Acute effects of anterior thigh foam rolling on hip angle, knee angle, and rectus femoris length in the modified Thomas test

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.

Recovery effect of self-myofascial release treatment using different type of a foam rollers

Among athletes, foam rolling is popular technique of myofascial release aimed to support recovery processes and counteract delayed onset muscle soreness. However, there is no consensus on the optimal parameters of the roller texture used in the procedure. The study aimed to determine whether using rollers with different textures and hardness (smooth/soft, grooved/mid, serrated/hard) in myofascial release affects post-exertional restitution rate and the level of perceived DOMS (Delayed Onset Muscle Soreness) after intense anaerobic exercise. The study involved 60 healthy and physically active men randomly divided into three experimental groups and one control group (passive rest)-each consisting of 15 individuals: STH-rolling with a smooth roller; G-rolling with a grooved roller; TP-rolling with a serrated roller; Pass-passive rest group. After performing a exercise test (one-minute high-intensity squat), blood lactate (LA), creatine kinase (CK) and pain perception (VAS Scale) were monitored. The analysis of the average LA concentration in the blood 30 min post-exercise showed a statistical difference for all rolling groups compared to the passive rest group: STH (p < 0.001), G (p < 0.001), TP (p = 0.035). No statistically significant differences were found between the CK measurement results in individual assessments. Statistically significant differences in VAS values were observed between G (p = 0.013) and TP (p = 0.006) groups and the Pass group at 48 h, as well as between STH (p = 0.003); G (p = 0.001); TP (p < 0.001) groups and the Pass group at 72 h. Based on statistical data, a strong influence (η2 = 0.578) of time on the quadriceps VAS variable was noted. The research results confirm the effectiveness of rolling in supporting immediate and prolonged recovery. The conducted studies indicate a significantly better pace of post-exertional recovery after a rolling procedure lasting at least 120 s. The texture and hardness of the tool used did not matter with such a duration of the treatment.

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.

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.

Validity and Reliability of Inertial Measurement Units in Active Range of Motion Assessment in the Hip Joint

Measuring joint range of motion has traditionally occurred with a universal goniometer, inclinometer, or expensive laboratory systems. The popularity of the inertial measurement unit (IMU) is growing, enabling the small and even single portable device to measure the range of motion. Until now, they were not used to assess hip joint range of motion. Our study aimed to check the validity of IMUs in assessing hip range of motion and compare them to other measurement devices-universal goniometer and inclinometer. Twenty participants completed three hip movements (flexion in standing and prone internal and external rotation) on both hips. Two testers independently assessed each movement with a goniometer, digital inclinometer, and IMU at different time points. To assess the agreement of active hip ROM between devices, Intraclass Correlation Coefficient (ICC) and Bland-Altman analysis were used. Furthermore, inter-rater and intra-rater reliability were also assessed by using ICC and Bland-Altman analysis. Limits of agreement (LOA) were calculated using Bland-Altman plots. The IMU demonstrated good to excellent validity (ICC: 0.87-0.99) compared to the goniometer and digital inclinometer, with LOAs < 9°, across all tested movements. Intra-rater reliability was excellent for all devices (ICC: 0.87-0.99) with LOAs < 7°. However, inter-rater reliability was moderate for flexion (ICC: 0.58-0.59, LOAs < 22.4) and poor for rotations (ICC: -0.33-0.04, LOAs < 7.8°). The present study shows that a single inertial measurement unit (RSQ Motion, RSQ Technologies, Poznan, Poland) could be successfully used to assess the active hip range of motion in healthy subjects, comparable to other methods accuracy.

The Effects of Massage Therapy on Sport and Exercise Performance: A Systematic Review

BACKGROUND

A massage is a tool that is frequently used in sports and exercise in general for recovery and increased performance. In this review paper, we aimed to search and systemize current literature findings relating to massages' effects on sports and exercise performance concerning its effects on motor abilities and neurophysiological and psychological mechanisms.

METHODS

The review has been written following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. One hundred and fourteen articles were included in this review.

RESULTS

The data revealed that massages, in general, do not affect motor abilities, except flexibility. However, several studies demonstrated that positive muscle force and strength changed 48 h after the massage was given. Concerning neurophysiological parameters, the massage did not change blood lactate clearance, muscle blood flow, muscle temperature, or activation. However, many studies indicate pain reduction and delayed onset muscle soreness, which are probably correlated with the reduction of the level of creatine kinase enzyme and psychological mechanisms. In addition, the massage treatment led to a decrease in depression, stress, anxiety, and the perception of fatigue and an increase in mood, relaxation, and the perception of recovery.

CONCLUSION

The direct usage of massages just for gaining results in sport and exercise performance seems questionable. However, it is indirectly connected to performance as an important tool when an athlete should stay focused and relaxed during competition or training and recover after them.

Acute and Prolonged Effects of Dermal Suction on Joint Range of Motion and Passive Muscle Stiffness: A Preliminary Study

This study aimed to investigate the acute and prolonged effects of dermal suction on joint range of motion (ROM) and passive muscle stiffness. Eight-minute dermal suction was prescribed for the quadriceps femoris in 15 participants. Hip extension ROM, knee flexion ROM, and passive muscle stiffness of the rectus femoris (RF) and vastus lateralis (VL) were measured before and immediately, 30 min, 60 min, 120 min, 24 h, and 48 h after dermal suction. Passive muscle stiffness was measured using shear wave elastography. Hip extension ROM significantly increased immediately (p = 0.032), 60 min (p = 0.029), and 120 min (p = 0.031) after dermal suction compared with before dermal suction; however, it was not significantly different at 30 min, 24 h, and 48 h after dermal suction (p > 0.05). Passive muscle stiffness of the RF and VL and knee flexion ROM did not significantly change at any measurement time compared with before dermal suction (p > 0.05). Our preliminary results suggest that dermal suction improves hip extension ROM immediately after dermal suction of the quadriceps femoris, followed by a return to the pre-prescription level 30 min after. However, the effect was prolonged for 120 min and disappeared before 24 h.

