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The objective of this study is to understand the effectiveness of foam rolling (FR) as a recovery tool after exercise-induced muscle damage, analyzing thigh girth, muscle soreness, range of motion (ROM), evoked and voluntary contractile properties, vertical jump, perceived pain while FR, and force placed on the foam roller. Twenty male subjects (≥3 yr of strength training experience) were randomly assigned into the control (n = 10) or FR (n = 10) group. All the subjects followed the same testing protocol. The subjects participated in five testing sessions: 1) orientation and one-repetition maximum back squat, 2) pretest measurements, 10 × 10 squat protocol, and POST-0 (posttest 0) measurements, along with measurements at 3) POST-24, 4) POST-48, and 5) POST-72. The only between-group difference was that the FR group performed a 20-min FR exercise protocol at the end of each testing session (POST-0, POST-24, and POST-48). FR substantially reduced muscle soreness at all time points while substantially improving ROM. FR negatively affected evoked contractile properties with the exception of half relaxation time and electromechanical delay (EMD), with FR substantially improving EMD. Voluntary contractile properties showed no substantial between-group differences for all measurements besides voluntary muscle activation and vertical jump, with FR substantially improving muscle activation at all time points and vertical jump at POST-48. When performing the five FR exercises, measurements of the subjects' force placed on the foam roller and perceived pain while FR ranged between 26 and 46 kg (32%-55% body weight) and 2.5 and 7.5 points, respectively. The most important findings of the present study were that FR was beneficial in attenuating muscle soreness while improving vertical jump height, muscle activation, and passive and dynamic ROM in comparison with control. FR negatively affected several evoked contractile properties of the muscle, except for half relaxation time and EMD, indicating that FR benefits are primarily accrued through neural responses and connective tissue.
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Foam Rolling as a Recovery Tool after an
Intense Bout of Physical Activity
GRAHAM Z. MACDONALD
1
, DUANE C. BUTTON
1
, ERIC J. DRINKWATER
1,2
, and DAVID GEORGE BEHM
1
1
School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, NL, CANADA;
and
2
School of Human Movement Studies, Charles Sturt University, Bathurst, New South Wales, AUSTRALIA
ABSTRACT
MACDONALD, G. Z., D. C. BUTTON, E. J. DRINKWATER, and D. G. BEHM. Foam Rolling as a Recovery Tool after an Intense
Bout of Physical Activity. Med. Sci. Sports Exerc., Vol. 46, No. 1, pp. 131–142, 2014. Purpose: The objective of this study is to understand
the effectiveness of foam rolling (FR) as a recovery tool after exercise-induced muscle damage, analyzing thigh girth, muscle soreness, range
of motion (ROM), evoked and voluntary contractile properties, vertical jump, perceived pain while FR, and force placed on the foam roller.
Methods:Twentymalesubjects(Q3 yr of strength training experience) were randomly assigned into the control (n= 10) or FR (n=10)
group. All the subjectsfollowed the same testing protocol. The subjects participated in five testing sessions: 1) orientation and one-repetition
maximum back squat, 2) pretest measurements, 10 10 squat protocol, and POST-0(posttest 0) measurements, along with measurements at
3) POST-24, 4) POST-48, and 5) POST-72. The only between-group difference was that the FR group performed a 20-min FR exercise
protocol at the end of each testing session (POST-0, POST-24, and POST-48). Results: FR substantially reduced muscle soreness at all time
points while substantially improving ROM. FR negatively affected evoked contractile properties with the exception of half relaxation
time and electromechanical delay (EMD), with FR substantially improving EMD. Voluntary contractile properties showed no substantial
between-group differences for all measurements besides voluntary muscle activation and vertical jump, with FR substantially improving
muscle activation at all time points and vertical jump at POST-48. When performing the five FR exercises, measurements of the subjects’
force placed on the foam roller and perceived pain while FR ranged between 26 and 46 kg (32%–55% body weight) and 2.5 and
7.5 points, respectively. Conclusion: The most important findings of the present study were that FR was beneficial in attenuating muscle
soreness while improving vertical jump height, muscle activation, and passive and dynamic ROM in comparison with control. FR
negatively affected several evoked contractile properties of the muscle, except for half relaxation time and EMD, indicating that FR
benefits are primarily accrued through neural responses and connective tissue. Key Words: SELF-MYOFASCIAL RELEASE, EX-
ERCISE-INDUCED MUSCLE DAMAGE, MUSCLE ACTIVATION, PERCEIVED PAIN, MUSCLE SORENESS, RECOVERY
Foam rolling (FR) is commonly used as a recovery tool
after a bout of physical activity, with advocates (3,15)
claiming that FR corrects muscular imbalances, alle-
viates muscle soreness, relieves joint stress, improves neu-
romuscular efficiency, and improves range of motion (ROM).
FR has been implemented into several different rehabilitation
and training programs to help promote soft tissue extensibil-
ity, enhance joint ROM, and promote optimal skeletal muscle
functioning (3,15,25). Although FR has been strongly advo-
cated and is commonly used, there have only been three peer-
reviewed research articles published to date. Pearcey et al.
(31) examined the effects of FR on pressure pain threshold
and dynamic performance measures after an intense exercise
protocol, concluding that FR is an effective method in re-
ducing delayed onset muscle soreness (DOMS) and asso-
ciated performance decrements in sprint time, power, and
dynamic strength/endurance. MacDonald et al. (25) investi-
gated the effects of acute FR before physical activity and
demonstrated that FR had no effects on neuromuscular per-
formance, although significantly increasing ROM at 2 and
10 min post-FR by 10% and 8%, respectively. Curran et al.
(15) determined that a higher density foam roller signifi-
cantly increased soft tissue pressure and isolated the soft
tissue contact area, potentially increasing the effects FR has
on improving soft tissue health. Quantifiable scientific evi-
dence to validate the use of foam rollers and understand the
effectiveness of FR as a recovery tool from physical activity
is rudimentary; thus, it would be prudent to further investi-
gate its effectiveness and mechanisms.
From the recreationally active to the elite athlete, many in-
dividuals commonly experience exercise-induced muscle
damage (EIMD) resulting in DOMS after an intense bout of
physical activity. EIMD is characterized by muscle soreness,
muscle swelling, temporary muscle damage, an increase in
intramuscular protein and passive muscle tension, and a de-
crease in muscular strength and ROM (10,36). In addition to
these responses, EIMD can affect neuromuscular performance
Address for correspondence: David George Behm, Ph.D., School of Human
Kinetics and Recreation, Memorial University of Newfoundland, St. John’s,
NL A1C 5S7, Canada; E-mail: dbehm@mun.ca.
Submitted for publication February 2013.
Accepted for publication June 2013.
0195-9131/14/4601-0131/0
MEDICINE & SCIENCE IN SPORTS & EXERCISE
Ò
Copyright Ó2013 by the American College of Sports Medicine
DOI: 10.1249/MSS.0b013e3182a123db
131
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Copyright © 2013 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
by reducing shock attenuation and altering muscle sequencing
and recruitment patterns, potentially placing unaccustomed
stress on muscle tendons and ligaments (10). There are several
proposed theories regarding the mechanisms of DOMS, with
the bulk of the literature reporting that high mechanical stress
placed on the myofibrils, most commonly seen during ec-
centric exercise, damages the muscle tissue and connective
tissue, triggering an acute inflammatory response consisting
of edema and inflammatory cell infiltration that leads to a loss
of cellular homeostasis, particularly due to high intracellular
calcium concentrations (36). Sarcomere damage, calcium
accumulation, protein degradation, and osmotic pressure all
combine to sensitize nociceptors and other pain receptors,
causing the sensation of DOMS (10). Through the analysis
of several review articles, treatments that have shown po-
tential benefits in treating symptoms of EIMD include
cryotherapy (12,20,36), light exercise (12,36), and com-
pression (10,12). Although these therapies have shown to be
beneficial in treating EIMD symptoms, the contrary has also
been demonstrated in the literature (10,12,20,36). On top of
this, although these methods have shown to be beneficial in
treating EIMD symptoms, no one therapy has proven to be
beneficial in treating the full array of symptoms often
presented by EIMD. Varying results demonstrated in the lit-
eraturecan be attributed to the varying EIMD protocols, along
with the heterogeneity among studies assessing a given
therapy in relation to the dose, frequency, and intensity of
the intervention.
Currently, there is only one published article by Pearcey
et al. (31) pertaining to the effects of FR on EIMD. Pearcey
et al. (31) analyzed the effects of FR on functional measures
such as sprint speed, agility, broad jump, squat strength, and
pain threshold but did not examine the possible underlying
mechanisms. With FR commonly being termed as a method
of self-myofascial release or self-massage (25), massage re-
search may allow us to gain insight into the mechanisms and
effects of FR on EIMD. Although massage has not been
shown to be an effective method in improving ROM (36,39)
or muscular strength (18,36,39) after EIMD, massage has been
showntobebeneficialintreating EIMD by increasing mito-
chondrial biogenesis (13), restoring blood flow (34), and im-
proving vertical jump height (26,38) while decreasing muscle
soreness (13,18,34,39), cellular stress (13), and inflammation
(13). Massage has also shown varying results in reducing limb
circumference (36,39) and creatine kinase levels (34,36) while
potentially increasing circulating neutrophil counts (12,34,36).
