The Accumulated Effects of Foam Rolling Combined with Stretching on Range of Motion and Physical Performance: A Systematic Review and Meta-Analysis

Effects of Foam Rolling Prior to Proprioceptive Neuromuscular Facilitation Stretching on Hamstring Flexibility and Thigh Skin Temperature

CONTEXT

Proprioceptive neuromuscular facilitation stretching (PNFS) is suggested to improve the range of motion and flexibility as an active warm-up. Recently, the foam rolling (FR) methods have also emerged as a passive warm-up. However, the combined effects of PNFS and FR are still unclear, and no reports have compared their effects using thermal imaging. This study investigated the acute effects of combining nonvibration FR (NVFR) and vibration FR (VFR) prior to PNFS, in comparison with PNFS alone, on hamstring flexibility and thigh skin temperature.

DESIGN

Randomized controlled trial.

METHODS

Participants (n = 60) were randomly assigned to PNFS, NVFR + PNFS, VFR + PNFS, and control group (CG). Active knee-extension (AKE), sit and reach (SR) test, and thermal imaging were evaluated before (pre-int), immediately after (post-int), and 30-minutes after (post30-int) intervention.

RESULTS

All intervention groups had a significant increase at all time periods (P < .001) except the CG in terms of AKE and sit and reach test (P > .05). Combined (NVFR + PNFS/VFR + PNFS) groups had also a significant increase in the post30-int compared with pre-int and post-int values of thigh skin temperature (P < .001). Combined groups, over time, had the best post30-int effect on increasing skin temperature. The study found a significant interaction effect between interventions and time across several measurements (P < .05). Combined groups showed more significant improvements in AKE compared to CG at post-int (P < .05). There is a similar change in AKE, SR test, and skin temperatures between combined groups and PNFS alone at both post-int and post30-int (P < .05).

CONCLUSIONS

These findings indicate that using FR, with or without vibration, before PNFS does not provide an additional benefit in improving hamstring flexibility and thigh skin temperatures compared with PNFS alone.

Effects of slow dynamic, fast dynamic, and static stretching on recovery of performance, range of motion, balance, and joint position sense in healthy adults

INTRODUCTION

Considering the effects of fatigue on athletic performance and the subsequent increase in the probability of injury, the purpose of this study was to compare the effects of slow dynamic, fast dynamic, and static stretching on the recovery of performance, range of motion (ROM), balance, and joint position sense.

METHODS

Fifteen collegiate healthy females were involved in four separate sessions of slow dynamic stretching (SDS), fast dynamic stretching (FDS), static stretching (SS), and control condition (CC; without stretching), in a random order with at least 48 h of rest between sessions. After warming up, the individuals performed ROM, balance, joint position sense (JPS) maximum voluntary isometric contraction (MVIC) force as well as countermovement (CMJ) and squat jump (SJ) as pre-tests. After performing the knee fatigue protocol of 4 sets of knee extension and flexion at 60% of 1 repetition maximum (RM) to exhaustion (CC; without stretching) or stretching programs (SDS or FDS or SS), the subjects repeated all the tests at post-test 1 (after 5 min) and post-test 2 (after 60 min).

RESULTS

A significantly lower JPS error was detected with SDS while JPS error increased in the SS and control conditions (p < 0.0001). MVIC force significantly increased with SDS and FDS but decreased in control and SS conditions (p < 0.0001). Moreover, a significant decrease in CMJ and SJ height in SS and control conditions was revealed (p < 0.0001). Also, a significant decrease in balance with the control condition was revealed. But only SDS minimized fatigue-induced balance decrements (p < 0.0001). Additionally, the control condition experienced a significant decrease in knee extensor ROM, which contrasted with the significant increase in the quadriceps flexibility with the stretching conditions.

CONCLUSIONS

The present results support the idea that SDS may increase quadriceps MVIC force, knee extensor ROM and knee JPS. So according to the present results, it is suggested that the SDS could be implemented and incorporated into a regular recovery program.

Foam rolling and stretching do not provide superior acute flexibility and stiffness improvements compared to any other warm-up intervention: A systematic review with meta-analysis

BACKGROUND

Acute improvement in range of motion (ROM) is a widely reported effect of stretching and foam rolling, which is commonly explained by changes in pain threshold and/or musculotendinous stiffness. Interestingly, these effects were also reported in response to various other active and passive interventions that induce responses such as enhanced muscle temperature. Therefore, we hypothesized that acute ROM enhancements could be induced by a wide variety of interventions other than stretching or foam rolling that promote an increase in muscle temperature.

