated adverse effects. Thus, the aim of this review was to determine the efficacy of various self-massage tools in managing pain and mobility and to explore the potential benefits of SM on resistance training performance. Many SM devices are available for athletes to manage ROM restrictions and pain, including differing densities of foam rollers, roller massagers, tennis balls, and vibrating devices. To attenuate adverse training effects, a 10-to-20-minute bout consisting of 2-minute bouts of SM on the affected area may be beneficial. When selecting a SM device, athletes should note that foam rollers appear to be more effective than roller massagers, with vibrating foam rollers eliciting an increased reduction to pain perception, and tennis balls and soft massage balls were shown to be efficacious in targeting smaller affected areas.

Myofascial release strategies and technique recommendations for athletic performance: A systematic review

OBJECTIVE

To identify the effects of instrument-assisted soft tissue mobilization (IASTM) and foam roller self-myofascial release (FRSMR) strategies and verify their results in athletic performance.

METHOD

Systematic review conducted in four databases from 2017. The inclusion criteria were randomized controlled trials assessing the effects of two forms of soft tissue mobilization on athletes' performance. The risk of bias was analyzed using the Cochrane Handbook scale.

RESULTS

Ten studies were included for qualitative analysis. IASTM increased range of motion, knee joint kinetic force, peak torque, and angular velocity in dorsiflexion and plantar flexion. The technique increases isometric strength and isokinetic power in vertical jumping. FRSMR was relevant in counter movement jumping between the pre- and post-intervention conditions, mainly by increasing strength in the initial jumping phase.

CONCLUSIONS

IASTM should be used in sports preparation to improve muscle response and explosive force production. FRSMR increases flexibility as it tends to restore tissue elasticity, but it does not improve aerobic activity. The suggested time for strategy intervention is at least 90 s per muscle group.

The immediate effects of foam rolling of the hamstrings muscle group on the contractile properties of the knee muscles in football players

INTRODUCTION

Excessive amounts of intense training, without adequate recovery time, can overload the musculoskeletal, immune, and metabolic systems, resulting in a potentially negative effects on later exercise performance. During the competitive period, the ability to recover after intense training and competition is an important factor of success in soccer. The purpose of this study was to determine the effect of hamstring foam rolling on the knee muscle contractile properties in soccer players, after a sports-specific load.

METHODS

20 male professional soccer players were included and contractile properties of the biceps femoris, rectus femoris, vastus medialis and vastus lateralis muscles were measured with tensiomyography, before and after a Yo-Yo interval test and after 5 × 45 s of hamstring foam rolling. Additionally, active and passive knee extensibility before and after the intervention were measured. A mixed linear model was performed to determine the differences between the mean values of the groups. The experimental group performed foam rolling, while the control was resting.

RESULTS

Five repetitions of 45 s of hamstring foam rolling had no statistically significant effect (p > 0.05) on any of the measured muscles following the Yo-Yo interval test or foam rolling intervention. There were no statistically significant differences in delay time, contraction time and maximum muscle amplitude between groups. Active and passive knee extensibility did not differ between groups.

DISCUSSION AND CONCLUSION

It seems that foam rolling does not affect mechanical properties of the knee muscles or hamstring extensibility in soccer players, after a sports-specific load.

Are Acute Effects of Foam-Rolling Attributed to Dynamic Warm Up Effects? A Comparative Study

Over the last decade, acute increases in range of motion (ROM) in response to foam rolling (FR) have been frequently reported. Compared to stretching, FR-induced ROM increases were not typically accompanied by a performance (e.g., force, power, endurance) deficit. Consequently, the inclusion of FR in warm-up routines was frequently recommended, especially since literature pointed out non-local ROM increases after FR. However, to attribute ROM increases to FR it must be ensured that such adaptations do not occur as a result of simple warm-up effects, as significant increases in ROM can also be assumed as a result of active warm-up routines. To answer this research question, 20 participants were recruited using a cross-over design. They performed 4x45 seconds hamstrings rolling under two conditions; FR, and sham rolling (SR) using a roller board to imitate the foam rolling movement without the pressure of the foam rolling. They were also tested in a control condition. Effects on ROM were tested under passive, active dynamic as well as ballistic conditions. Moreover, to examine non-local effects the knee to wall test (KtW) was used. Results showed that both interventions provided significant, moderate to large magnitude increases in passive hamstrings ROM and KtW respectively, compared to the control condition (p = 0.007-0.041, d = 0.62-0.77 and p = 0.002-0.006, d = 0.79-0.88, respectively). However, the ROM increases were not significantly different between the FR and the SR condition (p = 0.801, d = 0.156 and p = 0.933, d = 0.09, respectively). No significant changes could be obtained under the active dynamic (p = 0.65) while there was a significant decrease in the ballistic testing condition with a time effect (p < 0.001). Thus, it can be assumed that potential acute increases in ROM cannot be exclusively attributed to FR. It is therefore speculated that warm up effects could be responsible independent of FR or imitating the rolling movement, which indicates there is no additive effect of FR or SR to the dynamic or ballistic range of motion.

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.

A 1-Week Comprehensive Foam Rolling Intervention Program Can Improve Knee Pain but Not Muscle Function and Range of Motion in Patients with Total Knee Arthroplasty

We investigate the effect of a 1-week comprehensive foam rolling (FR) intervention program on knee pain, range of motion (ROM), and muscle function in patients with TKA.Thirty patients with TKA were randomly allocated to FR (n = 15) or control (n = 15) groups. The control group received only regular physical therapy. Patients in the FR group performed the FR intervention in addition to their regular physical therapy twice daily from postoperative weeks two to three (60 s × 3 repetitions × 2 times/day × 6 days: total = 2160 s). Pain score, knee flexion and extension ROM, muscle strength, walking function, and balance function were measured before and after the FR intervention. From the second to third postoperative weeks, there were significant improvements in all variables, and the reduction in pain score at stretching was significantly greater in the FR group (-26.0 ± 1.4; p < 0.05) than in the control group (-12.5 ± 1.9). However, there was no significant difference in changes in the other variables except for the pain score at stretching between FR and control groups. A 1-week comprehensive FR intervention program in patients with TKA could reduce pain scores at stretching without a synergistic effect on physical function, i.e., walking speed, balance function, and muscle strength of the knee extensors muscles.

Mechanisms Underlying Anti-Inflammatory and Anti-Cancer Properties of Stretching-A Review

Stretching is one of the popular elements in physiotherapy and rehabilitation. When correctly guided, it can help minimize or slow down the disabling effects of chronic health conditions. Most likely, the benefits are associated with reducing inflammation; recent studies demonstrate that this effect from stretching is not just systemic but also local. In this review, we present the current body of knowledge on the anti-inflammatory properties of stretching at a molecular level. A total of 22 papers, focusing on anti-inflammatory and anti-cancer properties of stretching, have been selected and reviewed. We show the regulation of oxidative stress, the expression of pro- and anti-inflammatory genes and mediators, and remodeling of the extracellular matrix, expressed by changes in collagen and matrix metalloproteinases levels, in tissues subjected to stretching. We point out that a better understanding of the anti-inflammatory properties of stretching may result in increasing its importance in treatment and recovery from diseases such as osteoarthritis, systemic sclerosis, and cancer.

