April 2014

Foam rolling: Early study findings suggest benefits

4rehab-shutterstock_157559-lrFoam rolling is a relatively new therapeutic approach, but early research suggests that it can help improve range of motion and muscle performance and aid in recovery after exercise. Questions remain, however, about the extent to which the effects involve myofascial mechanisms.

By Duane C. Button, PhD, CSEP-CEP, and David G. Behm, PhD

In recent years many individuals have used foam rollers for myo­fascial health. During foam rolling, individuals use their own body weight on a foam roller to exert pressure on soft tissue. The motions place both direct and sweeping pressure on the soft tissue, stretching the tissue and generating friction between the soft tissue and the foam roller. Foam rolling can be considered a form of self-induced massage because the pressure exerted by the roller resembles the pressure exerted on the muscles through manual manipulation by a massage therapist.

According to one distributor and manufacturer of foam roller products, foam rollers (cylindrical rollers that individuals place under a given body part) and roller-massagers (smaller cylindrical rollers with handles that individuals grasp and roll over a given body part) are used to “help increase blood flow and circulation in targeted areas, while also helping to increase muscle flexibility and joint range of motion.” Other advocates1,2 claim foam rolling: corrects muscular imbalances, alleviates muscle soreness, relieves joint stress, improves neuromuscular efficiency, and improves range of motion (ROM). A number of rehabilitation and training programs are using foam rolling to promote soft-tissue extensibility and optimal skeletal muscle functioning and enhance joint ROM.1-3 However, given that the development and use of these devices has been relatively recent, there are few peer-reviewed published studies to validate the claims.

Foam rolling and performance

Four studies from our laboratory that have examined the effects of rollers on ROM have led to uniformly positive findings. MacDonald et al3 reported knee joint ROM increases of 12.7% and 10.3% at two and 10 minutes, respectively, following two one-minute bouts of foam rolling of the quadriceps.

Figure 1: Figure illustrates relative (%) change in ROM relative to the pretest for three studies. Halperin et al6 (90 seconds of roller-massager application) and Sullivan et al5 (10 seconds of roller-massager application) used a roller massager and tested ankle ROM and sit and reach respectively, whereas MacDonald et al3 used a foam roller (120 seconds of foam rolling) and tested knee joint ROM.

Figure 1: Figure illustrates relative (%) change in ROM relative to the pretest for three studies. Halperin et al6 (90 seconds of roller-massager application) and Sullivan et al5 (10 seconds of roller-massager application) used a roller massager and tested ankle ROM and sit and reach respectively, whereas MacDonald et al3 used a foam roller (120 seconds of foam rolling) and tested knee joint ROM.

Bradbury-Squires et al4 applied a roller-massager (RM) to the quadriceps (five repetitions at 20 or 60 seconds per repetition) and found that knee joint ROM increased 10% for the 20-second condition and 16% for the 60-second condition compared with a control condition. The difference in ROM between the longer (60 seconds) and shorter (20 seconds) rolling durations trended toward statistical significance (p = .08).

Sullivan et al5 demonstrated an overall 4.3% increase in sit-and-reach ROM with one to two repetitions of five and 10 seconds of RM application to the hamstrings. The 10-second condition increased ROM by an additional 2.3% compared with the five-second condition, a trend approaching statistical significance (p = .06).

Halperin et al6 reported that ankle ROM was, respectively, 3.6% and 4.4% significantly greater immediately and 10 minutes after roller-massager application (three repetitions of 30 seconds with 10 seconds of rest between repetitions) to the plantar flexors.

Taken together, the findings from the four studies (see Figure 1 for a summary of changes in ROM following foam rolling) suggest that, even with as little as five or 10 seconds of rolling, ROM is improved, although longer durations seem to provide more substantial effects. The extent of increase in ROM associated with foam rolling is similar to those reported in studies of static stretching7-10 and massage (11.3% hip flexion,11 10.7% hamstrings12). An advantage of using foam rolling rather than static stretching to enhance ROM is that the latter has been reported to induce performance decrements.8,13 There have been no reports to date of foam rolling-induced performance decrements.