METHODS

After a systematic search in PubMed, Web of Science, and SPORTDiscus databases, 38 studies comparing the effects of stretching and foam rolling with several other interventions on ROM and passive properties were included. These studies had 1134 participants in total, and the data analysis resulted in 140 effect sizes (ESs). ES calculations were performed using robust variance estimation model with R-package.

RESULTS

Study quality of the included studies was classified as fair (PEDro score = 4.58) with low to moderate certainty of evidence. Results showed no significant differences in ROM (ES = 0.01, p = 0.88), stiffness (ES = 0.09, p = 0.67), or passive peak torque (ES = -0.30, p = 0.14) between stretching or foam rolling and the other identified activities. Funnel plots revealed no publication bias.

CONCLUSION

Based on current literature, our results challenge the established view on stretching and foam rolling as a recommended component of warm-up programs. The lack of significant difference between interventions suggests there is no need to emphasize stretching or foam rolling to induce acute ROM, passive peak torque increases, or stiffness reductions.

Golfers' Performance Is Improved More by Combining Foam Rolling and Dynamic Stretch to the Lead Hip Than Practice Golf Swinging

ABSTRACT

Hamada, Y, Akasaka, K, Otsudo, T, Sawada, Y, Hattori, H, Kikuchi, Y, and Hall, T. Golfers' performance is improved more by combining foam rolling and dynamic stretch to the lead hip than practice golf swinging. J Strength Cond Res 38(7): e391-e397, 2024-Warming up is considered effective in improving performance and preventing injury. Despite this, there have been few studies investigating warm-up programs in golf and whether specific factors contribute to improved performance. The purpose of this study was to examine the immediate effects of combined foam rolling and dynamic stretch (FR + DS) to the lead hip on golf swing performance, hip range of motion (ROM), and muscle strength in amateur golfers using a randomized crossover design. The study sample comprised 22 men (mean ± SD ; age, 32.6 ± 8.5 years, body mass index (BMI), 23.4 ± 2.7 kg·m -2 ). Subjects were assigned to receive either FR + DS or repetitive golf swing practice (SW) before crossing over to the other intervention for another day. Measurements included golf swing performance (ball speed, club head speed, flight distance ["carry"], spin rate, and launch angle), hip internal rotation (IR), and external rotation (ER) ROM, as well as hip IR and ER muscle strength. Comparisons between groups were made before and after each intervention. For golf swing performance, FR + DS improved "carry" significantly more than SW ( p < 0.05). No significant differences in golf swing performance other than "carry" were found. In addition, IR ROM and IR muscle strength of the lead hip were significantly increased in the FR + DS group ( p < 0.05). FR + DS has effects on improving lead hip IR ROM and IR muscle strength, which may facilitate golfers' swing and "carry." FR + DS shows promise as a warm-up method for amateur golfers who want to improve golf performance.

Effects of Myofascial Release Techniques on Joint Range of Motion of Athletes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Although myofascial release techniques (MRTs) are commonly used to improve athletes' range of motion (ROM), the effectiveness of MRTs may vary depending on the specific method performed. This systematic review and meta-analysis aimed to evaluate the effects of MRTs on the ROM performance of athletes. (2) Methods: The electronic databases of Cochrane Library, PubMed, Scopus, and Web of Science were searched to identify relevant articles published up to June 2023. This study utilized the PRISMA guidelines, and four databases were searched. The methodological quality of the studies was assessed using the PEDro scale, and the certainty of evidence was reported using the GRADE scale. The overall effect size was calculated using the robust variance estimator, and subgroup analyses were conducted using the Hotelling Zhang test. (3) Ten studies met the inclusion criteria. The overall effect size results indicated that the myofascial release intervention had a moderate effect on ROM performance in athletes when compared to the active or passive control groups. (4) Conclusions: Alternative MRTs, such as myofascial trigger point therapy, can further improve the ROM performance of athletes. Gender, duration of intervention, and joint type may have a moderating effect on the effectiveness of MRTs.

Is muscle stiffness a determinant for range of motion in the leg muscles?

Previous training studies with comprehensive stretching durations have reported that an increase in range of motion (ROM) can be related to decreases in muscle stiffness. Therefore, the purpose of this study was to analyze the association between the passive muscle stiffness of three muscle groups (triceps surae, quadriceps, hamstrings) to the respective joint ROM. Thirty-six healthy male soccer players volunteered in this study. After a standardized warm-up, the muscle stiffness was tested via shear wave elastography in six muscles (gastrocnemius medialis and lateralis, rectus femoris, semitendinosus, semimembranosus, and biceps femoris long head). The hip extension, hip flexion, and ankle dorsiflexion ROM were also assessed with a modified Thomas test, a sit and reach test, and a standing wall push test, respectively. We found significant moderate to large correlations between hip flexion ROM and muscle stiffness for the semimembranosus (rP = -0.43; P = 0.01), biceps femoris long head (rP = -0.45; P = 0.01), and overall hamstring stiffness (rP = -0.50; P < 0.01). No significant correlations were found for triceps surae (rP = -0.12; P = 0.51 to 0.67) and rectus femoris muscle stiffness (rP = 0.25; P = 0.14) with ankle dorsiflexion and hip extension ROM, respectively. We conclude that muscle stiffness is an important contributor to hip flexion ROM, but less important for hip extension or ankle joint ROM. Additional contributors to ROM might be tendon stiffness or stretch/pain tolerance.

