Foam-rolling in sport and therapy – Potential benefits and risks

Abstract

The effects of Foam-rolling exercises in therapy and sport are less investigated. There is no scientific evidence that Foam-rolling exercises can enhance warming-up procedures, blood flow, athletic performance, sensomotoric function, and coordination or reduce muscle and fascial connective tissue tone and stress-relaxation. In contrast, Foam-rolling exercises can improve flexibility (ROM) and delayed onset of muscular soreness (DOMS). However, more research to compare Foam-rolling exercises with traditional stretching and recovery treatments is required. During Foam-rolling exercises, a high mechanical load is inducted to the entire underlying tissue (e.g., fascia, muscular, nerve, vessel, and bone tissue). That external loads are 10-fold higher than the highest medical compression category 4 and exceed twice the pressure loads that are used in occlusion studies. To date, in regards to Foam-rolling exercises, there are no established and proven training methods overall. Future investigations to define fields of applications concerning Foam-rolling exercises in therapy, medicine, and sport are required. Therefore, in- and exclusion criteria as well as implementation of individualized Foam-rolling exercises are needed. In a further step, training principles and methods of Foam-rolling exercise including the use of different types of Foam-rollers according to different sports should be investigated and defined. Importantly, more research to investigate the underlying mechanical and physiological mechanisms of Foam-rolling exercises is strongly warranted. Overall, in regards to the observed minor scientific evidence with respect to athletic performance and underlying mechanical and physiological mechanism as well as the negligence of potential harmful effects in the scientific literature, Foam-rolling exercises should be used cautiously at this time.

Full text

REVIEW / SPECIAL ISSUE
Foam-Rolling in sport and
therapy – Potential benefits and
risks
Part 1 – Definitions, anatomy, physiology, and biomechanics
Ju¨rgen Freiwald, Christian Baumgart, Matthias Ku¨hnemann, Matthias W. Hoppe
Department of Movement and Training Science, University of Wuppertal,
Germany
Eingegangen/submitted: 13.06.2016; u¨berarbeitet/revised: 04.07.2016; akzeptiert/accepted: 05.07.2016
Online verfu¨gbar seit/Available online: 29.07.2016
Introduction
In recent years, fascial connective
tissue has shifted into the focus of
science in medicine and sport and
Foam-rolling exercises are fre-
quently used as a fascial targeting
treatment [30,39,44,49,60,63].
Although there is contradictory evi-
dence concerning the anatomy,
function, and adaptability of fascial
connective tissue, Foam-rolling
exercises have been used with
different objectives in therapy
and sport [19,59,64].Overall,the
methods are referred as ‘‘Myofascial
release’’, aiming to reduce thicken-
ing, adhesion, and tension of fascia
tissue and muscle as well as to
enhance sportive performance
[4,9,39].
Fascial connective tissue –
nomenclature and definitions
The nomenclatures and definitions
of fascial connective tissue are
widespread [61]. Based on different
anatomical, morphological, histo-
logical, and biomechanical findings,
Kumka and Bonar [34] classified
fascial connective tissue into four
functional categories (Tables 1
and 2).
Langevin and Huijing [35] specified
different terms of fascial connective
tissue, showing that the nomencla-
tures are both not entirely clear and
accepted (Table 3).
Overall, the provided different
nomenclatures and definitions
of the fascial connective tissue
show that there is no widely
accepted consents, potentially
providing difficulties for therapy
and training.
Fascial connective tissue –
anatomy and physiology
Muscles, organs, glands, neural
pathways, and vessels are all
encased by fascial connective tissue
that crosses the entire body. Fascial
connective tissue does not only
have mechanical properties, but is
also involved in the local and global
metabolism (e.g., healing of
wounds, immune functions) and
can serve as a storage for fat, water,
and other substances [10,38,55,
68,70,71].
Summary
This review aimed to provide an over-
view concerning Foam-rolling exercises
in medicine and sport. In the first part
of the review, nomenclatures and defi-
nitions as well as anatomical and bio-
mechanical aspects of fascial
connective tissue are discussed.
