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Immediate changes in pressure pain threshold in the Iliotibial band using a myofascial (foam) roller

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Background: Foam rolling is a self-release myofascial technique that can be applied to a variety of tissues. Previous studies have demonstrated physiological changes in range of motion and arterial stiffness with the application of a foam roller; however, no studies have investigated the change in pain levels. The present study investigated the effect on the pressure pain threshold (PPT) following the application of a foam roller for three minutes to the right iliotibial band (ITB) of asymptomatic participants.
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Immediate changes in pressure pain threshold in the iliotibial band after using a myofascial
(foam) roller.
Brett Vaughana,b
Patrick McLaughlina,b
a Discipline of Osteopathic Medicine, College of Health & Biomedicine, Victoria University,
Melbourne, Australia
b Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia
Corresponding Author
Brett Vaughan
College of Health and Biomedicine
Victoria University
PO Box 14428
Melbourne VIC 8001
P. 03 9919 1210
F. 03 9919 1030
E. brett.vaughan@vu.edu.au
Section: Research
ABSTRACT
Context
Foam rolling is used as a self-release myofascial technique that can be applied to a variety of
tissues. Previous studies have demonstrated physiological changes in range of motion and arterial
stiffness with the application of a foam roller. However no studies have investigated the change in
pain levels using a semi-objective measure.
Objective
The present study investigated the application of a foam roller for three minutes to the right iliotibial
band (ITB) of asymptomatic participants.
Design
Repeated measures design.
Setting
University teaching clinic.
Participants
Eighteen asymptomatic participants.
Interventions
Participants completed questionnaire and their height and mass measured. Three points on the
ITB were marked. The pressure pain threshold was measured at each point using a pressure
algometer. Measurements were undertaken pre-intervention, post-intervention and 5 minutes post-
intervention. The participant completed a single 3-minute bout on the foam roller.
Main outcome measures
Pressure pain threshold.
Results
Results demonstrated a statistically significant increase (p<0.05) in the PPT at the lower thigh
immediately post-bout however the difference was ameliorated five minutes later.
Conclusions
Foam rolling the ITB produces an immediate increase in the PPT in asymptomatic participants at
the lower part of the ITB. Further research is required to develop an evidence base for the use of
foam rollers in clinical practice. In the future, research should investigate the application of foam
rollers to different tissues, for different lengths of time and over a period of time.
KEYWORDS
myofascial release; foam rolling; iliotibial band; pressure algometry
Immediate changes in pressure pain threshold in the iliotibial band after using a myofascial
(foam) roller.
ABSTRACT
Background
Foam rolling is used as a self-release myofascial technique that can be applied to a variety of
tissues. Previous studies have demonstrated physiological changes in range of motion and arterial
stiffness with the application of a foam roller, however no studies have investigated the change in
pain levels. The present study investigated the effect on the pressure pain threshold (PPT)
following the application of a foam roller for three minutes to the right iliotibial band (ITB) of
asymptomatic participants.
Methods
Participants completed a questionnaire and had their height and mass measured. Three points on
the ITB of the right leg were marked. The PPT was measured at each point using a pressure
algometer. Measurements were taken pre-intervention, post-intervention and 5 minutes post-
intervention. The participant completed a single 3-minute bout on the foam roller.
Findings
Results demonstrated a statistically significant increase (p<0.05) in the PPT at the lower thigh
immediately post-treatment, however, the difference was ameliorated five minutes later.
Conclusions
Foam rolling the ITB produces an immediate increase in the PPT of the lower thigh in
asymptomatic participants.
Key words: myofascial release; foam rolling; iliotibial band; pressure algometry
INTRODUCTION
Iliotibial band syndrome (ITBS) often presents with pain over the lateral aspect of the lower thigh
and knee. Statistics indicate that ITBS effects between 5 and 14% of runners (van der Worp et al,
2012) and has been reported to effect other athletic populations including cyclists (Holmes et al,
1993) and competitive rowers (Rumball et al, 2005). Treatment for this complaint is varied and the
literature inconsistent with regard to the most effective treatment strategies (Falvey et al, 2010; van
der Worp et al, 2012). There is agreement however, that the conservative management in the
acute phase of ITBS should be directed towards pain reduction (Lavine 2010; Baker et al, 2011).
Current research suggests that a combination of advice on running gait, hip muscle strengthening,
anti-inflammatory medications, in addition to addressing the flexibility of the iliotibial band (ITB),
can assist in alleviating the pain associated with ITBS (Baker et al, 2011; van der Worp et al,
2012).
A possible method by which the flexibility of the ITB can be improved is through the use of a
myofascial foam roller (Strauss et al, 2011). Myofascial foam rollers are widely used in sport and
rehabilitation settings to achieve changes in muscle tone, restore tissue extensibility (Curran et al,
2008; MacDonald et al, 2013), and increase range of motion (MacDonald et al, 2013). The effect of
foam rolling has been proposed to be similar to that of other myofascial release techniques in that it
has an autonomic effect on the soft tissue (Schleip 2003) and potentially creates mechanical or
histological changes in the myofascial structures (Sefton 2004).
Previous work on the use of foam rollers applied to a variety of tissues has demonstrated foam
rolling reduces arterial stiffness and improves vascular endothelial function (Okamoto et al, 2013),
and produces conflicting results for improvements in range of motion (Miller and Rockey 2006;
MacDonald et al, 2013; Sullivan et al, 2013). Healey et al. (2014) also used short 30-second bouts
on multiple muscle groups and demonstrated no gain in vertical jump height and power, isometric
force production, and agility. The equivocal results of these studies suggest that investigation of
the physiological effect of the application of a foam roller, beyond increasing ROM, is warranted.