Effectiveness of physiotherapy interventions for injury in ballet dancers: A systematic review

Background

The unique repetitive nature of ballet dancing, which often involves transgressing endurance limits of anatomical structures, makes dancers prone to injury. The following systematic review aims to assess the effectiveness of physiotherapy interventions in the treatment of injuries in ballet dancers.

Methods

The review was performed in line with the PRISMA statement on preferred reporting items for systematic reviews and meta-analyses. Six electronic databases (PubMed, Ovid Embase, Cochrane, Medline, PEDro, Google Scholar) were queried. The study populations comprised active ballet dancers and/or ballet school attendees with acute and chronic injuries and those with persistent pain. There were no restrictions regarding age, sex, ethnicity or nationality. The Modified McMaster Critical Review Form for quantitative studies was used to assess the methodological quality of the studies reviewed in accordance with the relevant guidelines.

Results

Out of the total of 687 articles subjected to the review, 10 met the inclusion criteria. Diverse physiotherapeutic interventions were described and effectiveness was assessed using different parameters and measurements. Overall, the results indicate that physiotherapy interventions in ballet dancers exert a positive effect on a number of indices, including pain, ROM and functional status.

Conclusions

Due to the small amount of evidence confirming the effectiveness of physiotherapeutic interventions in ballet dancers after injuries and methodological uncertainties, it is recommended to improve the quality of prospective studies.

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.

Effect of Static Stretching, Dynamic Stretching, and Myofascial Foam Rolling on Range of Motion During Hip Flexion: A Randomized Crossover Trial

Siebert, T, Donath, L, Borsdorf, M, and Stutzig, N. Effect of static stretching, dynamic stretching, and myofascial foam rolling on range of motion during hip flexion: A randomized crossover trial. J Strength Cond Res XX(X): 000-000, 2020-Static and dynamic stretching (DS) are commonly used in sports and physical therapy to increase the range of motion (ROM). However, prolonged static stretching (SS) can deteriorate athletic performance. Alternative methods to increase ROM are thus needed. Foam rolling (FR) may initiate muscle relaxation, improve muscular function, physical performance, and ROM. Previous studies that examined effects of FR on ROM did not control for increased tissue compliance or shifted pain threshold. In this study, the isolated influence of altered tissue compliance on ROM after FR, SS, and DS was investigated using a randomized crossover design. Hip flexion ROM at given joint torques before and after SS, DS, and FR was randomly assessed in 14 young male adults (age: 23.7 +/- 1.3 years; height: 182 +/- 8 cm; body mass: 79.4 +/- 6.9 kg). Hip flexion ROM was measured in the sagittal plane with the subjects lying in a lateral position (no gravitational effects on ROM measurements). Surface electromyographic (EMG) analysis of 2 representative hip extensors (M. biceps femoris and M. semitendinosus) was applied to control for active muscle contribution during ROM measurements. Significant increases in ROM for SS (3.8 +/- 1.1[degrees]; p < 0.001) and DS (3.7 +/- 1.8[degrees]; p < 0.001) were observed, but not for FR (0.8 +/- 3.1[degrees]; p = 0.954). Because stretch forces on tendon and muscle tissue during SS and DS predominately act in longitudinal direction, FR induces mainly transversal forces in the muscle tissue. Thus, increased ROM after FR reported in the literature is more likely due to a shift in the pain threshold. These results provide a better understanding of differential loading conditions during SS, DS, and FR for coaches and practitioners.

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.

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.

Influence of Foam Rolling on Recovery From Exercise-Induced Muscle Damage

D'Amico, AP and Gillis, J. Influence of foam rolling on recovery from exercise-induced muscle damage. J Strength Cond Res 33(9): 2443-2452, 2019-The purpose of this study was to examine the impact of foam rolling (FR) on recovery from exercise-induced muscle damage (EIMD). Thirty-seven male individuals performed 40 × 15-m sprints, inducing muscle damage. Immediately after sprinting and in the 4 days following, perceived muscle soreness, hip abduction range of motion (ROM), hamstring muscle length, vertical jump (VJ), and agility measures were recorded. Eighteen subjects (mean ± SD; age 22.4 ± 2.0 years; BMI [body mass index] 26.9 ± 4.2 kg·m) foam rolled before testing each day, whereas 19 (mean ± SD; age 23.2 ± 3.2 years; BMI 26.3 ± 4.0 kg·m) served as a non-FR control (CON). Measurements recorded during the 5 days of recovery from the repeated sprint protocol were compared with week 1 baseline measurements. The area under the curve (AUC) was calculated by summing all 5 scores as they changed from baseline measurement, and these data were compared by condition using a 2-tailed Mann-Whitney U-test (alpha level = 0.05). Perceived soreness, hip abduction ROM, hamstring muscle length, and VJ were not significantly different between groups (p ≥ 0.25). Agility was less impaired in the FR condition (p = 0.0049) as AUC was higher in CON (2.88 ± 2.45 seconds) than in FR (0.33 ± 2.16 seconds). Based on these data, FR appears to expedite recovery of agility after EIMD instigated by a repeated sprint protocol. Foam rolling may be useful for athletes requiring adequate agility who need to recover quickly from demanding bouts of exercise.

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.

Evidence based treatment options for common knee injuries in runners

The purpose of this paper is to review the current literature regarding conservative treatment options for the three most common knee injuries in runners including patellofemoral pain syndrome (PFPS), iliotibial band friction syndrome (ITBFS), and patellar tendinopathy (PT). Each diagnosis is discussed using current research to describe the pathophysiology, evaluation process, and evidence based effective treatment strategies including therapeutic exercise, manual therapy, neuromuscular re-education, and modalities. The result is a comprehensive overview of each diagnosis and a research-based approach to effectively evaluate and treat each condition for best outcomes.

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.

