Saturday, August 17, 2013

To Roll or Not to Roll

Foam rolling or also called self myofascial release is getting popular in fitness, exercise therapy and manual therapies. It is claimed to be an effective complement to massage, trigger point treatments, and also for stretching & increasing ROM. As many would then say "More research is needed to know its effects."
There are several skeptics website that mentioned foam roller is a waste of time (no research to prove it works). Well, in effect foam roller is not much different from applying pressure to the muscles. The following is a discussion by Robert Schleip on Foam Rolling.


How does it work?
Robert Schleip said "I don't think anybody 'knows' at this time. All people do is speculate based on their personal experience plus on more or less wild interpretations. "

Some people do not think foam rolling is useful, mostly stated that ITB cannot be stretched and quoting Robert Schleip's 2003 article on Fascial plasticity published in JBMT which mentioned that it is not possible for a therapist to generate force to 'melt' or deform the ITB. A paper by Threlkeld showed that the ITB can withstand longitudinal strain up to approx. 600 N (60 kg) without long lasting deformations. Based on this Robert raised questions, on whether the elbow power of a Rolfer would be sufficient for a purely mechanical plastic deformation effect in such dense collagenous structures.

However, many therapists claim they get beneficial effects from deep tissue massage on the ITB and similar dense fascial structures. In Schelip's 2003 article article, he then developed the hypothetical model, that at least some of deep tissue effects may be due to the stimulation of sensory nerve endings in fascia, which then can trigger changes in nearby skeletal muscle fibres (for the ITB maybe the vastus lateralis directly under the band, or the gluteus max or tensor fascia lata) or changes in the autonomic nervous system which can result in an altered fluid hydration of the fascial structure. Robert believed that this is one of the most likely/valid explanations for the often observed tissue release effects in hands-on myofascial work.

Applying self myofascial release by foam rolling can create similar force or effects as a hands-on (or elbow) stroke from a manual therapist.A newer and more intriguing explanation for the effects of myofascial work is that we may be squeezing water out of the tissue areas directly under our hands, and that these areas subsequently fill with new water molecules. See e.g.http://fasciaresearch.de/Schleip2012_StrainHardeningFascia.pdf.

At the last Fascia Congress keynote lecturer Gerald Pollack also emphasized his assumption, that the newly sucked in water molecules will associate more in a 'bound water' state with the proteoglycans in the tissue and will behave more like a liquid crysal, as compared to the higher content of unbound bulk water which often characterizes stagnant water zones in the body or tissues in a pathological condition.

Therefore Schleip suggested that most of the beneficial effects of foam roller self treatments in addition to sponge squeezing & rehydration effects are:
  • increasing pain tolerance, i.e. activating descending inhibitory cortical pathways
  • stimulation of sensory receptors on fascia (Ruffini, Golgi, FNE) with resultant downstream effects, such as decrease of related skeletal myofibre tonus, increased proprioception, increase of vasodilation & plasma extrusion.
  • stimulation of fibroblasts, which can lead to increased production of antiinflammatory and anti-fibrotic cytokines (in super-slow rolling speeds) or to increased collagen production (in rapid & forceful stimulations).
For effective application, it is helpful that the treated person pays detailed mental attention (state of mindfulness, curiosity for tiny details, etc.). The proprioceptive input can also be used to support specific changes in cortical body mapping (body schema, body image). If this aspect is important and included, then one can orchestrate the direction of the last tissue strokes such, that they support a specific body perception change (e.g. working in a distal direction for more 'grounding', or proximally for more lightness, etc.).

For the second, it is helpful if multiple directions of tissue squeezing are applied (analogy with cleaning a dirty towel in water, etc.) and also if the squeezing movement is done as slowly as possible in order to reach the tiny micro-vacuoles within the tissue.

The studies from Healey and Mac Donald (see below) seem to also describe stress related recovery effects in foam rolling. The study by Ohkamoto showed the increased expression of plasmic nitrous oxide is usually seen as beneficial. However it also is a well known response to mechanical tissue stress. The increased ROM in McDonald's paper does not necessarily mean that there was softening effect on joint capsules or related connective tissues. I would suspect that it was rather due to an increase of the perceived 'comfort zone' of the patient which was used for the measurement of this parameter.


How much Force?

The amount of pressure one can take can be different, one person to another can vary up to 5000% (i.e. factor of 50). It is best to choose a roller firmness that allows you to play around the edges of your subjective pain tolerance (often one will increase in roller firmness after a few weeks/months of application).

It is possible that some people overdo the self-torture effect of foam rolling and create bruises and minor vascular tears.

But even then the question can be asked: how much micro-injury (at what intensity and what time interval) is appropriate for possibly inducing a long term beneficial recovery response in terms of an ultimately increased physiological and/or biomechanical tissue resilience? E.g. the new and expensive 'cryogenic chamber therapy' or Gua Sha seems to work by creating irritation, stress and inflammatory reactions in the tissues close to the skin, which – if calibrated appropriately – stimulates the body to activate some pain modulating, anti-inflammatory and matrix remodeling cytokine responses during the subsequent hours and days.

