Journal of Bodywork & Movement Therapies 21 (2017) 446e451

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Journal of Bodywork & Movement Therapies

journal homepage: www.elsevier.com/jbmt

FASCIA SCIENCE AND CLINICAL APPLICATIONS: NARRATIVE REVIEW

Effect of self-myofascial release on myofascial pain, muscle flexibility,

and strength: A narrative review
Leonid Kalichman*, Chen Ben David
Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences at Ben-Gurion University of the Negev, Beer-
Sheva, Israel

a r t i c l e i n f o a b s t r a c t

Article history: Background: Numerous techniques have been employed to treat myofascial pain syndrome. Self-
Received 20 August 2016 myofascial release (SMFR) is a relatively new technique of soft tissue mobilization. The simplicity and
Received in revised form portability of the SMFR tools allow it to be easily implemented in any type of fitness or rehabilitation
27 October 2016
program. It is an active method and can be used by anyone at home or at the workplace.
Accepted 6 November 2016
Objective: To review the current methods of SMFR, their mechanisms, and efficacy in treating myofascial
pain, improving muscle flexibility and strength.
Keywords:
Methods: PubMed, Google Scholar, and PEDro databases were searched without search limitations from
Myofascial pain
Trigger points
inception until July 2016 for terms relating to SMFR.
Myofascial release Results and conclusions: During the past decade, therapists and fitness professionals have implemented
Self-myofascial release SMFR mainly via foam rolling as a recovery or maintenance tool. Researchers observed a significant
Stretching increase in the joint range of motion after using the SMFR technique and no decrease in muscle force or
Foam rolling changes in performance after treatment with SMFR. SMFR has been widely used by health-care pro-
fessionals in treating myofascial pain. However, we found no clinical trials which evaluated the influence
of SMFR on myofascial pain. There is an acute need for these trials to evaluate the efficacy and effec-
tiveness of SMFR in the treatment of the myofascial syndrome.
© 2016 Elsevier Ltd. All rights reserved.

1. Introduction Borg-Stein and Simons, 2002). The prevalence of myofascial pain

Myofascial pain syndrome is a common chronic condition
characterized by pain originating from myofascial trigger points
(MTrPs) and fascial restrictions. MTrPs are small, highly sensitive
areas located in a palpable taut band of skeletal muscle fibers (Borg-
Stein and Simons, 2002; Simons et al., 1999; Vulfsons et al., 2012).
MTrPs in a particular muscle causes a specific pain pattern and
dysfunction that is easily detected by weakness and reduced range
of motion (ROM) (Vulfsons et al., 2012). A growing number of in-
dividuals experience musculoskeletal pain which affects their daily
activities and function (Vernon and Schneider, 2009; Vulfsons et al.,
2012).
Myofascial pain is considered one of the most frequent causes of
muscular pain presenting in primary care (Aguilera et al., 2009;
* Corresponding author. Department of Physical Therapy, Recanati School for
Community Health Professions, Faculty of Health Sciences, Ben-Gurion University
of the Negev, P.O.B. 653, Beer Sheva, 84105, Israel.
E-mail addresses: kalichman@hotmail.com, kleonid@bgu.ac.il (L. Kalichman).
syndrome varies from 21% of patients seen in a general orthopedic
clinic and 30% of patients seen in general medical clinic com-
plaining of regional pain to as high as 85e93% of patients pre-
senting to specialty pain management centers (Borg-Stein and
Simons, 2002).
Numerous techniques are presently being employed to treat
myofascial pain categorized as invasive (injection therapy, MTrP
dry needling, etc.) and noninvasive (massage, stretching, myofas-
cial release (MFR), deep tissue massage, neuromuscular therapy,
therapeutic ultrasound, laser, etc.) (Aguilera et al., 2009).
One of the commonly used manual techniques is MFR to help
reduce restrictive barriers or fibrous adhesions observed between
layers of the fascial tissue (MacDonald et al., 2013). MFR is a hands-
on soft tissue procedure applying a gentle stretch to the restricted
fascia. Deep tissue massage is a type of massage therapy focusing on
realigning deeper layers of muscles and connective tissue (Riggs,
2007). Some of the same strokes are used in classic massage ther-
apy, however, the movement is slower, the pressure is deeper and
the manipulation is concentrated on areas of muscular tension (i.e.