Posterior Thigh Foam Rolling Increases Knee Extension Fatigue and Passive Shoulder Range-of-Motion

Monteiro, ER, Costa, PB, Corrêa Neto, VG, Hoogenboom, BJ, Steele, J, and da Silva Novaes, J. Posterior thigh foam rolling increases knee extension fatigue and passive shoulder range-of-motion. J Strength Cond Res 33(4): 987-994, 2019-The purpose of this study was to analyze the acute effects of different foam rolling (FR) volumes on knee extensors fatigue and shoulder passive range-of-motion (PROM). Twelve recreationally active women were recruited for participation in 2 experiments separated by 3 weeks, and the same subjects performed all procedures in each experiment. In experiment 1, subjects performed 3 sets of knee extensions using a predetermined 10 repetition maximum load to momentary concentric failure: control condition (CG) with passive rest and 2 FR conditions for the hamstrings using 2 volumes (60 and 120 seconds; FR60 and FR120, respectively). Experiment 2 consisted of 2 shoulder flexion and extension baseline PROM tests. Following baseline measures, subjects performed a single 60-second bout of FR on the hamstrings. Outcome PROM measures were measured through manual goniometry immediately (post-0), 10 minutes (post-10), 20 minutes (post-20), 30 minutes (post-30), 24 hours (post-24), and 48 hours (post-48) after the intervention to assess the effects on PROM over an extended period. Fatigue index indicated significantly greater fatigue resistance for CG when compared with FR60 (p = 0.035; [INCREMENT]% = 6.49) and FR120 (p = 0.002; [INCREMENT]% = 9.27), and there were no significant differences between FR60 and FR120 (p = 0.513; [INCREMENT]% = 2.78). Shoulder flexion PROM increased in post-0 as compared to baseline 1 (p = 0.002; d = 1.58), baseline 2 (p < 0.001; d = 1.92), and baseline higher measurement (p < 0.001; d = 1.59) and remained increased for post-10 as compared to baseline 2 (p = 0.017; d = 1.55). Shoulder extension PROM increased in post-0 as compared to baseline 1 (p < 0.001; d = 2.61), baseline 2 (p < 0.001; d = 2.83), and baseline higher measurement (p < 0.001; d = 2.59) and remained increased for post-10 as compared to baseline 1 (p < 0.001; d = 1.93), baseline 2 (p < 0.001; d = 2.16), and baseline higher measurement (p < 0.001; d = 1.91) and post-20 as compared to baseline 1 (p = 0.008; d = 1.58), baseline 2 (p = 0.001; d = 1.85), and baseline higher measurement (p = 0.011; d = 1.55). Foam rolling volumes equal to or greater than 60 seconds are detrimental to the ability to continually produce force in the lower extremity and should not be applied to the hamstrings muscle group between sets of knee extensions. PROM results indicate that FR applied to the hamstrings demonstrates an increase in both shoulder flexion and extension PROM. This work may have important clinical (rehabilitation) implications, as it demonstrates global effects of FR on functional outcomes.

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.

Foam Rolling and Joint Distraction with Elastic Band Training Performed for 5-7 Weeks Respectively Improve Lower Limb Flexibility

Both foam rolling and joint distraction training with elastic bands are very popular interventions designed to improve muscular function, motor performance, and joint range of motion, as well as to reduce feeling of fatigue and delayed onset of muscle soreness. The heterogeneity of methods used among studies however prevents from drawing firm conclusions about the optimal content of pre/post interventions. The present study aims at answering the following questions: i) Do foam rolling and joint distraction with elastic band training improve joint range of motion in national rugby players? ii) Do short and long rolling durations have similar effects on range of motion? In a first experiment, we compared ankle, knee, and hip flexibility scores in 30 national rugby players after a 7-week foam rolling training program involving either a short (20s) or long (40s) rolling duration. Data revealed that foam rolling substantially improved all range of motion scores, regardless the rolling duration (performance gains ranged from 9 to 18° in the foam rolling groups, i.e. 8 to 20% increase, but remained under 2° in the control group). In a second experiment, we investigated the effect of a 5-week joint distraction with elastic band training program on hamstring and adductor range of motion in 23 national rugby players. Data showed that elastic band training significantly improved sit-and-reach (29.16% increase, p = 0.01) as well as side split (2.31% increase, p < 0.001) stretching performances. Taken together, present findings confirm that both foam rolling and joint distraction exercises with elastic bands are likely to enhance joint range of motion and specific mobility patterns during sport performance, and further serve prophylaxis. Such effects therefore constitute a promising avenue for clinical, home therapy, and personal flexibility training.

The Effect of Foam Rolling of the Hamstrings on Proprioception at the Knee and Hip Joints

The purpose of this study was to determine the acute effect of hamstring foam rolling on proprioception at the knee and hip joints. Twenty-five participants completed two proprioceptive tests on separate days, in a random order. The joint position matching test used no visual feedback. Participants were verbally guided to a target lunge position, which was maintained for six seconds while right hip and knee angles were recorded. After rest, participants reproduced this position without guidance for six seconds. Three trials were completed at baseline, and zero, 10, and 20 minutes post-intervention. In the force matching test, participants completed three trials with feedback about force output from a graph, and three trials without. They gradually applied knee flexion force against the dynamometer until reaching target force output. This test was also completed at baseline, and zero, 10, and 20 minutes post-intervention. A significant main effect was found for absolute knee position matching error (F(1.97, 47.36), p = 0.004). No significant differences were found between post-intervention values at zero and 10 minutes, zero and 20 minutes, or 10 and 20 minutes for absolute hip position matching error or absolute knee force matching error at zero, 10, or 20 minutes (p > 0.05). Foam rolling improved knee joint position sense for at least 20 minutes post-intervention, and did not decrease hip joint position sense or knee joint force sense. This indicates that foam rolling may be used immediately prior to exercise without the risk of injury due to proprioceptive deficits.

The Parameters of Foam Rolling, Self-Myofascial Release Treatment: A Review of the Literature

Self-myofascial release (SMR) is a well-known and popular therapy. Its growing popularity is based on high effectiveness and availability. However, there is a lack of agreement about which parameters should be used to optimize the effects of the therapy. The purpose of this review is to critically select and assess current literature and ascertain the values of the follow­ing parameters: (1) therapy duration, (2) volume of applied pressure, (3) speed and (4) frequency of roll, (5) type of roller, (6) the number of treatment applications during one session, (7) the duration of intervals between applications that yield the best results in terms of soft tissue.