With several studies showing the benefits of massage when
treating EIMD, the purpose of our research was to substanti-
ate if FR was an effective tool to aid in the recovery from an
intense bout of physical activity that induces DOMS and iden-
tify potential mechanisms. We specifically addressed the effects
of FR on muscle soreness, voluntary and evoked contractile
properties, vertical jump, and ROM. This investigation also
explored the general characteristics of FR relating to force
application and perceived pain during five different lower
body FR exercises.
METHODS
Subjects
Twenty physically active resistance-trained male subjects
volunteered for the study. All the subjects regularly resis-
tance trained three times a week or more (one-repetition
maximum (1RM) squat, 129.2 T26.7 kg; 1RM as percent
body weight, 152.2% T24.5%). The subjects were randomly
assigned to an experimental ‘‘foam rolling’’ (FR) (n= 10;
height, 180.9 T5.5 cm; weight, 82.4 T9.4 kg; age, 25.1 T
3.6 yr; 1RM squat, 130.0 T20.6 kg) or ‘‘control’’ (CON)
(n= 10; height, 179.4 T4.0 cm; weight, 86.9 T8.6 kg; age,
24.0 T2.8 yr; 1RM squat, 128.4 T32.9 kg) group. Written
informed consent was obtained from all the subjects. The
Memorial University of Newfoundland Human Investiga-
tion Committee approved the study.
Experimental Design
All the subjects were required to participate in five testing
sessions, all occurring at the same time of day for each
participant. The organization of the five testing sessions was
1) orientation and 1RM testing, 2) pretest measurements
(PRE), 10 10 squat protocol, posttest 0 (POST-0), 3)
posttest 24 (POST-24), 4) posttest 48 (POST-48), and 5)
posttest 72 (POST-72) h. All testing sessions were separated
by 24 h, except sessions 1 and 2, which were separated by at
least 96 h, to ensure that the subjects had recovered from the
1RM protocol. (See Figure 1.) The flowchart displays
methodology along with the dependent variables assessed
each time test measurements were taken.
In session 1, the subjects were provided with a verbal
explanation of the study and read and signed an informed
consent form. Participants’ age, height, weight, and thigh girth
(TG) were recorded. The subjects were randomly assigned to
one of two test groups, FR or CON.
Once the subjects were assigned to their test group, the
subjects’ 1RM for a free weight back squat was determined.
The 1RM protocol consisted of a general warm-up on a
stationary cycle ergometer with the resistance set at 1 kp,
cycling at a cadence of 70 rpm for 5 min. The squat protocol
required the subjects to perform a full ROM (thighs parallel
to floor) plate-loaded barbell back squat. The subjects were
instructed to position the plate-loaded barbell above the
posterior deltoids at the base of the neck.
Before attempting a 1RM lift, the subjects performed a
series of submaximal sets of eight, five, and two repetitions
(reps) with increasing loads. The subjects rested for 2 min
between submaximal lift trials and for 3 min between each
1RM trial. If the subjects successfully performed a squat with
proper form, the weight was increased by approximately
1–10 kg, and the subject would attempt another squat at the
new set weight. A failed lift was defined as a squat falling
short of full ROM or failure to complete the squat repetition.
If a subject failed in two consecutive attempts at a set weight
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or felt that they had reached their 1RM, the previous suc-
cessfully lifted weight was considered the subject’s 1RM.
Once the subjects’ 1RM was determined, all the subjects
were familiarized with the EIMD protocol, along with the
test measures and instruments used to conduct the experi-
ment. The subjects in the FR group were also oriented with
the FR exercise protocol (see FR section), instructed on how
to perform the experimental exercise techniques, and given
time to ask any questions they had regarding the FR exer-
cise protocol.
In session 2, all the subjects were required to complete an
EIMD protocol consisting of 10 sets of 10 reps of back
squats, with 2 min of rest between each set. The weight was
set at 60% of their 1RM weight. Three subjects from each
group failed to complete the EIMD protocol, implementing
the 2-min rest period between each set. Adequate rest was
given to the subjects, allowing them to complete all 100 reps
outlined in the protocol. Two subjects were exempt from
the study because they were unable to complete the required
100 reps. Before completing the EIMD protocol, the sub-
jects performed the same previously described 5-min cycle
ergometer warm-up, followed by two sets of five reps at
50% of their 1RM. Squats were performed at a tempo of 4-s
eccentric movement, 1-s pause at the bottom, 1-s concentric
movement, and 1-s pause at the top of the lift to focus on the
eccentric phase of the lift for greater EIMD. The tempo was
controlled using an interval timer, with the investigator sig-
naling the subject regarding the changes in the lifting phase.
Testing sessions 2–5 had similar sequences. Upon entering
the laboratory, the subjects would have their TG measured
and perceived pain assessed. The subjects then performed
the previously described 5-min stationary cycle ergometer
warm-up. The subjects completed the vertical jump trials fol-
lowed by a randomized allocation of the assessment of their
maximal voluntary contractile (MVC) force and quadriceps
and hamstrings ROM measurements. Vertical jump was not
randomized and was tested before MVC and ROM mea-
surements because it is a bilateral movement, whereas MVC
was measured with the subjects’ right leg, and ROM was mea-
sured with the subjects’ left leg. The subjects performed three
trials for each test measurement, with the best result being
recorded. Session 2 differed slightly because it included the
EIMD protocol after the PRE, along with posttest (POST-0)
measurements immediately after the EIMD protocol. The sub-
jectsintheFRgroupwererequiredtoperformtheFRexercise
protocol upon completion of the testing protocol at POST-0,
POST-24, and POST-48.
Independent Variable
FR. The subjects in the FR group performed five differ-
ent FR exercises, targeting the major muscle groups of the
FIGURE 1—Methodology. Flow chart displays methodology, along with the dependent variables assessed each time test measurements were taken.
FOAM ROLLING ACCELERATES EIMD RECOVERY Medicine & Science in Sports & Exercise
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anterior, lateral, posterior, and medial aspect of the thigh,
along with the gluteal muscles. A custom-made foam roller
that was constructed of a polyvinyl chloride pipe (10.16-cm
outer diameter and 0.5-cm thickness) surrounded by neo-
prene foam (1-cm thickness) was used for all exercises be-
cause greater pressure can be placed on the soft tissues of the
body when using a high-density foam roller versus a low-
density foam roller (15,25). The subjects performed each of
the five exercises on both the right and left legs for two 60-s
bouts each. For exercises targeting the thigh (anterior, lat-
eral, posterior, and medial), the subjects were instructed to
place their body weight on the foam roller, starting at the
proximal aspect of the thigh and rolling down the thigh,
using small undulating movements, gradually working their
way toward the knee. Once the foam roller reached the distal
aspect of the thigh, the subjects were instructed to return the
roller to the starting position in one fluid motion and con-
tinue the sequence for the remainder of the 60-s trial. For the
fifth exercise, targeting the gluteal muscles, the subjects
were instructed to sit on top of the foam roller, placing both
of their hands on the floor behind the foam roller. The sub-
jects then crossed their right/left leg over their left/right
knee, positioning their body so their right/left gluteal mus-
cles were in contact with the roller, and their body weight
was placed on the foam roller. The subjects were instructed
to undulate back and forth, with the foam roller running
inline with the origin to insertion point of the gluteus
maximus muscle. The subjects completed all five exercises
on one side of the body and then switched to the other side
of the body and repeated all five exercises.
Dependent Variables
TG. TG was defined as the circumference at midthigh.
Midthigh was defined as the halfway point between the an-
terior superior iliac spine and the proximal aspect of the
patella. All measurements were taken when the subject was
standing erect, with their right thigh muscles relaxed. A line
was permanently marked around the circumference of the
right thigh on the first day of testing to ensure measurements
were reliable between testing sessions.
Muscle soreness. Muscle soreness was measured
using the BS-11 Numerical Rating Scale (NRS). The NRS
allowed the subjects to express the amount of pain in refer-
ence to muscle soreness they perceived. The NRS is an
11-point scale, ranging from 0 to 10, with ‘‘0’’ being defined as
‘absolutely no muscle soreness’’ and ‘‘10’’ being defined as
‘the worst muscle soreness you have ever felt.’’ Muscle
soreness measurements were taken before each testing ses-
sion. The subjects performed a squat using only body weight
(no external resistance), squatting down until their thighs
were parallel with the floor. Once the subjects had assumed
the squat position with their thighs parallel with the floor,
the subjects were then asked to rate their perceived pain
on the basis of muscle soreness.
ROM. To assess hamstrings and quadriceps ROM, three
measurements were taken at the knee and hip of the left
leg. The three measurements included quadriceps passive
ROM (QP-ROM), hamstrings passive ROM (HP-ROM),
and hamstrings dynamic ROM (HD-ROM). QP-ROM was
measured by having the subjects perform a modified kneel-
ing lunge and measuring passive knee flexion angle using a
manual goniometer (accurate to 1-), as outlined in a previous
study (25). All landmark sites were marked with permanent
marker and remained marked for all testing sessions to en-
sure reliability across trials. A decrease in the angle between
the posterior aspect of the shank and thigh indicated an in-
crease in quadriceps ROM.
Hamstrings ROM measurements were taken using a
custom-made electronic goniometer (Memorial University
Technical Services, St. John’s, Newfoundland, Canada) and
analyzed using a software program (AcqKnowledge 4.1;
BioPac Systems Inc., Holliston, MA), measuring changes in
ROM at the hip. The subject’s left leg was equipped with
a knee brace to prevent movement at the knee joint and to
isolate the hip. The subjects stood erect and were strapped
to a wooden platform harnessed to the wall. Three straps
placed around the right ankle, right thigh, and across the
chest harnessed the subject to the wooden platform. HP-ROM
was assessed by having the investigator passively flex the
subject’s right hip until the subject reached a point of
maximum discomfort. HP-ROM measurements have been
reported to have a high intraclass correlation coefficient re-
liability (r= 0.96) (30). HD-ROM was assessed with the
same harnessing and knee brace on the custom-made elec-
tronic goniometer by having the subjects contract their hip
flexors and kick up as high and as fast as possible.