The construction of the foam roller itself requires consideration. Curran et al (2008) investigated
the pressure applied to the lateral thigh by two types of foam roller; a cylindrical polystyrene foam;
and a roller consisting of a hollow polyvinyl chloride core with a neoprene outer layer. Data
suggest that the hollow roller exerted a higher pressure and lower contact area when compared to
the polystyrene roller and may be appropriate to address deeper myofascial structures. It is these
deeper myofascial structures that may play a neurophysiologic role in increases in the PPT (Mense
2000).
Foam rollers are used as part of the rehabilitation of a number of musculoskeletal complaints,
where one of the commonly desired outcomes is a reduction in pain. An objective method for
assessing changes in pain level is pressure algometry (Ylinen 2007). Pressure algometry allows
the determination of the pressure pain threshold; the minimum amount of pressure which induces
pain or tenderness (Fisher 1987; Nussbaum and Downes 1998). Pressure algometry is a
repeatable tool for the quantification of pain and tenderness in a variety of tissues (Reeves et al,
1986; Fisher 1987; Vanderweeen et al, 1996; Frank et al, 2013). At a neurophysiological level, the
PPT “…reflects noiceptive sensitivity in superficial and deep tissues” (Rollman and Lautenbacher
2001) and is one of the most sensitive tests for investigating the mechanisms of musculoskeletal
pain (Rollman and Lautenbacher 2001). At present, no studies have investigated the changes in
pain level with the use of a foam roller. The aim of the present study is to investigate the
immediate effect on the PPT of the application of a foam roller to the ITB.
METHOD
The study was approved by the Victoria University (VU) Human Research Ethics Committee.
Participants
Potential participants were recruited from the student population of the VU osteopathy program.
Exclusion criteria were a history of manual therapy to the lower extremity in the past week, current
low back, right hip or right knee pain, popping/clicking/locking of the right knee, currently taking
pain-relieving or anti-inflammatory medications or their right lower extremity being operated on in
the last 12 months. Participants were also excluded if they currently had, or previously had a
bleeding disorder, fibromyalgia, chronic fatigue syndrome or myofascial pain syndrome.
Equipment
Foam roller
A Comffit Pilates foam roller with medium density foam (90cm length, 15cm diameter) was used
(available www.sportstek.net).
Pressure algometer
A hand-held electronic pressure algometer (Somedic Algometer Type II, Sweden) was used to
measure the PPT. This device has been previously used by the authors investigating device
validity and the repeatability of PPT measures with 95% confidence intervals ranging from 0.968 to
0.988 (Vaughan et al, 2007) and 0.676 to 0.958 (Frank et al, 2013). The author (BV) has used the
device in a previous study (Vaughan et al, 2007) and conducted two practice sessions with willing
participants prior to this study.
Procedure
Participants were asked to complete a questionnaire detailing their age, gender and dominant leg.
Height and mass measurements were taken using electronic scales and a stadiometer. Body mass
index (BMI) was subsequently calculated. Each participant was asked to wear running shorts (or
similar) to allow access to the lateral thigh. With the participant lying supine, the other author
(PMc) measured and marked three points on the right lateral thigh: 10cm below the greater
trochanter, 10cm above the lateral femoral epicondyle, and a point half way between these two
marks. At each point, the circumference of the thigh was measured using a flexible measuring
tape.
The pressure algometer was applied by the same investigator (BV) three times at each of the three
marked points. Each application of the pressure algometer was stopped when the participant
perceived a change in sensation from pressure to pain at the measurement point. The participant
pressed a hand-held button to stop the reading and the maximum pressure reading (kPa) on the
device was recorded on the screen which could not be seen by the researcher. Measurements
were recorded by a research assistant. Participants then undertook a three minute session on the
foam roller, slowly moving on the roller from the greater trochanter to lateral knee under the
guidance of another research assistant (Figure 1). The PPT measurements were then taken
immediately after the foam rolling session and after a 5-minute rest period. During the rest period
the participant was required to sit still.
INSERT Figure 1 here
Data analysis
All data from the pre-study questionnaire and PPT recording sheets were entered into SPSS
Version 21 (IBM Corp, USA) for analysis. The mean PPT for each location at each time point was
calculated with the first measurement removed. Previous research has shown that more than one
measurement produces a reliable estimate of the PPT (Ohrbach and Gale 1989), particularly if the
first measurement is removed (Nussbaum and Downes 1998; Persson et al, 2004). Three mixed
plot ANOVAs were used (one for each location) to investigate any differences in the PPT between
males and females across time (3) with alpha set at p<0.05. Circumference data were correlated
to PPT measures using Pearson’s r and also compared across gender. Pearson’s r was interpreted
according to Hopkins (2000): <0.10 (trivial); 0.10-0.30 (small); 0.30-0.50 (moderate); 0.50-0.70
(large); 0.70-0.90 (very large); 0.90-1.0 (perfect).
FINDINGS
Eighteen participants (n=10 males) were recruited for the study with a mean age of 26.1±6.7 years,
mean mass of 68.9±12.9kg and mean BMI of 22.9±3.2. Females recorded significantly smaller leg
circumferences at the mid-thigh (female 49±3cm vs male 53±3cm; p=0.01) and lower thigh (female
39±3cm vs male 43±4cm; p=0.046) but there was no significant difference between gender for
upper thigh circumference (female 55±4cm vs male 59±4cm; p=0.11).
There were no significant differences in PPT between each time point for the upper (F(2, 32) = 0.6, p
= 0.57, 1-b = 0.14) and mid-thigh (F(1.63, 26) = 0.94, p = 0.4, 1-b = 0.18). A significant difference in
PPT for the lower thigh was demonstrated (F(1.54, 24.6)=3.72, p = 0.049, 1-b =0.56) with the
difference existing between the initial PPT measure and the PPT taken immediately after use of the
foam roller (Table 1).