The authors launched their research in May 2018. The search strategy included the electronic databases EBSCOhost and PubMed. The following inclusion criteria were assessed:

- English language, high quality manuscripts (evaluation in PEDro scale)

- at least one of the groups using the foam roller, tennis ball or the stick to fascial release

- basic parameters of therapy described.A total 55 articles met the inclusion criteria. Patients can usually withstand a maximum tolerable pressure for 30-120 seconds, repeated 1-3 times, separated by 30 seconds of rest. The intensity of a single rolling movement should be moderate, and the movement should last about 3 seconds. Keeping the roller on particularly sensitive areas is recommended to release tension and enhance blood perfusion.Currently, there is no consensus on an optimal FR programme. However, there is a tendency to use SMR tools with a physiol­ogy-based method to enhance therapeutic efficiency.

Higher Quadriceps Roller Massage Forces Do Not Amplify Range-of-Motion Increases nor Impair Strength and Jump Performance

Grabow, L, Young, JD, Alcock, LR, Quigley, PJ, Byrne, JM, Granacher, U, Škarabot, J, and Behm, DG. Higher quadriceps roller massage forces do not amplify range-of-motion increases nor impair strength and jump performance. J Strength Cond Res 32(11): 3059-3069, 2018-Roller massage (RM) has been reported to increase range of motion (ROM) without subsequent performance decrements. However, the effects of different rolling forces have not been examined. The purpose of this study was to compare the effects of sham (RMsham), moderate (RMmod), and high (RMhigh) RM forces, calculated relative to the individuals' pain perception, on ROM, strength, and jump parameters. Sixteen healthy individuals (27 ± 4 years) participated in this study. The intervention involved three 60-second quadriceps RM bouts with RMlow (3.9/10 ± 0.64 rating of perceived pain [RPP]), RMmod (6.2/10 ± 0.64 RPP), and RMhigh (8.2/10 ± 0.44 RPP) pain conditions, respectively. A within-subject design was used to assess dependent variables (active and passive knee flexion ROM, single-leg drop jump [DJ] height, DJ contact time, DJ performance index, maximum voluntary isometric contraction [MVIC] force, and force produced in the first 200 milliseconds [F200] of the knee extensors and flexors). A 2-way repeated measures analysis of variance showed a main effect of testing time in active (p < 0.001, d = 2.54) and passive (p < 0.001, d = 3.22) ROM. Independent of the RM forces, active and passive ROM increased by 7.0% (p = 0.03, d = 2.25) and 15.4% (p < 0.001, d = 3.73) from premeasure to postmeasure, respectively. Drop jump and MVIC parameters were unaffected from pretest to posttest (p > 0.05, d = 0.33-0.84). Roller massage can be efficiently used to increase ROM without substantial pain and without subsequent performance impairments.

Quadriceps foam rolling and rolling massage increases hip flexion and extension passive range-of-motion

Increases in joint range-of-motion may be beneficial for improving performance and reducing injury risk. This study investigated the effects of different self-massage volumes and modalities on passive hip range-of-motion. Twenty-five recreationally resistance-trained men performed four experimental protocols using a counterbalanced, randomized, and within-subjects design; foam rolling (FR) or roller massage (RM) for 60 or 120-s. Passive hip flexion and extension range-of-motion were measured in a counterbalanced and randomized order via manual goniometry before self-massage (baseline) and immediately, 10-, 20-, and 30-min following each self-massage intervention. Following FR or RM of quadriceps, there was an increase in hip flexion range-of-motion at Post-0 (FR: Δ = 19.28°; RM: Δ = 14.96°), Post-10 (FR: Δ = 13.03°; RM: Δ = 10.40°), and Post-20 (FR: Δ = 6.00°; RM: Δ = 4.64°) for all protocols, but these did not exceed the minimum detectable change at Post-10 for RM60 and RM120, and Post-20 for FR60, FR120, RM60, and RM120. Similarly, hip extension range-of-motion increased at Post-0 (FR: Δ = 8.56°; RM: Δ = 6.56°), Post-10 (FR: Δ = 4.64°; RM: Δ = 3.92°), and Post-20 (FR: Δ = 2.80°; RM: Δ = 1.92°), but did not exceed the minimum detectable change at Post-10 for FR60, RM60, and RM120, and Post-20 for FR60, FR120, RM60, and RM120. In conclusion, both FR and RM increased hip range-of-motion but larger volumes (120- vs. 60-second) and FR produced the greatest increases. These findings have implications for self-massage prescription and implementation, in both rehabilitation and athletic populations.

The Addition of Transcutaneous Electrical Nerve Stimulation with Roller Massage Alone or in Combination Did Not Increase Pain Tolerance or Range of Motion

Roller massage (RM) can be painful and induce muscle activity during application. Acute increases in pain pressure threshold (PPT) and range of motion (ROM) have been previously reported following RM. It is unclear whether the RM-induced increases in PPT and ROM can be attributed to changes in neural or muscle responses. To help determine if neural pain pathways are affected by roller massage, transcutaneous electrical nerve stimulation (TENS) was utilized as a form of electroanalgesia during RM with PPT and ROM tested on the affected and contralateral quadriceps. The purpose of this study was to evaluate in both quadriceps, the effect of brief intense TENS on PPT and ROM following unilateral RM of the quadriceps. A randomized within subjects' design was used to examine local and non-local effects of TENS and roller massage versus a control condition (rolling without TENS application). Four 30s bouts of roller massage of the dominant quadriceps were implemented with 30s of rest. The researcher applied the RM using a constant pressure device with approximately 70% of the maximum tolerable load. Perceived pain was monitored using a visual analog scale (VAS) during RM. Ipsilateral and contralateral quadriceps ROM and PPT were measured immediately following RM. Significant main effects for time showed increased PPT and ROM in both the treated and contralateral quadriceps, with no significant main effects for intervention or interactions for intervention and time. Moderate to large effect sizes and minimal clinically important differences (MCID) were detected when comparing baseline to pre- and post-tests respectively. VAS scores were significantly (main effect for intervention) and near significantly (interactions) reduced with MCID when TENS was applied during rolling. The addition of TENS to rolling did not increase PPT or ROM in the affected or contralateral quadriceps, likely due to a repeated testing effect.