http://dx.doi.org/10.1016/j.jbmt.2016.11.006
1360-8592/© 2016 Elsevier Ltd. All rights reserved.
 L. Kalichman, C. Ben David / Journal of Bodywork & Movement Therapies 21 (2017) 446e451
the palpable tight band in the muscles, densified fascia, etc). Other
methods such as neuromuscular therapy (Granger, 2011) and
myotherapy (Prudden, 2011) use static pressure, also called
ischemic compression (Cagnie et al., 2013) on MTrPs.
Most of the methods mentioned above are passive; the patient
is contingent on the therapist. Self- myofascial release (SMFR) a
technique of soft tissue mobilizations that become popular in the
last decade (Boyle, 2006), is performed under the same principles,
but instead of a therapist providing soft-tissue manual therapy, an
individual treats him/herself. SMFR is increasingly becoming a
common practice in treating soft-tissue restrictions. The simplicity
and availability of SMFR allow it to be easily implemented in many
types of training or rehabilitation program.
The SMFR technique involves small undulations back and forth
over a special tool such as a dense foam roller or massage balls,
starting at the proximal portion of the muscle and working
downwards to the distal portion of the muscle or vice versa.
Sometimes the undulations are concentrated over the painful area
of the muscle or a patient can be positioned over the SMFR tool for
6e30 s in order to provide sustained compression on the MTrP. The
small undulations place direct and sweeping pressure on the soft-
tissue which is believed to cause a warming of the fascia, breaking
up fibrous adhesions between the fascial layers and thus restoring
soft-tissue extensibility (MacDonald et al., 2013). On the other
hand, the effect as suggested by others is similar to one of deep
tissue massage or ischemic compression (Ferna
ndez-de-las-Pen~ as
et al., 2006; Fryer and Hodgson, 2005; Hanten et al., 2000; Hong
et al., 1993).
Aim: To examine the current methods of SMFR, their mecha-
nisms, and efficacy in treating myofascial pain, improving muscle
flexibility and strength.
2. Methods
PubMed, Google Scholar and PEDro databases were searched
without search limitations from inception until July 2016. The da-
tabases were searched for the keywords related to self-myofascial
release: myofascial pain, trigger points, tight muscles, muscle
pain, myofascial release, self-myofascial release, stretching, foam
rolling, pain ball, lacrosse ball, golf ball, tennis ball, “the stick”,
Thera Cane, Knobler, and the combination of these terms.
Criteria for inclusion in the review were use of any type of
research deals with existing methods of SMFR and their applica-
tions. Trails of any design and methodological quality were
included. No language restrictions were imposed. The reference
lists of all articles retrieved in full were also searched.
The search results were pooled duplicates deleted. The titles and
abstracts of all articles were reviewed. Full texts of potentially
relevant papers were read and their reference lists were searched
for additional relevant articles. After excluding all irrelevant papers
total of 42 publications were included in the review.
3. Findings
3.1. SMFR tools/methods
Different tools can be used for SMFR, i.e. a foam roller, roller
massager, “the Stic”Thera Cane, massage balls, and even sports
equipment such as tennis, lacrosse or golf balls.
Foam rollers were first used by practitioners of the Feldenkrais
method, a mind-body modality combining theories of motor
development, biomechanics, psychology and martial arts. This
method encourages the student to experiment and ideally become
more aware of their movements without much assistance from the
instructor. Foam rollers are used to restore alignment, improve
447
body awareness, posture and flexibility, challenge neuromuscular
control and alleviate muscular tension and pain (Feldenkrais,
2009).
Foam rolling is performed with a foam cylinder that can vary in
size, shape, and density. Different lengths are available rendering
foam rollers more travel-friendly and easier to maneuver on
different parts of the body. Foam rollers have become popular in
clinics and athletic training rooms for their easy use and versatility.
They also aim to improve mobility and ROM, reduce scar tissue and
adhesions, decrease muscle tone and overactive muscles, improve
the quality of movement, and replace hands-on sessions or deep
tissue massage.
