Foam rolling (also called physio rolling) — or, by its more technical name, self-myofascial release (self-myofascial release) — is being used more and more in both sport and physiotherapy. In practice, it means rolling/releasing the muscles and the structures that cover them. As this activity, said to speed recovery and improve joint mobility, has brought a considerable number of self-rollers—both elite and recreational athletes—into training halls, we should look for well-grounded evidence for such self-imposed, at first glance rather uncomfortable pressure and kneading.

Myofascial release is one part of the manual techniques used by manual therapists, massage therapists, or physiotherapists to release tense or stiff fascia and to treat and prevent soft-tissue dysfunction. To clarify: fascia is the connective tissue that surrounds and interconnects muscles; when injured, inactive, or inflamed it can restrict joint mobility and thus reduce muscular strength or endurance. It is also important to note that there is not yet consensus on the exact definition of fascia (Sullivan et al., 2013).

Thus, myofascial release is a method used to influence the condition of different tissues in the body, including muscles, fascia, nerves, and epithelial tissues (skin, vasculature). When rolling, tissues are simultaneously subjected to stretch, friction, and compression, which can be considered analogous to the effects achieved in manual therapy (Pearcey et al., 2015). Rolling or self-myofascial release is purportedly used to “release muscle knots” caused by so-called fascial adhesions. It is thought that sustained pressure applied to a “knot” (trigger point) helps the small soft-tissue nodule or stiff spot to release and thereby restore normal alignment of muscle fibers. Such release increases tissue elasticity, improves joint range of motion, and can reduce pain syndromes (Clark et al., 2014).

At the same time, some argue that “fascia release” and its effects actually arise from neurobiological mechanisms—namely, that sustained manual pressure affects mechanoreceptors (especially the Golgi tendon organ—a mechanoreceptor that senses muscle tension). When excessive muscle tension or compression is present, the Golgi tendon organ sends a signal to the nervous system, which in turn induces a relaxing effect via the muscle spindle (the muscle spindle is a mechanoreceptor that regulates muscle contraction when a muscle is subjected to too rapid or forceful a stretch). We can regard this as a protective mechanism of the body that helps prevent soft-tissue injuries (also called autogenic inhibition).

For example, during the bench press, if the load is too heavy the body “switches off the signals” to the working muscles, so the person cannot complete the movement. A similar effect appears in manual therapy: pressure applied by the therapist to a defined “muscle knot” can, within seconds, lead to a tissue “release” and an immediate feeling of relief. Of course, this is a simplified description of rather complex neurobiological mechanisms, in which other neural pathways and mechanoreceptors—such as Ruffini and Pacinian corpuscles—also play a role (Sutton, 2016).

BUT WHAT DOES THE SCIENCE SAY NOW?

Until now, the rationale for foam rolling has drawn on foundational concepts from manual therapy, which claim that pressure creates transient ischemia followed by a hyperemic response—i.e., improved blood flow (Hanten et al., 2000). As foam rolling grows in popularity, the number of scientific studies has increased and may offer more precise answers about its effects. Notably, the latest findings are promising.

Foam rolling and joint mobility

For example, Bushell et al. (2015) found that foam rolling increases the elasticity of the hip flexor located on the anterior aspect of the hip joint, enabling rollers to perform lunges with a greater hip-extension range than the control group. It has also been found that, for improving hip flexion range, foam rolling the hamstrings combined with static stretching is more effective than stretching or rolling alone—so roll first, then stretch (Mohr et al., 2014). In one study, rolling the hamstrings to improve hip mobility was considered as effective as the PNF stretching discussed in an earlier blog post (Junker & Stöggl, 2015).

For the ankle joint as well, rolling and stretching the calf were more effective at increasing dorsiflexion than stretching or rolling alone. However, these changes in joint mobility were not permanent, returning to baseline within 10 minutes—so regular practice matters (Škarabot et al., 2015).

In a similar study, Halperin et al. (2014) also found that static stretching plus rolling was the most effective for improving joint mobility. Moreover, rolling did not reduce maximal strength, a decrease often observed after static stretching performed before exercise. MacDonald et al. (2013) likewise showed that, in addition to improving knee-flexion range, foam rolling does not reduce the quadriceps’ maximal contractile capacity. Thus, the notion that massage leaves you weaker does not hold here: self-massage and rolling do not negatively affect strength and can be used before training or competition.

Although the list above highlights positive findings, some studies on foam rolling have not shown such strong results (Morton et al., 2015; Vigotsky et al., 2015). Because foam rolling tends to raise pain tolerance, studies that assess range of motion up to the point of discomfort or pain may overestimate its effects on muscle or fascia; the real effect may instead stem from increased tolerance to stretch (Couture, 2015). Still, given the preponderance of positive studies, using foam rolling to improve joint mobility is by no means a bad idea (Cheatham et al., 2015).