Effects of Foam Rolling on Range of Motion, Peak Torque, Muscle Activation, and the Hamstrings-to-Quadriceps Strength Ratios

Madoni, SN, Costa, PB, Coburn, JW, and Galpin, AJ. Effects of foam rolling on range of motion, peak torque, muscle activation, and the hamstrings-to-quadriceps strength ratios. J Strength Cond Res 32(7): 1821-1830, 2018-To examine the effects of foam rolling (FR) on range of motion (ROM), peak torque (PT), hamstrings-to-quadriceps (H:Q) ratios, and muscle activation. Twenty-two recreationally active women (mean age ± SD = 21.55 ± 1.82 years, 161.91 ± 6.58 cm, 61.47 ± 10.54 kg) volunteered for this study. Participants performed pre- and posttests analyzing PT and surface electromyography (EMG) of their dominant limb, completing maximal knee extension and flexion at 3 different velocities. Participants foam rolled the hamstrings muscles or sat for the control condition between the pre- and posttests. Hamstrings ROM increased in the FR condition from (mean ± SE) 123.23 ± 3.49 to 126.41 ± 3.62° (p < 0.001) and decreased in the control condition from 118.82 ± 4.25 to 117.95 ± 4.29° (p = 0.013). Concentric hamstrings PT and conventional H:Q ratios decreased after both conditions, with smaller decreases after FR (p ≤ 0.05). No significant changes were found for eccentric hamstrings PT, eccentric hamstrings EMG, or functional H:Q ratios (p > 0.05). Foam rolling resulted in greater changes in hamstrings ROM without creating a deficit in PT or muscle activation when compared with the control group. When compared with other methods of stretching, FR may be beneficial in increasing ROM without decreasing functional H:Q ratios.

FOUR WEEKS OF ROLLER MASSAGE TRAINING DID NOT IMPACT RANGE OF MOTION, PAIN PRESSURE THRESHOLD, VOLUNTARY CONTRACTILE PROPERTIES OR JUMP PERFORMANCE

BACKGROUND

Roller massagers are popular devices that are used to improve range of motion (ROM), enhance recovery from muscle soreness, and reduce pain under acute conditions. However, the effects of roller massage training and training frequency are unknown.

PURPOSE

The objective was to compare two different roller massage training frequencies on muscle performance.

STUDY DESIGN

Randomized controlled intervention study.

METHODS

Twenty-three recreationally active university students were randomly allocated to three groups: control (n=8;), rolling three (3/W; n=8;) and six (6/W; n=7) times per week for four weeks. The roller massage training consisted of unilateral, dominant limb, quadriceps and hamstrings rolling (4 sets x 30 seconds). Both legs of participants were tested pre- and post-training for active and passive hamstrings and quadriceps range of motion (ROM), electromyography (EMG) activity during a lunge movement, unilateral countermovement jumps (CMJ), as well as quadriceps and hamstrings maximum voluntary isometric contraction (MVIC) forces and electromechanical delay. Finally, they were tested for pain pressure threshold at middle and distal segments of their quadriceps and hamstrings.

RESULTS

There were no significant training interactions for any measure with the exception that 3/W group exhibited 6.2% (p=0.03; Effect Size: 0.31) higher CMJ height from pre- (38.6 ± 7.1 cm) to post-testing (40.9 ± 8.1 cm) for the non-dominant limb.

CONCLUSIONS

Whereas the literature has demonstrated acute responses to roller massage, the results of the present study demonstrate no consistent significant training-induced changes. The absence of change may highlight a lack of muscle and myofascial morphological or semi-permanent neurophysiological changes with rolling.

LEVELS OF EVIDENCE

2c.

ROLLER MASSAGE: A COMMENTARY ON CLINICAL STANDARDS AND SURVEY OF PHYSICAL THERAPY PROFESSIONALS- PART 1

Roller massage (RM) has become a popular intervention used by rehabilitation professionals and active individuals. The emerging popularity has resulted in the production of various types of rollers and a growing body of research on the therapeutic effects and science behind RM. Despite the growing popularity and research, there is no consensus on clinical standards such as a describing the intervention, indications, precautions, contraindications, and assessment. There have been no specific peer reviewed publications that have discussed such standards. This leaves a gap in the knowledge regarding how clinicians are integrating the RM research into their clinical practice. The purpose of this clinical commentary is to discuss proposed clinical standards for RM. Part I will discuss the proposed clinical standards and Part II will report the results of a 20-question survey sent to physical therapy (PT) professional members of the Orthopedic and Sports Physical Therapy Sections of the American Physical Therapy Association.

LEVEL OF EVIDENCE

5.

THE EFFECTS OF AN ACUTE BOUT OF FOAM ROLLING ON HIP RANGE OF MOTION ON DIFFERENT TISSUES

BACKGROUND

Foam Rolling (FR) has steadily gained in popularity as an intervention to increase range of motion (ROM) and reduce pain. It is believed that FR can remove restrictions due to fascial adhesions, thus improving ROM. FR has been proposed as a means to increase ITB length as a means to achieve these outcomes. Previous research has focused on the effects of FR over both muscle and fascia tissue together. However, no studies have examined the effects of FR over fascial tissue not containing muscle.

PURPOSE

The purpose of this study was to compare the acute effect of a single bout of foam rolling (FR) over the Iliotibial Band (ITB) compared to FR over the gluteal muscle group on hip adduction passive range of motion (PROM).

METHODS

Twenty-seven participants were recruited for the study. Each participant performed three sessions: FR over tissue devoid of muscle, the ITB (PFR), FR over contractile tissue, the gluteal muscles (AFR), and a session without FR (control) in a randomized order. Hip adduction PROM was measured in a pre-post manner for each session.

RESULTS

Results of the repeated measures ANOVA showed a significant interaction across session and time (F_{(2, 25)} = 25.202, p < 0.001, ηp2 = 0.502, 1 - β = 1.000). Post-hoc analysis showed the AFR post-test measure was significantly different from both control (p < 0.001) and PFR counterparts (p < 0.001). FR over the gluteal muscle group lead to a 14.8% improvement in hip adduction ROM, with PFR only a 2% improvement.

CONCLUSION

A single bout of FR over a myofascial group appears to increase PROM in healthy young adults, whereas FR over the ITB itself (primarily fascial tissue) does not. This suggests the conventional theory behind FR may need to be reevaluated.