Foam rollers are best used in treating large muscle groups. Each
muscle group has a designated position and protocol with different
starting and end points. Generally, most rolling protocols include
30e60 s of rolling on the specified muscle with the action repeated
on the opposite limb. Some protocols also call for the roller to be
stopped and held on any tender or painful areas in an attempt to
release a muscle spasm or MTrPs. Individuals with poor tissue
quality and are new to foam rolling, generally need to spend more
time on the roller in order to achieve best results. Foam rolling
sessions can be performed once or twice a day and may be used
before a workout as a warm-up tool or after as a recovery option
(Weerapong et al., 2005).
The medicine ball (special balls or tennis, golf, lacrosse balls)
may be more versatile than the foam roller since the balls can
concentrate on a focal spot as well as work in a three-dimensional
mode. A tennis ball is suitable for treating muscle or fascia on a
smaller surface area (Robertson, 2008).
The roller massager (or “the stick”) is a portable ergogenic de-
vice constructed of dense foam wrapped around a solid plastic
cylinder. This device used in a similar fashion as the foam roller is
increasingly being used by athletes to massage muscles and other
soft tissues (Halperin et al., 2014). However, instead of relying on
body weight, the patient uses his upper body. Manufacturers claim
that in as little as 30 s of massage, muscles can improve in flexi-
bility, strength, and power (Halperin et al., 2014). The roller
massager is also narrower in diameter which aids in reaching some
tendons (Robertson, 2008).
Thera Cane (Thera Cane Co, PO Box 9220, Denver, CO 80262) is a
plastic J-shaped cane with six knobs placed at various points on the
cane. The cane was designed to allow minimal exertion by the user
and create sustained pressure in hard-to-reach areas.
Despite the popularity and numerous benefits of SMFR, limited
research has been conducted on its efficacy and effectiveness in
treating musculoskeletal disorders. Most of these studies have
focused on SMFR using the foam roller. The studies on other SMFR
tools such as the roller massager and Thera Cane are rare and no
studies were found on the use of medicine balls.
3.2. Biological mechanism of SMFR
Research reports on SMFR mechanisms are limited. However,
the theoretical framework of bodywork methods can be used to
understand the mechanisms of the SMFR. Exerting mechanical
pressure is theorized to decrease adhesions between tissue layers,
improve muscular compliance and decrease muscle stiffness of the
muscle fibers (Sherer, 2013). Applying prolonged or amplified
pressure with a foam roller to the muscle belly will cause the
muscle to relax. A massage appears to help athletes reduce
ischemia by increasing blood circulation to the skin and muscles,
reduce parasympathetic activity and release relaxation hormones
and endorphins. The possible neurological effects occurring with
reflex stimulation, decrease the neuromuscular excitability of the
muscle and minimize MTrPs activity and pain, muscle spasms and
448 L. Kalichman, C. Ben David / Journal of Bodywork & Movement Therapies 21 (2017) 446e451
excessive tension (Sherer, 2013).
The pressure applied by SMFR tools is comparable to the pres-
sure induced by manual ischemic compression. The rolling is
similar to longitudinal stroking (striping) of deep tissue massage
(Rolfing). Performing ischemic compression entails applying
increasing pressure on the MTrPs usually with the thumb, to a
degree severe enough to result in temporary ischemia or a lack of
blood flow to the compressed area until the pain reaches its
maximal tolerable level (Abes, 2013; Cagnie et al., 2013). The pur-
pose of this method is to increase local blood flow upon release,
which is thought to facilitate the removal of waste products, supply
oxygen, and promote healing of the tissue (Abes, 2013).
A possible explanation for the increased ROM after ischemic
compression is that manual pressure on the contraction knot of the
MTrPs causes lengthening of the sarcomeres. Decreased abnormal
tension of the taut band and general pain reduction may also
contribute to increased ROM. Cagnie et al. (2013) examined the
short-term effects of ischemic compression treatment in a small
sample of office workers with mildly severe chronic pain. They
found that a four-week treatment of MTrPs for ischemic compres-
sion resulted in significant improvements in general neck and
shoulder complaints, pressure pain sensitivity, mobility and muscle
strength (Cagnie et al., 2013). A possible explanation for the sig-
nificant improvement of muscle strength may be that the short-
ened sarcomeres were lengthened by ischemic compression and
may have contributed to the contraction of the involved muscle.
The theory is that reactive hyperemia after applying ischemic
compression may lead to an improved oxygen supply and a
decreased production of nociceptive and inflammatory substances,
thus resulting in less damage to the muscle fibers and conse-
quently, better strength production (Cagnie et al., 2013).