Evoked contractile properties. Peak twitch force
(TF) was evoked with electrodes connected to a high-
voltage stimulator (Stimulator Model DS7AH; Digitimer,
Welwyn Garden City, Hertfordshire, UK) as outlined in a
previous study (32). Stimulating electrodes were placed over
the inguinal triangle (proximal) and directly above the pa-
tella (distal) of the right leg. To determine the peak TF,
voltage was sequentially increased (100–300 V) until a
maximum TF was achieved. The amperage (1 A) and du-
ration (50 Hs) were kept constant throughout. Once peak
twitch was achieved, the voltage used to achieve the peak
TF was maintained throughout the testing session.
An evoked twitch was administered 2 s before the sub-
ject’s MVC, allowing peak TF, electromechanical delay (EMD),
rate of force development (RFD), and half relaxation time
(2RT) to be analyzed. An evoked twitch was also adminis-
tered 2 s post-MVC to analyze potentiated twitch character-
istics. EMD was defined as the period between the onset of
muscle stimulation and the onset of TF production (91% of
the twitch amplitude from baseline) (2). RFD was measured
over a 50-ms window, beginning at the onset of TF devel-
opment, defined as the force deviating 91% of the twitch
amplitude from baseline force measurements (2). 2RT was
defined as the time required for the TF to decrease from
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peak TF to 50% of peak TF (37). Potentiated TF (PTF) was
defined as the peak force produced from an evoked twitch
elicited 2 s after the MVC.
Voluntary contractile properties. MVC force was
assessed via an isometric knee extension (knee angle, 90-)
of the right leg. MVC force protocol followed methods
outlined in a previous study (32). Button and Behm (7)
reported that MVC demonstrated excellent day-to-day reli-
ability (r= 0.99). Before attempting an MVC, the subjects
performed two submaximal contractions. The subjects
performed three 3- to 5-s MVC, separated by 2 min each,
with all forces detected by the strain gauge, amplified
(BioPac Systems Inc. DA 150 and analog-to-digital con-
verter MP150WSW), and displayed on a computer monitor.
Data were sampled at 2000 Hz and analyzed using a soft-
ware program (AcqKnowledge 4.1, BioPac Systems Inc.).
To ensure that the subjects were performing to their maximal
effort, the subjects had to perform two MVC with no 95%
variance in force outputs between trials (7). Verbal encour-
agement was given to all the subjects during the MVC to
provide motivation.
Voluntary muscle activation (VA) was assessed using
the interpolated twitch technique (ITT). ITT was used to
measure muscle activation and the CNS’s ability to fully ac-
tivate the contracting muscle (5). The voltage used to elicit
the peak TF was used during the MVC to provide an inter-
polated or superimposed twitch. ITT methods administrated
were similar to previous studies (4,7,32). ITT was performed
using two evoked twitches: 1) an interpolated twitch once the
subjects reached their maximal force output, determined via
visual inspection (once the subjects’ MVC force output
plateaued) and 2) a potentiated twitch approximately 2 s post-
MVC. An interpolated twitch ratio was calculated comparing
the amplitude of the interpolated twitch with the potentiated
twitch to estimate the extent of activation during a voluntary
contraction ([1 j(interpolated doublet force / potentiated
doublet force)] 100 = % of muscle activation) (4).
Integrated EMG (iEMG) activity was used as a measure
of peripheral muscle activation. Surface EMG recording elec-
trodes (Meditrace 133 ECG Conductive Adhesive Electrodes;
Tyco Healthcare Group LP, Mansfield, MA) were placed on
the right leg, over the muscle belly of the rectus femoris. Elec-
trodes were placed at half the distance between the anterior
superior iliac spine of the pelvis and the patella. A ground
electrode was secured on the fibular head. Thorough skin
preparation for all electrodes was administered (32). EMG ac-
tivity was sampled at 2000 Hz, with a Blackman j92 dB band
pass filter between 10 and 500 Hz, was amplified (bipolar
differential amplifier, input impedance = 2 M6,common
mode ejection ratio 9110 dB minimum (50/60 Hz), gain
1000, noise 95HV), and was analog-to-digitally converted
(12 bit) and stored on a personal computer for analysis. iEMG
was measured for a 1-s period during the subject’s peak MVC
force (0.5-s premaximum and postmaximum force output).
Vertical jump. Vertical jump testing followed the vertical
jump protocol outlined in The Canadian Physical Activity,
Fitness and Lifestyle Approach (CPAFLA) manual (14). One
modification was made to the protocol. Instead of pausing at
the bottom of the squat, the subjects were instructed to per-
form a countermovement jump (CMJ). The subjects were
given the same instructions before performing each CMJ for
the entirety of the study. Depth and speed of the counter-
movement were not controlled to allow the movement to be
as natural as possible. Permanent marker was placed on the
tip of the subject’s middle finger. The difference between the
subject’s standing reach height and CMJ height was recorded
as the subject’s vertical jump height. Visual inspection of the
marking as it lined up with the measuring tape was recorded
to the nearest 0.1 cm.
Foam Roller
Perceived pain while FR (FR-pain) was measured while
the subjects performed the FR exercise protocol using the
NRS. The NRS 11-point scale ranged from 0 to 10, with ‘‘0’
being defined as ‘‘absolutely no pain’’ and ‘‘10’’ being de-
fined as ‘‘the worst pain you have ever felt.’’ At 30 s into
each 60-s FR trial, the subjects rated their perceived pain for
each of the five FR exercises.
Force placed on the foam roller (FR-force) was mea-
sured using a force plate (Biomechanics Force Platform
model BP400600HF; Advanced Mechanical Technology,
Inc., Watertown, MA). The force plate contains four load
cells that measure the three orthogonal force and moment
components along the X,Y, and Zaxes, producing a total
of six outputs (Fx, Fy, Fz, Mx, My, and Mz). The subjects
foam rolled over the force plate, with the force plate being
the only point of contact for the roller. The subjects were
instructed to perform the FR exercise protocol, keeping the
foam roller on the force plate while keeping all body parts
off the force plate. Force was analyzed using the force mea-
surements recorded in the Fz-plane during each 60-s trial and
collected at a sampling rate of 60 Hz.
Statistical Analysis
To avoid the shortcomings in relation to the clinical sig-
nificance of the present research base on null hypothesis sig-
nificance testing, magnitude-based inferences and precision
of estimation were used (21). Magnitude-based inferences
on the interaction effects in the mean changes between the
intervention trials (CON and FR) were determined. The in-
teraction effect of time and FR was calculated from the
mean difference between PRE and each time point (PRE to
POST-24, 48, and 72) for CON and FR. The two differ-
ences were then subtracted to estimate the effect of FR at
each time point.
Qualitative descriptors of standardized effects were assessed
using these criteria: trivial, G0.2; small, 0.2–0.5; moderate,
0.5–0.8; and large, 90.8 (11). Precision of estimates is indi-
cated with mean difference T95% confidence limits, which
FOAM ROLLING ACCELERATES EIMD RECOVERY Medicine & Science in Sports & Exercise
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defines the range representing the uncertainty in the true value
of the (unknown) population mean.
We were interested in practical differences between groups
and time, so we based the smallest worthwhile change on
a small effect size (90.2). The likelihood that the observed
effect size was larger than the smallest worthwhile change
(i.e., was clinically meaningful) was calculated on the basis
of previous methods. Chances of clinically meaningful dif-
ference were interpreted qualitatively as follows: G1%,
almost certainly not; G5%, very unlikely; G25%, unlikely;
25%–75%, possible; 975%, likely; 995%, very likely; and
999%, almost certain (21). Therefore, results are expressed
by the percent change from PRE (%$), percent likelihood
that the observed between-group difference was greater than
a small effect size (% likelihood), and the effect size. Results
with a 975% likelihood were considered to be substantial.
RESULTS
Fatigue: EIMD. The prescribed EIMD protocol induced
substantial changes in all the dependent variables except
HP-ROM (j1%, unclear, trivial (%$, % likelihood, effect
size)) and HD-ROM (0%, unclear, trivial). The DOMS pro-
tocol induced a substantial increase in TG (2%, 999%, small),
along with several performance decrements in the dependent
variables measured: QP-ROM (j7%,76%,small),TF(j40%,
999%, large), RFD (j39%, 999%, large), PTF (j41%, 999%,
large), vertical jump (j13%, 999%, large), MVC force
(j24%, 999%, large), muscle activation (j9%, 999%,
large), and iEMG (j14%, 96%, small). EMD (j6%, 95%,
moderate) and 2RT (j22%, 999%, moderate) were the only
two dependent measures to show improvements immediately
after the DOMS protocol (Fig. 2).
TG. TG, with PRE of FR, 58.3 T2.7 cm, and CON,
59.1 T4.2 cm, showed no substantial between-group dif-
ferences at POST-24 (FR, 1%; CON, 1%; 0.03 T0.31 cm;
FR, %$; CON, %$; mean difference T95% CI), POST-48
(FR, 3%; CON, 3%; 0.03 T0.65 cm), and POST-72
(FR, j1%; CON, j2%; 0.03 T0.51 cm), with all time
points showing ‘‘unclear’’ results regarding whether FR is
beneficial or detrimental due to trivial effect sizes (POST-
24, j0.09 T0.96; POST-48, j0.04 T0.96; POST-72,
j0.06 T0.97; dT95% CI).