LEVEL OF EVIDENCE

Level 1B, laboratory study, repeated measures design.

ROLLER MASSAGE: SURVEY OF PHYSICAL THERAPY PROFESSIONALS AND A COMMENTARY ON CLINICAL STANDARDS- PART II

BACKGROUND

Roller massage (RM) has become a popular intervention prescribed by physical therapy (PT) professionals. While this popularity has stimulated an increase in research and product development, the trends in the use of RM among PT professionals remain undocumented. It is unknown how professionals are using RM and integrating the research into their clinical practice.

PURPOSE

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

DESIGN

Cross-sectional survey study.

METHODS

A 20-question online survey related to personal and professional demographics, beliefs about RM, preferred RM devices, RM exercise prescription, and client education was emailed to PT members of the Orthopedic and Sports Physical Therapy Sections.

RESULTS

A total of 685 sports and orthopedic PT professionals completed the survey. Most professionals surveyed believe that RM decreases pain (80%), increases mobility (68%), and increases range of motion (ROM) (40%). Fifty-one percent believed moderate density rollers have the greatest effect. Eighty percent of professionals use a foam roller in their practice and 51% recommend to clients. A high proportion of professionals prescribe RM for injury treatment (82%) and for pre and post-exercise interventions (55%). Most professionals recommend rolling daily for 30 seconds to two minutes (55%), per muscle group (64%), at a self-paced cadence (47%). A high proportion of professionals use patient reported outcomes (80%), followed by joint ROM (59%), and movement-based testing (42%) to measure effects of RM. Eighty-seven percent of professionals use live instruction to educate clients and 91% believe there is a gap in the research.

CONCLUSION

The results of this survey should be considered descriptive and a starting point for future research to establish a consensus on optimal RM programming, devices, and application parameters for different musculoskeletal conditions. The observed responses provide some insight into how PT professionals are using RM in their practice and highlight the existing gap between the research and professional practice. Further research is needed to explore the responses documented in this study.

LEVEL OF EVIDENCE

3.

COMPARISON OF THREE DIFFERENT DENSITY TYPE FOAM ROLLERS ON KNEE RANGE OF MOTION AND PRESSURE PAIN THRESHOLD: A RANDOMIZED CONTROLLED TRIAL

BACKGROUND

Foam rolling is a popular form of roller massage. To date, no studies have examined the therapeutic effects of different density type rollers. Understanding the different densities may provide clinicians with the knowledge to accurately prescribe a particular foam roller and safely progress the client.

PURPOSE

The purpose of this study was to compare the immediate effects of three different density type foam rollers on prone passive knee flexion range of motion (ROM) and pressure pain thresholds (PPT) of the quadriceps musculature.

STUDY DESIGN

Pretest, posttest randomized controlled trial.

METHODS

Thirty-six recreationally active adults were randomly allocated to one of three groups: soft density, medium density, and hard density foam roller. The intervention lasted a total of two minutes. Outcome measures included prone passive knee flexion ROM and PPT. Statistical analysis included parametric and non-parametric tests to measure changes among groups.

RESULTS

Between group comparisons revealed no statistically significant differences between all three rollers for knee ROM (p=.78) and PPT (p=.37). Within group comparison for ROM revealed an 88 (p < 0.001) post-intervention increase for the medium and hard density rollers and a 78 (p < 0.001) increase for the soft density roller. For PPT, there was a post-intervention increase of 180 kPa (p < 0.001) for the medium density roller, 175 kPa (p < 0.001) for the soft density roller, and 151 kPa (p < 0.001) for the hard density roller.

CONCLUSION

All three roller densities produced similar post-intervention effects on knee ROM and PPT. These observed changes may be due to a local mechanical and global neurophysiological response from the pressure applied by the roller. The client's pain perception may have an influence on treatment and preference for a specific foam roller. Clinicians may want to consider such factors when prescribing foam rolling as an intervention.

LEVEL OF EVIDENCE

2C.

ACUTE EFFECTS OF DIFFERENT ANTERIOR THIGH SELF-MASSAGE ON HIP RANGE-OF-MOTION IN TRAINED MEN

BACKGROUND

Self-massage is a ubiquitous intervention similar to massage, but performed by the recipient him- or herself rather than by a therapist, most often using a tool (e.g., foam roller, roller massager). Self-massage has been found to have a wide range of effects. It is particularly known for increasing flexibility acutely, although not always. The variability of the results in previous studies may potentially be a function of the tool used. Recent findings also suggest that self-massage exerts global effects. Therefore, increased flexibility should be expected in the areas adjacent to the ones treated.

PURPOSE

To investigate the acute effects of foam rolling and rolling massage of anterior thigh on hip range-of-motion (ROM) - i.e., hip extension and hip flexion - in trained men.

METHODS

Eighteen recreationally active, resistance trained males visited the lab on two occasions over a 4-day period separated by at least a day. Each session included two baseline ROM measures of passive hip flexion and extension taken in a randomized fashion. Recording of baseline measures was followed by the intervention of the day, which was either foam rolling or rolling massage of the anterior thigh as per randomization. Immediately post intervention, passive hip flexion and hip extension ROM were reassessed. In order to assess the time course of improvements in ROM, hip flexion and hip extension ROM were reevaluated at 10, 20, and 30 minutes post-intervention.

RESULTS

Hip flexion and hip extension ROM increased immediately following both interventions (foam rolling or roller massager) and remained increased for 30 minutes post intervention. Foam rolling was statistically superior in improving hip flexion and hip extension ROM immediately post intervention. However, immediately post-intervention was the only time point that measurements exceeded the minimum detectable change for both interventions.

CONCLUSION

Both foam rolling and rolling massage appear to be effective interventions for improving hip flexion and extension ROM when applied to the anterior thigh, but the observed effects are transient in nature.

LEVEL OF EVIDENCE

2b.

Acute effects of different foam rolling volumes in the interset rest period on maximum repetition performance

Background:

Foam rolling (FR) is a ubiquitous intervention utilised for the purpose of acutely increasing the range of motion without subsequent decreases in performance. Thus, it is commonly used during the periworkout period—that is, prior to, during, or after an athlete's workout.