Curran et al. (2008) compared the effects of two types of foam
rollers: a bio-foam and a multi-rigid layered roll. The amount of
pressure exerted on the soft tissue was significantly different. The
mean pressure exerted on the soft tissue of the lateral thigh by a
multi-rigid layered roll (51.8 ± 10.7 kPa) was significantly greater
than that of the conventional bio-foam roll (33.4 ± 6.4 kPa). The
mean contact area of a multi-rigid layered roll (47.0 ± 16.1 cm2)
was significantly less than that of the bio-foam roll
(68.4 ± 25.3 cm2). In conclusion, using the more dense foam roller
lead to a more focal and greater pressure on the treated tissue
(Curran et al., 2008).
According to Schleip, the physiology behind the SMFR technique
can be attributed to the autonomic nervous system and the central
nervous system (Schleip, 2003a, 2003b).
3.2.1. Autonomic nervous system
Pressure applied through the SMFR is believed to activate the
autonomic nervous system by stimulating interstitial type III and IV
receptors which respond to a light touch; the Ruffini endings in the
fascia respond to deep sustained pressure. SMFR proponents argue
that stimulating these receptors lowers the overall sympathetic
tone, increases gamma motor neuron activity and promotes the
relaxation of intra-fascial smooth muscle cells (Wiktorsson-Moller
et al., 1983). In addition, it is believed that the autonomic nervous
system promotes vasodilation and local fluid dynamics which alter
the viscosity of fascia by changing the ground substance to a more
gel-like state. All of these combined effects are hypothesized to
yield a palpable release of the trigger point and improve muscle
function (Abes, 2013; Barnes, 1997; Schleip, 2003a).
3.2.2. Central nervous system
Stimulation of the mechanoreceptors simultaneously activates
the autonomic nervous system and the central nervous system. The
central nervous system's response to such localized pressure
includes decreasing the tonus of a related striated muscle fibers
which subsequently contributes to the release felt through the
application of SMFR (Abes, 2013; Schleip, 2003a). SMFR results in
breaking the pain-spasm cycle by releasing muscle spasms and
decreasing adhesions, thus restoring normal homeostasis to con-
nective tissue (Mohr et al., 2014).
The muscle spindle is located in the belly of the muscle and
senses muscle length change. When the muscle spindle detects an
aggressive stretch to the muscle, the neural pathways send efferent
signals to that muscle, ensuring a contraction which resists the
excessive stretch. Forceful static stretching that does not alleviate
muscle spindle activation after 8 s can damage muscle spindle re-
ceptors and increase the risk of muscle strains or tears (Fama and
Bueti, 2011).
The Golgi tendon organ, located in the tendon, reacts to
changes in tension placed upon the muscle. If the Golgi tendon
organ senses excessive muscle contraction that can potentially
harm the related soft tissue structures, it becomes excited and
results in the relaxation or failure of a contraction. Stimulation of
the Golgi tendon organ inhibits the muscle spindle and causes
muscle relaxation (Fama and Bueti, 2011). This phenomenon is
called autogenic inhibition. Autogenic inhibition can also occur by
applying pressure during the foam roll thus stimulating the Golgi
tendon organ. When stimulation passes a certain threshold, it
inhibits muscle spindle activity and decreases muscular tension. If
autogenic inhibition occurs during foam rolling, muscle stiffness
decreases and muscle compliance increases, thus negatively
affecting performance and increasing the risk of injury during
physical activity (Fama and Bueti, 2011). This could explain the
potential decrease in performance and strength which was seen in
Fama and Bueti's (Fama and Bueti, 2011) study. They concluded
that foam rolling warm up exhibited negative effects by
decreasing jump performance.
3.3. Effects of SMFR
3.3.1. SMFR in treating myofascial pain
In spite the wide use of foam rolling, medicine balls and roller
massagers in treating myofascial pain, we found no clinical trials
which specifically evaluated the influence of these methods of
SMFR on myofascial pain.
3.3.2. Effect of Thera Cane SMFR on myofascial pain
Hanten et al. (2000) evaluated the effectiveness of a home
program of ischemic pressure using Thera Cane followed by sus-
tained stretching for the treatment of MTrPs. The subjects were
instructed to place the muscle with the primary MTrP in a
lengthened position using various combinations of head and
shoulder girdle movements, depending on the location of the MTrP.