INSERT Table 1 here
Of interest, there was a significant difference between males and females within the sample for the
PPT at the mid-thigh with the males recording a significantly higher value immediately after use of
the foam roller (p=0.03). Mid-thigh circumference was significantly correlated to the post treatment
PPT measures across the sample (immediately post r=0.55, p=0.019; 5 minutes post r=0.56;
p=0.015) but not to pre-treatment PPT values (r=0.33, p=0.18). There were no other significant
relationships between thigh circumference and PPT measures.
The PPT of the males was generally higher at all locations than the females and there is a trend
towards an immediate, but non lasting, effect of the foam roller on PPT (Figure 2). The larger (by
circumference) thighs of the males respond better to 3 minutes of foam rolling than the smaller
thighs of the females.
INSERT Figure 2 here
CONCLUSIONS
This study investigated the immediate changes in PPT following a short bout of foam rolling. The
results suggest that there is an immediate significant increase in the PPT post-foam rolling for the
lower thigh however this increase is not present 5 minutes later. Whilst this increase in PPT was
demonstrated for the upper and mid-thigh measurements, there were no significant differences
across time for these locations. A possible mechanism to account for this immediate increase in
PPT is proposed in the work of Mense (2000) who suggest that the descending antinoiceptive
systems are more responsive to inputs from muscle noiceptors than from skin noiceptors. It is
possible that the foam roller is stimulating both the skin and muscle noiceptors, and activating the
descending antinoiceptive systems to produce an increase in the PPT.
Although Strauss et al (2011) have recommended the use of a foam roller to break up ‘adhesions’
in the ITB as part of the management of ITB syndrome, they provide no guidance on the length of
time it should be used for. The 3-minute bout in the present study is longer compared to previous
studies (MacDonald et al, 2013; Sullivan et al, 2013) and more reflective of how a patient would
use a foam roller in their home or in a rehabilitation setting. Whether this length of time is optimal
for increasing the PPT in the ITB requires further investigation.
Further research should be directed towards the potential for a cumulative effect of foam rolling
over time. Most patients will not use the foam roller as a once-off, instead using it daily or as part
of a warm-up/down routine. It may be that using the foam roller on the same tissue daily, or
multiple times in a day, produces a longer lasting effect, providing the change in sensation in the
tissue that patient’s anecdotally report. Such a result is plausible given MacDonald et al. (2014)
demonstrated a subjective decrease in muscle soreness over a 48-hour period. Participants in this
study completed single 60-second bouts rolling the thigh bilaterally (10 minutes overall) following a
10 x 10 back squat program. Healey et al (2014) have also presented an alternative hypothesis for
the subjective benefit of foam rolling. These authors suggest the decrease in perceived muscle
fatigue with foam rolling may be psychological. These authors demonstrated that when compared
to a plank exercise, athletes who used a foam roller as part of their warm up perceived less muscle
fatigue even though there was no difference in athletic performance between the groups. This
between group difference in perception could influence the PPT. Further research with a control
intervention is required in order to investigate this effect.
The amount of time spent foam rolling a tissue also requires investigation. In the present study,
participants completed a 3-minute bout on the foam roller. This may have been too much time for
some participants, and not enough for others, to achieve changes in tissue sensitivity. It may also
be that a fixed length of time is not relevant. The time spent on the foam roller could be directed by
the patient’s own response, that is, once they cease feeling pain in the tissue being rolled it is time
to stop. Change in pain level experienced by the patient could indicate a change in the underlying
tissue, therefore further use of the foam roller may have no additional benefit. This assertion
requires further investigation. A moderate positive relationship was identified between thigh
circumference and the post-intervention PPT measures. We can speculate that this may be due to
the presence of a more muscular thigh, with minimal superficial fat, meaning that the foam roller is
effectively stimulating the muscle noiceptors and activating the descending antinoiceptive
mechanisms (Mense 2000). Whether the soft tissue composition of the thigh, and an associated
increase or decrease in thigh circumference, plays a role in the outcome of foam rolling the ITB
should be studied further.
Gender differences were also demonstrated in the present study. The results presented here
confirm the findings of both Chesterton et al (2003) and Garcia et al (2007), and are supported by a
commentary from Rollman and Lautenbacher (2001). These authors have previously
demonstrated that females exhibit lower PPT values compared to males. The female participants in
the present study recorded lower PPT values and smaller thigh circumference data. Whilst the
males tended to respond better to foam rolling for three minutes, it may be a difference in pain
tolerance rather than a change in underlying tissue that creates this effect. This assertion is
supported by research suggesting women have a greater sensitivity to pain, particularly when
pressure pain is the applied stimulus (Riley III et al, 1998). Further research using pressure
algometry may need to be conducted on a gender specific basis, with control and experimental
groups of matched participants of the same sex. Based on the findings of this study, it is difficult to
discern how a clinician would advise a female patient compared to a male patient on the length of
time to use a foam roller.
The limited sample size may have impacted on the ability to detect changes at the three time
points and future research should include greater participant numbers. Data output suggests that
the study was underpowered and correlation values were small to medium. All of the participants
were symptom-free and the results may be different in symptomatic populations. Foam rolling is
also used on other muscle groups and further research should ascertain whether the PPT also
changes at other sites.
This is the first study to investigate the changes in PPT following a bout of foam rolling.
Measurement of the PPT allows the practitioner to ‘objectively’ measure changes post-intervention.
Given that decreasing the sensation of pain in a tissue is a goal of foam rolling, pressure algometry
provides an avenue to investigate the changes. This study also replicated more closely how foam
rolling would be applied to the ITB in clinical practice. An immediate increase in the PPT was
demonstrated post-bout however this difference was ameliorated 5 minutes later. Future research
should investigate PPT changes in other tissues along with investigating the cumulative effect of
foam rolling over time.