Muscle soreness. Muscle soreness, recorded before
each testing session, with PRE of FR, 0.7 T1.0 points, and
CON, 0.7 T1.1 points, showed substantial between-group
differences at POST-24 (FR, 543%; CON, 714% (%$)),
with FR (85% (% likelihood)) having a substantial effect
in reducing muscle soreness, demonstrating a ‘‘moderate’
effect size, POST-48 (FR, 414%; CON, 807%), and POST-72
(FR, 243%; CON, 607%), with FR (48 h, 98%; 72 h, 97%)
having a substantial effect in reducing muscle sore-
ness, demonstrating a ‘‘large’’ effect size, based on NRS
measurements (Fig. 3).
ROM. QP-ROM PRE was 59.0-T12.8-for FR and
64.7-T14.6-for CON. QP-ROM showed no substantial
between-group differences at POST-24 (FR, 8%; CON,
5%) but showed substantial differences at POST-48 (FR,
11%; CON, 0%) and POST-72 (FR, 13%; CON, 4%), with
FR increasing QP-ROM, demonstrating a ‘‘moderate’’ effect
size (Table 1).
HP-ROM PRE was 111.2-T6.9-for FR and 103.8-T
14.8-for CON. HP-ROM showed no substantial between-
group differences at POST-24 (FR, j1%; CON, j3%) and
POST-48 (FR, 0%; CON, 0%) but showed substantial differ-
ences at POST-72 (FR, 3%; CON, 0%), with FR increasing
HP-ROM, demonstrating a ‘‘moderate’’ effect size (Table 1).
HD-ROM, with PRE of FR, 105.5-T6.2-, and CON,
98.0-T11.3-, showed substantial between-group differ-
ences at POST-24 (FR, 0%; CON, j4%), with FR increas-
ing HD-ROM, demonstrating a ‘‘moderate’’ effect size, but
showed no substantial differences at POST-48 (FR, 0%;
CON, j3%) and POST-72 (FR, 1%; CON, j1%) (Table 1).
Evoked contractile properties. TF, with PRE of FR,
153.4 T34.8 N, and CON, 135.7 T27.8 N, showed sub-
stantial between-group differences at POST-24 (FR, j14%;
CON, j5.%), POST-48 (FR, j9%; CON, 8%), and POST-72
(FR, j10%; CON, j3%), with FR reducing TF, demon-
strating ‘‘moderate,’’ ‘‘large,’’ and ‘‘moderate’’ effect sizes,
respectively (Table 2).
EMD PRE was 46.1 T4.7 ms for FR and 46.4 T4.4 ms
for CON. EMD showed substantial between-group differ-
ences at POST-24 (FR, j2%; CON, 7%) and POST-48
(FR, j1%; CON, 6%), with FR shortening EMD dura-
tion, demonstrating a ‘‘moderate’’ effect size, but showed no
substantial differences at POST-72 (FR, 2%; CON, j2%)
(Table 2).
RFD, with PRE of FR, 1852.6 T478.8 NIs
j1
, and CON,
1488.5 T460.5 NIs
j1
, showed substantial between-group
differences at POST-24 (FR, j23%; CON, 5%) and
POST-48 (FR, j17%; CON, 15%), with FR reducing RFD,
demonstrating a ‘‘large’’ effect size, but showed no sub-
stantial differences at POST-72 (FR, j10%; CON, j4%)
(Table 2).
2RT PRE was 68.4 T21.0 ms for FR and 64.6 T20.8 ms
for CON. 2RT showed no substantial between-group dif-
ferences at POST-24 (FR, 9%; CON, 1%), POST-48
(FR, 7%; CON, j5%), and POST-72 (FR, 6%; CON,
j3%) (Table 2).
PTF, with PRE of FR, 223.2 T31.4 N, and CON, 183.6 T
31.8 N, showed no substantial differences at POST-24
(FR, j7%; CON, j6%) but showed substantial between-
group differences at POST-48 (FR, j5%; CON, 9%) and
POST-72 (FR, j6%; CON, 1%), with FR decreasing PTF,
demonstrating ‘‘large’’ and ‘‘moderate’’ effect sizes at
POST-48 and POST-72, respectively (Table 2).
Voluntary contractile properties. MVC force, with
PRE of FR, 761.4 T126.3 N, and CON, 621.9 T100.9 N,
showed no substantial between-group differences at POST-24
(FR, j9%; CON, j12%), POST-48 (FR, j6%; CON,
j6%), and POST-72 (FR, j7%; CON, j6%), demonstrating
a ‘‘trivial’’ effect size at all time points (Table 2).
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VA PRE was 93.3% T4.2% for and 91.9% T4.0% for
CON. VA showed substantial between-group differences
at POST-24 (FR, 0%; CON, j4%), POST-48 (FR, 1%;
CON, j5%), and POST-72 (FR, 1%; CON, j2%), with
FR increasing VA, demonstrating ‘‘moderate,’’ ‘‘large,’’ and
‘moderate’’ effect sizes, respectively.
iEMG, with PRE of FR, 0.43 T0.11 mV, and CON,
0.42 T0.16 mV, showed no substantial between-group differ-
ences for POST-24 (FR, j2%;CON, j7%), POST-48 (FR, j4%;
CON, 0%), and POST-72 (FR, j9%; CON, j2%) (Table 2).
Vertical jump. Vertical jump height PRE was 51.7 T
7.9 cm for FR and 46.5 T7.0 cm for CON. Vertical jump
height approached substantial between-group differences at
POST-24 (FR, 0%; CON, j6%), with FR increasing ver-
tical jump height, demonstrating a ‘‘small’’ effect size, and
showed substantial between-group differences for POST-
48 (FR, 1%; CON, j5%), with FR increasing vertical
jump height, demonstrating a ‘‘large’’ effect size, but
showed no substantial differences at POST-72 (FR, 0%;
CON, 0%).
FIGURE 2—Changes induced by EIMD protocol. A, 1/2RT, half-relaxation time; EMD, electromechanical delay; iEMG, integrated electromyogra-
phy; HDR, hamstrings dynamic ROM; HPR, hamstrings passive ROM; MVC, maximal voluntary contractile force; PTF, potentiated twitch force;
QPR, quadriceps passive ROM; RFD, rate of force development; TF, twitch force; TG, thigh girth; VA, voluntary muscle activation; VJ, vertical
jump. The y-axis displays %$from PRE. The x-axis displays the dependent variables. Asterisks (*) indicate conditions with substantial change (975%
likelihood that the difference exceeds the smallest worthwhile difference). B, Graph plots standardize effect size differences between CON and FR
groups. Plots represent the magnitude of difference between the two groups. Error bars indicate 95% confidence limits of the mean difference between
groups. The shaded area of the graph indicates the region in which the difference between groups is trivial (i.e., between j0.20 and 0.20 standardized
effect sizes.
FIGURE 3—Muscle soreness. A, The y-axis displays muscle soreness on the basis of the NRS. The x-axis displays PRE and posttest measurements for
the four different time points. Asterisks (*) indicate conditions with substantial change (975% likelihood). B, Please see Figure 2B for description.
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FR force. FR-force averaged between 28–46 kg or 35%–
55% of the subjects’ body weight at POST-0, 26–44 kg
or 32%–53% of the subjects’ body weight at POST-24, and
26–44 kg or 32%–53% of the subjects’ body weight at
POST-48 (Tables 3–4).
FR-force showed substantial time differences between
POST-0 and POST-24 for the anterior (j10%, moderate
(%$, effect size)), lateral (j15%, large), medial (j7%,
small), and gluteal (j8%, moderate) FR exercises, with no
substantial differences for the posterior (2%, trivial) exercise
(Table 3A).
FR-force showed no substantial between-time differences
between POST-24 and POST-48 for the anterior (j6%,
small), lateral (j1%, trivial), posterior (0%, trivial), me-
dial (j2%, trivial), and gluteal (2%, trivial) FR exercises
(Table 3B).
FR pain. FR-pain ranged between 2.5 and 7.5 points
at POST-0, 3 and 7.5 points at POST-24, and 2.5 and
6.5 points at POST-48 on the NRS for the five different
FR exercises (Table 3).
FR-pain showed substantial time differences between
POST-0 and POST-24 for the medial (19%, moderate) and
gluteal (24%, moderate) FR exercises, with no substantial
differences for the anterior (5%, small), lateral (2%, trivial),
and posterior (11%, small) exercises (Table 3A).
FR-pain showed substantial time differences between
POST-24 and POST-48 for the anterior (j16%, moderate),
lateral (j12%, moderate), medial (j8%, small), and gluteal
(j15%, small) FR exercises, with no substantial differences
for the posterior (10%, small) exercises (Table 3B).
DISCUSSION
The study by Pearcey et al. (31) is the only research
article to analyze the effects of FR on recovery from EIMD
resulting in DOMS. No research to date has examined the
TABLE 2. Contractile properties.