While holding this position, the subject was instructed to place the
Thera Cane over the patient's primary MTrP, then to gradually in-
crease the pressure to the MTrP and hold the pressure until a
release (feels like a “letting go” or a “melting” of the muscle with
the primary MTrP, accompanied by a decrease in pain) was felt. The
subject was instructed to repeat the procedure, at least twice a day
for five consecutive days until no further release was obtained. The
results of this study showed that a combination of these techniques
is effective in reducing MTrPs sensitivity and pain intensity in in-
dividuals with neck and upper back pain. However, it is impossible
to determine if the effect was produced by the Thera Cane ischemic
compression, by the sustained stretch or by the combination of
both techniques.
There is an acute need for these trials to evaluate the efficacy
and effectiveness of SMFR in the treatment of the myofascial
syndrome.
 L. Kalichman, C. Ben David / Journal of Bodywork & Movement Therapies 21 (2017) 446e451
3.3.3. Influence of the foam roller SMFR on ROM/flexibility
One of the most common methods used to improve flexibility
and joint ROM is static stretching; however, a major limitation of
this method is that it could lead to decreased power and force
production if performed prior to an athletic activity (Simic et al.,
2013). Stretching places strain on the origin and insertion of the
muscle and may cause damage to the sarcomeres, thus diminishing
muscle force output. In addition, the elongation of tendinous tis-
sues can have an effect on force output through a reduction in
either the passive or active stiffness of the musculotendinous unit
(Sullivan et al., 2013).
An alternative, which has been growing in popularity, is SMFR
with either a foam roller or a roller massager. Halperin et al. (2014)
found that both roller massage and static stretching (performed for
three sets of 30 s each) increased ROM of plantar flexor muscles
immediately and 10 min after the interventions. However, the roller
massage increased and static stretching decreased maximal force
output during the post-test measurements. In a recent study
(Skarabot et al., 2015) of 11 resistance-trained, adolescent athlete
use of foam rolling alone did not lead to improvement in passive
ankle dorsiflexion ROM, however using the foam rolling in addition
to static stretching was significantly superior to using static
stretching alone (9.1% vs. 6.2%, p < 0.05).
A study conducted by MacDonald et al. (2013) found that two
sets of 1 min of SMFR using a foam roller on the quadriceps mus-
cles, improved knee joint ROM for up to 10 without a concomitant
deficit in muscle performance. Mohr et al. (2014) examined the
combination of foam rolling and static stretching and their influ-
ence on passive hip flexion ROM. Forty subjects with less than a 90
passive hip flexion ROM participated in the study. During each of
the six sessions, the subject's passive hip flexion ROM was
measured before and immediately after static stretching, foam
rolling and static stretching, foam rolling or nothing (controls).
Subjects using the foam roll and static stretch experienced a greater
change in passive hip flexion ROM compared with the static stretch,
foam-rolling and control groups (Mohr et al., 2014). The study
concluded that using the foam roller for three sets of 2-min repe-
titions increased hip flexion ROM.
Sherer et al (Sherer, 2013) studied the effects of foam roller use
on hamstring flexibility (measured by the sit-and-reach method) in
a group of weight training athletes. Participants in the intervention
group performed the foam rolling twice a week for a period of four
weeks. The control group did not receive any intervention. The
results showed that hamstring flexibility in the control group did
not change; in the foam rolling group flexibility significantly
increased (Sherer, 2013). Similarly, Sullivan et al. (2013) found a
4.7% increase in hamstring ROM following two sets of five and 10 s
with a roller massager.
On the other hand, there were studies that found that SMFR was
ineffective in increasing hamstring flexibility (Couture et al., 2015;
Miller and Rockey, 2006; Morton et al., 2016). For example, Miller
and Rockey (2006) investigated whether foam rollers would in-
crease the flexibility of the hamstring muscles when measured by
an active knee extension test. Foam rolling was performed three
days a week for eight weeks on individuals considered to have tight
hamstrings prior to the study. No significant differences were found
between the foam rolling and the control groups.