Effects of Percussive Massage Treatments on Symptoms Associated with Eccentric Exercise-Induced Muscle Damage

Percussive massage (PM) is an emerging recovery treatment despite the lack of research on its effects post-eccentric exercise (post-EE). This study investigated the effects of PM treatments (immediately, 24, 48, and 72 h post-EE) on the maximal isometric torque (MIT), range of motion (ROM), and an 11-point numerical rating scale (NRS) of soreness of the nondominant arm's biceps brachii from 24-72 h post-EE. Seventeen untrained, college-aged subjects performed 60 eccentric elbow flexion actions with their nondominant arms. Nine received 1 minute of PM, versus eight who rested quietly (control [CON]). In order, NRS, ROM, and MIT (relative to body mass) were collected pre-eccentric exercise (pre-EE) and after treatment (AT) at 24, 48, and 72 h post-EE. NRS was also collected before treatment (BT). Electromyographic (EMG) and mechanomyographic (MMG) amplitudes were collected during the MIT and normalized to pre-EE. There were no interactions for MIT, EMG, or MMG, but there were interactions for ROM and NRS. For ROM, the PM group had higher values than the CON 24-72 h by ~6-8°, a faster return to pre-EE (PM: 48 h, CON: 72 h), and exceeded their pre-EE at 72 h by ~4°. The groups' NRS values did not differ BT 24-72 h; however, the PM group lowered their NRS from BT to AT within every visit by ~1 point per visit, which resulted in them having lower values than the CON from 24-72 h by ~2-3 points. Additionally, the PM group returned their NRS to pre-EE faster than the CON (PM: BT 72 h, CON: never). In conclusion, PM treatments may improve ROM without affecting isometric strength or muscle activation 24-72 h post-EE. Although the PM treatments did not enhance the recovery from delayed onset muscle soreness until 72 h, they consistently provided immediate, temporary relief when used 24-72 h post-EE.

The Acute Effect of Percussive Massage Intervention with and without Heat Application on Plantar Flexor Muscles' Passive and Active Properties

Recently, percussive massage (PM) intervention using a handheld percussive massage device, namely a massage gun, has been used as an easy way to perform vibration functions. Additionally, a product has been developed that allows PM intervention and heat application to be performed simultaneously. Thus, this study aimed to compare the acute effects of PM intervention with and without heat application on dorsiflexion (DF) range of motion (ROM), passive stiffness, and muscle strength in the gastrocnemius muscle. Fifteen healthy young men (20.9 ± 0.2 years) participated in this study. We measured the DF ROM, passive torque at DF ROM (an indicator of stretch tolerance), passive stiffness, and maximum voluntary isometric contraction (MVIC) torque of the plantar flexor muscles before and immediately after 120 seconds PM intervention with and without heat application. The results showed that PM intervention with and without heat application significantly increased DF ROM and passive torque at DF ROM and decreased passive stiffness, not MVIC torque. These results suggest that PM intervention increased ROM and decreased passive stiffness regardless of the presence or absence of the heat application.

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.

Effects of functional correction training on movement patterns and physical fitness in male college students