Regarding the nomenclatures and
effects of Foam-rolling exercises on
fascia connective tissue, conflicting
findings are evident. Additionally, there
is only poor evidence in terms of the
assumed six myofascial lines that pro-
vide a framework for treatments in
medicine and sport. Fascial connective
tissue links muscles with the surround-
ing tissues, transmits forces, and serves
compressions. From a biomechanical
point of view, fascial connective tissue
possess contractile abilities; however,
the generated contraction forces are
small. During Foam-rolling exercises,
all the underlying tissue is mechanically
stressed, potentially leading to dam-
age, for example, in neuronal tissues,
receptors, vessels, or bones. This con-
cern especially rises in users with dis-
eases, for example, diabetes, varices,
or osteoporosis.
Keywords
Biomechanics– myofascial release– training–
fascia– physiotherapy
J. Freiwald et al.
Foam-Rolling in Sport und
Therapie – Potentieller
Nutzen und Risiken.
Teil 1 – Definitionen,
anatomische, physiologische
und biomechanische
Aspekte
Zusammenfassung
Im Zentrum des Beitrages steht das
Foam-Rolling in den Anwendungsfel-
dern des Sports und der Therapie. Im
ersten Teil werden die Definitionen und
Klassifikationen, die Anatomie und
Physiologie sowie biomechanische As-
pekte des Fasziengewebes besprochen.
Deutlich wird die Uneinheitlichkeit der
Sports Orthop. Traumatol. 32, 258–266 (2016)
ßElsevier GmbH
www.SOTjournal.com
http://dx.doi.org/10.1016/j.orthtr.2016.07.001
Orthopaedics
and
Traumatology
258 J. Freiwald et al. Foam-rolling in sport and therapy
REVIEW / SPECIAL ISSUE

According to the function, fascial
connective tissue is present in
different forms with respect to the
density and alignment within fibers
[11,60,61,63].
Lymph, nerves, interoception,
and blood vessels
Lymph, nerves, and blood vessels
passing through the fascial connec-
tive tissue are mostly found
combined in orthogonal direction
(Fig. 1).
Fascial connective tissue also has an
extensive innervation and is supplied
by different mechano- and chemo-
receptors [20,31,38].Importantly,
the number of receptors is up to
ten-fold higher in fascial connective
tissue than in muscle [72]. Further,
the periosteum is considered as fas-
cial connective tissue and is densely
supplied by receptors [40].
By interoceptive, proprioceptive,
and nociceptive capabilities, mech-
anical and chemical information are
collected and transmitted to the
CNS. Through changes in afferents,
the perception of the own body
image is affected and the
sensomotoric system adapts to
these altered information [15,17,
23,41–43,51,57,58].
In consideration of the lower leg,
Staubesand and Li [67] showed that
the lamina superficialis of fascia cru-
ris possesses slotted to funnel-
shaped passage openings for the
Vv. perforantes, connecting the
superficial and deep venous system.
Usually, such points of passages are
accompanied by a respective small
artery and/or vein, mostly vegeta-
tive nerve, and thin-walled lym-
phatic vessel. Further, openings
for larger skin nerves and vessels
can be found [67].
The local myelinated axons con-
duct afferents from the skin for
touch and pressure (Ab-fibersof
an average diameter of 8 mm) as
well as temperature and surface
pain (Ad- fibers of an average
diameter of <3mm). Also, there
are many unmyelinated fibers con-
ducting afferents from the skin and
proceed deep pain through C-fibers
[20,67].
In conclusion, this particular
anatomy of fascia connective tissue
is potentially not suited for high
mechanical compression forces
induced by Foam-rolling exercises.
Superficial, deep, and visceral
layers
The superficial layer of fascial con-
nective tissue consists of loose con-
nective and fat tissue and is
subcutaneously located. Mostly, it
is connected to the reticular layer
of the dermis and is multiply
attached to tendons and bones. In
comparison to the deeper layer,
superficial fascial connective tissue
tolerates higher stretching tensions
[24–29,32,73].