KEY POINTS
· Foam rollers are widely used in physical and manual therapy but there is little literature on their
effectiveness, particularly in relation to pain reduction
· Previous research on foam rollers has demonstrated small improvements in range of motion
post-foam roller application
· Pressure pain threshold increases immediately post-foam roller application but the change is
not maintained
· Differences in the effect of foam roller use were observed for gender however further research
is required
· Further research into repeated applications of a foam roller is required, at varying time intervals
as well as with symptomatic participants
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CONTRIBUTORSHIP
Both authors conceived the study. PMcL undertook the data analysis. Both authors undertook the
literature review and development of the manuscript. Both authors approved the final version of the
manuscript.
FUNDING
The authors received no funding to conduct the study.
CONFLICT OF INTEREST
The authors declare no conflict of interest in relation to this manuscript.
Figure 1. Foam rolling the iliotibial band.
Figure 2. Mean PPT over time for males and females.
* significant difference between pre- and post-measurements for both genders (p=0.04)
^ significant difference between males and females immediately post foam roller use (p=0.04)
±
Location of PPT
measurement
Pre
Post
Post + 5 mins
p
Gender
p
Upper thigh (UT)
339±179
366±222
355±210
0.23
Females
291±116
285±105
293±84
Males
377±215
432±271
404±267
Mid-thigh (MT)
356±166
403±185
377±178
0.04
Females
291±146
298±87
289±92
Males
409±170
486±204
447±202
Lower thigh (LT)
344±154*
400±134*
375±131
0.08
Females
290±100
335±85
311±75
Males
388±179
452±147
426±147
(mean ± standard deviation)
*Significant increase in PPT between pre and post measurements in the lower thigh (p=0.011)
Table 1. PPT measurements over the three time periods.
Table 1. PPT measurements over the three time periods.
Location of PPT
measurement
Pre
Post
Post + 5 mins
RM
p
Gender
p
Upper thigh (UT)
339±179
366±222
355±210
0.47
0.23
Mid-thigh (MT)
356±166
403±185
377±178
0.32
0.04
Lower thigh (LT)
344±154*
400±134*
375±131
0.04
0.08
*Significant increase in PPT between pre and post measurements in the lower thigh (p=0.011)
Figure 1. Foam rolling the iliotibial band.
Figure 2. Differences in PPT for males versus females.
* significant difference between pre- and post-measurements for both genders (p=0.04)
... It may be due to activation of descending antinociceptive systems by stimulating the skin and muscle nociceptors. 33,34 These¯ndings were similar to previous studies which stated that foam rolling was e®ective in improving the plantar°exor and iliotibial band PPTs in healthy individuals. 33,34 In our study, foam rolling technique has also shown to be e®ective in improving ROM and hence displaying an increased WBLT score. ...
... 33,34 These¯ndings were similar to previous studies which stated that foam rolling was e®ective in improving the plantar°exor and iliotibial band PPTs in healthy individuals. 33,34 In our study, foam rolling technique has also shown to be e®ective in improving ROM and hence displaying an increased WBLT score. Possible mechanism for the increase in WBLT score may be change in thixotropic property of the fascia. ...
... These¯ndings were found to be in line with previous studies. 17,34,35 Thus, both techniques were e®ective individually in decreasing pain and increasing the ROM. However, when we compared the e®ectiveness of both techniques, there was no statistically signi¯cant di®erence in improving any of the outcome measures except the PPTs for gastrocnemius and soleus, which showed statistically signi¯cant di®erences. ...
Article
Background:Stretching has been proven to be effective on pain and range of motion (ROM) in patients with plantar fasciitis. Despite recent gain in popularity and the proposed theories of effectiveness of foam roller, there is a lack of literature on the effect of foam rolling on plantar fasciitis. Objective:The objective of this study was to compare the effects of foam rolling and stretching on pain and ankle ROM in patients with plantar fasciitis. Methods:A total of 50 participants were included and randomly allocated to the stretching and foam roller groups. Visual analog scale (VAS), pressure pain thresholds (PPTs) for gastrocnemius, soleus and plantar fascia and weight-bearing lunge test (WBLT) measurements were recorded at baseline and immediately after treatment. Results:Within-group analysis has shown there is a statistically significant difference ([Formula: see text]) in all the outcome measures in both foam roller and self-stretching groups. The between-groups analysis showed no statistical significance difference in VAS, plantar fascia PPT and WBLT parameters (with [Formula: see text]-values of 0.171, 0.372 and 0.861, respectively); however, significant differences were found in gastrocnemius PPT ([Formula: see text]) and soleus PPT ([Formula: see text]). Conclusion: It was seen that both stretching and foam rolling techniques helped in reducing pain and increasing the ROM. However, the effectiveness of foam roller was superior to stretching in terms of increase in PPTs at gastrocnemius and soleus. Clinical Trial Registration No: CTRI/2018/01/011398. Name of registry: The Clinical Trials Registry — India (CTRI); https://ctri.nic.in .
... FR has been advocated to increase performance (Healey et al., 2014;MacDonald et al., 2013;Peacock et al., 2015), improve recovery (Kalen et al., 2017;Rey et al., 2017;Pearcey et al., 2015), increase flexibility (Boguszewski et al., 2017;Griefahn et al., 2017;Mohr et al., 2014), reduce delayed onset of muscle soreness (DOMS) and pain (Romero-Moraleda et al. 2017Vaughan et al., 2014), affect arterial function (Murray et al., 2016), and modulate the autonomic nervous system (Kim et al., 2014). With that said, a review by Freiwald et al. (2016) suggested that FR should be used cautiously based on the available scientific evidence to enhance athletic performance and underlying mechanical and physiological mechanisms. ...
... Foam Rolling has become one of the most popular SMR tools available, and is said to mimic the effects of MR (Curran et al., 2008;Peacock et al., 2014;Vaughan et al., 2014). It has rapidly gained popularity amongst elite and recreational athletes (Bushell et al., 2015), despite the FR research being in its infancy. ...
... However, more research is needed on this topic. It is believed that FR may act by reducing neural inhibition, as seen by the increase in vertical jump scores (MacDonald et al., 2014) and the increase in PPT (Vaughan et al., 2014). This may be an example of the mechanical effect. ...