Measurement Time % Likelihood ,/jMean Diff Lower 95% CL Upper 95% CL dLower dUpper d
VJ (cm) POST-24 74 j2.38 j2.14 6.9 0.49 j0.4 1.43
POST-48 92 j2.8 j0.22 5.82 0.81 j0.06 1.69
POST-72 Unclear 0.1 j2.82 2.62 j0.04 j1 0.93
MVC force (N) POST-24 Unclear 8.15 j62.66 78.96 0.11 j0.9 1.12
POST-48 Unclear 9.3 j93.24 74.64 j0.11 j1.07 0.86
POST-72 Unclear 11.32 j86.05 63.41 j0.15 j1.11 0.82
VA (%) POST-24 88 j2.88 j0.76 6.52 0.71 j0.2 1.61
POST-48 97 j5.34 0.89 9.79 1 0.17 1.83
POST-72 79 j2.62 j1.63 6.87 0.57 j0.35 1.49
iEMG (mVIs
j1
)POST-24 53 j0.02 j0.07 0.12 0.23 j0.72 1.19
POST-48 53 ,0.02 j0.12 0.07 j0.23 j1.19 0.72
POST-72 62 ,0.05 j0.19 0.09 j0.33 j1.29 0.62
TF (N) POST-24 88 ,15.03 j33.59 3.53 j0.73 j1.6 0.17
POST-48 98 ,25.6 j46.08 5.13 j1.03 j1.85 j0.21
POST-72 86 ,11.68 j27.01 3.64 j0.69 j1.59 0.21
EMD (ms) POST-24 85 ,4.4 j1.63 10.43 0.66 j0.25 1.66
POST-48 75 ,3.05 j2.63 8.73 0.5 j0.43 1.43
POST-72 58 j1.7 j7.23 3.83 j0.29 j1.25 0.66
RFD (NIs
j1
)POST-24 999 ,489.84 j700.7 j279 j1.47 j2.1 j0.84
POST-48 999 ,544.7 j839.6 j249.8 j1.32 j2.03 j0.6
POST-72 59 ,125.84 j523.4 271.7 j0.3 j1.26 0.65
2RT (ms) POST-24 61 j5.2 j9.92 20.32 j0.33 j1.28 0.6
POST-48 67 j7.75 j10.5 26 j0.4 j1.35 0.54
POST-72 59 j6.05 j12.58 24.68 j0.31 j1.26 0.64
PTF (N) POST-24 Unclear 5.85 j38.14 26.44 0.17 j1.1 0.79
POST-48 92 ,26.17 j54.82 2.47 0.8 j1.68 0.08
POST-72 84 ,15.7 j37.6 6.21 0.65 j1.56 0.26
Please see Table 1 for description.
1/2RT, half-relaxation time; EMD, electromechanical delay; iEMG, integrated electromyography; MVC Force, maximal voluntary contractile force; PTF, potentiated twitch force; RFD, rate
of force development; TF, twitch force; VA, voluntary muscle activation; VJ, vertical jump.
TABLE 1. Range of motion.
Measurement Time % Likelihood ,/jMean Diff Lower 95% CL Upper 95% CL dLower dUpper d
QP-ROM (-)POST-24 Unclear 1.3 j6.18 8.78 0.17 j0.79 1.1
POST-48 90 j6.6 j0.96 14.16 0.77 j0.11 1.66
POST-72 79 j4.95 j3.24 13.14 0.56 j0.37 1.48
HP-ROM (-)POST-24 60 j1.5 j3.07 6.08 0.31 j0.6 1.27
POST-48 Unclear 0.04 j4.8 4.71 j0.01 j0.97 0.96
POST-72 83 j3.4 j1.62 8.42 0.62 j0.3 1.53
HD-ROM (-)POST-24 79 j3.9 j2.43 10.22 0.57 j0.4 1.49
POST-48 65 j3.03 j4.68 10.75 0.37 j0.58 1.32
POST-72 66 j2.75 j3.96 9.46 0.39 j0.56 1.33
Table displays between-group differences regarding percentage likelihood that the FR intervention had an effect on the recovery of the dependent variable, whether FR caused an increase
(j), a decrease (,), or an unclear change (unclear) in the dependent variable, the mean differences (Mean Diff) between CON and FR groups, and standardized effect size (d). 95%
confidence limits (CL) are displayed for both mean difference and effect size. Bold numbers (% likelihood) indicate conditions with substantial change (975% likelihood). HD-ROM,
hamstrings dynamic ROM; HP-ROM; hamstrings passive ROM; QP-ROM, quadriceps passive ROM.
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potential physiological mechanisms regarding the recovery
benefits seen with FR that have been outlined in previous
literature (31). The most important findings of the present
study were that FR was beneficial in improving dynamic
movement, percent muscle activation, and both passive and
dynamic ROM in comparison with the CON group while
attenuating muscle soreness, although no benefits were seen
at the muscular level when it was isolated.
EIMD protocol. Similar to previous EIMD-related
studies (19,33), substantial muscular fatigue and damage
were inflicted by the EIMD protocol, resulting in a sub-
stantial increase in TG, along with substantial decrements in
QP-ROM, TF, RFD, PTF, vertical jump height, MVC force,
muscle activation, and iEMG. Only two muscle properties
showed improvements immediately postexercise, with a re-
duction in the duration of EMD and 2RT.
Muscle soreness: DOMS. In the FR group, muscle
soreness peaked at POST-24, whereas the CON group
peaked at POST-48. Results are parallel to the findings in
a study by Smith et al. (34) comparing a massage interven-
tion group with a CON group. The massage group reported
peak muscle soreness at POST-24, whereas the CON group
peaked at POST-48. In the present study, substantially higher
muscle soreness readings were recorded at all time points for
the CON group, showing the effectiveness of FR in reducing
muscle soreness. Reductions in muscle soreness readings
can be further supported by the force plate data collected
from the FR exercise protocol (Table 4) at POST-24 and
POST-48. Although the FR group showed no substantial
changes in FR-force between POST-24 (26–44 kg) and
POST-48 (26–44 kg) for all five foam roller exercises,
substantial decreases in FR-pain (POST-24, 3–7.5 points,
and POST-48, 2.5–6.5 points) were seen while performing
four out of the five exercises. This finding further supports
that muscle soreness peaked at POST-24 for the FR group
and then began to return to baseline levels. The improved
recovery rate in muscle soreness in the FR group signifies
that FR is an effective tool to treat DOMS.
DOMS has been attributed to both muscle (8,12,29,35)
and connective (17,23,28,35) tissue damage. Although DOMS
is associated with muscle cell damage, it is unlikely that
DOMS is the direct result of muscle cell damage (35) because
muscle enzyme efflux and myofibrillar damage are not corre-
lated with the actual sensation of muscle soreness (10,23). It
has been postulated that DOMS may be the result of connec-
tive tissue damage more so than muscle damage. Connolly
TABLE 4. FR-force.
POST-0 POST-24 POST-48
Exercise Mean (% BW) Mean (kg) SD (kg) Mean (% BW) Mean (kg) SD (kg) Mean (% BW) Mean (kg) SD (kg)
Anterior 52 42.34 6.99 47 38.05 7.62 44 36.05 8.19
Lateral 53 43.30 5.70 46 36.91 6.17 45 36.40 7.10
Posterior 52 42.39 7.58 53 43.22 7.97 53 43.15 7.99
Medial 35 28.72 4.78 32 26.59 5.17 32 26.15 5.01
Gluteal 55 45.39 8.20 51 41.76 8.21 52 42.43 8.27
Table displays FR-force for all five FR exercises. FR-force is displayed as the average force placed on the foam roller for each exercise. FR-force is displayed as a percentage of body
weight (% BW) and kilograms of force.
TABLE 3. FR properties.
Exercise Measurement % Likelihood ,/=/jMean Diff Lower 95% CL Upper 95% CL dLower dUpper d
A. POST-0 to POST-24
Anterior FR-force (kg) 999 ,4.29 j6.2 j2.83 j0.56 j0.81 j0.31
FR-pain 63 j0.27 j0.11 0.66 0.26 j0.11 0.63
Lateral FR-force (kg) 999 ,6.39 j8.23 j4.55 j1.04 j1.33 j0.74
FR-pain 73 = 0.14 j0.19 0.47 0.11 j0.16 0.38
Posterior FR-force (kg) 78 = 0.82 j1.13 2.77 0.10 j0.14 0.35
FR-pain 59 j0.3 j0.12 0.72 0.24 j0.09 0.57
Medial FR-force (kg) 96 ,2.13 j3.33 j0.93 j0.41 j0.64 j0.18
FR-pain 99 j0.84 0.3 1.37 0.70 0.26 1.15
Gluteals FR-force (kg) 999 ,3.63 j4.98 j2.28 j0.44 j0.61 j0.28
FR-pain 98 j0.9 0.37 1.43 0.56 0.23 0.90
B. POST-24 to POST-48
Anterior FR-force (kg) 67 ,2.01 j3.65 j0.37 j0.25 j0.45 j0.04
FR-pain 999 ,1.01 0.51 1.51 j0.64 j0.96 j0.32
Lateral FR-force (kg) 94 = 0.51 j1.68 0.66 j0.07 j0.24 0.09
FR-pain 999 ,0.89 0.54 1.23 j0.54 j0.74 j0.33
Posterior FR-force (kg) 97 = 0.07 j1.5 1.36 j0.01 j0.19 0.17
FR-pain 60 ,0.3 0.04 0.56 j0.22 j0.42 j0.03
Medial FR-force (kg) 95 = 0.44 j1.12 0.24 j0.09 j0.22 0.05
FR-pain 86 ,0.45 0.12 0.78 j0.34 j0.58 j0.09
Gluteals FR-force (kg) 94 = 0.67 j0.57 1.91 0.08 j0.07 0.23
FR-pain 97 ,0.69 0.36 1.02 j0.38 j0.56 j0.20
Table displays between-time difference for FR-force and FR-pain regarding the percentage likelihood that there was a change/no change in the dependent variable, whether FR caused an
increase (j), no substantial change (=), or a decrease (,) in the dependent variable, the mean values for each time point, and the standardized effect size (d) with 95% confidence limits
(CL). Bold numbers (% likelihood) indicate conditions with substantial change (975% likelihood).