The deeper layer of fascial connec-
tive tissue is organized as apo-
neuroses or fascia latae, plantar
fascia, ligaments, tendons, joint
capsules, and muscle septa. It is
Klassifikationen und Schwierigkeiten,
mittels Foam-Rolling fasziales Bindege-
webe zu beeinflussen. Die in Sport und
Therapie beschriebenen sechs ‘‘Myo-
fascial lines’’ sind nicht evidenzbasiert.
Fasziales Bindegewebe verbindet un-
terschiedliche K€
orperregionen und -ge-
webe und dient der Kraft€
ubertragung
und Kompression. Dar€
uber hinaus
trennt fasziales Bindegewebe verschie-
dene Kompartimente und -gewebe. Aus
biomechanischer Sicht ist fasziales Bin-
degewebe in der Lage zu kontrahieren,
wenn auch nur mit kaum messbarer
Kraftentwicklung. In Sport und Thera-
pie wird durch Foam-Rolling hoher
Druck auf das darunter liegende Ge-
webe ausge€
ubt, was zu Sch€
adigungen
von Nervengewebe, Rezeptoren, Gef€
a-
ßen und Knochen f€
uhren kann – insbe-
sondere bei Vorsch€
adigungen und Er-
krankungen wie Diabetes mellitus,
Krampfadern oder Osteoporose.
Schl€
usselw€
orter
Biomechanik– Myofascial release– Training –
Faszien– Physiotherapie
Figure 1
Passage of a triad through superficial
fascial connective tissue. Left – nerve,
middle – vein; right – artery. Most of
these perforation points are topographi-
cally identical with traditional Chinese
acupuncture points. Usually, the perfor-
ating nerves innervate Pacinian and
Meissner corpuscles under the skin
[56,67].
J. Freiwald et al. Foam-rolling in sport and therapy 259
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 258–266 (2016)

fibrous and encloses muscles,
bones, nerves, and blood vessels
as well as has a lower blood flow
than the superficial fascial connec-
tive tissue due to its different func-
tion [36,75].
The visceral layer of fascial connec-
tive tissue consists of a serous
double membrane layer and serves,
among other purposes, as a suspen-
sion and protection for the inner
organs [6,36].
Overall, due to the particular
anatomy, the dissimilar fascial con-
nective tissue layers possess differ-
ent functions.
Evidence of myofascial lines
For many years, therapeutic inter-
ventions have focused on fascial
connective tissue. However, its
anatomy, physiology, and biome-
chanical functions are not suffi-
ciently investigated (among others
[73]). Therefore, the existing con-
cepts for therapy and training should
be critically reviewed [46,52,64].For
example, Wilke, Krause [73] ques-
tioned in their comprehensive review
the presence of assumed myofascial
lines and provided the following
conclusions (Table 4):
Strong evidence was only found
for three of the six assumed myo-
fascial lines, namely, the super-
ficial back, back functional, and
front functional line.
Moderate to strong evidence was
found forthe spiral andlateral line.
No evidence was found for the
superficial frontline.
To conclude, and in consideration of
that poor evidence, it is surprisingly
that patients in medicine and sport
are still treaded under the assump-
tion of six myofascial lines [48,
49,73].
Table 1. Fascial categories: functions, terms and histological features – linking (modified after [34]).