Article
Background: Foam Rolling (FR) is currently used by athletes at all levels. It is not known whether FR is more effective being used as a warm up to aid performance or more effectively used as a cool-down for recovery. Therefore, the purpose of this systematic review was to determine the effects of FR on performance and recovery. Methods: A customized search strategy was conducted to search seven electronic databases: Google Scholar; Science Direct; Pubmed Central; Pubmed; ISI Web of Science; Medline and Scopus. The database search was limited to journals published in English between January 2006 and June 2019. Any study design, for example, cross-over, repeated measures, randomized-control trials, was considered, as long as one of the interventions was using a FR. Studies that tested FR combined with other techniques were also considered, as long as one of the conditions was FR only. Results: A total of 49 articles met the inclusion criteria. Conclusion: FR may reduce muscle stiffness and increase ROM and should be used in combination with dynamic stretching and active warm-up before a training session. Furthermore, the optimum dosage to achieve these flexibility benefits seems to be a total 90s-120s of FR. FR reduced DOMS and increased PPT, and therefore may optimize recovery from training. Future studies on the effects of FR should include true controls or sham groups, and consider the FR experience of the athlete. Systematic review registration: PROSPERO - CRD42017064976.
... Rolling is often referred to as a self-myofascial release technique (Barnes, 1997;Beardsley and Skarabot, 2015;Cheatham et al., 2015;Grieve et al., 2015;Healey et al., 2014;MacDonald et al., 2013;Okamoto et al., 2014;Peacock et al., 2014;Skarabot et al., 2015;Vaughan, 2014); however, it is unlikely that the predominant mechanism for rolling-induced increases in ROM is a modification of the myofascia. According to Schleip (Schleip, 2003a;2003b), supra-physiological forces are needed to alter the mechanical properties of the fascia. ...
... Previous studies measuring pain tolerance following RM have shown significant increases in PPT (Aboodarda et al., 2015;Casanova et al., 2017;Jay et al., 2014;Vaughan, 2014). However, none of these studies targeted the quadriceps muscle. ...
Article
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Roller massage (RM) can be painful and induce muscle activity during application. Acute increases in pain pressure threshold (PPT) and range of motion (ROM) have been previously reported following RM. It is unclear whether the RM-induced increases in PPT and ROM can be attributed to changes in neural or muscle responses. To help determine if neural pain pathways are affected by roller massage, transcutaneous electrical nerve stimulation (TENS) was utilized as a form of electroanalgesia during RM with PPT and ROM tested on the affected and contralateral quadriceps. The purpose of this study was to evaluate in both quadriceps, the effect of brief intense TENS on PPT and ROM following unilateral RM of the quadriceps. A randomized within subjects' design was used to examine local and non-local effects of TENS and roller massage versus a control condition (rolling without TENS application). Four 30s bouts of roller massage of the dominant quadriceps were implemented with 30s of rest. The researcher applied the RM using a constant pressure device with approximately 70% of the maximum tolerable load. Perceived pain was monitored using a visual analog scale (VAS) during RM. Ipsilateral and contralateral quadriceps ROM and PPT were measured immediately following RM. Significant main effects for time showed increased PPT and ROM in both the treated and contralateral quadriceps, with no significant main effects for intervention or interactions for intervention and time. Moderate to large effect sizes and minimal clinically important differences (MCID) were detected when comparing baseline to pre- and post-tests respectively. VAS scores were significantly (main effect for intervention) and near significantly (interactions) reduced with MCID when TENS was applied during rolling. The addition of TENS to rolling did not increase PPT or ROM in the affected or contralateral quadriceps, likely due to a repeated testing effect.
... In the case of our study, the SFR not only increases the ROM and improves CMJ height, but also reduced the pain significantly at 24 hrs. Previous results suggests there is an acute increase on the PPTs post-foam roller 27 It is important to highlight that, corroborating previous studies where the use of SRF was not associated with a decrease in strength and performance after its immediate application 28 , the use of DN seems to follow the same behavior after treatment on the variables studied in the present investigation. It seems, therefore, that, despite the tissue damage generated by DN, both techniques can be used to increase ankle dorsiflexion mobility and performance without an increase in magnitude and duration of acute post-treatment pain. ...
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Objectives: myofascial pain syndrome (MPS) is associated with reductions in range of movement (ROM), decrease in physical function and performance and increase in pain in different populations. Elucidating the best prevention and treatment strategies for MPS has been one of the main goals in the last decade. The objective of the present study was to compare the acute effects of self-myofascial foam rolling (SFR) and dry-needling (DN) techniques on ankle dorsiflexion ROM, soreness post-needling and performance through countermovement jump (CMJ) height. Methods: a prospective crossover design composed by 12 active adults, aged 23.41 ± 1.68 years (weight: 78.33 ± 9.02 Kg; height: 1.79 ± 0.088 m) with active ankle dorsiflexion restriction was performed. Participants were randomized into the SFR and DN techniques to analyze its effects on ankle dorsiflexion ROM, muscle soreness and jump height at pre, post and 24 h post-intervention. Results: significant improvements were found by DN on ankle dorsiflexion at 24 hours post intervention and muscle soreness by SFR at the same time point. No significant differences were found between conditions. Conclusions: Both SFR and DN are effective in improving ankle dorsiflexion and performance in young adults without producing an acute effect in muscle soreness.
... The pain relieving effects of manual therapies using pressure to affect the musculature as in myofascial release techniques (Bialosky et al., 2010) are considered to be responsible for the increased stretch tolerance (Beardsley and Skarabot, 2015). Both, Vaughan et al. (2014) and Cheatham et al. (2017) reported a short-term increase in pressure pain threshold following a FR intervention. Interestingly, following a roller massage application of the contralateral side, an increase in pressure pain threshold in myofascial tender spots (Aboodarda et al., 2015) and a diminished evoked pain (Cavanaugh et al., 2017) was demonstrated. ...