EFFECT OF SINGLE AND MULTIPLE SESSIONS OF SELF-MYOFASCIAL RELEASE: SYSTEMATIC REVIEW

ABSTRACT Self-myofascial release with a roller has been used as a tool to accelerate recovery. The objective of this systematic review was to investigate how one session or multiple sessions of self-myofascial release with a roller affect the recovery of an athlete´s performance. The research was conducted in the PubMed, Scopus, Cochrane Library, BVS, Embase, SPORTDiscus, ScienceDirect, and Google Scholar databases using the terms: foam rolling, foam roller, and self-myofascial release combined with recovery, exercise, fatigue, and sport and acute effects, chronic effects and performance, resulting in 12,020 articles. After checking the inclusion criteria, 40 studies were selected and analyzed. It was concluded that multiple sessions of self-myofascial release with a roller are more effective in recovering lower limb power and speed performance than just one session. A single session is more effective for recovering strength performance than multiple sessions. Moreover, both single and multiple sessions showed similar results in the recovery of agility, pain, flexibility, blood lactate removal, and perception of recovery. Finally, multiple sessions between sets of resistance exercise seem to reduce performance, decreasing the number of repetitions and resistance to fatigue, while a single session did not produce a significant effect. Self-myofascial release with a roller demonstrates potential for speeding up the recovery process of athletes. Future studies should evaluate the effect of the regular use of self-myofascial release with a roller on performance recovery. Level of evidence II; Systematic review.

Frailty Status Improvement after 5-Month Multicomponent Program PROMUFRA in Community-Dwelling Older People: A Randomized Controlled Trial

A study was made of the effect of the PROMUFRA multicomponent frailty program upon physical frailty, kinanthropometry, pain and muscle function parameters in frail and pre-frail community-dwelling older people. Eighty-one participants were randomly allocated to the intervention group (IG) or control group (CG). The IG performed PROMUFRA for 20 weeks, using six strength exercises with three series of 8–12 repetitions until muscular failure, and seven myofascial exercises, with one set of 10 repetitions. The CG continued their routine. The frailty criteria number (FCN), kinanthropometric parameters and muscle function were measured at baseline and after the program. Between-group differences were found in the interaction for FCN, muscle mass, fat mass, skeletal muscle mass index, knee flexion range of motion (ROM), hip flexion with knee straight ROM, maximum isometric knee extension, maximum isotonic knee extension, maximum leg press and hand grip strength., and also on post-intervention frailty status. The IG showed a statistical trend towards decreased pain. In conclusion, the PROMUFRA program is a potential training approach that can bring benefits in physical frailty status, body composition, ROM and muscle function among frail or pre-frail community-dwelling older people.

The Effect of Self-Myofascial Release on the Pennation Angle of the Vastus Medialis Oblique and the Vastus Lateralis in Athletic Male Individuals: An Ultrasound Investigation

Background

Maintenance of patellar stability requires a balance between the vastus medialis oblique (VMO) and the vastus lateralis (VL). The imbalance between these muscles is thought to be implicated in the etiology of patellofemoral pain (PFP). Where there is hypertrophy of the VL in PFP patients, self-myofascial release (SMR) may be utilized for its management. However, there is no current evidence regarding SMR and its effects on VMO and VL architecture. The aim of this study, therefore, was to use ultrasound to gain further understanding of the effects of a program of SMR on the fiber angles of the VMO and VL.

Hypothesis

There will be a significant decrease in the pennation angles of the VMO and VL after seven weeks of SMR using a foam roller.

Study Design

Cohort Study.

Methods

Twenty-five young, athletic, male participants were recruited to use a foam roller, along the full length of both anterior thighs, three times weekly, on three separate days, for seven weeks. Ultrasound was used to determine the initial and final VMO and VL pennation angles on both limbs. One eligible participant was chosen as an intra-rater control and did not partake in the SMR regimen.

Results

There was a statistically significant (p < 0.001) decrease in the pennation angles of the VMO and VL after the SMR regime. Mean combined right and left VL angle change was -6.65° (-18% mean change) and the mean combined right and left VMO angle change was -7.65° (-11.5% mean change). A weak negative correlation was found between initial VMO fiber angle and the angle change (Rsquared = -0.21), as well as moderate negative correlation for the VL (Rsquared = -0.51).

Conclusion

A program of SMR on the anterior thighs of young, asymptomatic males resulted in changes to the fiber angles of both the VMO and VL. There was a significant decrease in pennation angle after seven weeks of SMR using a foam roller.

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.

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.

Effectiveness of self-myofascial release combined with biofeedback and electrical stimulation for the management of myofascial pelvic pain: A randomized controlled trial

BACKGROUND

Myofascial pelvic pain (MFPP) caused by myofascial trigger points (MTrPs) is a major contributor to chronic pelvic pain in women. However, the effect of the patient's self-myofascial release (SMFR) is unclear. This study aimed to investigate the effect of SMFR combined with biofeedback and electrical stimulation (BES) therapy in comparison with BES alone in patients with MFPP.

METHODS

A prospective randomized controlled study was conducted. Sixty-eight patients were randomly allocated into BES-SMFR group (n = 34) and BES group (n = 34). Every patient received 4 weeks of treatment, evaluated at baseline (T0), 4 weeks post-intervention (T4) and 12-week follow-up (T12). The primary outcome was pain intensity. The secondary outcomes were degree of activation of MTrPs, surface electromyography (sEMG) levels and Patient Global Impression of Improvement (PGI-I).

RESULTS

Compared with the effect of BES, BES-SMFR treatment significantly decreased pain intensity and the degree of activation of MTrPs in the levator ani (p = 0.02) and obturator internus (p = 0.03), as well as the sEMG levels of the pre-test resting baseline and post-test resting baseline (all p < 0.01). The degree of activation of MTrPs in the piriformis and coccygeus (all p > 0.05) and the sEMG levels of the quick flicks and endurance contraction were not significantly different. The BES-SMFR treatment improved the PGI-I scale at T4 (p = 0.02) but not at T12 (p = 0.40).

CONCLUSIONS

This study confirmed that the addition of SMFR to BES treatment resulted in superior outcomes compared with those with BES alone in patients with MFPP.

SIGNIFICANCE STATEMENT

Myofascial pelvic pain (MFPP) is a major contributor of female chronic pelvic pain. Myofascial release has been used commonly for better pain release; however, poor therapeutic effect due to poor patient compliance is common in clinical practice. Therefore, in future research, there is a need to investigate the effect of patient's self-myofascial release (SMFR) technique, which can eliminate the need for frequent office visits and improve patient compliance to some extent, in patients with MFPP.

Effectiveness of myofascial release on pain, sleep, and quality of life in patients with fibromyalgia syndrome: A systematic review

BACKGROUND AND PURPOSE

There is limited evidence on the effects of myofascial release on fibromyalgia symptoms. This review aims to update the evidence on the effectiveness of myofascial release on pain, sleep, and quality of life in patients with fibromyalgia syndrome.

METHODS

The review was prepared following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, Cochrane Library, Physiotherapy Evidence Database, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature Complete, and ProQuest Medical library were searched from their inception to April 1, 2021 for randomized or nonrandomized clinical trials published in English. Studies consisting of myofascial release alone or in combination with exercise as the intervention were included. The quality of the studies was evaluated using Cochrane Risk of Bias 2.0.