Fascial category Function (Example) Terminologia Anatomia Terminologia
Histologica
Histological Feature
Linking Dynamic Role in movement
and stability
Critical to
myofascial force
transmission
Creates significant
pretension in
musculature
Fasciae of muscles (investing layer) &
fasciae of individual muscles:
Pectoral fascia
Supraspinatus fascia
Deltoid fascia
Fasciae of trunk:
Thoracolumbar fascia
Diaphragmatic fascia
Iliopsoas fascia
Fasciae of limbs/membrorum:
Iliotibial tract
Axillary fascia
Dense regular
parallel ordered
unidirectional
connective tissue
proper
Collagen types:
I, XII, XIV
Actin-myosin
filaments
Pacinian corpuscles,
Free nerve endings
Passive Maintains
continuity, passive
force transmission
Proprioceptive
communication
throughout the
body
Fasciae of muscles (muscle sheaths)
Rectus sheath
Head & neck
Cervical fascia
Carotid sheath
Ligamentum nuchea
Ligamentum flavum
Fasciae of limbs/membrorum
Intermuscular septae
Anterior talofibular ligament
Aponeuroses
Erector spinae aponeurosis
Bicipital aponeurosis
Plantar aponeurosis
Tendinous arches
Muscular & vascular spaces/lacunae
Iliopectineal arch
Tendinous arch of soleus
Dense regular
woven connective
tissue
Multidirectional
parallel ordered
connective tissue
Collagen types:
I, III, XII, XIV
Elastin
Golgi tendon organs,
Pacinian & Ruffini
corpuscles
260 J. Freiwald et al. Foam-rolling in sport and therapy
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 258–266 (2016)

Biomechanics of fascial
connective tissue and FOAM-
rolling
Fascial connective tissue links
muscles with the surrounding tissue
and transmits and distributes forces
to muscles, adjacent muscles,
bones, and inner organs [5,25,32,
54,73,74].
Mechanical impact on the
underling tissue
During Foam-rolling exercises, all
the underlying tissue innervated
by mechano- and chemoreceptors
is mechanically stressed (e.g., joint
capsules, tendons, ligaments, nerves,
arteries, arterioles, veins, venules,
capillaries, lymphatics) [13,42,
45,66]. The mechanical effects of
Foam-rolling exercises on these tis-
sues have not been examined yet. For
example, whether and to which
Table 2. Fascial categories: functions, terms, and histological features – fascicular, compression, and separating (modified after [34]).
Fascial category Function (Example)
Terminologia Anatomia
Terminologia
Histologica
Histological feature
Fascicular Provides myofascial force
transmission & proprioceptive
feedback for movement
control
Maintains protection for
nerves and vessels
Allows vascular sheaths to be
in continuity with adventitia
Intramuscular & extramuscular
fasciae. Neuromuscular sheaths
Endomysium
Perimysium
Epimysium
Endotendon
Peritendon
Paratendon
Perichondrium
Endosteum
Periosteum
Endoneurium
Perineurium
Epineurium
Loose connective
tissue
Dense regular
multidirectional
parallel ordered
connective tissue
Dense irregular
connective tissue
Collagen types:
I, III, IV, V, XII, XIV
Golgi tendon organs
Compression Provides stocking,
compression and tension
compartmental effects
Influences venous return
Enhances proprioception,
muscular efficiency and
coordination
Fasciae of limbs/membrorum
Brachial fascia
Antebrachial fascia
Dorsal fascia of hand
Fascia lata
Crural fascia
Dorsal fascia of foot
Dense regular woven
connective tissue
Multidirectional
parallel ordered
connective tissue
Collagen type:
I
Elastin
Ruffini’s corpuscles
Separating Compartmentalizes organs and
body regions to maintain
structural functions
Promotes sliding and reduces
friction during motion
Responds to stretch and
distension
Provides physical support and
shock absorption
Limits the spread of infection
Parietal Fasciae
Parietal pleura
Fibrous pericardium
Endothoracic fascia
Parietal peritoneum
Endoabdominal fascia
Endopelvic fascia
Visceral fascia
Meninges
Visceral pleura
Serous pericardium
Visceral abdominal fascia
Visceral pelvic fascia
Extraserosal fascia
Sternopericardial ligaments
Bronchopericardial membrane
Pulmonary ligaments
Extraperitoneal fascia
Investing fascia
Subcutaneous tissue of abdomen
Membranous layer of perineum
Loose connective
tissue
Dense irregular
fusocellular
connective tissue
Collagen Types:
III, V, VII
Extracellular matrix:
reticular and elastic
fibers
Reticular fibers
provide a cellular
framework
Elastin
Pacinian and Ruffini’s
corpuscles
J. Freiwald et al. Foam-rolling in sport and therapy 261
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extent nerve tissue is influenced in
its ability to synthesize and express
neurotransmitter is unknown
[20,16,37].