Objective:

This study investigated how different FR durations applied to the quadriceps during the interset rest periods affects the numbers of repetitions in the knee extension exercise.

Methods:

Twenty-five females completed four sets of knee extensions with 10 repetitions of maximum load to concentric failure on four occasions. Between each set, a 4-minute rest interval was implemented in which participants either passively rested or performed FR for different durations (60 seconds, 90 seconds, and 120 seconds). The 95% confidence intervals revealed a dose-dependent relationship in which longer durations of FR resulted in fewer completed repetitions.

Results:

On average, the number of repetitions with PR was 13.8% greater than that in FR120, 8.6% greater than that in FR90, and 9.1% greater than that in FR60.

Conclusion:

For the purposes of performance and likely adaptation, interset FR seems to be detrimental to a person's ability to continually produce force, and should not be applied to the agonist muscle group between sets of knee extensions.

Acute effects of foam rolling on passive tissue stiffness and fascial sliding: study protocol for a randomized controlled trial

Background

Self-myofascial release (SMR) 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 still poorly understood. In addition to neuronal mechanisms, improved flexibility may be driven by acute morphological adaptations, such as a reduction in passive tissue stiffness or improved movement between fascial layers. The aim of the intended study is to evaluate the acute effects of SMR on the passive tissue stiffness of the anterior thigh muscles and the sliding properties of the associated fasciae.

Methods

In a crossover study design, 16 participants will receive all of the following interventions in a permutated random order: (1) one session of 2 × 60 s of SMR at the anterior thigh, (2) one session of 2 × 60 s of passive static stretching of the anterior thigh and (3) no intervention. Passive tissue stiffness, connective tissue sliding, angle of first stretch sensation, as well as maximal active and passive knee flexion angle, will be evaluated before and directly after each intervention.

Discussion

The results of the intended study will allow a better understanding of, and provide further evidence on, the local effects of SMR techniques and the underlying mechanisms for flexibility improvements.

Trial registration

ClinicalTrials.gov, identifier: NCT02919527. Registered on 27 September 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-1866-y) contains supplementary material, which is available to authorized users.

ACUTE EFFECTS OF DIFFERENT SELF-MASSAGE VOLUMES ON THE FMS™ OVERHEAD DEEP SQUAT PERFORMANCE

BACKGROUND

The Functional Movement Screen (FMS™) is a battery of tests designed to assess movement competency; the overhead deep squat test, specifically, has been shown to be an accurate predictor of overall FMS™ scores. Self-massage (SM) is a ubiquitous warm-up utilized to increase joint range of motion and, therefore, may be effective for improving performance of the overhead deep squat test.

PURPOSE

To examine how different doses (30, 60, 90, and 120 seconds) of SM of different areas of the body (plantar fascia, latissimus dorsi, and lateral thigh) affects the score obtained on an overhead deep squat test.

METHODS

Twenty recreationally active females were recruited to be tested on four occasions: sessions one and two consisted of baseline testing, session three consisted of SM applied to the lateral thigh, and session four consisted of SM applied to the lateral torso and plantar fascia.

RESULTS

In all SM conditions, at least 90 seconds was required for a change in deep squat score from baseline; therefore, it is concluded that SM the lateral torso, plantar fascia, and lateral thigh for 90 seconds or more are effective interventions for acutely improving overhead deep squat scores.

CONCLUSION

Self-massage appears to be an effective modality for inducing acute improvements in the performance of the FMS™ overhead deep squat in all conditions tested.

LEVEL OF EVIDENCE

2b.

MAXIMUM REPETITION PERFORMANCE AFTER DIFFERENT ANTAGONIST FOAM ROLLING VOLUMES IN THE INTER-SET REST PERIOD

BACKGROUND

Foam rollers, or other similar devices, are a method for acutely increasing range of motion, but in contrast to static stretching, do not appear to have detrimental effects on neuromuscular performance.

PURPOSE

The purpose of this study was to investigate the effects of different volumes (60 and 120 seconds) of foam rolling of the hamstrings during the inter-set rest period on repetition performance of the knee extension exercise.

METHODS

Twenty-five recreationally active females were recruited for the study (27.8 ± 3.6 years, 168.4 ± 7.2 cm, 69.1 ± 10.2 kg, 27.2 ± 2.1 m²/kg). Initially, subjects underwent a ten-repetition maximum testing and retesting, respectively. Thereafter, the experiment involved three sets of knee extensions with a pre-determined 10 RM load to concentric failure with the goal of completing the maximum number of repetitions. During the inter-set rest period, either passive rest or foam rolling of different durations (60 and 120 seconds) in a randomized order was employed.

RESULTS

Ninety-five percent confidence intervals revealed dose-dependent, detrimental effects, with more time spent foam rolling resulting in fewer repetitions (Cohen's d of 2.0 and 1.2 for 120 and 60 seconds, respectively, in comparison with passive rest).

CONCLUSION

The results of the present study suggest that more inter-set foam rolling applied to the antagonist muscle group is detrimental to the ability to continually produce force. The finding that inter-set foam rolling of the antagonist muscle group decreases maximum repetition performance has implications for foam rolling prescription and implementation, in both rehabilitation and athletic populations.

LEVEL OF EVIDENCE

2b.

CURRENT CONCEPTS AND TREATMENT OF PATELLOFEMORAL COMPRESSIVE ISSUES

Patellofemoral disorders, commonly encountered in sports and orthopedic rehabilitation settings, may result from dysfunction in patellofemoral joint compression. Osseous and soft tissue factors, as well as the mechanical interaction of the two, contribute to increased patellofemoral compression and pain. Treatment of patellofemoral compressive issues is based on identification of contributory impairments. Use of reliable tests and measures is essential in detecting impairments in hip flexor, quadriceps, iliotibial band, hamstrings, and gastrocnemius flexibility, as well as in joint mobility, myofascial restrictions, and proximal muscle weakness. Once relevant impairments are identified, a combination of manual techniques, instrument-assisted methods, and therapeutic exercises are used to address the impairments and promote functional improvements. The purpose of this clinical commentary is to describe the clinical presentation, contributory considerations, and interventions to address patellofemoral joint compressive issues.