RESULTS

Six studies, including a total of 279 participants, were included in the review. The meta-analysis showed a large significant effect of myofascial release on pain posttreatment (-0.81[95% CI = -1.15 to -0.47], p < 0.00001) and a moderate effect at 6 months post-treatment (-0.61, 95% CI = -0.95 to -0.28, p = 0.0003).

CONCLUSION

The review demonstrated moderate evidence for the effect of therapist administered and self-myofascial release in improving pain, sleep subscales, and quality of life against sham and no treatment, respectively, in fibromyalgia syndrome patients. However, more high-quality randomized controlled trials with manual control group are required to be conducted at different geographical locations to generalize the findings.

Myofascial Release for Chronic Low Back Pain: A Systematic Review and Meta-Analysis

Background: Chronic low back pain (CLBP) is one of the most common musculoskeletal diseases in the elderly, which has a severe impact on the health of the elderly. However, CLBP treatment is very challenging, and more effective treatment methods are needed. Myofascial release may be an effective therapy for the management of chronic musculoskeletal pain. It is widely used clinically to treat CLBP, but its clinical efficacy is still controversial. Objective: This study aims to systematically evaluate the effectiveness of myofascial release for patients with CLBP. Methods: We selected PubMed, Cochrane Library, EMBASE database, and Web of Science database articles published until April 5, 2021. Randomized controlled trials (RCTs) of myofascial release for CLBP were included. Outcome measures included pain, physical function, quality of life, balance function, pain pressure-threshold, trunk mobility, and mental health. For each outcome, Standardized mean differences (SMD) or mean differences (MD) and 95% confidence intervals (CIs) were calculated. Results: Eight RCTs (n = 375) were included based on inclusion and exclusion criteria. The meta-analysis showed that the overall efficacy of myofascial release for CLBP was significant, including two aspects: pain [SMD = -0.37, 95% CI (-0.67, -0.08), I 2 = 46%, P = 0.01] and physical function [SMD = -0.43, 95% CI (-0.75, -0.12), I 2 = 44%, P = 0.007]. However, myofascial release did not significantly improve quality of life [SMD = 0.13, 95% CI (-0.38, 0.64), I 2 = 53%, P = 0.62], balance function [SMD = 0.58, 95% CI (-0.49, 1.64), I 2 = 82%, P = 0.29], pain pressure-threshold [SMD = 0.03,95% CI (-0.75, 0.69), I 2 = 73%, P = 0.93], trunk mobility [SMD = 1.02, 95% CI (-0.09, 2.13), I 2 = 92%, P = 0.07] and mental health [SMD = -0.06, 95% CI (-0.83, 0.71), I 2 = 73%, P = 0.88]. Conclusions: In this study, we systematically reviewed and quantified the efficacy of myofascial release in treating CLBP. The meta-analysis results showed that myofascial release significantly improved pain and physical function in patients with CLBP but had no significant effects on balance function, pain pressure-threshold, trunk mobility, mental health, and quality of life. However, due to the low quality and a small number of included literature, more and more rigorously designed RCTs should be included in the future to verify these conclusions.

Foam Rolling Elicits Neuronal Relaxation Patterns Distinct from Manual Massage: A Randomized Controlled Trial

The present double-blinded, randomized controlled study sought to compare the effects of a full-body manual massage (MM) and a foam rolling (FR) intervention on subjective and objective indexes of performance and well-being. A total of 65 healthy individuals were randomly allocated to an FR, MM, or a control group who received a cognitively oriented relaxation routine. Self-report ratings of perceived anxiety, muscle relaxation, and muscle pain were used to index changes in affect and physical sensations. The sit-and-reach and toe-touch tests, as well as a mental calculation task, were used to index motor and cognitive performances, respectively. We also conducted resting-state electroencephalography and continuous skin conductance recordings before and after the experimental intervention. Both FR and MM groups exhibited neural synchronization of alpha and beta oscillations during the posttest. Skin conductance increased from the pretest to the posttest in the relaxation group, but decreased in the FR group. All interventions improved range of motion, although only the MM group outperformed the relaxation group for the toe-touch performance. MM was associated with reduced muscle pain and increased muscle relaxation. Reduced perceived anxiety after the intervention was observed in the FR group only. Overall, MM and FR both improved objective and subjective indexes of performance and well-being. Differences between the two massage interventions are discussed in relation to the effects of pressure stimulation on autonomic regulations and the proactive vs. retroactive nature of FR, compared to MM.

Effects of self-myofascial release interventions with or without sliding pressures on skin temperature, range of motion and perceived well-being: a randomized control pilot trial

Background

Self-myofascial release is an emerging technique in strength and conditioning. Yet, there is no consensus regarding optimal practice guidelines. Here, we investigated the acute effects of various foam rolling interventions targeting quadriceps muscles, with or without sliding pressures.

Methods

We conducted a blinded randomized control pilot trial in 42 healthy weightlifting athletes over 4 weeks. Participants were randomly allocated to one of the four intervention (120 s massage routine) groups: foam rolling, roller massager, foam rolling with axial sliding pressures, foam rolling with transverse sliding pressures. Knee range of motion, skin temperature and subjective scores of the perceived heat, range of motion, muscle pain and relaxation were the dependent variables. Measurements were carried on before, after and up to 15 min (follow-up) after the massage intervention.

Results

The range of motion increased immediately after the various foam rolling interventions (+ 10.72%, 95% CI 9.51 to 11.95, p < 0.001), but progressively returned back to the pre-intervention baseline along within the 15 min post-intervention. Foam rolling was the most effective intervention to increase skin temperature from thermographic measures (+ 14.06%, 95% CI 10.97 to 17.10, p < 0.001), while the increase in perceived heat was comparable in all experimental groups (107%, 95% CI 91.08 to 122.61, p < 0.001).

Conclusions

Subjective indexes of heat, range of motion, muscle pain and relaxation improved immediately after the intervention, but also gradually returned to the pre-intervention baseline. Overall, combining foam rolling with sliding pressures did not yield additional benefits from objective measures.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13102-021-00270-8.

Immediate effects of myofascial release maneuver applied in different lower limb muscle chains on postural sway

BACKGROUND

There is little evidence about the myofascial release maneuver (MLM) targeting the fascial tissue and its effect on postural balance. This study investigated the immediate effects of the MLM in different lower limb muscle chains on the postural sway of healthy men.

METHODS

Sixty-three healthy men (27.2 ± 4.7 years) were randomly assigned to 7 groups (n = 9 each) to receive MLM applied to the lower limb muscle chains (anterior, posterior, medial, lateral, anterior/posterior, and medial/lateral) or placebo intervention. Skin pressure during the 3-min MLM was determined by the visual analog scale between 5 and 7 as previously assessed on participants. Posturography analysis of the elliptical area (Area) and average velocity (Vavg) of the center-of-pressure displacement was performed before and immediately after the MLM in single-leg support and with eyes closed.

