Do you foam roll? Should you foam roll? Let's say you did....What does it even do? How does it work? Why does this post start with so many questions? Ahem...In today's post we break down the latest research on one of the most widely recommended yet most poorly understood practices in the fitness industry: self-myofascial release. Since no one wants to read that mouthful over and over, we will simply be referring to self-myofasical release as SMR for the remainder of this article.

The practice of SMR usually involves a tool such as the foam roller or massage stick. From the crude PVC pipe and lacrosse ball to the fancy battery operated studded foam roller, there is a tool for every budget (and did I mention pain tolerance?). The basic act of SMR requires you to roll your body over your weapon of choice for what seems like an eternity (but is likely only 30 seconds). Why do people put themselves through this foolishness? SMR is thought to have similar effects as massage therapy. According to the Registered Massage Therapist's Association of Ontario, massage therapy can help reduce or eliminate pain and muscular tension, and improve joint mobility, circulation and lymphatic drainage (Registered Massage Therapists' Association of Ontario 2017). The idea behind foam rolling is to cut out the middle man (sorry RMTs, we still love you). By using your own body mass, the goal is to compress the affected soft tissues in the hopes of breaking up 'fascial adhesions' that are limiting your mobility and causing you pain and/or soreness. But...does it actually? Despite limited evidence, foam rolling is widely used and recommended to clients by personal trainers and coaches. Just a quick google search on "foam rolling" and the first search result page is littered with articles praising the glories of the foam roller. Today we dive into the literature to better understand how and why someone would ever choose to foam roll.

Let's start with the type of tool you should use...

There is limited evidence comparing different SMR tools. Whether you are better off with a foam roller, massage stick, or tennis/lacrosse ball is unclear. The size and shape of the tool you use will affect the amount of pressure you are able to apply and how it is dispersed through the tissues. As far as the evidence goes, different pressures have not yet been directly compared (Beardsley & Skarabot, 2015) so it's not clear whether you should be applying the pressure of a gentle breeze or doing your best to crush the foam roller's hopes and dreams with your body mass. Intuitively you are likely to choose a bigger tool for bigger muscle groups. For areas that have a smaller surface area (think plantar fascia that line the bottom of your feet) or are difficult to access with a roller (think hip flexor or upper traps), you are probably better off with a smaller tool like a lacrosse or tennis ball.

Ok great. You can use whatever torture device you like. What we want to know is whether the torture is worth it. Stay tuned...

What does foam rolling do?

A recent systematic review (Schroeder & Best, 2015) investigated the effectiveness of SMR as a prexercise and recovery strategy. Nine randomized controlled trials were included in the review, six of which used a foam roller and 3 used a massage roller. Unfortunately, each of the nine studies used a different protocol for the frequency and duration of SMR and looked at different outcome measures making them difficult to compare. However, the systematic review authors were able to draw some important conclusions when grouping the studies by outcome measure (i.e. range of motion, soreness, performance etc.).

Does it improve your range of motion?

Five of the included studies using either a foam roller or massage stick increased range of motion while only one study showed no change. These studies all used a different SMR protocol, on different body sites, and examined range of motion at different time points. The kicker? The 5 studies that showed an increase in range of motion used a maximum of 1 min sets of foam rolling while the one study that showed no change used a protocol of 10 minutes of foam rolling the hamstrings post deadlift related soreness. Good grief.

Does it reduce soreness?

Using a foam roller or massage stick was found to decrease muscle soreness/fatigue postexercise. Two studies reported a decrease in muscle soreness after inducing delayed-onset muscle soreness via a heinous set of squats or stiff-legged deadlifts. This comes as good to news to those of us who have experienced the joys of toileting after a heavy leg day....if you haven't...well you just haven't lived.

Does it enhance performance?

Two studies showed positive effects on vertical jump height and maximum force output while others showed no change in performance. Interestingly, the two studies that showed an increase in athletic performance measures used a minimum of 90 seconds of foam rolling (either three sets of 30 seconds or two sets of 1 min) while all but one of the studies that showed no change in performance used less than 30 seconds of foam rolling. Even more interestingly, the studies that showed no change in performance still showed an increase in range of motion. Why is this so interesting? The study authors point out that being able to increase range of motion without interfering with performance (the exact problem with performing static stretching before exercise) makes foam rolling the superior choice as a preexercise strategy.

Conclusions of the study: There is some evidence to support the use of SMR for preexercise increases in range of motion and postexercise muscle soreness. The effect of SMR on performance is not clear. At the very least, the authors conclude SMR does not weaken performance.

More evidence please...