Article
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Self myofascial therapy via foam roller is a common technique used by many athletes and patients to aid recovery, improve range of motion (ROM) and prevent injury. Further, it is suggested that foam rolling improves core stability. However, research about the training effects of foam rolling on measures of core "strength en-durance", muscle performance, balance and flexibility is limited. Forty recreationally active females and males (age: 18-48 yrs) were randomly assigned to a foam roll (FOAM, n = 14), a core stabilization (CORE; n = 12) and a control group (CG, n = 12). FOAM massaged their lower leg muscles (5 exercises) with the foam roll 2 times per week for 8 weeks while CORE was assigned to core stability training including 5 exercises. CG underwent no intervention. Applied tests for outcome measurements were the Bourban trunk muscle strength test (TMS), standing long jump (SLJ), single leg triple hop for distance (SLTH) test, Y-Balance test and stand and reach test. There was an interaction effect (time x treatment) for the dorsal TMS (p = 0.043), demonstrating greater improvements in CORE compared with FOAM and CG with no difference between FOAM and CG. For the stand and reach test a main effect for time (p < 0.001) and time x treatment interaction (p = 0.005) were found, indicating an increase in ROM in FOAM compared with CORE and CG with no difference between the latter. No significant effects were found for balance and muscle performance. An 8-week training with the foam roll is effective in increasing ROM in the stand and reach test without con-comitant decreases in core "strength endurance", muscle performance and balance parameters. The core stabilization training was sufficient to improve performance in dorsal TMS test.
... The pain relieving effects of manual therapies using pressure to affect the musculature as in myofascial release techniques (Bialosky et al., 2010) are considered to be responsible for the increased stretch tolerance (Beardsley and Skarabot, 2015). Both, Vaughan et al. (2014) and Cheatham et al. (2017) reported a short-term increase in pressure pain threshold following a FR intervention. Interestingly, following a roller massage application of the contralateral side, an increase in pressure pain threshold in myofascial tender spots (Aboodarda et al., 2015) and a diminished evoked pain (Cavanaugh et al., 2017) was demonstrated. ...
... For example, warming up using dynamic strategies has been shown to positively affect performance (2,3) while static stretching in isolation has been shown to cause performance impairments (3)(4)(5). Foam rollers or roller massagers are also commonly utilized as part of a warm-up or as a cool down tool, and have been shown to help reduce feelings of fatigue and anxiety in athletes who become extremely tense prior to competition (6,7). Roller massagers and foam rollers have been shown to increase range of motion (8)(9)(10) with subsequent performance increases in in vertical jump, kicking speed, sprint speed, and agility tests (1,6,11,12). ...
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The purpose of the present study was to examine the effects of foam rolling on maximum sprint performance and range of motion (ROM) in recreational athletes. Eleven men (mean ± SD age = 22.16 ± 3.2 years, body mass = 81.6 ± 7.97 kg, height = 175.2 ± 5.4 cm) and eleven women (21.7 ± 1.8 years, 64.5 ± 8.8 kg, 162.8 ± 4.4 cm) volunteered for this study. Participants visited the laboratory and outdoor field on three occasions. The first visit was an orientation and familiarization session, the second and third days involved measuring the participant’s baseline range of motion during dorsiflexion, hip flexion, and knee flexion, in addition to baseline 20-m sprints with 2 minutes of rest in between. On the second and third visits, they took part in either a foam rolling intervention or a control condition. Then, the participant’s range of motion and sprint times were measured again. Range of motion improved significantly for both men and women after the foam rolling intervention (p ≤ 0.05). No significant changes were seen in range of motion for the control condition (p > 0.05). Sprint times did not significantly change from the control or foam rolling interventions for men or women (p > 0.05). While no significant decreases in sprint times were found with the implementation of foam rolling, it may be advantageous to implement foam rolling in individuals who need acute improvements in range of motion but wish to avoid decreases in performance occurring from other methods used to increase flexibility.
... The pressure applied to the skin stimulates lowthreshold mechanoreceptors, which can temporarily reduce pain sensation (Habig et al., 2017). For example, pain pressure threshold, measured with a pressure algometer, increased (decrease in pain sensation) after a 3-min bout of foam rolling over the iliotibial band in asymptomatic individuals (Vaughan & McLaughlin, 2014). This effect was also observed in symptomatic individuals. ...
Article
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We examined the influence of stretching alone (SS) or combined with self-massage (SM) on maximal ankle dorsiflexion angle, maximal voluntary contraction (MVC) torque and calf muscle activity, and subcutaneous tissue thickness in 15 young (25 ± 3 years) and 15 middle-aged (45 ± 5 years) adults. Participants performed two sessions of calf muscle stretches (3x 30-s stretches, 30-s rest): stretch after a 60-s control condition (SS) and stretch after 60 s of self-massage with therapy balls (SM). Evaluations were performed before and 5 min after the intervention. Linear mixed effects model revealed no main effect for age on ROM or MVC and significant main effects for treatment and time. Change in ankle angle was greater after SM: SS = 3.1 ± 2°, SM = 6.2 ± 3.3° (Hedges’ g = 0.98, p < 0.001). Similar results were observed for MVC torque: SS = −4 ± 16%, SM = 12 ± 16% (Hedges’ g = 0.97, p = 0.0001). Changes in MVC torque and absolute EMG amplitude were correlated, but subcutaneous tissue thickness was not altered by treatment. The gains in ROM were more pronounced in less flexible middle-aged adults, underscoring the need to include flexibility exercises in their training.