RESULTS

A two-way repeated measures analysis of variance showed no interaction effect of factors group and time (Area: p = 0.210, ω² = 0.004; Vavg: p = 0.358, ω² < 0.001). Within-factor main effect of time was observed for both Area (p < 0.001, ω² = 0.038) and Vavg (p < 0.001, ω² = 0.028), with decreased Area and Vavg after all interventions. No between-factor main effect of group was observed for Area or Vavg (MLM or placebo, p = 0.188 or higher).

CONCLUSION

MLM applied to the lower limb muscle chains showed no immediate specific effects on postural sway in healthy men. Pre-post effects of MLM were not different from those elicited by a superficial massage. MLM in lower limb muscle chains is not advocated for an immediate improvement of postural balance in this population.

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.

Comparison between neurodynamic therapy and foam rolling in cool-down sessions for delayed onset muscle soreness in healthy individuals

BACKGROUND

Delayed onset of muscle soreness (DOMS) is a common finding in trained and untrained individuals post high intensity exercises which can lead to injuries. Foam rolling (FR) and neurodynamic therapy (NDT) are types of active cool-down which provides effective for treatment of DOMS. But their role in reduction of intensity of the same in cool down is not established.

STUDY DESIGN

Crossover study.

METHODOLOGY

Total 60 healthy individuals participated in the study. Pre intervention readings were taken of strength and tightness by Range of motion. Subjects performed both the types of cool-down separated by 4 weeks interval with random allocation. Post intervention readings of hamstring and quadriceps tightness, grade of tenderness and stand to sit VAS score was taken post 24 h and 48 h and strength post 48 h.

RESULTS

Analysis was done for using repeated measures ANOVA and Friedman's test. The difference of values for Straight Leg Raise and Prone knee Flexion between NDT and FR post 24 h were statistically significant (p < 0.05) while that of NDT post 24 h being similar to FR post 48 h (p > 0.05). There was a significant difference between strength, tenderness and VAS in NDT and FR (p < 0.05). With the mean of post 24 h as well as post 48 h being less in the FR intervention.

CONCLUSION

Foam rolling is a better option than Neurodynamic therapy for reduction of intensity of DOMS.

Effectiveness of the PROMUFRA program in pre-frail, community-dwelling older people: A randomized controlled trial

This study evaluated the effect of PROMUFRA program on physical frailty, kinanthropometric, muscle function and functional performance variables in pre-frail, community-dwelling older people. Participants (n = 50, 75 ± 7 years) were randomly assigned to two groups: intervention group (IG), and control group (CG). The IG performed multi-component exercise program, focused on high-intensity resistance training (HIRT) combined with self-massage for myofascial release (SMMR) for 12 weeks (2 d.wk^-1). Two measurements were performed, at baseline and post-3 months. Participants (n = 43) were analyzed and significant differences were found in group-time interaction for muscle mass (p = 0.017), fat mass (p = 0.003), skeletal muscle mass index (p = 0.011), maximum isometric knee extension (p = 0.042), maximum dynamic knee extension (p = 0.001), maximum leg press (p < 0.001), Barthel Index (p = 0.039) and EuroQol 5-dimensions-3-levels (p = 0.012). We conclude that PROMUFRA program is an effective training method to achieve healthy improvements for the pre-frail community.

Foam Rolling Prescription: A Clinical Commentary

Behm, DG, Alizadeh, S, Hadjizadeh Anvar, S, Mahmoud, MMI, Ramsay, E, Hanlon, C, and Cheatham, S. Foam rolling prescription: a clinical commentary. J Strength Cond Res 34(11): 3301-3308, 2020-Although the foam rolling and roller massage literature generally reports acute increases in range of motion (ROM) with either trivial or small performance improvements, there is little information regarding appropriate rolling prescription. The objective of this literature review was to appraise the evidence and provide the best prescriptive recommendations for rolling to improve ROM and performance. The recommendations represent studies with the greatest magnitude effect size increases in ROM and performance. A systematic search of the rolling-related literature found in PubMed, ScienceDirect, Web of Science, and Google Scholar was conducted using related terms such as foam rolling, roller massage, ROM, flexibility, performance, and others. From the measures within articles that monitored ROM (25), strength (41), jump (41), fatigue (67), and sprint (62) variables; regression correlations and predictive quadratic equations were formulated for number of rolling sets, repetition frequency, set duration, and rolling intensity. The analysis revealed the following conclusions. To achieve the greatest ROM, the regression equations predicted rolling prescriptions involving 1-3 sets of 2-4-second repetition duration (time for a single roll in one direction over the length of a body part) with a total rolling duration of 30-120-second per set. Based on the fewer performance measures, there were generally trivial to small magnitude decreases in strength and jump measures. In addition, there was insufficient evidence to generalize on the effects of rolling on fatigue and sprint measures. In summary, relatively small volumes of rolling can improve ROM with generally trivial to small effects on strength and jump performance.

INYBI: A New Tool for Self-Myofascial Release of the Suboccipital Muscles in Patients With Chronic Non-Specific Neck Pain: A Randomized Controlled Trial

STUDY DESIGN

A randomized, single-blinded (the outcome assessor was unaware of participants' allocation group) controlled clinical trial.

OBJECTIVE

To investigate the effects of myofascial release therapy (MRT) over the suboccipital muscles, compared with self-MRT using a novel device, the INYBI tool, on pain-related outcomes, active cervical mobility, and vertical mouth opening, in adults with chronic non-specific neck pain (NSNP).

SUMMARY OF BACKGROUND DATA

MRT is used to manage chronic musculoskeletal pain conditions, with purported positive effects. The efficacy of self-MRT, compared with MRT, has been scarcely evaluated.

METHODS

Fifty-eight participants (mean age of 34.6 ± 4.7 yrs; range 21-40 yrs; 77.6% females, 22.4% males) with persistent NSNP agreed to participate, and were equally distributed into an INYBI (n = 29) or a control group (n = 29). Both groups underwent a single 5-minutes intervention session. For participants in the control group, MRT of the suboccipital muscles was performed using the suboccipital muscle inhibition technique, while those in the INYBI group underwent a self-MRT intervention using the INYBI device. Primary measurements were taken of pain intensity (visual analogue scale), local pressure pain sensitivity, as assessed with an algometer, and active cervical range-of-movement. Secondary outcomes included pain-free vertical mouth opening. Outcomes were collected at baseline, immediately after intervention and 45 minutes later.

RESULTS

The analysis of variance (ANOVAs) demonstrated no significant between-groups effect for any variable (all, P > 0.05). In the within-groups comparison, all participants significantly improved pain-related outcomes, and showed similar positive changes for mouth opening. Cervical range-of-movement- mainly increased after intervention for participants in the control group.

CONCLUSION

Both, MRT and self-MRT using the INYBI, are equally effective to enhance self-reported pain intensity, and local pressure pain sensitivity in chronic NSNP patients. For cervical mobility, MRT appears to be slighlty superior, compared with the INYBI, to achieve improvements in this population.

LEVEL OF EVIDENCE

2.