Noteworthy, during Foam-rolling
exercises, the commonly induced
mechanical pressure on the under-
lying tissue is clearly higher than
the upper permissible value of
maximal compression in vein
therapy [3].
Lastly, when performing Foam-roll-
ing exercises in the supine position,
users have reported ‘‘creaky’’ noises
at the vertebral bodies similar to
chiropractic treatments. Given the
fact that the education of chiroprac-
tic take many years, especially due
to the potential risks of the applied
treatments, it is not wise that
uneducated staff offer Foam-rolling
courses in gyms during which high
pressures to the spine and spinous
processes are applied.
To summarize, during Foam-rolling
exercises, a high mechanical load to
the entire underlying tissue is
induced, potentially leading to
harmful effects in connective tis-
sue, nerves, vessels, and bones that
need further research.
Contractile abilities of fascial
connective tissue
The previously prevailing idea that
fascial connective tissue has purely
passive functions needs revision. In
fact, stray smooth muscle cells
(myofibroblasts) were found in the
superficial sheet and deeper layers
of the fascia cruris, which can there-
fore actively contract [67].
Consequently, the stiffness of the
fascial connective tissue is also
affected by the density and acti-
vation potential of myofibroblasts
[69].
One possible function for the con-
tractile abilities of fascial connec-
tive tissue may be to adjust the
preload of the (fascial) collagen
scaffold to the respective resting
and action phases of the corre-
sponding muscle [67]. However,
Staubesand and Li [67] noted that
the discovery of contractile abilities
regarding fascial connective tissue
should not be overestimated,
because they are well known during
wound healing and scar formation
[7,67,69].
Also worth mentioning, the fascial
connective tissue is just mmtomm
thick, and thus, contributes only
minor to the contractile forces,
ranging from few Dyn up to
Table 3. Recommended use of terms regarding fascial structures [35].
Dense connective tissue Connective tissue containing closely packed, irregularly arranged (that is, aligned in many directions)
collagen fibers
Non-dense (areolar)
connective tissue
Connective tissue containing sparse, irregularly arranged collagen fibers
Superficial fascia Enveloping layer directly beneath the skin containing dense and areolar connective tissue and fat
Deep fascia Continuous sheet of mostly dense, irregularly arranged connective tissue that limits the changes in shape
of underlying tissues. Deep fascia may be continuous with epimysium and intermuscular septa and may
also contain layers of areolar connective tissue
Intermuscular septa A thin layer of closely packed bundles of collagen fibers, possibly with several preferential directions
predominating, arranged in various layers. The septa separate different, usually antagonistic, muscle
groups (for example, flexors and extensors), but may not limit force transmission
Interosseal membrane Two bones in a limb segment can be connected by a thin collagen membrane with a structure similar to
the intermuscular septa.
Periost Surrounding each bone and attached to it is a bi-layered collagen membrane similar in structure to the
epimysium
Neurovascular tract The extramuscular collagen fiber reinforcement of blood and lymph vessels and nerves. This complex
structure can be quite stiff. The diameter and, presumably, the stiffness of neurovascular tracts decrease
along limbs from proximal to distal parts. Their stiffness is related to the angle or angles of the joints
that they cross
Epimysium A multi-layered, irregularly arranged collagen fiber sheet that envelopes muscles and that may contain
layers of both dense and areolar connective tissue
Intra- and extramuscular
aponeurosis
A multilayered structure with densely laid down bundles of collagen with major preferential directions.
The epimysium also covers the aponeuroses, but is not attached to them. Muscle fibers are attached to
intramuscular aponeuroses by their myotendinous junctions
Perimysium A dense, multi-layered, irregularly arranged collagen fiber sheet that envelopes muscle fascicles.