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Context: Myofascial self-release is performed using a roller to exert pressure on the soft tissues and to promote effects similar to those of traditional massage. However, there is no standardization regarding its application, mainly in relation to time. Objective: To evaluate the effects of myofascial self-release with a rigid roller on range of motion (ROM), pressure pain threshold (PPT), and hamstring strength in asymptomatic individuals following 2 different times of intervention. Design: Randomized, controlled, blind, clinical trial comparing preintervention and immediately postintervention within 2 groups. Setting: Institutional physiotherapy clinic. Participants: A total of 40 university students (18-30 y), who had no symptoms, participated. Intervention: Foam roller for 30 seconds and 2 minutes for group 2. Main outcome measures: Hamstring PPT, knee-extension ROM, and peak knee-flexion torque measured before and immediately after the intervention. Results: Both groups experienced a statistically significant increase in ROM compared with baseline (30 s and 2 min for group 2 P < .024). There were no statistically significant differences comparing peak knee-flexion torque or PPT. Conclusions: Hamstring myofascial self-release using a roller for 30 seconds or 2 minutes produced an increase in ROM in healthy individuals. PPT and peak knee-flexion isometric torque showed no effects.
Article
Background Pilates has growing appeal to pregnant women, as a form of exercise and relaxation. It is purported to benefit lumbo-pelvic stability, as well as motor control, strength and endurance. Some suggest that modified Pilates exercises may assist low risk pregnant women to enjoy a healthier pregnancy and prepare for the physical demands of labour and birth. The feasibility and safety of Pilates during pregnancy is poorly understood. We describe the protocol for a feasibility study designed to compare a midwife-led 6-week community-based Pilates intervention with standard antenatal care. Methods A convenience sample of 30 low-risk pregnant women will be recruited from private obstetric clinics in Melbourne, Australia. Participants shall be randomly allocated to a six-week, one-hour weekly Pilates exercises group session or to usual care. The Pilates exercise class will have a warm-up phase, Pilates exercises, breathing exercises, and a cool down phase. Exercises have been designed to prepare for active birth. The primary outcome will be feasibility of implementation, determined by recruitment, retention, adherence and safety. Secondary outcomes include women’s health (quality of life, pain, mobility for daily activities, lower extremity performance, abdominal separation, continence) and labour and birth outcomes (duration of first stage and second stage labour, analgesia used, mode of birth). Validated questionnaires will include the Quality of life 12-item short form survey; Pregnancy Mobility Index, and International Consultation on Incontinence Questionnaire. Lower extremity performance and abdominal separation will also be measured. Discussion This trial will provide preliminary data regarding the feasibility and safety of Pilates exercise in healthy pregnant women. It will also provide preliminary outcome data used to inform the design of a future large scale, multi-centre RCT. Trial Registration This clinical trial has been registered with the Australian and New Zealand Clinical Trials Registry 2016 (ACTRN12616000809437).
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Background The popularity of running is still growing and, as participation increases, the incidence of running-related injuries will also rise. Iliotibial band syndrome (ITBS) is the most common injury of the lateral side of the knee in runners, with an incidence estimated to be between 5% and 14%. In order to facilitate the evidence-based management of ITBS in runners, more needs to be learned about the aetiology, diagnosis and treatment of this injury. Objective This article provides a systematic review of the literature on the aetiology, diagnosis and treatment of ITBS in runners. Search strategy The Cochrane Library, MEDLINE, EMBASE, CINAHL, Web of Science, and reference lists were searched for relevant articles. Selection criteria Systematic reviews, clinical trials or observational studies involving adult runners (>18 years) that focused on the aetiology, diagnosis and/or treatment of ITBS were included and articles not written in English, French, German or Dutch were excluded. Data collection and analysis Two reviewers independently screened search results, assessed methodological quality and extracted data. The sum of all positive ratings divided by the maximum score was the percentage quality score (QS). Only studies with a QS higher than 60% were included in the analysis. The following data were extracted: study design; number and characteristics of participants; diagnostic criteria for ITBS; exposure/treatment characteristics; analyses/outcome variables of the study; and setting and theoretical perspective on ITBS. Main results The studies of the aetiology of ITBS in runners provide limited or conflicting evidence and it is not clear whether hip abductor weakness has a major role in ITBS. The kinetics and kinematics of the hip, knee and/or ankle/foot appear to be considerably different in runners with ITBS to those without. The biomechanical studies involved small samples, and data seem to have been influenced by sex, height and weight of participants. Although most studies monitored the management of ITBS using clinical tests, these tests have not been validated for this patient group. While the articles were inconsistent regarding the treatment of ITBS, hip/knee coordination and running style appear to be key factors in the treatment of ITBS. Runners might also benefit from mobilization, exercises to strengthen the hip, and advice about running shoes and running surface. Conclusion The methodological quality of research into the management of ITBS in runners is poor and the results are highly conflicting. Therefore, the study designs should be improved to prevent selection bias and to increase the generalizability of findings.
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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.
Article
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Foam rollers are used to mimic myofascial release techniques and have been used by therapists, athletes, and the general public alike to increase range of motion (ROM) and alleviate pressure points. The roller-massager was designed to serve a similar purpose but is a more portable device that uses the upper body rather than body mass to provide the rolling force. OBJECTIVES/PURPOSE: A roller massager was used in this study to examine the acute effects on lower extremity ROM and subsequent muscle length performance. Seven male and ten female volunteers took part in 4 trials of hamstrings roller-massager rolling (1 set - 5 seconds, 1 set - 10 seconds, 2 sets - 5 seconds, and 2 sets - 10 seconds) at a constant pressure (13 kgs) and a constant rate (120 bpm). A group of 9 participants (three male, six female) also performed a control testing session with no rolling intervention. A sit and reach test for ROM, along with a maximal voluntary contraction (MVC) force and muscle activation of the hamstrings were measured before and after each session of rolling. A main effect for testing time (p<0.0001) illustrated that the use of the roller-massager resulted in a 4.3% increase in ROM. There was a trend (p=0.069) for 10s of rolling duration to increase ROM more than 5s rolling duration. There were no significant changes in MVC force or MVC EMG activity after the rolling intervention. The use of the roller-massager had no significant effect on muscle strength, and can provide statistically significant increases in ROM, particularly when used for a longer duration.