INFLUENCE OF AN ACUTE BOUT OF SELF-MYOFASCIAL RELEASE ON KNEE EXTENSION FORCE OUTPUT AND ELECTRO-MECHANICAL ACTIVATION OF THE QUADRICEPS

Background

In contrast to static stretching (SS), previous research has demonstrated increases in flexibility after an acute bout of self-myofascial release (SMR) without any subsequent decreases in force output. Previous research has utilized measures of surface electromyography (sEMG) and mechanomyography (MMG) to examine the influence of SS on the electrical and mechanical processes of muscle activation, respectively. However, there is a lack of research examining the potential changes in electro-mechanical muscle activation post-SMR.

Purpose

To examine the influence of SMR, via an acute bout of foam rolling (FR) to the vastus lateralis (VL), on the expression of knee extension force output and the inter-muscular electro-mechanical activation of the quadriceps musculature.

Study Design

Randomized crossover trial.

Methods

Twenty (10 males, 10 females) recreationally-active participants with prior FR experience completed both SMR and control (CON) testing protocols during separate testing sessions that were conducted in a randomized order 48 hours apart. During the SMR protocol, participants performed 3 sets of 60 seconds of FR over the VL portion of their quadriceps musculature, with 60 seconds of rest between sets. During the CON protocol, participants quietly sat upright for 10 minutes. Peak knee extension force output -(Force_peak) data, as well as sEMG and MMG data from the VL and the rectus femoris (RF) were collected during maximal voluntary isometric contractions (MVICs) before and after both testing protocols. Root mean square sEMG and MMG amplitudes were calculated to represent electro-mechanical muscle activation of the VL (VL-sEMG_RMS, VL-MMG_RMS) and RF (RF-sEMG_RMS, RF-MMG_RMS) musculature.

Results

Repeated measures analyses of variance (RM ANOVAs) identified a significant (p < 0.05) increase in Force_peak within the SMR protocol among males, but no change among females. No statistically significant changes in any electro-mechanical muscle activation measures were identified pre-to-post-SMR within either sex.

Conclusion

In contrast to the SS literature body, these results suggest that SMR does not influence the electro-mechanical aspects of muscle activation during MVICs. These results provide support for the absence of decreases in force output post-SMR, but further examination regarding the potential muscle mass influence of SMR on electro-mechanical muscle function remains warranted.

Level of Evidence

2c.

Effects of an active intervention based on myofascial release and neurodynamics in patients with chronic neck pain: a randomized controlled trial

BACKGROUND

While neck pain can be severely disabling and costly, treatment options have shown moderate evidence of effectiveness.

OBJECTIVE

The objective of this study was to explore the effects of a 4-week active program based on myofascial release and neurodynamics on trigger point (TrP) examination, pain, and functionality in patients with chronic neck pain.

METHODS

Randomized controlled trial. A total of 40 patients with chronic neck pain were randomly allocated to an experimental or a control group (n = 20). The primary outcome measure was TrP examination. Secondary outcomes were pain, assessed with the Brief Pain Inventory and a visual analogue scale, and functionality, evaluated with the Neck Outcome Score.

RESULTS

A between-group analysis showed significant differences (p < .05) in the percentage of active TrPs in the following muscles: suboccipital (50 vs. 92.4% in the right muscle and 37.5 vs. 89.6% in the left muscle), left scalene and levator scapulae. Significant differences (p < .05) were also found in pain severity, average pain, and functionality (i.e. symptoms, sleep, and participation).

CONCLUSIONS

A 4-week self-administered program for patients with chronic neck pain was effective in reducing the presence of active TrPs. Pain severity, average pain, and some aspects of functionality also improved significantly after the intervention.

The Effect of Foam Rolling Versus IASTM on Knee Range of Motion, Fascial Displacement, and Patient Satisfaction

CONTEXT

Soft tissue restrictions have been linked to poor flexibility and decreased range of motion (ROM). To decrease the soft tissue restrictions and ultimately increase ROM/flexibility, myofascial release techniques, such as foam rolling (FR) and instrument-assisted soft tissue mobilization (IASTM), have been used. However, the benefit regarding which technique is more beneficial remains unknown.

OBJECTIVE

To examine the effects of myofascial release techniques (FR vs the instrumented portion of IASTM) on knee joint ROM, rectus femoris (RF) and biceps femoris (BF) fascial displacement, and patient satisfaction.

DESIGN

Randomized controlled clinical trial.

SETTING

Mid-Atlantic University.

PARTICIPANTS

Twenty moderately active participants (age 21.1 [2.0] y) with variable levels of soft tissue restriction in the quadriceps and hamstrings started and completed the study. Participants were randomly assigned to 2 groups, FR or IASTM.

INTERVENTIONS

All participants completed the same warm-up prior to the intervention. The FR group followed the proper FR protocol for gluteals/iliotibial band, quadriceps, and hamstrings/adductors, and the participants were monitored while the protocol was completed. The IASTM group received treatment on the gluteals/iliotibial band followed by the quadriceps, adductors, and hamstrings. Participants in both groups attended intervention sessions twice per week for 3 weeks. Prior to the start, knee ROM measurements were taken, along with fascial displacement measured via ultrasound. Upon completion of the study, posttest measurements were completed. A patient satisfaction survey was also administered at this time.

MAIN OUTCOME MEASURES

Pretest to posttest knee ROM measurements, RF and BF fascial displacement, and patient satisfaction.

RESULTS

Both groups improved pretest to posttest for knee-extension ROM, with a slight trend toward increased knee-extension ROM for the FR group. Both groups improved pretest to posttest for BF and RF fascial displacement, in favor of the IASTM group for BF fascial displacement. Both groups were equally satisfied.

CONCLUSIONS

As both groups improved pretest to posttest, either treatment could be used.

An Acute Bout of Self-Myofascial Release Does Not Affect Drop Jump Performance despite an Increase in Ankle Range of Motion

This study examined the acute effects of self-myofascial release plus dynamic warm up versus dynamic warm up alone on ankle range of motion and drop jump performance. Twenty-five recreationally active participants (male: 16, female: 9) were randomly assigned into a foam rolling (FR) or a dynamic warm up group (CON) (age: 22.8 ± 3.9 years, body mass 75.9 ± 13.2 kg, stretch stature: 174.1 ± 10.1 cm). In a randomised crossover design, each participant completed two experimental sessions that were separated by seven days. Ankle range of movement was assessed while using a weight-bearing lunge test and drop jump performance was recorded via bilateral force plates. Following a 5 min cycle, the foam rolling group undertook self-myofascial release to the lower limb and thoracic/lumbar regions, followed by a dynamic warm up. The control group undertook the same initial warm up plus the dynamic exercises. The level of significance was set at p ≤ 0.05. There was a significant increase (p < 0.001) in ankle range of motion immediately after the warm up for both groups (pre CON: 37.5 ± 5.31, post CON: 39.8 ± 5.76; pre FR 38.7 ± 7, post FR: 40.3 ± 7.3 deg). No significant difference was found between the conditions (p > 0.05). There were no significant differences for any indices of jump performance (p > 0.05). Based on these results, foam rolling plus dynamic exercises does not appear to impair or enhance drop jump performance, despite the increases in ankle range of movement.

Roller Massage: Difference in Knee Joint Range of Motion and Pain Perception Among Experienced and Nonexperienced Individuals After Following a Prescribed Program

CONTEXT

Roller massage (RM) is a popular myofascial intervention. To date, no research has investigated the effects of RM on experienced and nonexperienced individuals and if there are differences between a prescribed RM program and a self-preferred program.