Anterior, quadriceps; lateral, iliotibial band; posterior, hamstrings; medial, adductors; gluteals, gluteal muscles—referring to the muscles/area targeted for each FR exercise.
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et al. (12) stated that pain and stiffness may be more related
to the inflammatory response (13), as a result of cells and
fluid moving into the interstitial spaces rather than the actual
muscle damage incurred. This can be supported by Mills
et al. (28) who demonstrated the presence of muscle dam-
age without the presence of muscle soreness, as well as
the presence of muscle soreness without muscle damage.
Jones et al. (23) suggested that changes in connective tis-
sue properties are the main cause of DOMS, with the myo-
tendinous junction being the predominant area of soreness
(24). Previous studies have reported connective tissue
breakdown after eccentric exercise (1,24), with damaged
connective tissue stimulating mechanically sensitive recep-
tors, giving rise to pain when stretched or pressed (23). This
finding suggests that the benefits of FR may be more pre-
dominant for the treatment of connective tissue rather than
muscle tissue damage.
Evoked contractile properties. The evidence that FR
has a greater effect on connective tissue rather than muscle
can be further strengthened by the greater decrement in
evoked contractile properties with FR versus CON. Decre-
ments in TF, PTF, and RFD in the FR group may be a re-
sult of increased muscle damage from the FR protocol.
Callaghan (8) showed that after a vigorous massage pro-
tocol, an increase in lactate dehydrogenase and creatine
kinase was reported, both being markers of muscle dam-
age. Zainuddin et al. (39) and Crane et al. (13) both showed
that massage was effective in alleviating DOMS, although
Zainuddin et al. (39) found that massage had no effect on
muscle function. The present findings suggest that although
FR may be beneficial in treating connective tissue damage,
minor damage to muscle tissue may incur. Whether this is
beneficial for the repair process occurring in the muscle or
only causing more damage to the muscle is unknown (10).
The only evoked contractile property to benefit from
the FR protocol in comparison with the CON group was
EMD, being substantially shorter at POST-24 (9%) and
POST-48 (7%) when compared with CON. EMD has been
shown to be influenced by several factors, including series
elastic components, ability of the action potential to propagate,
and excitation–contraction coupling (22). Zhou et al. (40)
considered EMD to reflect the elastic properties of the mus-
cle, with the major portion of the EMD representing the time
required to stretch the series elastic components of the muscle
(9). After EIMD, elongation of EMD is believed to be due to
mechanical stress placed on the muscle and increased passive
tension on noncontractile structures in the myofibers (29),
resulting in connective tissue damage. On the basis of these
findings, with FR improving the recovery of EMD to base-
line measurements after EIMD, potentially by restoring the
passive noncontractile structures (series of elastic compo-
nents) in the muscle, it is likely that FR provides a more
clinically significant recovery effect upon connective tissue
versus muscle tissue after EIMD.
Voluntary contractile properties. Although FR did
not help in treating EIMD at the muscular level, the FR
group showed no decrements in voluntary properties in com-
parison with the CON group and showed substantially greater
muscle activation in comparison with the CON group from
POST-24 to POST-72. The most substantial between-group
difference in muscle activation was seen at POST-48, occur-
ring when muscle soreness was also at its most substantial
between-group difference of any of the three posttest time
points. This being said, the FR group may have been able to
maintain muscle activation where decrements were seen in
the CON group, potentially because of a substantial reduction
in DOMS and less neural inhibition as a result of healthier
connective tissue, allowing for appropriate afferent feedback
from mechanical and sensory receptors located within the
connective tissue enveloping the muscle (12,19) because of
a substantial reduction in DOMS. To our knowledge, there
is no information on the effects of massage on muscle acti-
vation, although the decrements seen in the CON group were
similar to previous EIMD studies (19,33).
There were no substantial iEMG between-group differ-
ences. This may seem perplexing because muscle activation
showed substantial between-group differences. This finding
may be the result of large interindividual variations in EMG
levels when analyzing sore muscles (6). McGlynn et al. (27)
showed that EMG SD increased by 25-fold from PRE
to POST-72. Along with the previously noted findings,
Abraham (1) demonstrated no changes in EMG readings
using bipolar electrodes, with Devries (16) claiming that
bipolar electrodes may not be sensitive enough to detect
changes in EMG. Although not evident with iEMG mea-
sures, the improved muscle activation may be the result of
decreased neural inhibition (12,19) associated with less pain,
due to a decrease in inflammation (13).
MVC force showed no substantial between-group differ-
ences, with both groups showing deficits (6%–12%) at all
time points and not recovering to PRE by POST-72. MVC
force deficits are similar to those reported in a previous
EIMD study (39). It is interesting to note that there were
no substantial between-group differences in MVC force
even though the FR group showed substantial decrements
in TF, demonstrating greater damage within the muscle
(19). Although muscle fibers produced less force (as seen
through TF measurement) in the FR group, most likely a
result of greater individual muscle fibers damage (29),
the subjects’ ability to activate a greater number of mus-
cle fibers (as seen through VA measurements) may have
acted to counterbalance the decrement in force production
per fiber (33).
ROM. FR was beneficial in improving both passive and
dynamic ROM in comparison with the CON group. FR in-
creased passive ROM (QP-ROM and HP-ROM) and main-
tained dynamic ROM (HD-ROM) in relation to PRE (Table 1).
EIMD research (23,33) attributes a loss in ROM to the
shortening of noncontractile elements. Previously published
research from our laboratory demonstrates that the ap-
plication of FR increases ROM (25). Improved ROM was
attributed to FR acting in a similar fashion to myofascial
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release techniques, potentially reducing muscle soreness,
decreasing inflammation, and/or reducing adhesions be-
tween layers of fascia (3,15). Muscular manipulation has
been shown to promote active blood flow and move intersti-
tial fluid back into circulation, reducing inflammation and
muscle soreness (8,13).
Vertical jump height. Vertical jump performance in-
corporates all three of the major properties analyzed in the
present study (muscle, CNS, and ROM). Similar to the find-
ings by Pearcey et al. (31), the FR group showed substantial
benefits in comparison with the CON group when assessing
dynamic performance at POST-24 and POST-48. Research
by Willems et al. (38) and Mancinelli et al. (26) supports
these findings, with massage shown to improve vertical jump
height at 48 h postexercise by 3% and 4.5%, respectively.
Farr et al. (18) contradicts the present findings, showing
decrements in vertical jump height at POST-24 in the mas-
sage group, although there were no differences between the
massage and CON limb. It must be noted that vertical jump
tests in the research by Willems et al. (38) and Farr et al. (18)
consisted of one-legged vertical jumps, with the contralateral
leg acting as the CON. Because evoked contractile properties
are not improved by FR, FR likely acts by reducing neural
inhibition (12,33) due to accelerated recovery of the connec-
tive tissue as a result of decreased inflammation and increased
mitochondria biogenesis (13), decreasing nociceptor activa-
tion (17), allowing for better communication from afferent
receptors in the connective tissue (33). Better communication
with afferent receptors may possibly allow for the mainte-
nance of natural muscle sequencing and recruitment patterns
(33) maintaining vertical jump height.
CONCLUSION
From the present findings, it is speculated that FR pro-
vides recovery benefits primarily through the treatment of
connective tissue. Because the present evidence is indirect,
further research should be conducted.
The FR group displayed substantially less pain at all time
points in comparison with the CON group. Because con-
nective tissue (i.e., myotendinous junction) is the major site
of EIMD disruption and pain (17,23,24,35), FR can be con-
sidered to be beneficial in the recovery of connective tissue.
Research by Crane et al. (13) supports this finding, reporting
that massage decreased pain and inflammation, potentially by
promoting blood flow to areas of low blood flow, such as the
muscle–tendon interface. The FR group recorded substantially
less muscle soreness while having substantially greater dec-
rements in evoked contractile properties, ruling out improved
muscle recovery as the determining factor. The reduction in
pain with FR may have been an influential factor for the
maintenance of muscle activation (i.e., less neural inhibition)
(12,33). When analyzing dynamic movements (vertical
jump height and HD-ROM) or EMD, all heavily involving
the series elastic components, FR proved to be beneficial.
When comparing isometric (MVC Force) versus dynamic
contraction (vertical jump height) results in the FR group,
the greatest benefits from FR were displayed in the dynamic
movement. It must be emphasized that most of the benefits
seen with FR after EIMD are the result of FR maintaining
rather than improving PRE (VA, EMD, HD-ROM, and
vertical jump height), where the CON group incurred sub-
stantial decrements.
There was no direct funding for this research. D. G. Behm and
D. C. Button participate with the Theraband Research Advisory
Council. Theraband’s products include foam rollers.
The authors declare no conflicts of interest.
The results of the present study do not constitute endorsement
by the American College of Sports Medicine.
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http://www.acsm-msse.org142 Official Journal of the American College of Sports Medicine
APPLIED SCIENCES
Copyright © 2013 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
... The aim of foam rolling is to decrease pain and improve the pliability of the fascia, which is a complex network of connective tissue throughout the entire body [29]. Foam rolling has shown increases in ROM of 4-10° [28,30], without the negative effects seen with static stretching [28,31]. MacDonald et al. [30] stated that foam rolling can improve the vertical jumping performance along with muscle activation. ...