Article
Background and Purpose. Algometers have been used to measure muscle and other soft tissue tenderness. The purpose of this study was to investigate (1) “normal” pressure-pain threshold (PPT) in the biceps brachii muscle, (2) the reliability of repeated measurements of PPT in subjects without pain over 3 consecutive days, (3) the reliability of measurements of PPT between examiners, and (4) the number of measurements required to obtain a best estimate of PPT. Subjects. Thirty-five subjects participated in the study. Methods. Pain-pressure threshold of the biceps brachii muscle was measured using a Fischer algometer. Three test trials were done on each subject on each of 3 days by each of two examiners. Intraclass correlation coefficients (ICCs) and graphical methods were used to analyze the results. Results. The ICCs revealed almost perfect reliability for measurements of PPT within and across 3 days and substantial reliability between examiners. The best estimate of PPT was obtained using the mean of the second and third trials each day. Graphical methods demonstrated that agreement between examiners was greatest at low mean pain thresholds. There was no effect for order of examiner. Conclusion and Discussion. The PPT is a reliable measure, and repeated algometry does not change pain threshold in healthy muscle over 3 consecutive days. The PPT can be used to evaluate the development and decline of experimentally induced muscle tenderness. Reliability is enhanced when all measurements are taken by one examiner.
Article
Myofascial release is a manual therapy that addresses musculoskeletal concerns. Often successful where other therapies fail, it is easily adapted to the field or athletic training room. In the next issue, we will look at how to perform general myofascial techniques.
Article
This project sought to determine measurement effects, topographic variability, and reliability of pressure pain thresholds (PPT) as an index of normal tenderness in the masseter and temporalis muscles of non-patient subjects.PPTs were measured using the ascending method of limits in 10 subjects. The PPT over 5 trials at each of 5 temporalis sites and 10 masseter sites was measured in 1 experiment. Interpretation of the data with repeated measures analysis of variance indicated that the PPT was significantly higher in the temporalis than in the masseter; additionally, the PPT at a tendon area was significantly higher than at the belly area. These differences should be considered in reducing unwanted variability in PPT measures, receptor distribution, and in inference based on patient examination. There were no differences in the PPT over 5 trials and, thus, no measurement effects. The mean of the first 2 trials at each site appeared to give a better estimate of the PPT than the data from either the first trial or second trial alone from that site. In a second experiment, the PPT was measured in 2 trials at each of 4 sites over 5 sessions. The between-session PPT across multiple sessions was reliable and without differences.
Article
OBJECTIVE: Recent claims suggest foam rollers are useful in self-myofascial release and are a stretching technique used by health care professionals to treat patients with a variety of soft tissue conditions including muscle tightness. The purpose of this study was to determine if foam rollers are beneficial in gaining range of motion (ROM) in the hamstring muscle group. DESIGN AND SETTING: All subjects' ROM was tested prior to the beginning of the stretching protocol. All stretching routines were performed three times a week in the Mitchell Hall athletic training room. Treatment consisted of three-one minute stretching bouts with a one minute rest between each stretch. The control group was instructed to continue with normal activity, but to perform no additional stretching. SUBJECTS: Twenty-three male and female college students (ages 18-32) from the University of Wisconsin- La Crosse participated in this study. All subjects were healthy with no history of recent injury. The criterion for subject inclusion was tight hamstrings as defined by a knee extension range of motion less than 80˚. MEASUREMENTS: Active knee extension measurements were determined using an inclinometer and a Flexometer® before the start of the stretching program, at four weeks and at the conclusion of eight weeks. RESULTS: A doubly multivariate repeated measures analysis was used to interpret the data. The statistical significance was set at p
Article
In myofascial manipulation an immediate tissue release is often felt under the working hand. This amazing feature has traditionally been attributed to mechanical properties of the connective tissue. Yet studies have shown that either much stronger forces or longer durations would be required for a permanent viscoelastic deformation of fascia. Fascia nevertheless is densely innervated by mechanoreceptors which are responsive to manual pressure. Stimulation of these sensory receptors has been shown to lead to a lowering of sympathetic tonus as well as a change in local tissue viscosity. Additionally smooth muscle cells have been discovered in fascia, which seem to be involved in active fascial contractility. Fascia and the autonomic nervous system appear to be intimately connected. A change in attitude in myofascial practitioners from a mechanical perspective toward an inclusion of the self-regulatory dynamics of the nervous system is suggested.
Article
Background To determine if electronic pressure algometry is a statistically stable measure of spinal pressure pain threshold (PPT) in asymptomatic individuals, in particular, to determine if repeated measurements at the same site changes the PPT, and to determine if repeatability differs in each of the spinal regions tested. Design Repeated measures design. Setting University teaching clinic. Participants Thirty-three asymptomatic participants. Interventions The PPT of three spinal segments (C6, T6 and L4) was measured three times in consecutive measures (10 s apart), then repeated one day and two days post-initial measurement. Measurements were taken using an electronic pressure algometer. Main outcome measures PPT, intra-class correlation coefficient and test of significant equality. Results Results demonstrated that the PPT measurement is statistically stable both between days (p < 0.001) and within day (p < 0.001). The intra-class correlation coefficient (ICC) values between the mean scores of daily trials demonstrated excellent concordance for each spinal segment (ICC = 0.860–0.953), with the exception of the correlation between day 1 and day 3 at T6, demonstrating good concordance (ICC = 0.676). All trial-to-trial correlations demonstrated excellent concordance both within trials of the same day (ICC = 0.833–0.988) and subsequent days (ICC = 0.823–0.940). Conclusion Electronic pressure algometry is a repeatable and statistically stable measure of the spinal PPT, both between days and within-day. The results provide evidence that the use of this device may be of value as an outcome measure for primary spinal complaints such as low back or thoracic spine pain.