The objective of this study is to investigate the effects of functional corrective training and static stretching on the quality of movement patterns and physical fitness in college students. The study was conducted with 30 male college students from a university in Guangzhou, China. The participants were randomly assigned to either the functional corrective training group (FCT, n = 15, age = 20.93 ± 0.85, BMI = 22.07 ± 2.33) or the static stretching group (SS, n = 13, age = 20.85 ± 0.86, BMI = 21.98 ± 1.80). Two participants from the SS group dropped out due to personal reasons, leaving 13 subjects in that group. Both groups underwent a 6-week training intervention, with sessions held twice a week. The FCT group participated in flexibility training, and/or static motor control training, and/or dynamic motor control training for 10-15 min. The SS group performed static stretching exercises targeting five specific muscles, with 30 s per side and two sets. The Functional Movement Screen (FMS), body composition, sit-and-reach, standing long jump, and pull-ups were assessed before and after the intervention. Differences in FMS outcomes were analyzed using two samples of the Mann-Whitney U test. Physical fitness outcomes were analyzed using a repeated measures analysis of variance (ANOVA) with a 2 (group) × 2 (time) design. After 6 weeks of intervention, the FCT group showed statistically significant improvements in the hurdle step (Z = -2.449, p = 0.014), inline lunge (Z = -2.000, p = 0.046), rotary stability (Z = -2.309, p = 0.021), and composite scores (Z = -3.316, p = 0.001). Comparisons between groups indicated that BMI (FCT, ES = 0.04; SS, ES = -0.11), 30-m sprint (FCT, ES = 0.12; SS, ES = 0.28), body fat percentage (BF%) (FCT, ES = -0.25; SS, ES = -0.07), and sit-and-reach (FCT, ES = 0.17; SS, ES = 0.06) were not statistically significant in both the pre- and post-tests. The effect sizes of all physical fitness indicators were greater in the FCT group than in the SS group. The FCT, consisting of two sessions per week for 6 weeks, has been proven to be effective in improving the quality of movement patterns by improved stability and advanced movements. However, the improvements in physical fitness did not reach statistical significance. FMS and FCT are generally affordable and accessible for college students. College students have the opportunity to employ the FMS tool to assess potential injury risks and address them, thereby reducing the risk of injuries.

The non-local effects of 7-week foot sole static stretching and foam rolling training on shoulder extension range of motion

Static stretching and foam rolling can increase the range of motion (ROM) of a joint acutely as well as chronically. Although studies have reported ROM increases of a non-stretched heterologous muscle (non-local) following an acute static stretching or foam rolling session, these effects have not been studied for long-term training interventions. Therefore, the purpose of this study was to investigate the effects of a comprehensive 7-week static stretching and foam rolling training program of the foot sole on shoulder extension ROM. A total of 33 healthy, physically active participants (20 male) were assigned to either the intervention (n = 19) or control (n = 14) group. The intervention group performed a 7-week combined static stretching and foam rolling intervention comprising three sessions a week, including three exercises of the foot sole for 5 min each. Before and after the intervention period, the shoulder extension ROM was tested with three-dimensional (3D) motion caption. The level of significance for all statistical analyses was set to ρ ≤ 0.05. There was no significant time (p = 0.70, F1, 31 = 0.157; η2 = 0.005) or time×group effect (p = 0.38, F1, 31 = 0.785; η2 = 0.025) in shoulder extension ROM, indicating no ROM changes in the intervention or the control group. Although previous studies on the acute effects of stretching and foam rolling reported non-local increases in ROM in heterologous muscles, this study could show that such effects do not occur after chronic SS and foam rolling training for 7 weeks. Consequently, if the goal is to chronically increase the ROM of a specific joint, it is recommended to directly treat the muscles of interest.

Stretch tolerance and elastic passive reaction of the quadriceps femoris seem to depend more on the fascia profundis taut surfaces than on the underlying stretched muscle

The rectus femoris and its covering, the fascia lata (i.e., fascia profundis), are two anatomical structures involved in anterior thigh stretching. This study aimed to identify the role of strain changes in the fascia lata in limiting stretch tolerance. The reaction force intensity of 11 men and 5 women was assessed during passive stretching of the anterior thigh at 130, 110, 90, and 70° of knee flexion. Recent data suggest that the fascia lata strain field is modified with knee flexion. Therefore, the relationship between knee flexion angle and stretch tolerance was assessed. We found that the reaction force of the anterior thigh increased almost linearly with the degree of knee extension between 130° and 70°. The fascia lata stretched surface proprioceptive information seems responsible for stretch tolerance. Fascia profundis strain field must be considered during stretching experiments.

Acute Effects of Various Stretching Techniques on Range of Motion: A Systematic Review with Meta-Analysis

Background

Although stretching can acutely increase joint range of motion (ROM), there are a variety of factors which could influence the extent of stretch-induced flexibility such as participant characteristics, stretching intensities, durations, type (technique), and muscle or joint tested.

Objective

The objective of this systematic review and meta-analysis was to investigate the acute effects of stretching on ROM including moderating variables such as muscles tested, stretch techniques, intensity, sex, and trained state.

Methods

A random-effect meta-analysis was performed from 47 eligible studies (110 effect sizes). A mixed-effect meta-analysis subgroup analysis was also performed on the moderating variables. A meta-regression was also performed between age and stretch duration. GRADE analysis was used to assess the quality of evidence obtained from this meta-analysis.