However, similar to cryotherapy, Kneipp cures and other stress-imposing interventions, this therapy can also be overdone and then will not result in an increased tolerance to the same irritation but rather induce a longterm decrease of tolerance. In my limited clinical experience, I would think if the increased sensitivity (and resultant decrease in tolerance) lasts no longer than 1 or 2 days, it may still induce a tolerance-increasing long term effect afterwards. However if the perceived 'soreness' lasts 3 days or longer, then I am more doubtful about any long term benefits. Usually in those cases it then takes 1 or several weeks until the tissue returns to its previous resilience (if at all; while a subsequent super-compensation recovery effect towards an increased tolerance is very rare). An important exception to this 2 day rule of thumb are fibromyalgia patients: in some of them the immediate soreness period and resultant recovery period – even if ultimately beneficial – may take much longer than that.

How fast?
Robert recommended 1-2mm per breath – for softening scars and other tight and stiff collagenous tissues - seems to be too idealistic for most people. In my own teaching I have had good responses when replacing that with "slowest possible continuous rolling movement" and the added remark that a super slow speed of 1/2 to 1/4 inch per breath could be a great start.

Contraindications

Acute injury, acure inflammatory conditions (for forceful rolling applications), lack of embodiment and grim determination of the user. Otherwise I don't think there is a wrong way of doing it. Variation is usually better for fascial stimulation than repetition of the same exact 'correct' loading styles.

Direction of Rolling

Some people believed that (similar to one of the myths in massage) is that rolling should be distal to proximal (following blood circulation). However as in manual therapy, the direction of manipulation has a more notional and neural effect.

Robert commented: "I don't think it is very likely that we can push a piece of fascial tissue from A to B and that it will stay there during the following work day. What we do with directional rolling is the same as when gently brushing one's skin in a particular direction: we propose to the brain a suggested movement gesture. Like when stroking down several times with a soft brush on the right leg and upwards on the left one, the patients then tend to feel' longer' on their right leg afterwards and shorter on their left one. Same for rolling the upper ITB band in an anterior direction, which may invite the brain towards a more pigeon-toed stance or gait afterwards (for a few steps only). This 'gestural' effect probably involves short term changes in the cortical body schema and it can be beautifully tailored towards the specific needs of each client. For me it makes most sense to include such individually tailored 'directional rolling' at the very end of the therapeutic session, in order to increase a higher likelihood of transfer into their daily living habit formation. "


Here are Some Studies on Foam Roller

Acute Effects of Self-Myofascial Release Using a Foam Roller on Arterial Function

Authors: Takanobu Okamoto, Mitsuhiko Masuhara, Komei Ikuta

Flexibility is associated with arterial distensibility. individuals who practice yoga have significantly less arterial stiffness that those who are sedentary. Thus, flexibility exercises such as stretching or yoga might reduce arterial stiffness. Many individuals involved in sport, exercise and/or fitness perform self-myofascial release (SMR) using a foam roller, which restores muscles, tendons, ligaments, fascia and/or soft-tissue extensibility. However, the effect of SMR on arterial stiffness and vascular endothelial function using a foam roller is unknown.

The present study investigates the acute effect of SMR using a foam roller on arterial stiffness and vascular endothelial function. Ten healthy young adults performed SMR and control (CON) trials on separate days in a randomized controlled crossover fashion. Brachial-ankle pulse wave velocity, blood pressure, heart rate and plasma nitric oxide concentration were measured before and 30 min after both SMR and CON trials. The participants performed SMR of the adductor, hamstrings, quadriceps, iliotibial band and trapezius. Pressure was self-adjusted during myofascial release by applying body weight to the roller and using the hands and feet to offset weight as required. The roller was placed under the target tissue area and the body was moved back and forth across the roller. In the CON trial, SMR was not performed.

Results showed that the brachial-ankle pulse wave velocity significantly decreased (from 1202 ± 105 to 1074 ± 110 cm/s) and the plasma nitric oxide (NO) concentration significantly increased (from 20.4 ± 6.9 to 34.4 ± 17.2 μmol/L) after SMR using a foam roller, but neither significantly differed after CON trials. These results indicate that SMR using a foam roller reduces arterial stiffness and improves vascular endothelial function.

Journal of Strength and Conditioning Research Publish Ahead of Print. DOI: 10.1519/JSC.0b013e31829480f5



The Effects of Myofascial Release with Foam Rolling on Performance.

Authors: Healey KC, Hatfield DL, Blanpied P, Dorfman LR, Riebe D.

The purpose of this study was to determine whether the use of myofascial rollers before athletic tests can enhance performance.

Twenty-six (13 men and 13 women) healthy college aged individuals (21.56±2.04 years, 23.97±3.98 body mass index (BMI), 20.57±12.21 percent body fat) were recruited. The study design was a randomized, crossover design in which subject performed a series of planking exercises or foam rolling exercises then performed a series of athletic performance tests (vertical jump height and power, isometric force, and agility.) Fatigue, soreness, and exertion were also measured.