Adjacent fascicles share a wall of the tube (like the cells of a honeycomb)
Endomysium Fine network of irregularly arranged collagen fibers that form a tube enveloping and connecting each
muscle fiber. Adjacent muscle fibers share a wall of the tube (like the cells of a honeycomb)
262 J. Freiwald et al. Foam-rolling in sport and therapy
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 258–266 (2016)

4.1 mN/cell [69]. The generated
forces show oscillative character-
istics, lasting from seconds to
minutes. Nevertheless, long-term
fascial connective tissue contrac-
tions are also known that can led
to contractures [62]. Finally, in
vivo, it is difficult to differentiate
between the changes of stiffness in
muscles or/and fascial connective
tissue [43].
The influencing factors of the fascial
contractile abilities include mental
factors, age, trigger points, illness,
and water content [1,8,12,21,
22,33,43,50] as well as impair-
ment-, disease-, and stress-induced
changes in the chemical environ-
ment (e.g., through cytokines, pH)
[53]. Therefore, it is conceivable
that changes in the biomechanical
or chemical environment of the
fascial myofibroblasts could led to
changes in myofascial tissue stiff-
ness (tone) [43]. The term ‘tone’
is defined as a mechanical tension
state, including both the ‘viscoelas-
tic tone’ and ‘contractile activity’
[18,43]. Beside this peripheral fac-
tors, there are also central nervous
and medical induced aspects that
have an impact on the myofascial
tissue stiffness, for instance, drugs
effecting the CNS [47] and infiltra-
tion of C3 transferase and botulinum
toxin, respectively [65]. Moreover,
thixotropic aspects should also be
taken into account [2,14,43].
To summarize, fascial connective
tissue has contractile abilities.
However, both the function and
underlying physiology is not com-
pletely understood. The observed
contraction forces of the fascia con-
nective tissue are small and the
influential factors requires more
research.
Conclusions and future
requirements
To date, Foam-rolling is frequently
applied as a treatment in medicine
and sport. However, the nomencla-
ture, definitions, and anatomy of
fascia connective tissue are not
entirely clear. Furthermore, it is sur-
prisingly that patients in medicine
and sport are treaded under the
assumption of six myofascial lines,
whereas the scientific evidence is
only poor.
For an appropriate application of
Foam-rolling exercises in therapy
and training, universally accepted
nomenclatures and definitions of
fascial connective tissue regarding
its anatomy and physiology are
necessary. In consideration to
potential harmful effects, more evi-
dence based knowledge is strongly
required.
Due to the particular anatomy, the
dissimilar fascia connective tissue
Table 4. Myofascial lines and corresponding soft tissue components (modified after
[73]).
Myofascial Line Soft tissue component
Superficial back line Plantar fascia
Achilles tendon/M. gastrocnemius
Hamstrings (M. biceps femoris, M. semitendinosus,
M. semimembranosus)
Sacrotuberous ligament
Lumbar fascia/erector spinae
Superficial front line Toe extensors, M. tibialis anterior, anterior crural
department
Subpatellar tendon
M. rectus femoris/quadriceps
M. rectus abdominis
M. sternalis/sternochondral fascia
M. sternocleidomastoideus
Back functional line M. vastus lateralis
M. gluteus maximus
Lumbar fascia
M. latissimus dorsi
Front functional line M. adductor longus
M. rectus abdominis
M. pectoralis major
Spiral line Lumbar/erector spinae
Sacrotuberous ligament
M. biceps femoris
M. peroneus longus
M. tibialis anterior
M. tensor fasciae latae, iliotibial tract
M. obliquus abdominis internus
M. obliquus abdominis externus
M. serratus anterior
M. rhomboideus major and minor
M. splenius capitis and cervicis
Lateral line M. peroneus longus and brevis, lateral crural compartment
Iliotibial tract/gluteus medius
M. tensor fasciae latae
M. gluteus maximus
M. obliquus abdominis externus and internus
M. intercostalis externus and internus
M. splenius capitis/M. sternocleidomastoid
J. Freiwald et al. Foam-rolling in sport and therapy 263
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 258–266 (2016)

layers possess different functions.
Fascia connective tissue has contrac-
tile abilities. However, both the
function and underlying physiology
are also not completely understood.