Results

The meta-analysis revealed a small ROM standard mean difference in favor of an acute bout of stretching compared to non-active control condition (ES = −0.555; Z = −8.939; CI (95%) −0.677 to −0.434; p  < 0.001; I2 = 33.32). While there were ROM increases with sit and reach (P  = 0.038), hamstrings (P  < 0.001), and triceps surae (P  = 0.002) tests, there was no change with the hip adductor test (P  = 0.403). Further subgroup analyses revealed no significant difference in stretch intensity (P  = 0.76), trained state (P  = 0.99), stretching techniques (P  = 0.72), and sex (P  = 0.89). Finally, meta-regression showed no relationship between the ROM standard mean differences to age (R2 = −0.03; P  = 0.56) and stretch duration (R 2 = 0.00; P  = 0.39), respectively. GRADE analysis indicated that we can be moderately confident in the effect estimates.

Conclusion

A single bout of stretching can be considered effective for providing acute small magnitude ROM improvements for most ROM tests, which are not significantly affected by stretch intensity, participants’ trained state, stretching techniques, and sex.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40798-023-00652-x.

The meta-analysis on joint range of motion (ROM) increases revealed a small effect size in favor of an acute bout of stretching compared to the control condition. Subgroup analysis revealed a significant increase in ROM with sit and reach, hamstrings, and triceps surae tests, but no improvement with the hip adductor tests. Whereas all moderating variables presented significant increases in ROM, further subgroup analyses revealed no significant difference in ROM gains with the stretch intensity, trained state of the participants, stretching techniques, and sex. A meta-regression showed no relationship between the effect sizes to age and stretch duration, respectively.

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.

The Acute Effects of Theragun™ Percussive Therapy on Viscoelastic Tissue Dynamics and Hamstring Group Range of Motion

Handheld percussive therapy (PT) massage guns have seen a rapid rise in use and with-it increased attention within injury prevention and sport performance settings. Early studies have proposed beneficial effects upon range of motion (ROM), however the mechanism behind these increases remains unreported. This study aimed to determine the influence of a minimal frequency PT dose upon ROM and myotonometry outcomes. Twenty participants (N = 20; 13 males and 7 females, height 1.78cm ± 9.62; weight 77.35kg ± 8.46) participants were allocated to either a PT group receiving 2 x 60-seconds (plus 30-seconds rest) via a Theragun™ Pro4 to the hamstrings covering a standardised 20 lengths from proximal to distal via the standard ball attachment at 1 bar of pressure or a control group (CON) of 2-minutes 30-seconds passive supine rest. Pre and post intervention outcomes were measured for ROM via passive straight leg raise (PSLR) and tissue dynamics via MyotonPro (Tone, Stiffness, Elasticity, Relaxation Time). Results showed significant within-group increases (p < 0.0001, ηp2 0.656, +11.4%) in ROM following PT and between group difference against CON (P < 0.026). Significant within-group differences in stiffness (p < 0.016, ηp2 0.144, -6%), tone (p < 0.003, ηp2 0.213, +2%) and relaxation time (p < 0.002, ηp2 0.232, +6.3%) were also reported following PT. No significant difference was reported in elasticity (P > 0.05) or any other between group outcomes. PT therapy can provide an acute increase in hamstring group ROM following a resultant decrease in tissue stiffness.

A systematic review and net meta-analysis of the effects of different warm-up methods on the acute effects of lower limb explosive strength

OBJECTIVE

To evaluate the effects of different warm-up methods on the acute effect of lower limb explosive strength with the help of a reticulated meta-analysis system and to track the optimal method.

METHODS

R software combined with Stata software, version 13.0, was used to analyse the outcome metrics of the 35 included papers. Mean differences (MD) were pooled using a random effects model.

RESULTS

1) Static combined with dynamic stretching [MD = 1.80, 95% CI: (0.43, 3.20)] and dynamic stretching [MD = 1.60, 95% CI: (0.67, 2.60)] were significantly better than controls in terms of improving countermovement jump height (cm), and the effect of dynamic stretching was influenced by the duration of stretching (I2 = 80.4%), study population (I2 = 77.2%) and age (I2 = 75.6%) as moderating variables, with the most significant effect size for dynamic stretching time of 7-10min. 2) Only dynamic stretching [MD = -0.08, 95% CI: (-0.15, -0.008)] was significantly better than the control group in terms of improving sprint time (s), while static stretching [MD = 0.07, 95% CI: (0.002, 0.13)] showed a significant, negative effect. 3) No results were available to demonstrate a significant difference between other methods, such as foam axis rolling, and the control group.

CONCLUSION

The results of this review indicate that static stretching reduced explosive performance, while the 2 warm-up methods, namely dynamic stretching and static combined with dynamic stretching, were able to significantly improve explosive performance, with dynamic stretching being the most stable and moderated by multiple variables and dynamic stretching for 7-10min producing the best explosive performance. In the future, high-quality studies should be added based on strict adherence to test specifications.