EFFECT OF DIFFERENT FOAM ROLLING VOLUMES ON KNEE EXTENSION FATIGUE

BACKGROUND

Foam rolling (FR) is a common intervention utilized for the purpose of acutely increasing range-of-motion without subsequent decreases in performance. FR is characterized as an active technique which subject performs upon themselves. Thus, it is believed that the accumulated fatigue can influence whether the task can be continued.

PURPOSE

To analyze the effect of different foam rolling volumes on fatigue of the knee extensors.

METHODS

Twenty-five recreationally active females (age 27.7 ± 3.56 y, height 168.4 ± 7.1 cm, weight 69.1 ± 10.2 kg) were recruited for the study. The experiment involved three sets of knee extensions with a pre-determined 10 repetition maximum load to concentric failure. Then, subjects performed the control (CONT) and foam rolling (FR) conditions. FR conditions consisted of different anterior thigh rolling volumes (60-, 90-, and 120-seconds) which were performed during the inter-set rest period. After that, the fatigue index was calculated and compared between each experimental condition. Fatigue index indicates how much (%) resistance the subjects experienced, calculated by the equation: (thidset/firstset) x 100.

RESULTS

Fatigue index was statistically significantly greater (greater fatigue resistance) for CONT compared to FR90 (p = 0.001) and FR120 (p = 0.001). Similarly, higher fatigue resistance was observed for FR60 when compared to FR120 (p = 0.048). There were no significant differences between the other conditions (p > 0.005).

CONCLUSION

The finding of foam rolling fatigue index decline (less fatigue resistance) as compared to control conditions may have implications for foam rolling prescription and implementation, in both rehabilitation and athletic populations. For the purposes of maximum repetition performance, foam rolling should not be applied to the agonist muscle group between sets of knee extensions. Moreover, it seems that volumes greater than 90-seconds are detrimental to the ability to continually produce force.

LEVEL OF EVIDENCE

2b.

Is self-massage an effective joint range-of-motion strategy? A pilot study

Increases in joint range of motion may be beneficial in both improving performance and reducing the risk of injury. The purpose of this study was to investigate short-term changes in passive hip flexion (HF) and extension (HE) after foam rolling (FR) and roller massage (RM) durations of 60 and 120s. Ten recreationally active men (27.6 ± 2.4 years old; 164.8 ± 6.6 cm; 62.2 ± 8.0 kg; 24.2 ± 2.1 m²/kg) were recruited for this study. Subjects performed foam rolling (FR) and roller massage (RM) on the hamstrings for 60 (FR60 and RM60) and 120 (FR120 and RM120) seconds. Significant differences between FR120 and RM60 were observed in both HF (p < 0.001) and HE (p < 0.001) suggesting an intervention (roller style) effect. Furthermore, significant differences (p < 0.001) between RM60 and RM120 suggest a dosage based response. Thus, the findings indicate that different roller type or rolling volume may affect range-of-motion.

The modified Thomas test is not a valid measure of hip extension unless pelvic tilt is controlled

The modified Thomas test was developed to assess the presence of hip flexion contracture and to measure hip extensibility. Despite its widespread use, to the authors’ knowledge, its criterion reference validity has not yet been investigated. The purpose of this study was to assess the criterion reference validity of the modified Thomas test for measuring peak hip extension angle and hip extension deficits, as defined by the hip not being able to extend to 0º, or neutral. Twenty-nine healthy college students (age = 22.00 ± 3.80 years; height = 1.71 ± 0.09 m; body mass = 70.00 ± 15.60 kg) were recruited for this study. Bland–Altman plots revealed poor validity for the modified Thomas test’s ability to measure hip extension, which could not be explained by differences in hip flexion ability alone. The modified Thomas test displayed a sensitivity of 31.82% (95% CI [13.86–54.87]) and a specificity of 57.14% (95% CI [18.41–90.10]) for testing hip extension deficits. It appears, however, that by controlling pelvic tilt, much of this variance can be accounted for (r = 0.98). When pelvic tilt is not controlled, the modified Thomas test displays poor criterion reference validity and, as per previous studies, poor reliability. However, when pelvic tilt is controlled, the modified Thomas test appears to be a valid test for evaluating peak hip extension angle.

SPECIFIC AND CROSS-OVER EFFECTS OF FOAM ROLLING ON ANKLE DORSIFLEXION RANGE OF MOTION

BACKGROUND

Flexibility is an important physical quality. Self-myofascial release (SMFR) methods such as foam rolling (FR) increase flexibility acutely but how long such increases in range of motion (ROM) last is unclear. Static stretching (SS) also increases flexibility acutely and produces a cross-over effect to contralateral limbs. FR may also produce a cross-over effect to contralateral limbs but this has not yet been identified.

PURPOSE

To explore the potential cross-over effect of SMFR by investigating the effects of a FR treatment on the ipsilateral limb of 3 bouts of 30 seconds on changes in ipsilateral and contralateral ankle DF ROM and to assess the time-course of those effects up to 20 minutes post-treatment.

METHODS

A within- and between-subject design was carried out in a convenience sample of 26 subjects, allocated into FR (n=13) and control (CON, n=13) groups. Ankle DF ROM was recorded at baseline with the in-line weight-bearing lunge test for both ipsilateral and contralateral legs and at 0, 5, 10, 15, 20 minutes following either a two-minute seated rest (CON) or 3 3 30 seconds of FR of the plantar flexors of the dominant leg (FR). Repeated measures ANOVA was used to examine differences in ankle DF ROM.

RESULTS

No significant between-group effect was seen following the intervention. However, a significant within-group effect (p<0.05) in the FR group was seen between baseline and all post-treatment time-points (0, 5, 10, 15 and 20 minutes). Significant within-group effects (p<0.05) were also seen in the ipsilateral leg between baseline and at all post-treatment time-points, and in the contralateral leg up to 10 minutes post-treatment, indicating the presence of a cross-over effect.

CONCLUSIONS

FR improves ankle DF ROM for at least 20 minutes in the ipsilateral limb and up to 10 minutes in the contralateral limb, indicating that FR produces a cross-over effect into the contralateral limb. The mechanism producing these cross-over effects is unclear but may involve increased stretch tolerance, as observed following SS.

LEVELS OF EVIDENCE

2c.