OBJECTIVE

The main objective was to measure the effects of a prescribed RM program with a foam roller on knee passive range of motion (ROM) and pressure pain threshold (PPT) among experienced and nonexperienced individuals. A secondary objective was to determine if there are differences between a prescribed RM program and a self-preferred program in experienced individuals.

DESIGN

Pretest and posttest observational study.

SETTING

University kinesiology laboratory.

PARTICIPANTS

A total of 60 healthy adults (age = 26 [5.3] y) were allocated into 3 groups of 20 subjects: experienced, nonexperienced, and control. The experienced and nonexperienced groups followed a prescribed 2-minute RM intervention. The control group did their own 2-minute self-preferred program.

MAIN OUTCOME MEASURES

Knee passive ROM and PPT.

RESULTS

For the experienced and nonexperienced, the between-group analysis revealed a statistically significant difference for ROM and PPT (P < .001). Within-group analysis revealed a posttest knee passive ROM increase of 8° for experienced and 7° for the nonexperienced. For PPT, there was a posttest increase of 180 kPa for the experienced and 169 kPa for the nonexperienced. For the prescribed versus self-preferred program, the between-group analysis (experienced vs control) revealed a statistically significant difference (P < .001). The within-group analysis revealed a posttest knee passive ROM increase of 8° for the prescribed and 5° for the self-preferred program. For PPT, there was a posttest increase of 180 kPa for the prescribed program and 137 kPa for the self-preferred program.

CONCLUSION

These findings suggest that experienced and nonexperienced individuals have similar responses to a prescribed RM program. A prescribed RM program may produce better outcomes than a self-preferred program.

Effects of Static Stretching and Foam Rolling on Ankle Dorsiflexion Range of Motion

Static stretching (SS) has been used for inducing acute and long-term increases in range of motion (ROM). Foam rolling (FR) has recently gained popularity for acutely increasing ROM. However, the long-term effects of FR on ROM have not been thoroughly evaluated. Therefore, the purpose of this study was to investigate the acute and long-term changes in dorsiflexion ROM as a result of 6 wk of FR, SS, and FR followed by SS (FR + SS).

METHODS

Participants (n = 44) were randomly assigned to FR, SS, and FR + SS groups. The FR group foam rolled the triceps surae. The SS group performed a wall stretch for both legs. The FR + SS group performed FR immediately followed by SS. All groups completed 12 training sessions in 6 wk. Dorsiflexion ROM was assessed before and after the first training session, before the second session of week 3, before and after the last session in week 6, and at week 7.

RESULTS

There was a 4.0% acute increase in ROM at week 6 (P = 0.004) for all three groups. ROM increased 8.4% from week 3 to week 7 for all three groups (P < 0.001). When comparing week 1 baseline to week 7, ROM increased 18.3% for all three groups (P = 0.003).

CONCLUSION

SS and FR seem to be comparable in terms of increasing dorsiflexion ROM acutely as well as after 6 wk of training for healthy, university-age participants. FR combined with SS does not seem to provide a synergistic effect on improving dorsiflexion ROM.

Influence of Foam Rolling Velocity on Knee Range of Motion and Tissue Stiffness: A Randomized, Controlled Crossover Trial

CONTEXT

Foam rolling (FR) increases joint range of motion (RoM), but the optimal training parameters are unknown.

OBJECTIVE

To investigate the effect of FR velocity on RoM and tissue stiffness.

DESIGN

Randomized, controlled crossover trial.

SETTING

University.

PARTICIPANTS

A total of 17 healthy, physically active adults (10 females; 25 [2] y).

INTERVENTIONS

(1) Four 45-second high-velocity FR of the anterior thigh (FAST-FR), (2) four 45-second slow-velocity FR of the anterior thigh (SLOW-FR), and (3) inactive control.

OUTCOME MEASURES

Maximal knee-flexion RoM (ultrasonic movement analysis) and anterior thigh tissue stiffness (semielectronic tissue compliance meter) assessed pre, immediately post (T0), as well as 5 (T5) and 10 (T10) minutes postintervention. Statistical analysis included Friedman tests with adjusted post hoc comparisons (Wilcoxon tests).

RESULTS

According to omnibus testing, RoM remained unchanged in all 3 conditions and at all time points (P > .05), while differences were found for tissue stiffness (P < .05). Post hoc tests revealed significant decreases following FAST-FR (T5: -17%, T10: -24%; P < .05) and SLOW-FR (T10: -15%; P < .05). The observed stiffness changes were significant in comparison with control (P < .01), but no difference was found between the 2 FR conditions (P > .05).

CONCLUSIONS

FR of the anterior thigh decreases myofascial stiffness regardless of velocity. The lack of effects on RoM contrasts findings of recent literature and warrants further investigation.

Roller Massage: A Descriptive Survey of Allied Health Professionals

BACKGROUND

In sports medicine, the interprofessional care of athletes has become a frequent practice. This type of care often involves different interventions used among professionals. One common intervention prescribed is roller massage (RM) or self-myofascial release. The trends in the use of RM among allied health professionals are nonexistent. The surveillance of such responses has not been documented.

PURPOSE

To survey and document responses in the knowledge, clinical application, and use of RM devices among allied health professionals in the United States.

DESIGN

Cross-sectional descriptive survey study.

METHODS

A 20-question survey was sent to allied health professionals including physical therapists, athletic trainers, and fitness professionals. The survey covered topics such as demographics, beliefs about RM, preferred devices, exercise prescription, and client education.

RESULTS

One thousand and forty-two professionals (N = 1042) completed the survey. Most respondents believed that RM decreases pain (82%) and increases mobility (76%). A high percentage use a foam roller in their practice (81%), recommend a full-size foam roller (49%), and believe the medium density (48%) is the most effective. A high proportion of respondents prescribe RM for injury treatment (69%) and for preexercise and postexercise (61%). They also recommend rolling daily for 30 seconds to 2 minutes per muscle group (33%) at a self-paced cadence (46%). A high percentage of respondents use patient-reported outcomes (74%), joint range of motion (49%), and movement-based testing (48%) to measure effects of RM. Eighty-seven percent use live instruction to educate clients, and 88% believe there is a gap in the research.

CONCLUSION

The results of this survey document responses in the use of RM among allied health professionals. The reported responses provide insight into how professionals are using RM as an intervention and the potential gaps between the research and professional practice. Future studies are needed to further validate these findings.