The comparison between foam rolling either combined with static or dynamic stretching on knee extensors' function and structure

Static stretching (SS) and dynamic stretching (DS) in combination with foam rolling (FR) have been attracting attention as warm-up routines in sports. However, the combined and intervention order effects of SS or DS and FR on flexibility, muscle strength, and jump performance are still unclear. Therefore, this study aimed to compare the combined effects of FR and SS or DS with the various intervention orders (i.e., SS + FR, DS + FR, FR + SS, DS + FR) on the function and properties of the knee extensors. Using a crossover, random allocation design, 17 male university students (21.0 ± 1.1 y) performed four conditions combining FR and SS or DS. The measurement included knee flexion range of motion (ROM), pain pressure threshold (PPT), tissue hardness, maximum voluntary isometric contraction (MVC-ISO), maximum voluntary concentric contraction (MVC-CON) torque, and single-leg countermovement jump (CMJ) height of the knee extensors. All interventions significantly (p < 0.01) increased knee flexion ROM (SS + FR: d = 1.29, DS + FR: d = 0.45, FR + SS: d = 0.95, FR + DS: d = 0.49), and significantly (p < 0.01) decreased tissue hardness (SS + FR: d = -1.11, DS + FR: d = -0.86, FR + SS: d = -1.29, DS + FR: d = -0.65). There were no significant changes in MVC-ISO, MVC-CON, and CMJ height in all conditions, but a near significant, small magnitude (p = 0.056, d = -0.31) decrease of MVC-ISO was observed in the FR + SS condition. Our results showed that all the combinations of SS or DS and FR effectively decreased tissue hardness and increased ROM without decreasing muscle strength. Also, effect sizes indicated the largest increase in ROM and decrease in tissue stiffness after SS + FR without decreasing muscle strength and jump performance.

The Combined Effect of Static Stretching and Foam Rolling With or Without Vibration on the Range of Motion, Muscle Performance, and Tissue Hardness of the Knee Extensor

ABSTRACT

Nakamura, M, Konrad, A, Kasahara, K, Yoshida, R, Murakami, Y, Sato, S, Aizawa, K, Koizumi, R, and Wilke, J. The combined effect of static stretching and foam rolling with or without vibration on the range of motion, muscle performance, and tissue hardness of the knee extensor. J Strength Cond Res 37(2): 322-327, 2023-Although the combination of static stretching (SS) and foam rolling (FR) is frequently used for warm-up in sports, the effect of the intervention order is unclear. This study compared mechanical tissue properties, pain sensitivity, and motor function after SS and FR (with and without vibration) performed in different orders. Our randomized, controlled, crossover experiment included 15 healthy male subjects (22.5 ± 3.3 years) who visited the laboratory 5 times (inactive control condition, FR + SS, FR vibration + SS, SS + FR, and SS + FR vibration ) with an interval of ≥48 hours. In each session, subjects completed three 60-second bouts of FR and SS, targeting the anterior thigh. Pressure pain threshold, tissue hardness, knee flexion range of motion (ROM), maximal voluntary isometric (MVC-ISO), and concentric (MVC-CON) torque, as well as countermovement jump height, were determined before and after the intervention. All interventions significantly ( p < 0.01) increased knee flexion ROM ( d = 0.78, d = 0.87, d = 1.39, and d = 0.87, respectively) while decreasing tissue hardness ( d = -1.25, d = -1.09, d = -1.18, and d = -1.24, respectively). However, MVC-ISO torque was significantly reduced only after FR + SS ( p = 0.05, d = -0.59). Our results suggest that SS should be followed by FR when aiming to increase ROM and reduce tissue hardness without concomitant stretch-induced force deficits (MVC-ISO, MVC-CON, and countermovement jump height). Additionally, adding vibration to FR does not seem to affect the magnitude of changes observed in the examined outcomes.

IMPACT OF PLYOMETRIC TRAINING ON THE LOWER LIMB STRENGTH OF GYMNASTS

ABSTRACT Introduction: Plyometric training consists of a compound of stretching followed by immediate contraction, favoring the elastic properties of the soft tissues and aiming to promote a higher explosive force in the athletes. Objective: Explore the impact of plyometrics on aerobic gymnastics practitioners' explosive force in the lower limbs. Methods: In this experiment, a total of 16 aerobic gymnastics athletes were selected and divided into two groups: the control group and the experimental group. The control group remained with their usual training, while a sport-specific plyometric protocol was added to the experimental group. Results: Composite plyometric training can improve the short-distance running ability of aerobic gymnastics athletes; the effect of running 5m in the start and 10m in the start was statistically evidenced. However, the 20m run had similar results. Conclusion: The explosive power of the lower limbs in different activities is related to the specific training of aerobic gymnastics athletes focused on the muscles corresponding to the activity, showing a significant positive correlation. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