... Foam rolling has shown increases in ROM of 4-10° [28,30], without the negative effects seen with static stretching [28,31]. MacDonald et al. [30] stated that foam rolling can improve the vertical jumping performance along with muscle activation. However, the effects on performance are mixed as Healey et al. [32] reported that foam rolling had no impact on performance (vertical jump height and power, isometric force, and agility), but could reduce the "feeling" of fatigue. ...
... In summary, the current research on the effects of these modalities are mixed on exactly what is happening mechanically. It ranges from increased water content [45] to neurological changes [30]. It may even vary by sex, as results have differed between males and females [49]. ...
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Prior to training, many athletes perform different soft-tissue preparation protocols. Many of these protocols involve stretching, foam rolling, and/or percussion massage. Many of these modalities have been studied, but not as a group to observe muscle alterations and differences in males and females. In total, 40 (20 males, 20 females) participants performed five minutes of static stretching, foam rolling, and percussion massage. Pre- and post-isometric leg strength, muscle activation and ultrasound assessments (cross-sectional area, echo intensity, pennation angle, fascicle length, and muscle thickness) were taken. The results indicate that there is no significant difference among modalities, and that they do not significantly alter any muscle characteristic or improve performance. There is a significant difference in size between males and female, with males having larger muscle and greater pennation angles than females. This allows males to generate significantly more muscle force. However, they both respond similarly to each modality. In conclusion, the muscle response to static stretching, foam rolling, and percussion massage do not differ among modalities and do not contribute to an increase or decrease in maximal isometric knee extension with similar effects between males and females.
... More and more research on its use has begun to emerge. Authors often compare its action to manual massage or other physical treatments [1,3,6,22,24,28]. One potential application of rolling is to support post-workout recovery, so the aim of the present study was to assess the effect of roll-over self-massage on the occurrence of symptoms of delayed post-workout muscle soreness after high intensity interval training (Tabata formula). ...
... Our results confirm the opinions presented in the literature on pain reduction in the course of DOMS as a result of roller application [22,26]. Macdonald et al. [22] also noted lower intensity of muscle soreness after rolling during the whole study. ...
... Our results confirm the opinions presented in the literature on pain reduction in the course of DOMS as a result of roller application [22,26]. Macdonald et al. [22] also noted lower intensity of muscle soreness after rolling during the whole study. It used a longer self-massage time than in our own research, 60 seconds per muscle group, and the treatment area was extended to the posterior thigh muscle group and gluteal muscles. ...
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Study aim The aim of the present study was to assess the effect of roll-over self-massage on the occurrence of symptoms of delayed post-workout muscle soreness after Tabata training. Material and methods The research involved 81 people, randomly divided into two groups. A series of three roller self-massages was applied by members of Group 1 (n = 33). Persons assigned to control Group 2 (n = 48) did not undergo any procedures supporting the post-workout recovery. All participants performed training of lower limb muscles, according to the Tabata protocol. Then the frontal surface of the thighs was tested with a thermal imaging camera. The intensity of pain was measured (by the Visual Analogue Scale – VAS) after 24, 48 and 72 hours. Results The highest average pain level in Group 1 was recorded at the second measurement, i.e. 24 hours after training, and in Group 2 after 48 h. In the study group, a significantly lower result was observed on each successive day. The differences between the groups in pain levels measured 48 and 72 hours after exercise were statistically significant (p < 0.05). Conclusion Self-massage with a roller accelerated muscle regeneration. It can therefore be an effective procedure to support post-workout recovery, especially for athletes during the start period.
... In the presented results, the highest VAS values were obtained at 24 or 48 h in all studied groups. These values are reflected in many studies evaluating the effectiveness of SMR on Delayed Onset Muscle Soreness (DOMS) 8,12,15,45,46 . A thorough assessment of VAS and obtaining statistically significant differences between all rolling groups and the Passive Rest (Pass) group on the third day, as well as between the G and TP groups and the Pass group on the second day within the quadriceps muscles, allows the conclusion that rolling can bring a beneficial effect after maximal anaerobic effort. ...
... The collected data align with the results of other researchers who found the highest CK values after intense short-term anaerobic exercise at 24 or 48 h 47,48 however the availability of studies evaluating the impact of rolling on CK levels after exercise is quite limited. Visconti et al. 49 following the protocol of MacDonald et al. 8 , obtained statistically significantly higher CK values between the measurement at 48 h vs. before exercise and at 48 h vs. 24 h in both studied groups (rolling and passive rest). However, no differences between groups were found, which may confirm the lack of a connection between SMR and post-exercise CK concentration with a high load however the protocol used a high-density foam roller, but the texture was not specified. ...
... Analyzing the results of studies evaluating the impact of rolling on Delayed Onset Muscle Soreness (DOMS), MacDonald et al. 8 obtained significantly lower NRS scale results between the rolling group and the control group at 24, 48, and 72 h after the exercise. Mustafa et al. 52 , using the same study protocol as MacDonald et al. 8 , also achieved statistically better results in subsequent days between the rolling group and the group resting passively. ...
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Among athletes, foam rolling is popular technique of myofascial release aimed to support recovery processes and counteract delayed onset muscle soreness. However, there is no consensus on the optimal parameters of the roller texture used in the procedure. The study aimed to determine whether using rollers with different textures and hardness (smooth/soft, grooved/mid, serrated/hard) in myofascial release affects post-exertional restitution rate and the level of perceived DOMS (Delayed Onset Muscle Soreness) after intense anaerobic exercise. The study involved 60 healthy and physically active men randomly divided into three experimental groups and one control group (passive rest)—each consisting of 15 individuals: STH—rolling with a smooth roller; G—rolling with a grooved roller; TP—rolling with a serrated roller; Pass—passive rest group. After performing a exercise test (one-minute high-intensity squat), blood lactate (LA), creatine kinase (CK) and pain perception (VAS Scale) were monitored. The analysis of the average LA concentration in the blood 30 min post-exercise showed a statistical difference for all rolling groups compared to the passive rest group: STH (p < 0.001), G (p < 0.001), TP (p = 0.035). No statistically significant differences were found between the CK measurement results in individual assessments. Statistically significant differences in VAS values were observed between G (p = 0.013) and TP (p = 0.006) groups and the Pass group at 48 h, as well as between STH (p = 0.003); G (p = 0.001); TP (p < 0.001) groups and the Pass group at 72 h. Based on statistical data, a strong influence (η² = 0.578) of time on the quadriceps VAS variable was noted. The research results confirm the effectiveness of rolling in supporting immediate and prolonged recovery. The conducted studies indicate a significantly better pace of post-exertional recovery after a rolling procedure lasting at least 120 s. The texture and hardness of the tool used did not matter with such a duration of the treatment.
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... This method is preferred to accelerate recovery after physical activity and increase muscle flexibility. (Macdonald et al., 2014) Recent studies have shown that the applications performed by athletes with foam roller has positive effects on flexibility and normal joint movement; however, these effects are observed for a short time. (Beardsley and Skarabot, 2015;Bushell et al., 2015;Cheatham et al., 2015;MacDonald et al., 2013;Mohr et al., 2014;Škarabot et al., 2015) The athletes should be aware of the proper techniques and parameters for applying foam rollers to ensure effectiveness and safety. ...
... Measurements were taken from the muscle belly of the rectus femoris, from the 2/3 proximal region between the anterior superior iliac spine and the superior pole of the patella. (Macdonald et al., 2014) The device probe was placed in a vertical orientation on the skin, directly over the designated muscle point for assessment (Figure 2). The device applies a brief mechanical pulse, inducing a temporary deformation. ...
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... In the aforementioned context, instrument-assisted manual therapy (IAMT) has been used to optimize movement prerequisites alongside actively applied myofascial self-release exercises, such as foam rolling, potentially leading to a reduction in hamstring injuries [5,6,[8][9][10][11][12]. Even a single two-minute IAMT session on the front and back thighs has been observed to result in better and more sustained range of motion (ROM) adaptations compared with foam rolling of identical location and time in soccer players [6]. ...
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Introduction: Instrument-assisted manual therapy (IAMT) is suitable for optimizing movement prerequisites, such as range of motion, flexibility, microcirculation, and pain inhibition along myofascial chains, potentially leading to a reduction in hamstring injuries. To date, however, IAMT’s modes of action remain largely unclear. This study aimed to examine the functional and structural effects of repetitive IAMT after 2.5 and five weeks. Methods: Sixteen healthy female soccer players (age: 21.4 (±5.1) years) were randomly grouped into an intervention group and a placebo control group. The intervention group received nine IAMT sessions twice weekly at the right lumbar region. The placebo group received a single pressureless “therapy” at baseline. In addition to structural ultrasound analyses (absolute motion and shear motion), functional mobility tests (passive straight leg raise (PSLR) test and lumbar and thoracic double inclinometry) were performed 4.0 (±2.0) days after the fourth IAMT and 3.4 (±1.1) days after the ninth IAMT in both groups. Results: Hamstring flexibility in the PSLR test improved significantly after the ninth IAMT compared with the placebo group (p < 0.05, effect size: 0.913). No systematic differences were seen at the structural level. Conclusion: Repetitive IAMT can improve hamstring flexibility. Further studies in larger groups and diverse collectives are necessary to additionally test the postulated preventive effect also on hamstring injuries. Whether ultrasound is the right method for detecting structural changes in this context needs to be verified in the future.