In a study by Sharp (2012), the benefits of using a hands-on
approach of MFR called the 'Emmet technique' was compared to
the use of SMFR using the foam roller. The results showed that ROM
significantly increased in both groups, but the Emmet hands-on
approach was more effective in increasing ROM. A vertical jump
was also evaluated showing no significant differences between the
foam rolling group and the Emmet group (Sharp, 2012). Even the
effectiveness of a hands-on approach was shown to be superior to
449
foam rolling; the greatest advantage of the SMFR is that the subject
is not dependent on the presence of the therapist.
Two systematic reviews were recently published on the effect of
SMFR (Beardsley and Skarabot, 2015; Cheatham et al., 2015). The
common conclusion of these reviews is that SMFR appears to have a
range of potentially valuable effects for both athletes and the
general population, including enhancing ROM. However, due to the
heterogeneity of methods among studies, there currently is no
consensus on the optimal SMFR program.
3.3.4. The influence of foam roller SMFR on performance and
strength
Healey et al. (2014) conducted a randomized, crossover study
examining whether the use of foam rollers before athletic tests
could enhance performance. Twenty-six healthy athletes per-
formed a series of planking or foam rolling exercises and then
performed a series of athletic performance tests (vertical jump
height and power, isometric force and agility). No significant dif-
ferences were found between foam rolling and planking for all four
of the athletic tests, however, the study found that post-exercise
fatigue after foam rolling was significantly less in subjects who
had 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 (Healey
et al., 2014).
Abes (2013) investigated the immediate effects of a standard
foam rolling protocol on the explosive strength of the plantar
flexors and alpha motor neuron excitability in the soleus. Explosive
strength was measured through vertical jump height and the
Reactive Strength Index. Alpha motor neuron excitability was
measured by H-reflex amplitude as an H-wave to M-wave ratio
obtained from the soleus muscle. The intervention which followed
standard professional guidelines consisted of 2.5 min of foam
rolling for the intervention group and rest for the control group,
followed by a 5-min warm-up on a cycle ergometer. With respect to
explosive strength, this study found that the foam rolling protocol
did not induce any significant changes in jump height or explosive
strength of the plantar flexors. In addition, the foam rolling protocol
produced no significant effect on the excitability of the motor
neuron pool. These findings are similar to Sullivan et al.'s (Sullivan
et al., 2013) who found that an acute bout of foam rolling had no
effect on maximal voluntary contraction, electromechanical decay
and evoked twitch force on the quadriceps.
Fama and Bueti (2011) evaluated the acute effect of a foam
roller warm-up routine and a dynamic warm-up routine on
strength, power, and reactive power. The outcome measures were
three different jump testing: squat jump, countermovement jump
and depth jump. Subjects were randomly assigned into the dy-
namic warm up group or the foam roller group: the foam roller
was bilaterally applied to the lower extremities on each muscle
group for 1 min. The dynamic treatment consisted of 10 repeti-
tions performed on each leg, with a walk-back recovery. Nine
college-aged recreational males with a minimum of one-year
experience in plyometric training completed the study. The re-
sults showed that a dynamic warm-up produced a significant in-
crease in countermovement jump height compared to the foam
roller warm-up. When comparing the two warm-up techniques,
the foam roller routine did not elicit any significant changes in
performance in the squat jump or depth jump. Also, the foam
roller warm-up did not improve performance, on the contrary, it
was actually detrimental to the countermovement jump (Fama
and Bueti, 2011).
To conclude the aforementioned, there is no evidence that foam
rolling SFMR is effective in improvement of muscle strength or
performance and cannot be recommended pre as a warm-up
450 L. Kalichman, C. Ben David / Journal of Bodywork & Movement Therapies 21 (2017) 446e451
routine before activities required strength or enhanced
performance.
3.3.5. Foam rolling as a post-exercise recovery tool
Macdonald et al. (2014) evaluated the effectiveness of foam
rolling as a recovery tool after exercise-induced muscle damage by
analyzing thigh girth, muscle soreness, ROM, evoked and voluntary
contractile properties, vertical jump, perceived pain while foam
rolling and force placed on the foam roller. They found that foam
rolling was beneficial in improving dynamic movements, the per-
centage of muscle activation and both passive and dynamic ROM
compared to the control group. Substantially higher muscle sore-
ness was recorded at all-time points in the control group showing
the effectiveness of foam rolling in reducing muscle soreness
(Macdonald et al., 2014).