The Effects of Foam Rolling Training on Performance Parameters: A Systematic Review and Meta-Analysis including Controlled and Randomized Controlled Trials

Foam rolling (FR) is a new and popular technique for increasing range of motion. While there are a few studies that demonstrate increased performance measures after an acute bout of FR, the overall evidence indicates trivial performance benefits. As there have been no meta-analyses on the effects of chronic FR on performance, the objective of this systematic meta-analytical review was to quantify the effects of FR training on performance. We searched PubMed, Scopus, the Cochrane library, and Web of Science for FR training studies with a duration greater than two weeks, and found eight relevant studies. We used a random effect meta-analysis that employed a mixed-effect model to identify subgroup analyses. GRADE analysis was used to gauge the quality of the evidence obtained from this meta-analysis. Egger's regression intercept test (intercept 1.79; p = 0.62) and an average PEDro score of 6.25 (±0.89) indicated no or low risk of reporting bias, respectively. GRADE analysis indicated that we can be moderately confident in the effect estimates. The meta-analysis found no significant difference between FR and control conditions (ES = -0.294; p = 0.281; I² = 73.68). Analyses of the moderating variables showed no significant differences between randomized control vs. controlled trials (Q = 0.183; p = 0.67) and no relationship between ages (R² = 0.10; p = 0.37), weeks of intervention (R² = 0.17; p = 0.35), and total load of FR (R² = 0.24; p = 0.11). In conclusion, there were no significant performance changes with FR training and no specific circumstances leading to performance changes following FR training exceeding two weeks.

Effects of CT Combined with Modified Qinfan Decoction on Improving Sores and Promoting Angiogenesis

In order to explore the clinical treatment of severe acne, this paper proposed the effect of CT technology combined with modified qinfan decoction on improving sores and promoting angiogenesis. From October 2016 to November 2017, 69 patients with severe acne treated in the first traditional Chinese medicine hospital of a city were selected for retrospective analysis. The 69 patients were randomly divided into control group and treatment group. There were 34 patients in the control group and 35 patients in the treatment group. Patients in the control group were treated with VSD. Patients in the treatment group were treated with qinfan decoction combined with VSD. Then, the total effective rate, the time of clinical symptom improvement, the time when the new granulation began to grow, and the time when the sore surface area was reduced by 1/2 were compared between the two groups. The results showed that after treatment, the total effective rate of the treatment group was higher than that of the control group. The time for the improvement of clinical symptoms, the time for the growth of new granulation, and the time for the reduction of the sore surface area by 1/2 were shorter than those of the control group, and the healing rate of the sore surface was higher than that of the control group (P < 0.05). Qinfan decoction combined with negative pressure sealing drainage technology has a significant effect on the treatment of severe acne and can promote its rehabilitation.

Effects of a dynamic stretching warm-up on functional movement patterns in female hip-hop dancers

Background: A large percentage of dancers suffer an injury to their musculoskeletal system at least once in their careers, as well as from pain caused by overloading or overtraining this system. A high frequency of injuries has been observed in hip-hop dancers. Before each workout, there should be a solid warm-up and stretching period. The lack of these two important elements increases the risk of injury. Aim of the study: This study aimed to examine the effects of dynamic stretching warm-ups on fundamental movement patterns in female hip-hop dancers. Material and methods: This study included 14 hip-hop female dancers, aged 15–17. Dancers participated in 6 weeks of dynamic stretching warm-ups. Anthropometric and demographic variables were measured. The effectiveness of dynamic stretching warm-ups in improving fundamental movement patterns was assessed using the Functional Movement Screen (FMS) test including qualitative assessments using Deep Squat (DS) Hurdle Step (HS), In-Line Lunge (ILL), Shoulder Mobility (SM), Active Straight-Leg Raise (ASLR), Trunk Stability Push-Ups (TSPU) and Rotational Stability (RS). Results: Before the intervention, the mean composite FMS™ score was 15.00 ± 1.84 points and after the intervention was 16.64 ± 1.39 (p < 0.05). There were also statistically significant differences before and after the intervention in the DS (1.86 ± 0.53 vs. 2.36 ± 0.49, p < 0.05) and ASLR (2.21 ± 0.69 vs. 2.57 ± 0.65, p < 0.05). The number of dancers who scored 14 points or less on the FMS test before and after dynamic stretching warm-ups decreased from 50% to 0%. HS (r = 0.63, p = 0.01) and TPSU (r = 0.79, p = 0.01) were positively correlated with composite FMS scores before the intervention. After the intervention, positive correlations were observed between ASLR and composite FMS scores (r = 0.68; p = 0.01). Conclusions: Dynamic stretching warm-ups significantly improve functional movement patterns, including DS, ASLR, and composite FMS scores. It is important to use movement competency screenings in injury prevention programs.