... lumbar flexion. The authors hypothesized that foam rolling not only increases the elasticity of muscles as previously shown in the literature(MacDonald et al., 2014), but also the mobility of fascia itself. However, as the study only looked at measurements immediately following an acute intervention it is unknown whether any adaptations remained after the study had ended. ...
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Full-text available
Eccentric exercise continues to receive attention as a productive means of exercise. Coupled with this has been the heightened study of the damage that occurs in early stages of exposure to eccentric exercise. This is commonly referred to as delayed onset muscle soreness (DOMS). To date, a sound and consistent treatment for DOMS has not been established. Although multiple practices exist for the treatment of DOMS, few have scientific support. Suggested treatments for DOMS are numerous and include pharmaceuticals, herbal remedies, stretching, massage, nutritional supplements, and many more. DOMS is particularly prevalent in resistance training; hence, this article may be of particular interest to the coach, trainer, or physical therapist to aid in selection of efficient treatments. First, we briefly review eccentric exercise and its characteristics and then proceed to a scientific and systematic overview and evaluation of treatments for DOMS. We have classified treatments into 3 sections, namely, pharmacological, conventional rehabilitation approaches, and a third section that collectively evaluates multiple additional practiced treatments. Literature that addresses most directly the question regarding the effectiveness of a particular treatment has been selected. The reader will note that selected treatments such as anti-inflammatory drugs and antioxidants appear to have a potential in the treatment of DOMS. Other conventional approaches, such as massage, ultrasound, and stretching appear less promising.
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Full-text available
Muscle soreness, a familiar phenomenon to most athletes, has been differentiated into 'acute' and 'delayed onset'. The etiology of acute muscle soreness has been attributed to ischemia and the accumulation of metabolic by-products. However, the etiology of delayed onset muscle soreness (DOMS) is not so clear. Six theories have been proposed: lactic acid, muscle spasm, torn tissue, connective tissue, enzyme efflux, and tissue fluid theories. The treatment of DOMS has also been investigated. Studies in which anti-inflammatory medications have been administered have yielded varying results based on the dosage and the time of administration. Submaximal concentric exercise may alleviate soreness but does not restore muscle function. Neither cryotherapy nor stretching abates the symptoms of DOMS. Transcutaneous electrical stimulation]Ins been shown to decrease soreness and increase range of motion, but the effect on the recovery of muscle function is unknown. Therefore, the treatment of DOMS remains an enigma.
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Context: After an intense bout of exercise, foam rolling is thought to alleviate muscle fatigue and soreness (ie, delayed-onset muscle soreness [DOMS]) and improve muscular performance. Potentially, foam rolling may be an effective therapeutic modality to reduce DOMS while enhancing the recovery of muscular performance. Objective: To examine the effects of foam rolling as a recovery tool after an intense exercise protocol through assessment of pressure-pain threshold, sprint time, change-of-direction speed, power, and dynamic strength-endurance. Design: Controlled laboratory study. Setting: University laboratory. Patients or other participants: A total of 8 healthy, physically active males (age = 22.1 ± 2.5 years, height = 177.0 ± 7.5 cm, mass = 88.4 ± 11.4 kg) participated. Intervention(s): Participants performed 2 conditions, separated by 4 weeks, involving 10 sets of 10 repetitions of back squats at 60% of their 1-repetition maximum, followed by either no foam rolling or 20 minutes of foam rolling immediately, 24, and 48 hours postexercise. Main outcome measure(s): Pressure-pain threshold, sprint speed (30-m sprint time), power (broad-jump distance), change-of-direction speed (T-test), and dynamic strength-endurance. Results: Foam rolling substantially improved quadriceps muscle tenderness by a moderate to large amount in the days after fatigue (Cohen d range, 0.59 to 0.84). Substantial effects ranged from small to large in sprint time (Cohen d range, 0.68 to 0.77), power (Cohen d range, 0.48 to 0.87), and dynamic strength-endurance (Cohen d = 0.54). Conclusions: Foam rolling effectively reduced DOMS and associated decrements in most dynamic performance measures.
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The objective of this study was to investigate the effect of expected and unexpected interpolated stimuli (IT) during a maximum voluntary contraction on quadriceps force output and activation. Two groups of male subjects who were either inexperienced (MI: no prior experience with IT tests) or experienced (ME: previously experienced 10 or more series of IT tests) received an expected or unexpected IT while performing quadriceps isometric maximal voluntary contractions (MVCs). Measurements included MVC force, quadriceps and hamstrings electromyographic (EMG) activity, and quadriceps inactivation as measured by the interpolated twitch technique (ITT). When performing MVCs with the expectation of an IT, the knowledge or lack of knowledge of an impending IT occurring during a contraction did not result in significant overall differences in force, ITT inactivation, quadriceps or hamstrings EMG activity. However, the expectation of an IT significantly (p ¼ 0.0001) reduced MVC force (9.5%) and quadriceps EMG activity (14.9%) when compared to performing MVCs with prior knowledge that stimulation would not occur. While ME exhibited non-significant decreases when expecting an IT during a MVC, MI force and EMG activity significantly decreased 12.4% and 20.9% respectively. Overall, ME had significantly (p ¼ 0.0001) higher force (14.5%) and less ITT inactivation (10.4%) than MI. The expectation of the noxious stimuli may account for the significant decrements in force and activation during the ITT. Key pointsA single orientation session may not be adequate for a valid estimation of muscle activation using the ITT.The expectation of an electrical stimulation whether delivered or not can impair performance.The validity of the ITT for estimating the extent of full muscle activation must be viewed with caution, since the expectation of IT discomfort may inhibit the individual's ability to exert maximum force, especially with inexperienced participants.
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Delayed onset muscle soreness (DOMS) is a familiar experience for the elite or novice athlete. Symptoms can range from muscle tenderness to severe debilitating pain. The mechanisms, treatment strategies, and impact on athletic performance remain uncertain, despite the high incidence of DOMS. DOMS is most prevalent at the beginning of the sporting season when athletes are returning to training following a period of reduced activity. DOMS is also common when athletes are first introduced to certain types of activities regardless of the time of year. Eccentric activities induce micro-injury at a greater frequency and severity than other types of muscle actions. The intensity and duration of exercise are also important factors in DOMS onset. Up to six hypothesised theories have been proposed for the mechanism of DOMS, namely: lactic acid, muscle spasm, connective tissue damage, muscle damage, inflammation and the enzyme efflux theories. However, an integration of two or more theories is likely to explain muscle soreness. DOMS can affect athletic performance by causing a reduction in joint range of motion, shock attenuation and peak torque. Alterations in muscle sequencing and recruitment patterns may also occur, causing unaccustomed stress to be placed on muscle ligaments and tendons. These compensatory mechanisms may increase the risk of further injury if a premature return to sport is attempted. A number of treatment strategies have been introduced to help alleviate the severity of DOMS and to restore the maximal function of the muscles as rapidly as possible. Nonsteroidal anti-inflammatory drugs have demonstrated dosage-dependent effects that may also be influenced by the time of administration. Similarly, massage has shown varying results that may be attributed to the time of massage application and the type of massage technique used. Cryotherapy, stretching, homeopathy, ultrasound and electrical current modalities have demonstrated no effect on the alleviation of muscle soreness or other DOMS symptoms. Exercise is the most effective means of alleviating pain during DOMS, however the analgesic effect is also temporary. Athletes who must train on a daily basis should be encouraged to reduce the intensity and duration of exercise for 1–2 days following intense DOMS-inducing exercise. Alternatively, exercises targeting less affected body parts should be encouraged in order to allow the most affected muscle groups to recover. Eccentric exercises or novel activities should be introduced progressively over a period of 1 or 2 weeks at the beginning of, or during, the sporting season in order to reduce the level of physical impairment and/or training disruption. There are still many unanswered questions relating to DOMS, and many potential areas for future research.
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A four-minute standard exercise consisting of wrist hyperextension every two seconds with 9 1/2 pounds of resistance was administered to 17 subjects. The subjects then applied static stretching technique to the nondominant arm immediately after the exercise and 2, 6, 20, and 22 hours afterward. Observations of muscular distress were made on both arms during the exercise and at 4, 8, 24, 48, and 72 hours after the exercise. Significantly lesser magnitudes of muscular distress were found in the experimental arm at the 24- and 48-hour observations, at the .01 and .05 levels of confidence respectively. A lower level of muscular distress was also found in the experimental arm when all observations for each subject subsequent to the exercise bout were summed. This difference achieved significance at the .01 level of confidnce.
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Objective The purpose of this study was to determine if post-exercise massage has an effect on delayed-onset muscle soreness (DOMS) and physical performance in women collegiate athletes.DesignThis study used a randomized pre-test post-test control group design.ParticipantsTwenty-two NCAA Division I women basketball and volleyball players participated. On the day of predicted peak soreness, the treatment group (n=11) received a thigh massage using effleurage, petrissage and vibration while the control group (n=11) rested.Outcome measuresPaired t-tests were used to assess differences between pre and post massage measures (α=0.05) for vertical jump displacement, timed shuttle run, quadriceps length and pressure-pain threshold in the thigh.ResultsA significant increase (slowing) was found in shuttle run times for the control group (p=0.0354). There were significant changes in vertical jump displacement (p=0.0033), perceived soreness (p=0.0011) and algometer readings (p=0.0461) for the massage group.Conclusions This study supports the use of massage in women collegiate athletes for decreasing soreness and improving vertical jump.