Foam rolling and recovery

Pearcey et al. (2015) investigated the effectiveness of foam rolling in alleviating delayed-onset muscle soreness (DOMS). Their study showed that foam rolling is effective for reducing post-exercise soreness and the associated decline in performance. MacDonald et al. (2014) likewise found that participants who regularly rolled after intense training reported less muscle soreness. They also showed better muscle activation patterns, higher jump height, and greater hamstring and quadriceps elasticity.

A recent systematic review (Cheatham et al., 2015) also concluded that foam rolling can be effective for improving joint range of motion and relieving post-exercise muscle soreness and the related performance decline. Using foam rolling during warm-ups may reduce the development of exercise-induced fatigue, allowing athletes to increase training volume and, with regular practice, achieve higher performance. However, in that review a single bout of foam rolling did not improve performance, again underscoring the importance of consistency (Healey et al., 2014).

Earlier studies have shown that even a single session of foam rolling reduces arterial stiffness and improves vascular function. Thus, foam rolling may enhance overall blood flow and vascular health (Okamoto et al., 2014). With increased circulation, lactate clearance accelerates, swelling decreases, and oxygen delivery improves—all of which support faster recovery (Cheatham et al., 2015).

TOOLS FOR MYOFASCIAL RELEASE

The main tools used are massage rollers and sticks of various sizes and designs, and rubber or tennis balls (Cheatham et al., 2015). These vary in size, texture, and firmness. When choosing a foam roller or another device for myofascial release, pick the tool according to the user. Beginners should opt for a softer roller, as one that is too firm may cause excessive discomfort and pain, leading the user to tense up and avoid future sessions. With longer practice, one can choose firmer textures or patterned rollers—particularly since firmer rollers are more effective, producing greater pressure on the treated tissue. For instance, firmer rollers have yielded better outcomes for improving joint mobility (Couture et al., 2015).

Not every body region (the cervical spine, shoulders, and upper limbs) can be effectively treated with a foam roller; for these areas, hand-held massage tools or balls are recommended. Such solutions may also suit overweight individuals or patients with orthopedic conditions who have difficulty getting down to the floor and working at that level (Sutton, 2016).

HOW TO ROLL?

When rolling at a slow pace, it is recommended to identify tender areas within the target muscle group and maintain pressure until the soreness decreases by at least 75% (Clark et al., 2014). Typically this takes 30–90 seconds, depending largely on the person’s ability to relax. A 10-minute rolling routine can reduce pain for up to 30 minutes (Cheatham et al., 2015). Because the duration of foam-roller use varies across studies, a practical guideline is 60–90 seconds up to 5 minutes per muscle group (Paolini, 2009).

Because one aim of myofascial release is to reduce involuntary muscle tension and excessive tone, you should maintain a calm, relaxed state—consciously relaxing even if rolling causes mild discomfort. When using hand-held tools, the pressure should likewise be slow and steady. Avoid rushing or creating excessive skin friction.

Self-myofascial release should not be performed in the presence of varicose veins, skin damage or wounds, eczema, infectious skin diseases, or sunburn. In the case of chronic diseases such as diabetes or osteoporosis, or during chemotherapy, consult your treating physician before foam rolling (Clark et al., 2014).

IN SUMMARY

A closer look at the scientific literature shows that (Cheatham et al., 2015):

• Foam rolling is an effective method for alleviating muscle soreness, improving joint mobility and tissue elasticity, and increasing blood flow.
• Self-myofascial release can be useful both before and after exercise, and there is no need to fear a loss of muscle strength after rolling.
• Despite the popularity of foam rolling, its exact physiological effects are still being clarified, so the optimal dosage for best results has not yet been established.

It’s important to consider individual differences when rolling, and for some people rolling may be difficult. In such cases, various hand-held massage rollers can be used—often a more comfortable option for those with orthopedic complaints or for overweight patients. Based on current scientific literature, this seemingly uncomfortable activity can, in the long run, be quite beneficial for health. If you have questions or are unsure, it is advisable to consult your doctor or physiotherapist before using a foam roller.

Happy rolling!

References

Referenced articles:

http://www.ptonthenet.com/articles/the-science-of-self-myofascial-release-4036

http://www.mikereinold.com/tag/self-myofascial-release/

https://www.strengthandconditioningresearch.com/foam-rolling-self-myofascial-release/

https://www.t-nation.com/training/feel-better-for-10-bucks

Bushell, J. E., Dawson, S. M., & Webster, M. M. (2015). Clinical Relevance of Foam Rolling on Hip Extension Angle in a Functional Lunge Position. Journal of Strength and Conditioning Research, 29(9), 2397–2403. doi:10.1519/jsc.0000000000000888

Clark, M., Lucett, S., & Sutton, B. (Eds.). (2014). NASM Essentials of Corrective Exercise Training. Burlington, MA: Jones and Bartlett Learning.