Comparison of A Single Vibration Foam Rolling and Static Stretching Exercise on the Muscle Function and Mechanical Properties of the Hamstring Muscles

Knee extension and hip flexion range of motion (ROM) and functional performance of the hamstrings are of great importance in many sports. The aim of this study was to investigate if static stretching (SS) or vibration foam rolling (VFR) induce greater changes in ROM, functional performance, and stiffness of the hamstring muscles. Twenty-five male volunteers were tested on two appointments and were randomly assigned either to a 2 min bout of SS or VFR. ROM, counter movement jump (CMJ) height, maximum voluntary isometric contraction (MVIC) peak torque, passive resistive torque (PRT), and shear modulus of semitendinosus (ST), semimembranosus (SM), and biceps femoris (BFlh), were assessed before and after the intervention. In both groups ROM increased (SS = 7.7%, P < 0.01; VFR = 8.8%, P < 0.01). The MVIC values decreased after SS (-5.1%, P < 0.01) only. Shear modulus of the ST changed for -6.7% in both groups (VFR: P < 0.01; SS: P < 0.01). Shear modulus decreased in SM after VFR (-6.5%; P = 0.03) and no changes were observed in the BFlh in any group (VFR = -1%; SS = -2.9%). PRT and CMJ values did not change following any interventions. Our findings suggest that VFR might be a favorable warm-up routine if the goal is to acutely increase ROM without compromising functional performance.

Foam Rolling Training Effects on Range of Motion: A Systematic Review and Meta-Analysis

Background

A single foam-rolling exercise can acutely increase the range of motion (ROM) of a joint. However, to date the adaptational effects of foam-rolling training over several weeks on joint ROM are not well understood.

Objective

The purpose of this meta-analysis was to investigate the effects of foam-rolling training interventions on joint ROM in healthy participants.

Methods

Results were assessed from 11 studies (either controlled trials [CT] or randomized controlled trials [RCTs]) and 46 effect sizes by applying a random-effect meta-analysis. Moreover, by applying a mixed-effect model, we performed subgroup analyses, which included comparisons of the intervention duration (≤ 4 weeks vs > 4 weeks), comparisons between muscles tested (e.g., hamstrings vs quadriceps vs triceps surae), and study designs (RCT vs CT).

Results

Our main analysis of 290 participants with a mean age of 23.9 (± 6.3 years) indicated a moderate effect of foam-rolling training on ROM increases in the experimental compared to the control group (ES = 0.823; Z = 3.237; 95% CI 0.325–1.322; p = 0.001; I² = 72.76). Subgroup analyses revealed no significant differences between study designs (p = 0.36). However, a significant difference was observed in the intervention duration in favor of interventions > 4 weeks compared to ≤ 4 weeks for ROM increases (p = 0.049). Moreover, a further subgroup analysis showed significant differences between the muscles tested (p = 0.047) in the eligible studies. Foam rolling increased joint ROM when applied to hamstrings and quadriceps, while no improvement in ankle dorsiflexion was observed when foam rolling was applied to triceps surae.

Conclusion

Longer duration interventions (> 4 weeks) are needed to induce ROM gains while there is evidence that responses are muscle or joint specific. Future research should examine possible mechanisms underpinning ROM increases following different foam-rolling protocols, to allow for informed recommendations in healthy and clinical populations.

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.

Relationship between Eccentric-Exercise-Induced Loss in Muscle Function to Muscle Soreness and Tissue Hardness

It is well-known that unusual exercise, especially eccentric contraction (ECC), could cause delayed-onset muscle soreness. However, the factors related to the loss of muscle strength and range of motion (ROM) caused by eccentrically damaged muscle, such as increases in muscle soreness, tissue hardness, and pain threshold, have not been investigated in detail. Thus, this study was conducted to investigate the factors related to the loss of muscle strength and ROM caused by eccentrically damaged muscle in a large sample. Fifty-six sedentary healthy young male volunteers were instructed to perform 60 repetitions of ECC exercise. The outcome variables were measured before and 48 h after the ECC exercise. The results showed that a decrease in ROM was correlated to an increase in tissue hardness, whereas a decrease in muscle strength was correlated to an increase in muscle soreness. Our results suggested that tissue hardness must be controlled for ROM loss, and muscle soreness must be controlled for muscle-strength loss.