Another recent systematic review (Cheatham, Kolber, Cain, & Lee, 2015) looked at the effects of using a foam roller or massage stick on joint range of motion, muscle recovery, and performance. Of the 14 studies included in the review, 5 used a foam roller (the rest were massage rollers). The good news? The results of this systematic review support the findings from the first review we discussed! SMR using either a foam roller or massage stick was found to have short‐term improvements in joint ROM, no effect on athletic performance, and decreased post-exercise muscle soreness. The study authors caution readers with the following:

Four important considerations:

1) The research on foam rolling is still emerging. The evidence that exists comes from studies that differ in design, choice of outcome measure, intervention protocol, and follow-up timeline. These differences make it difficult to compare the effects of one study to another.

2) The types of foam rollers and massage sticks used in the studies range from those commercially available to custom-made. Higher-density tools (the ones that really hurt) may have a stronger effect than softer density tools (the ones you barely feel)...Sigh.

3) All the studies included in this review found only short-term benefits - some of which lasted only 60 seconds! The longer the follow-up period, the less of an effect remained.

4) How exactly foam rolling works is still a mystery. There are a few theories as to why foam rolling works. Whether the foam roller improves recovery by enhancing blood lactate removal, reducing swelling and increasing oxygen delivery to the muscle, or it increases range of motion by altering the stretch perception of the muscle tissue, or that it mechanically breaks down scar tissue which in turn remobilizes the fascia....is not yet known. In fact the mystery of the foam roller may only be exceeded by its power. Ok, the study authors didn't conclude that last bit....but really we don't quite understand the physiology behind foam rolling.

But wait, there's more!

Foam rolling for cardiovascular health??

Something you might not expect a foam roller to do is to reduce arterial stiffness...A foam roller keep your arteries healthy? Really? There is very limited evidence (aka one study) that showed an improvement in arterial stiffness and vascular endothelial function (Okamoto, Masuhara, & Ikuta, 2014). In this study participants were instructed to foam roll each major muscle group for 1 minute. Before and 30 minutes after foam rolling, arterial stiffness and flexibility were measured using brachial-ankle pulse wave velocity (baPWV) and plasma nitric oxide (NO) concentration. BaPWV significantly decreased and plasma NO concentration significantly increased after SMR suggesting foam rolling exerts a favourable effect on arterial function! How neat is that?! The precise mechanism by which these changes occurred is still a mystery. The study authors speculate that compression from the foam roller may cause an increase in the velocity of blood flow, which then stresses the walls of the vasculature, which in turn signals the body to produce nitric oxide (a potent vasodilator) that may cause a reduction in arterial stiffness. Basically, all that pressure you are applying from the foam roller squishes the underlying vasculature making your blood flow faster. The body reacts by increasing the diameter of the blood vessels to ease the pressure on the arterial walls. This may lead to healthier, more elastic arteries over the long term. Bottom line, foam rolling has the potential to improve cardiovascular health....we just need more research to support this exciting new finding.

Practical Implications

Use foam rolling to increase your range of motion before you perform exercises requiring a decent amount of mobility (think overhead squats)
Use foam rolling as a recovery tool to reduce delayed onset muscle soreness (think: can't sit down the day after those damn overhead squats)
Maybe use foam rolling for long-term cardiovascular health....maybe
Don't use foam rolling to enhance your athletic performance....it doesn't work
Don't spend forever on the foam roller....set a timer and roll each muscle group for up to 2 minutes....you've gotten all you can out of that piece of foam....move on with your day
Using a stick, ball, or roller doesn't matter (as far as we know) so choose what is convenient for you and the area you are working on

In summary, research on foam rolling is still in its infancy. As per usual, the fitness industry has pulled way ahead of the evidence in the race for consumer attention. We are still learning how best to use a foam roller and why it works (or doesn't work). To date, the evidence supports foam rolling as a means to: increase range of motion acutely (but sadly temporarily), to reduce delayed-onset muscle soreness, and to have no effect on athletic performance. It is reasonable to recommend athletes and the general public alike use foam rolling as means of increasing preexercise functional mobility or to enhance postexercise recovery. So make like Limp Bizkit and just keep rollin, rollin, rollin, rollin.

Coach P.

Get it? bales of hay all rolled up? Rolling? Roll?.               &n… — **Get it? bales of hay all rolled up? Rolling? Roll?**
**. ...Save me from myself.**

References

1. Registered Massage Therapists' Association of Ontario 2017, accessed 4 April 2017, <https://secure.rmtao.com/massage_therapy/the_benefits_of_mt>

2. Beardsley, C. & Skarabot, J. (2015) Effects of Self-Myofascial Release: A Systematic Review. Journal of Bodywork & Movement Therapies, doi: 10.1016/j.jbmt.2015.08.007

2. Schroeder, A. & Best, T.M., (2015) Is Self Myofascial Release an Effective Preexercise and Recovery Strategy? A Literature Review. Current Sports Medicine Reports, 14(3): 200-8

3. 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

5. 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.

Does foam rolling work?