On the contrary, there is some evidence of performance enhancement following foam rolling. The application of five repetitions of 20 or 60 seconds of roller-massage to the quadriceps increased neuromuscular efficiency during a lunge compared with the control condition, with the 60-second RM enhancing muscle efficiency to an even greater degree than 20-second RM.4 While overall vastus lateralis activity, as measured using electromyography (EMG), decreased by 3% and 7% for the 20-second and 60-second conditions, respectively, compared with the control condition, the 24% and 30% decreases in vastus lateralis activity observed during the push-off phase compared with the control condition might represent increased efficiency resulting from a more efficient stretch-shortening cycle (SSC).

SSC exercises use accumulated elastic energy during the eccentric contraction to augment the concentric phase.14 An increase in muscle compliance can accentuate the ability of the musculotendinous unit to store elastic energy over a longer period.8,15-17 Since quadriceps and hamstrings EMG muscle activation was approximately 7% to 8% of a maximal voluntary isometric contraction (MVC) during the roller massaging, the combination of active contractions and 20 to 60 seconds of roller-massage may work together to improve ROM as well as muscular efficiency during a lunge.

Isometric force output following foam rolling has not been adversely affected in any studies to date. Indeed, Halperin et al6 demonstrated 8.2% significantly greater MVC force after roller massage than after static stretching at 10 minutes postintervention. Other roller studies have also reported no MVC force impairment.3,5 Force increases might be attributed to friction-induced increases in muscle temperature,18-20 release of myofascial restrictions,21 phosphorylation of the myosin regulatory light chains22 associated with the submaximal muscle contractions during the rolling, or a combination of these factors.

The findings of foam rolling-induced increases in ROM without subsequent force impairments suggest the mechanisms of action may be more closely related to those of massage than those of static stretching. The mechanical stress of foam rolling may induce a more gel-like tissue state23,24 and affect the viscoelasticity and thixotropic properties of the fascia25 without any impairment to the neuromuscular properties. Additionally, friction-related increases in tissue heat could reduce viscosity.23 There could also be neural influences associated with foam rolling. Low-intensity contractions during foam rolling4 may act similarly to contract-relax proprioceptive neuromuscular facilitation stretching. Contraction intensities as low as 20% of MVC held for six seconds have been reported to be effective for increasing ROM, possibly altering muscle spindle length or stretch perception.26 Vigorous pressure can overload the cutaneous receptors, diminishing sensation and increasing stretch tolerance.27 Foam rolling has been suggested to act as a self myofascial release technique similar to massage.5 Massage has been reported to suppress H-reflexes,28-30 thereby decreasing the afferent excitation of the motorneurones.31

It is likely that the improved ROM with foam rolling is the result of a combination of changes in the musculotendinous and neural responses as well as the tolerance to the stretch. Further research is necessary to determine the mechanisms underlying the increased ROM associated with roller-massage and foam rolling.

Foam rolling and muscle recovery

Many individuals commonly experience exercise-induced muscle damage (EIMD), resulting in delayed onset of muscle soreness (DOMS) following an intense bout of physical activity. DOMS is characterized by muscle soreness, muscle swelling, temporary muscle damage, and an increase in intramuscular protein and passive muscle tension, which can potentially lead to soft-tissue restrictions. DOMS generally reaches its peak intensity between 24 and 48 hours after exercise,32,33 and generally subsides within five to seven days.33-35 In the days following an intense bout of physical activity, there is a loss of proprioceptive function, including joint ROM,33 muscular strength,36 joint-angle perception,37 and force perception.37 Other studies have shown that EIMD is associated with losses in maximal voluntary force production,36,38-41 decreased muscle activation,41-43 increased EMG-to-force ratios,44 and decreased performance in other dynamic movements such as sprint speed, agility, broad jump, squat strength.45

There are a number of theories regarding the mechanisms of DOMS. The bulk of the literature reports that high mechanical stress placed on the myofibrils (most commonly seen during eccentric exercise) damages both muscle and connective tissue. This tissue damage subsequently triggers an acute inflammatory response, consisting of edema and inflammatory cell infiltration, which leads to a loss of cellular homeostasis, particularly due to high intracellular calcium concentrations.46

