Background:

Foam rolling has become an increasingly popular form of self myofascial release among athletes and fitness enthusiasts. Advocates believe it corrects muscular imbalances, alleviates muscle soreness, relieves joint stress, and improves range of motion. However, despite these beliefs literature on foam rolling is quite rudimentary.

Clinical Case:

The patient is a 40 year old female presenting to physical therapy with chief complaints of intense muscle soreness in her right leg and an inability to straighten her leg without pain after her last gym session 4 days ago. She is an avid bootcamp enthusiast and reports that she has had recurring injuries since beginning bootcamp, but this is the worst she has experienced. Upon physical exam, she ambulates with an antalgic gait with decreased gait speed, decreased strength and limited range of motion secondary to pain in her right lower extremity. She rates her pain as a 3/10 at rest that increases to 6/10 when doing functional movements such as squatting or climbing stairs. Her goals include decreasing her pain, increasing her flexibility and learning how to help prevent future injuries at the gym.

PICO Question:

In adults (>18 years) participating in exercise, does foam rolling increase range of motion and decrease muscle soreness after activity as compared to no intervention?

Search Strategy:

A literature search was conducted using the databases PubMed, CINAHL, PEDro. The search terms included the following in each database: “foam roller” AND “foam rolling” AND “self myofascial release”. Articles considered for inclusion met the following criteria: peer reviewed, English language, articles published within the last 10 years, healthy adults, RCTs, studies that measured the effects of a foam roller on joint ROM, acute muscle soreness and/or DOMS, studies that compared an intervention program using a foam roll to a control group, and studies focused on the lower extremities. Articles were excluded if self myofascial release consisted of a roller massager or trigger point therapy, subjects were adolescents, studies focused on upper extremities, or if the outcomes were muscle performance measures. As a result, five articles were included.

Results:

Limitations:

Clinical Bottom Line:

• Based on limited, low level evidence, foam rolling acutely increases range of motion and decreases muscle soreness after exercise in healthy, physically active adults
• Foam rolling shows benefit being used both prior to and after activity with no adverse events
• At this time there is no standardized protocol for foam rolling

Application to Case:

• Patient’s goal: Decrease soreness, increase flexibility, learn how to prevent future injury!
• To deter DOMS and maintain ROM, patient will foam roll:
  • Prior to exercise to acutely increase ROM
  • Post-exercise to decrease muscle soreness
• Perform every time she exercises since it shows short term results
• Would not progress sets or reps (unless patient preference) because there is no standardized foam rolling procedure

References:

1. Barnes, MF. The basic science of myofascial release: Morphologic change in connective tissue. J Bodywork Move Ther 1: 231–238, 1997.
2. Pearcey GE, Bradbury-Squires DJ, Kawamoto JE, Drinkwater EJ, Behm DG, Button DC. Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. Journal of athletic training. 2015 Jan;50(1):5-13.
3. MacDonald GZ, Button DC, Drinkwater EJ, Behm DG. Foam rolling as a recovery tool after an intense bout of physical activity. Med Sci Sports Exerc. 2014 Jan 1;46(1):131-42.
4. Junker DH, Stöggl TL. The foam roll as a tool to improve hamstring flexibility. The Journal of Strength & Conditioning Research. 2015 Dec 1;29(12):3480-5.
5. MacDonald GZ, Penney MD, Mullaley ME, Cuconato AL, Drake CD, Behm DG, Button DC. An acute bout of self-myofascial release increases range of motion without a subsequent decrease in muscle activation or force. The Journal of Strength & Conditioning Research. 2013 Mar 1;27(3):812-21.
6. Bushell JE, Dawson SM, Webster MM. Clinical relevance of foam rolling on hip extension angle in a functional lunge position. The Journal of Strength & Conditioning Research. 2015 Sep 1;29(9):2397-403.