Cheatham, S. W., Kolber, M. J., Cain, M., & Lee, M. (2015). THE EFFECTS OF SELF-MYOFASCIAL RELEASE USING A FOAM ROLL OR ROLLER MASSAGER ON JOINT RANGE OF MOTION, MUSCLE RECOVERY, AND PERFORMANCE: A SYSTEMATIC REVIEW. International Journal of Sports Physical Therapy, 10(6), 827–838.

Couture, G., Karlik, D., Glass, S. C., & Hatzel, B. M. (2015). The Effect of Foam Rolling Duration on Hamstring Range of Motion. The Open Orthopaedics Journal, 9, 450–455. http://doi.org/10.2174/1874325001509010450

Halperin I., Aboodarda S., Button D., Andersen L., & Behm D. (2014). Roller massager improves range of motion of plantar flexor muscles without subsequent decreases in force parameters. International Journal of Sports Physical Therapy. Feb;9(1):92–102.

Hanten, W., Olson, S., Butts, N., & A, N. (2000). Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points. Physical Therapy, 80(10), 997–1003.

Healey K., Hatfield D., Blanpied P., Dorfman L., & Riebe D. The effects of myofascial release with foam rolling on performance. Journal of Strength and Conditioning Research. Jan;28(1):61–8. doi: 10.1519/JSC.0b013e3182956569.

Junker D., & Stöggl T. (2015). The Foam Roll as a Tool to Improve Hamstring Flexibility. Journal of Strength and Conditioning Research. Dec;29(12):3480–5. doi: 10.1519/JSC.0000000000001007.

MacDonald G., Penney M., Mullaley M., Cuconato A., Drake C., Behm D., & Button D. (2013). An acute bout of self-myofascial release increases range of motion without a subsequent decrease in muscle activation or force. Journal of Strength and Conditioning Research. Mar;27(3):812–21. doi: 10.1519/JSC.0b013e31825c2bc1.

Macdonald G., Button D., Drinkwater E., & Behm D. (2014). Foam rolling as a recovery tool after an intense bout of physical activity. Medicine and Science in Sports and Exercise. Jan;46(1):131–42. doi: 10.1249/MSS.0b013e3182a123db.

MacDonald GZ, Penney MD, Mullaley ME, et al. An acute bout of self-myofascial release increases range of motion without a subsequent decrease in muscle activation or force. J Strength Cond Res 2013; 27(3): 812–21. http://dx.doi.org/10.1519/JSC.0b013e31825c2bc1

Mohr R., Long C., & Goad L. (2014). Effect of foam rolling and static stretching on passive hip-flexion range of motion. Journal of Sport Rehabilitation. Nov;23(4):296–9. doi: 10.1123/jsr.2013-0025.

Morton R., Oikawa S., Phillips S., Devries M., & Mitchell C. (2015). Self-Myofascial Release Does Not Improve Functional Outcomes in “Tight” Hamstrings. International Journal of Sports Physiology and Performance. Nov 9.

Škarabot J., Beardsley C., & Štirn I. (2015). Comparing the effects of self-myofascial release with static stretching on ankle range-of-motion in adolescent athletes. International Journal of Sports Physical Therapy. Apr;10(2):203–12.

Paolini, J. Review of myofascial release as an effective massage therapy technique. Athl Ther Today 15: 30–34, 2009.

Pearcey G., Bradbury-Squires D., Kawamoto J., Drinkwater E., Behm D., & Button D. (2015). Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. Journal of Athletic Training. Jan;50(1):5–13. doi: 10.4085/1062-6050-50.1.01.

Okamoto, T., Masuhara, M., & Ikuta, K. (2014). ACUTE EFFECTS OF SELF-MYOFASCIAL RELEASE USING A FOAM ROLLER ON ARTERIAL FUNCTION. Journal of Strength and Conditioning Research, 28(1), 69–73. doi:10.1519/JSC.0b013e31829480f5

Sullivan, K. M., Silvey, D. B. J., Button, D. C., & Behm, D. G. (2013). ROLLER-MASSAGER APPLICATION TO THE HAMSTRINGS INCREASES SIT-AND-REACH RANGE OF MOTION WITHIN FIVE TO TEN SECONDS WITHOUT PERFORMANCE IMPAIRMENTS. International Journal of Sports Physical Therapy, 8(3), 228–236.

Vigotsky, A. D., Lehman, G. J., Contreras, B., Beardsley, C., Chung, B., & Feser, E. H. (2015). Acute effects of anterior thigh foam rolling on hip angle, knee angle, and rectus femoris length in the modified Thomas test. PeerJ, 3, e1281. http://doi.org/10.7717/peerj.1281