Effects of Foam Rolling as a Recovery Tool in Professional Soccer Players

Rey, E, Padrón-Cabo, A, Costa, PB, and Barcala-Furelos, R. Effects of foam rolling as a recovery tool in professional soccer players. J Strength Cond Res 33(8): 2194-2201, 2019-Foam rolling (FR) is a common strategy used after training and competition by players. However, no previous studies have assessed the effectiveness of FR as a recovery tool in sports populations. The aim of this study was to examine the effectiveness of FR (20 minutes of FR exercises on quadriceps, hamstrings, adductors, gluteals, and gastrocnemius) and passive recovery (20 minutes sit on a bench) interventions performed immediately after a training session on Total Quality Recovery (TQR), perceived muscle soreness, jump performance, agility, sprint, and flexibility 24 hours after the training. During 2 experimental sessions, 18 professional soccer players (age 26.6 ± 3.3 years; height: 180.2 ± 4.5 cm; body mass: 75.8 ± 4.7 kg) participated in a randomized fully controlled trial design. The first session was designed to collect the pretest values of each variable. After baseline measurements, the players performed a standardized soccer training. At the end of training unit, all the players were randomly assigned to the FR recovery group and the passive recovery group. A second experimental session was conducted to obtain the posttest values. Results from the between-group analyses showed that FR had a large effect on the recovery in agility (effect sizes [ES] = 1.06), TQR (ES = 1.08), and perceived muscle soreness (ES = 1.02) in comparison with the passive recovery group at 24 hours after training. Thus, it is recommended that soccer coaches and physical trainers working with high-level players use a structured recovery session lasting from 15 to 20 minutes based on FR exercises that could be implemented at the end of a training session to enhance recovery between training loads.

Different Effects of Foam Rolling on Passive Tissue Stiffness in Experienced and Nonexperienced Athletes

CONTEXT

Foam rolling (FR) has been developed into a popular intervention and has been established in various sports disciplines. However, its effects on target tissue, including changes in stiffness properties, are still poorly understood.

OBJECTIVE

To investigate muscle-specific and connective tissue-specific responses after FR in recreational athletes with different FR experience.

DESIGN

Case series.

SETTING

Laboratory environment.

PARTICIPANTS

The study was conducted with 40 participants, consisting of 20 experienced (EA) and 20 nonexperienced athletes (NEA).

INTERVENTION

The FR intervention included 5 trials per 45 seconds of FR of the lateral thigh in the sagittal plane with 20 seconds of rest between each trial.

MAIN OUTCOME MEASURES

Acoustic radiation force impulse elastosonography values, represented as shear wave velocity, were obtained under resting conditions (t0) and several times after FR exercise (0 min [t1], 30 min [t2], 6 h [t3], and 24 h [t4]). Data were assessed in superficial and deep muscle (vastus lateralis muscle; vastus intermedius muscle) and in connective tissue (iliotibial band).

RESULTS

In EA, tissue stiffness of the iliotibial band revealed a significant decrease of 13.2% at t1 (P ≤ .01) and 12.1% at t3 (P = .02). In NEA, a 6.2% increase of stiffness was found at t1, which was not significantly different to baseline (P = .16). For both groups, no significant iliotibial band stiffness changes were found at further time points. Also, regarding muscle stiffness, no significant changes were detected at any time for EA and NEA (P > .05).

CONCLUSIONS

This study demonstrates a significant short-term decrease of connective tissue stiffness in EA, which may have an impact on the biomechanical output of the connective tissue. Thus, FR effects on tissue stiffness depend on the athletes' experience in FR, and existing studies have to be interpreted cautiously in the context of the enrolled participants.

Effect of vibration vs non-vibration foam rolling techniques on flexibility, dynamic balance and perceived joint stability after fatigue

Background

Foam roller and vibration techniques are currently used to assist in recovery after fatigue. The main purpose of this study was to determine the effects of the use of a foam roller with and without vibration on dynamic balance, ankle dorsiflexion, hamstring and lumbar spine flexibility and perceived knee and ankle stability after an induced fatigue protocol.

Methods

A total of 24 healthy recreationally active participants (17 males and seven females) were recruited to a randomized cross over trial consisting of; no treatment (NT), foam roller treatment (FR) and vibration foam roller treatment (VFR). The assessments included; the Sit & Reach test, Y balance test and post-treatment perceived knee and ankle stability. Measurements were taken after a standardized warm up (baseline) and repeated following an exercise-induced muscle fatigue protocol consisting of repeated lunges until volitional fatigue. The three treatment conditions were assessed on three separate days in a randomized order. A 3 × 3 repeated measures ANOVA was used to investigate differences between the three treatments over the three time points and a one factor repeated measures ANOVA was used to determine any differences between treatments using the Global Rate of Change scale when considering perceived stability.

Results

FR and VFR conditions both showed a greater ankle dorsiflexion range of motion (ROM) (p < 0.001), greater posteromedial and posterolateral reach distances (p < 0.001) and a better knee and ankle perceived stability (p < 0.001) when compared to the NT condition. A trend toward significance was observed in the hamstring and lumbar spine flexibility (p = 0.074) in both treatment conditions when compared to the NT condition. However, no differences were seen between the FR and VFR conditions.

Conclusions

Both FR conditions seem to assist in exercise-induced muscle fatigue recovery with improvements in ROM, balance and perceived stability.

Self-Myofascial Release Effect With Foam Rolling on Recovery After High-Intensity Interval Training

The goal of this experiment was to assess the impact of self-myofascial massage with the aid of a foam roller on a lower limb immediately after high-intensity interval training (HIIT), using the Tabata protocol (20 s work/10 s rest, repeated 8 times), according to selected recovery variables. The method used Tabata squats (20 s of air squats/10 s of rest, repeated 8 times), after which the subject performed three series of self-myofascial massage with a foam roller on one leg, the other leg being used as the control. Biomechanical lower limb performance was assessed through a squat jump, a countermovement jump, and a hopping on the spot test. Flexibility was assessed through the active and passive range of motion at the hip, knee, and ankle. Pain was measured by recording the delay of muscle soreness (DOMS). Measurements were recorded immediately after the workout, then 24 and 48 h later. Twenty healthy males participated in the study. The results revealed no effect on jumping performance, in terms of height, leg stiffness, power or force output. Additionally, HIIT had a significant impact on muscle damage, as revealed by the reduction in performance 48 h later (−9.7% for the countermovement height). The self-myofascial release decreased DOMS by 50% for the massaged leg compared with 20% for the control leg and increased the hip range of motion by approximately 4.2% for the massaged leg in comparison with the unmassaged leg. This experiment reveals the poor effect of self-myofascial release on regaining the initial value of performance but could be useful for reducing DOMS after high-intensity interval training.

Acute effects of foam rolling on passive stiffness, stretch sensation and fascial sliding: A randomized controlled trial

PURPOSE

Foam Rolling (FR), aims to mimic the effects of manual therapy and tackle dysfunctions of the skeletal muscle and connective tissue. It has been shown to induce improvements in flexibility, but the underlying mechanisms are poorly understood. The aim of the present study was to further elucidate the acute, systemic and tissue-specific responses evoked by FR.

METHODS

In a crossover study, 16 (34 ± 6y, 6f) participants received all of the following interventions in a random order: a) 2 × 60 seconds of FR at the anterior thigh, b) 2 × 60 seconds of passive static stretching of the anterior thigh (SS), and c) no intervention (CON). Maximal active and passive knee flexion range of motion (ROM), passive stiffness, sliding of fascial layers, as well as knee flexion angle of first subjectively perceived stretch sensation (FSS) were evaluated before and directly after each intervention.