The observed contraction forces of
the fascia connective tissue are small
and the influential factors require
more research.
Potentially, the particular anatomy
of fascia connective tissue is not
suited for high mechanical com-
pression forces induced by Foam-
rolling exercises. During Foam-roll-
ing, high mechanical loads to the
entire underlying tissue are induced,
hypothetically leading to harmful
effects in connective tissue, nerves,
vessels, and bones that also require
further research.
Especially, this question arises in
users with diseases of the metab-
olism and peripheral nerves. Of
particular relevance are the typical
syndromes of hereditary neuropathy
with liability to pressure palsies,
diabetic neuropathy, and peripheral
artery occlusive disease (PAOD),
which occur more frequently in
smokers and conjunction with arte-
riosclerosis. In these diseases, the
affected vessels and nerve tissue
must not be exposed to high pres-
sure loads as they react with sensory
and motor disorders. Furthermore,
Foam-rolling exercises in older or
people with osteoporosis may
induce damage. Generally, an
important question is, whether
Foam-rolling exercises can influence
fascial connective tissue as desired.
Therefore, future studies should
examine in detail, whether Foam-
rolling effects are positive or nega-
tive for both sportive and thera-
peutic purposes.
Conflict of interest
There is no conflict of interest.
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Corresponding author:
Univ. Prof. Dr. Ju¨ rgen Freiwald M.A.,
Department of Movement
and Training Science, University of
Wuppertal, Wuppertal, Germany.
Fax: +49 0202 439 2956.
E-Mail: freiwald@uni-wuppertal.de
Available online at www.sciencedirect.com
ScienceDirect
266 J. Freiwald et al. Foam-rolling in sport and therapy
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 258–266 (2016)

REVIEW / SPECIAL ISSUE
Foam-Rolling in sport and
therapy – Potential benefits and
risks
Part 2 – Positive and adverse effects on athletic performance
Ju¨rgen Freiwald, Christian Baumgart, Matthias Ku¨hnemann, Matthias W. Hoppe
Department of Movement and Training Science, University of Wuppertal, Germany
Eingegangen/submitted: 27.06.2016; u¨ berarbeitet/revised: 08.07.2016; akzeptiert/accepted: 08.07.2016
Online verfu¨ gbar seit/Available online: 26.07.2016
Introduction
Foam-rolling exercises are a popular
treatment with respect to different
purposes in medicine and sport.
Foam-rolling is performed on an
individual basis through various
types of massage roller (Fig. 1)[77].
In MedLine, the keyword ‘‘Foam-roll-
ing’’ reveals 17 publications (01/24/
2016). The first publication is dated
back to 2013, but the existing num-
bers have continuously increased in
the following years. This indicates
both an overall poor scientific evi-
dence and increased interest in
Foam-rolling exercises.
With respect to the lack of scientific
evidence existing in sport and
therapy, Schroeder and Best [77]
showed that the effects of Foam-
rolling exercises as a pre-exercise
or recovery strategy are neither
homogeneous nor evident.
McKenney et al. [54] included in
their systematic review 10 publi-
cations and showed that the qual-
ity of the included studies was
mixed and only few conclusions
could be drawn. Moreover, the
authors pointed out that more
randomized controlled trials are
needed. In a further systematic
review, Beardsley and Skarabot
[10] showed contradictory results
of Foam-rolling exercises on flexi-
bility, force-production, athletic
performance, and delayed onset
of muscle soreness.
Foam-rolling – devices,
exercises, and training
principles
For the self-treatment of fascial con-
nective tissue, different types of
Foam-rollers are used (e.g.,
material, size) (Fig. 1). The Foam-
rollers are intended to achieve a
massage and/or stretch effect on
the underlying tissue, especially
for the fascial connective tissue.
However, from the biomechanical
point of view, it is not possible to
solely influence the fascial connec-
tive tissue by external induced
pressures [8,18,59].