One treatment that is often utilized to reduce DOMS is massage. Although massage has not been shown to be an effective method for improving ROM46,47 or muscular strength46-48 following EIMD, massage has been shown to be beneficial in treating EIMD by increasing mitochondrial biogenesis49 and restoring blood flow,50 while decreasing muscle soreness,47-50 cellular stress,49 and inflammation.49 Massage has also shown varying results in reducing limb circumference46,47 and creatine kinase levels46,50 while potentially increasing circulating neutrophil counts.32,46,50

Foam rolling, a form of massage, has also become common practice for treating and preventing soft-tissue restrictions to aid recovery from DOMS. Until recently, there was no peer-reviewed research illustrating the effect of foam rolling on recovery of neuromuscular and physical performance after EIMD and, subsequently, DOMS. In the past year, two studies from our laboratory have shown that, following an intense bout of eccentric muscle contractions that caused EIMD and DOMS, foam rolling enhanced the recovery of neuromuscular51 and physical performance.52 In both studies, participants performed the same eccentric contraction squat protocol to induce EIMD and DOMS and performed the same foam-rolling protocol on the legs following the squat protocol (see Macdonald et al51 and Pearcey et al52 for more details). In both studies, the control group and the foam-rolling group were assessed before the intervention, immediately after the intervention, and 24, 48, and 72 hours after the intervention. Foam rolling was performed at the end of each postintervention testing session.

Pearcey et al52 analyzed the effects of foam rolling on physical performance measures such as sprint speed, agility, broad jump, squat strength, and pain threshold. They found that, compared with the control condition, foam rolling substantially reduced quadriceps muscle tenderness at 24 and 48 hours while also substantially improving sprint time (at 24 and 72 hours), power (at 24 and 72 hours) and dynamic strength-endurance (at 48 hours). They concluded that foam rolling is effective in reducing DOMS and associated decrements in most dynamic performance measures. Since Pearcey et al52 took an applied research approach, the next progression was to analyze the possible underlying mechanisms of foam rolling-induced improvements in the recovery process following EIMD.

MacDonald et al51 analyzed the effects of foam rolling on neuromuscular performance measures such as evoked and voluntary contractile properties, ROM, vertical jump height, and pain. They found that foam rolling substantially reduced muscle soreness at all time points while substantially improving ROM compared with the control condition. Voluntary and evoked contractile properties showed no substantial between-group differences for all measurements besides voluntary muscle activation and vertical jump, with foam rolling substantially improving muscle activation at all time points and improving vertical jump at 48 hours compared with the control condition.

In both studies, physical and neuromuscular performance was negatively impacted for up to 72 hours irrespective of foam rolling. However, the results clearly show that foam rolling reduces the pain associated with DOMS and subsequently enhances the rate of recovery throughout the typical 72 hours after onset of EIMD, when DOMS is greatest. Because evoked contractile properties are not improved by foam rolling, foam rolling likely acts by reducing neural inhibition32,37 due to accelerated recovery of the connective tissue as a result of decreased inflammation, increased mitochondria biogenesis,49 and decreasing nociceptor activation,53 which allows for better communication from afferent receptors in the connective tissue.37 Better communication with afferent receptors may allow for the maintenance of natural muscle sequencing and recruitment patterns,37 thus improving neuromuscular and physical performance.

Conclusions

Although the use of foam rollers and roller-massagers is relatively recent, the few published studies examining their effectiveness have had positive findings. Both foam rolling and roller massage have increased ROM and either improved performance (eg, neuromuscular efficiency of a lunge) or did not lead to subsequent performance impairments (MVCs have either increased or not changed). The rollers have also been effective for improving recovery from EIMD by decreasing the pain associated with DOMS and accelerating performance recovery. While these early findings suggest that neural mechanisms underlie these effects, additional work is needed to discern whether there are significant myofascial mechanisms involved as well.

Duane C. Button, PhD, CSEP-CEP, is assistant professor in the School of Human Kinetics and Recreation and cross-appointed with the Faculty of Medicine at Memorial University of Newfoundland in St. John’s, Canada. David G. Behm, PhD, is professor and the associate dean of Graduate Studies at the School of Human Kinetics and Recreation at Memorial University of Newfoundland.

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