RESULTS

Flexibility increased only after, FR (active (+1.8 ± 1.9%) and passive ROM (+3.4 ± 2.7%), p = .006, respectively) and SS (passive ROM (+3.2 ± 3.5%), p = .002). Angle of FSS was altered following FR (+4.3° (95% CI: 1.4°-7.2°)) and SS (+6.7° (3.7°-9.6°)), while tissue stiffness remained unchanged after any intervention compared to baseline. Movement of the deepest layer (-5.7 mm (-11.3 mm to -0.1 mm)) as well as intrafascial sliding between deep and superficial layer (-4.9 mm (-9.mm to -0.7 mm)) decreased only after FR.

CONCLUSION

FR improved knee flexion ROM without altering passive stiffness, but modified the perception of stretch as well as the mobility of the deep layer of the fascia lata. The mechanisms leading to altered fascial sliding merit further investigation.

Jogging and Practical-Duration Foam-Rolling Exercises and Range of Motion, Proprioception, and Vertical Jump in Athletes

CONTEXT

Foam-rolling exercises are frequently included in warmups due to their benefits for increasing range of motion (ROM). However, their effects on proprioception and vertical jump have not been analyzed and therefore remain unclear. Moreover, the effects of performing practical-duration foam-rolling exercises after typical warmup exercises such as jogging are unknown.

OBJECTIVE

To analyze the effects of jogging and practical-duration foam-rolling exercises on the ROM, knee proprioception, and vertical jump of athletes.

DESIGN

Randomized controlled study.

SETTING

Sports laboratory and university track.

PATIENTS OR OTHER PARTICIPANTS

Thirty athletes were randomly classified into an experimental group (EG) or control group (CG).

INTERVENTION(S)

The EG performed 8-minute jogging and foam-rolling exercises. The CG performed 8-minute jogging.

MAIN OUTCOME MEASURE(S)

Knee flexion, hip extension, active knee extension, ankle dorsiflexion (ADF), knee-joint position sense, and countermovement jump (CMJ) were evaluated before the intervention (baseline), after (post 0 min), and 10 minutes later.

RESULTS

The EG exhibited higher values for ADF and CMJ at post 0 min (ADF: P < .001, d = 0.88; CMJ: P < .001, d = 0.52) and 10 minutes later (ADF: P = .014, d = 0.41; CMJ: P = .006, d = 0.22) compared with baseline. Although the CG also showed increased CMJ at post 0 min (P = .044, d = 0.21), the EG demonstrated a greater increase (P = .021, d = 0.97). No differences were found in the remaining ROM variables (knee flexion, hip extension, active knee extension: P values > .05). For knee-joint position sense, no differences were found (P > .05).

CONCLUSIONS

Combining jogging and practical-duration foam rolling may increase ADF and CMJ without affecting knee proprioception and hip or knee ROM. Jogging by itself may slightly increase ADF and CMJ, but the results were better and were maintained after 10 minutes when foam rolling was added.

Foam Rolling as a Recovery Tool Following Eccentric Exercise: Potential Mechanisms Underpinning Changes in Jump Performance

Purpose

Recovery from exercise-induced muscle damage (EIMD) is paramount in sports performance. Foam rolling (FR) has been suggested to improve acute performance; however, the ability to facilitate recovery from eccentric (ECC) exercise remains unclear.

Methods

Eleven males undertook 6 × 25 ECC knee extensions to induce muscular damage. Immediately, 24, 48, and 72 h post-training countermovement jump (CMJ), maximal voluntary isometric contraction (MVIC), pressure-pain threshold (PPT), knee flexion range of motion (ROM), and mid-thigh circumference (MTC) were assessed. Neurophysiological measures included voluntary activation (VA), peak twitch torque (PTT), time to peak twitch (PTT_time), and rate of twitch torque development (RTD). Participants then spent 15 min FR prior to each time point or control (CON). Repeated measures analysis of variance (ANOVA) and standardized effect sizes (Hedges' g) ± 95% confidence intervals (95% CI) were used to compare FR and CON.

Results

CMJ was greater for FR compared to CON (P = 0.030) at 72 h (8.6%, P = 0.004) with moderate effects observed at 48 and 72 h (g = 0.54-0.66). PPT was greater with FR (P = 0.018) at 48 h only (23.7%, P = 0.013), with moderate to large effects noted at all-time points (g = 0.55-0.98). No significant differences were reported for MVIC (P = 0.777, -5.1 to 4.2%), ROM (P = 0.432, 1.6-3.5%), VA (P = 0.050, 3.6-26.2%), PTT (P = 0.302, -3.9 to 9.9%), PTT_time (P = 0.702, -24.4 to 23.5%), RTD (P = 0.864, -16.0 to -1.0%), or MTC (P = 0.409, -0.5 to -0.1%) between conditions.

Conclusion

FR appears to improve jump performance in the later stages of recovery following ECC exercise. This may be in part due to improved pain tolerance; however, mechanical and neurophysiological are not modulated with FR.

Roller massage: Comparison of three different surface type pattern foam rollers on passive knee range of motion and pain perception

INTRODUCTION

Roller massage with a foam roller has become a common intervention. To date, no studies have examined the therapeutic effects of different surface type rollers. The purpose of this study was to measure the therapeutic effects of three different surface type pattern foam rollers with the same density on passive knee joint range of motion (ROM) and pressure pain threshold (PPT) of the quadriceps.

METHODS

This pre-test, post-test randomized controlled trial was conducted in a university laboratory. Thirty-six participants (M = 22, F = 14; mean age = 25.20 ± 4.44 years) were randomly assigned to three groups: (1) smooth surface, (2) multilevel surface, and (3) GRID surface. The intervention was a 2-min rolling session. Outcomes included knee ROM and PPT.

RESULTS

Between group comparisons revealed a statistically significant post-intervention difference between the three rollers for knee ROM (p = 0.04) and PPT (p < 0.001). Within group comparison for ROM revealed a 3-degree (p = 0.015) increase for the smooth, a 5-degree (p < 0.001) increase for the multilevel, and a 6-degree (p < 0.001) increase for the GRID surface roller. For PPT, there was an increase of 14 kPa (p = 0.562) for the smooth, 179 kPa (p < 0.001) for the multilevel, and 182 kPa (p < 0.001) for the GRID.

CONCLUSION

The GRID and multilevel surface rollers produced greater immediate post-intervention effects than the smooth roller. The therapeutic effects of the GRID and multilevel rollers may be due to the surface architecture. These rollers may provide a greater deformation of the tissues which creates a local mechanical and global neurophysiological effect.

The immediate effects of foam roller with vibration on hamstring flexibility and jump performance in healthy adults

This study aimed to determine whether foam roller with vibration (FRV) can improve hamstring flexibility and jump performance in young adults. Twenty subjects were randomly allocated into either the FRV or the foam-roller with no vibration (FRNV) groups. The vibration of the vibration foam-roller was 32 Hz. All participants completed one 10-min session on the hamstring. Active straight leg raising (ASLR) test in supine position and active knee extension (AKE) test in sitting position were performed to measure hamstring flexibility, before and immediately after the session. ASLR, AKE, and vertical jump performance test were performed before the session and immediately after the session. Analysis of covariance was used to determine statistical significance. ASLR and AKE tests were significantly different between FRV and FRNV, except the right hamstring. There was significant improvement with respect to ASLR and AKE tests after the session in FRV group. The vertical jump performance test of both groups was not significantly different after the session. FRV is more effective than FRNV for improving hamstring flexibility.