A 2 x 2 (Trial x Gender) ANOVA with repeated measures and appropriate post-hoc was used to analyze the data. There were no significant differences between foam rolling and planking for all four of the athletic tests. However, there was a significant difference between genders on all of the athletic tests .

As expected there were significant increases from pre to post during both trials for fatigue, soreness, and exertion. Post-exercise fatigue after foam rolling was significantly less than after the subjects performed planking (p ≤ 0.05). The reduced feeling of fatigue may allow participants to extend acute workout time and volume, which can lead to chronic performance enhancements. However, foam rolling had no affect on performance.

J Strength Cond Res. 2013 Apr 12. The Effects of Myofascial Release with Foam Rolling on Performance.



An acute bout of self-myofascial release increases range of motion without a subsequent decrease in muscle activation or force.

Authors: MacDonald GZ, Penney MD, Mullaley ME, Cuconato AL, Drake CD, Behm DG, Button DC.

The objective of the study was to determine the effect of self-myofascial release (SMR) via foam roller application on knee extensor force and activation and knee joint ROM. Eleven healthy male (height 178.9 ± 3.5 cm, mass 86.3 ± 7.4 kg, age 22.3 ± 3.8 years) subjects who were physically active participated. Subjects' quadriceps maximum voluntary contraction force, evoked force and activation, and knee joint ROM were measured before, 2 minutes, and 10 minutes after 2 conditions: (a) 2, 1-minute trials of SMR of the quadriceps via a foam roller and (b) no SMR (Control). A 2-way analysis of variance (condition × time) with repeated measures was performed on all dependent variables recorded in the precondition and postcondition tests.

There were no significant differences between conditions for any of the neuromuscular dependent variables. However, after foam rolling, subjects' ROM significantly increased by 10° and 8° at 2 and 10 minutes, respectively. There was a significant negative correlation between subjects' force and ROM before foam rolling, which no longer existed after foam rolling.

In conclusion, an acute bout of SMR of the quadriceps was an effective treatment to acutely enhance knee joint ROM without a concomitant deficit in muscle performance.

J Strength Cond Res. 2013 Mar;27(3):812-21. doi: 10.1519/JSC.0b013e31825c2bc1.



Roller-massager application to the hamstrings increases sit-and-reach range of motion within five to ten seconds without performance impairments.

Authors: Sullivan KM, Silvey DB, Button DC, Behm DG.

BACKGROUND: Foam rollers are used to mimic myofascial release techniques and have been used by therapists, athletes, and the general public alike to increase range of motion (ROM) and alleviate pressure points. The roller-massager was designed to serve a similar purpose but is a more portable device that uses the upper body rather than body mass to provide the rolling force.

OBJECTIVES/PURPOSE: A roller massager was used in this study to examine the acute effects on lower extremity ROM and subsequent muscle length performance.

METHODS: Seven male and ten female volunteers took part in 4 trials of hamstrings roller-massager rolling (1 set - 5 seconds, 1 set - 10 seconds, 2 sets - 5 seconds, and 2 sets - 10 seconds) at a constant pressure (13 kgs) and a constant rate (120 bpm). A group of 9 participants (three male, six female) also performed a control testing session with no rolling intervention. A sit and reach test for ROM, along with a maximal voluntary contraction (MVC) force and muscle activation of the hamstrings were measured before and after each session of rolling.

RESULTS: A main effect for testing time illustrated that the use of the roller-massager resulted in a 4.3% increase in ROM. There was a trend for 10s of rolling duration to increase ROM more than 5s rolling duration. There were no significant changes in MVC force or MVC EMG activity after the rolling intervention.

CONCLUSIONS: The use of the roller-massager had no significant effect on muscle strength, and can provide statistically significant increases in ROM, particularly when used for a longer duration.

Int J Sports Phys Ther. 2013 Jun;8(3):228-36. http://www.ncbi.nlm.nih.gov/pubmed/23772339



A Comparasion between static stretch and self-myofascial release in order to improve the range of motion in the hamstrings: A five-week intervention study

Author: Lindström & Persson, Helena & Karolina (Halmstad University, School of Business and Engineering (SET))

Purpose: To determine whether static stretch or SMR, using The Grid (foam roller), were most effective to improve range of motion in the hamstrings.

Participants: Fourteen healthy men and women (26.5±8 years).

Methods: Participants were divided into two groups, performed either static stretch or SMR during five weeks. The participants performed five trials per week, one compulsory with the test leaders and remaining trials by themselves. All subjects were tested (One Leg Raise-test) before and after the study period. Pre-test were performed two separate times, with one day in between. Three tests were measured per leg and day, the average value of the six measurements on each leg were calculated and used as pre-test result. Same procedure during post-test and the average results were compared and analysed.

Results: Both groups showed an improvement in range of motion (ROM) over five weeks intervention, however this improvement was only significant in the stretch group . There was no significant difference in mean difference of improvement between the two groups.

Conclusion: There was no significant different between the methods in improving ROMs in the hamstrings after five weeks intervention.

Thesis, Halmstad University, School of Business and Engineering (SET) http://www.diva-portal.org/smash/record.jsf?pid=diva2:627616

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