3.3.6. Vascular function
Okamoto et al. (2014) were the first to conduct a study using a
foam roller to determine the effect of SMFR on arterial stiffness and
vascular endothelial function. The baseline hypothesis was that
flexibility is associated with arterial distensibility. Ten healthy
young adults performed foam roller SMFR or control procedure
(evaluations without any intervention) on separate days in a ran-
domized controlled crossover fashion. Brachial-ankle pulse wave
velocity, blood pressure, heart rate and plasma nitric oxide con-
centration were measured before and 30 min after both SMFR and
control trials. The participants performed SMFR on the adductor,
hamstrings, quadriceps, iliotibial band, and trapezius. Pressure was
self-adjusted during SMFR by applying body weight to the roller
and using the hands and feet to offset the 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 control trial, SMFR was not performed. The brachial-ankle
pulse wave velocity significantly decreased (from 1202 ± 105 to
1074 ± 110 cm s 1) and the plasma nitric oxide concentration
significantly increased (from 20.4 ± 6.9 to 34.4 ± 17.2 mmol L 1)
after SMFR using a foam roller (both p < 0.05), but neither signif-
icantly differed in the control trials. These results indicate that
SMFR, using a foam roller, reduces arterial stiffness and improves
vascular endothelial function (Okamoto et al., 2014).
3.3.7. Stress reduction
Recent Korean pilot study (Kim et al., 2014) aimed to examined
the effect of the SFMR induced with a foam roller on the reduction
of stress by measuring the serum concentration of cortisol. Young
female subjects were asked to walk for 30 min on a treadmill and
then the control group rested for 30 min by lying down, whereas
the experimental group performed a 30 min of SMFR. Statistically
significant levels of serum cortisol reduced in both groups, but
there was no significant difference between the groups. Therefore
SFMR is not more effective in stress reduction than just resting by
lying down.
3.4. Effect of SMFR using a roller massager (“the stick”)
Halperin et al. (2014) compared the effects of static stretching
and roller massage SMFR of the calf muscles on ankle ROM, plantar
flexors maximal voluntary contraction force and force produced in
the first 100 ms of the maximal voluntary contraction (F100), soleus
and tibialis anterior electromyography (EMG) and single limb bal-
ance. The results showed that roller massage treatment increased
maximal force output during the post-test measurements, while
static stretching decreased maximal force output with a significant
difference occurring between the two interventions at 10 min post-
test (p < 0.05). Both, roller massage and static stretching increased
ROM immediately and 10 min after the interventions. No significant
effects were found on balance or EMG measures (Halperin et al.,
2014).
Mikesky et al. (2002) assessed the effects of roller massage on
muscular strength, power, and flexibility in a group of collegiate
athletes. Thirty collegiate athletes consented to participate in a
four-week, a double-blind study consisting of four testing sessions
(one familiarization and three data collection sessions) scheduled a
week apart. There were no statistically significant changes in
hamstring flexibility or vertical jump immediately after roller
massage treatment; nevertheless, the speed in the 20-yard dash did
show positive changes.
Sullivan et al. (2013) examined the effects of a roller massager
on hip ROM, demonstrating a 4.3% improvement in hip flexion ROM
immediately following both five and 10 s of rolling their hamstrings
(Sullivan et al., 2013). Black et al. (2013) assessed the effects of roller
massage on hamstring length and found that over a three-week
period, hamstring flexibility significantly increased (as measured
by the straight leg raise test).
4. Conclusions
SMFR is an inexpensive and highly accessible tool allowing the
individual to maintain flexibility and potentially release the pa-
tient's myofascial pain anywhere and anytime.
The results of this review suggest that the use of SMFR, partic-
ularly with a foam roller, significantly increases joint ROM with no
concomitant detrimental effects on neuromuscular force produc-
tion. Most of the studies showed no decrease in muscle force and no
differences in performance following foam rolling. It appears that
SMFR techniques can be used to increase flexibility, without
damaging muscle force and performance.
On the other hand, there is very limited research on the influ-
ence of SMFR on myofascial pain. Taking into account that many
practitioners use this technique to treat various musculoskeletal
disorders, there is an acute need for high-quality clinical trials to
evaluate the efficacy and effectiveness of SMFR in the treatment of
the myofascial syndrome.
Conflict of interest
The authors declare that they have no conflict of interest.
Acknowledgments
The authors thank Mrs. Phyllis Curchack Kornspan for her
editorial services.
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