The purposes of Foam-rolling exer-
cises are manifold. Schleip and
Muller [75] mentioned the following
purposes:
improving fascial remodeling;
improving elastic recoil of fascial
tissues;
improving myofascial health;
Summary
The effects of Foam-rolling exercises in
therapy and sport are less investigated.
There is no scientific evidence that Foam-
rolling exercises can enhance warming-up
procedures, blood flow, athletic perform-
ance, sensomotoric function, and coordina-
tion or reduce muscle and fascial
connective tissue tone and stress-relaxa-
tion. In contrast, Foam-rolling exercises
can improve flexibility (ROM) and delayed
onset of muscular soreness (DOMS).
However, more research to compare
Foam-rolling exercises with traditional
stretching and recovery treatments is
required. During Foam-rolling exercises, a
high mechanical load is inducted to the
entire underlying tissue (e.g., fascia, mus-
cular, nerve, vessel, and bone tissue). That
external loads are 10-fold higher than the
highest medical compression category 4
and exceed twice the pressure loads that
are used in occlusion studies. To date, in
regards to Foam-rolling exercises, there are
no established and proven training
methods overall. Future investigations to
define fields of applications concerning
Foam-rolling exercises in therapy, medi-
cine, and sport are required. Therefore,
in- and exclusion criteria as well as imple-
mentation of individualized Foam-rolling
exercises are needed. In a further step,
training principles and methods of Foam-
rolling exercise including the use of differ-
ent types of Foam-rollers according to
different sports should be investigated
and defined. Importantly, more research
to investigate the underlying mechanical
and physiological mechanisms of Foam-
rolling exercises is strongly warranted.
Overall, in regards to the observed minor
scientific evidence with respect to athletic
performance and underlying mechanical
and physiological mechanism as well as
the negligence of potential harmful effects
in the scientific literature, Foam-rolling
exercises should be used cautiously at this
time.
Keywords
Foam-rolling– myofascial release – fascia –
therapy– sport
J. Freiwald et al.
Sports Orthop. Traumatol. 32, 267–275 (2016)
ßElsevier GmbH
www.SOTjournal.com
http://dx.doi.org/10.1016/j.orthtr.2016.07.002
Orthopaedics
and
Traumatology
J. Freiwald et al. Foam-rolling in sport and therapy 267
REVIEW / SPECIAL ISSUE

improving fascial hydration and
renewal;
improving proprioceptive refinement.
Fascial connective tissue –
treatments
For many years, myofascial connec-
tive tissue complaints were treated
by methods like massage, osteop-
athy, and physiotherapy and are
supposed to reduce thickening,
adhesion, and tension of muscle
and fascia tissue [17,54,58].
Furthermore, it is generally recom-
mended to perform special physical
exercises, potentially helping to
maintain fascial connective tissue
‘‘health’’ that are referred as
‘‘Fascial Fitness’’ (Figs. 2 and 3)
[4,10,54,71,75,77,78,81].
Foam-rolling – expected
effects and state of research
Foam-rolling exercises are used for
the treatment of myofascial pain in
both preventive and rehabilitative
Foam-Rolling in Sport und
Therapie – Potentieller
Nutzen und Risiken
Teil 2 – Positive und
negative Effekte auf die
athletische
Leistungsf€
ahigkeit
Zusammenfassung
Die Wirkungen des Foam-Rolling sind so-
wohl im therapeutischen als auch im sport-
lichen Anwendungsfeld wenig untersucht.
FOAM-Rolling zeigt keinen Einfluss auf das
Aufw€
armen, den Blutfluss, die Kraft-
f€
ahigkeiten, die Sprungleistungen, die an-
aerobe Leistungsf€
ahigkeit sowie die Sen-
somotorik (Koordination). Nach dem bis-
herigen Kenntnisstand k€
onnen durch
Foam-Rolling weder der Muskeltonus noch
Stressfaktoren reduziert werden. Hinweise
zur Wirksamkeit des Foam-Rolling gibt es
im Bereich der Beweglichkeit, wobei die
Effekte des Foam-Rolling nicht an die Wir-
kungen traditioneller Dehnmethoden her-
anreichen. F€
ur die Bereiche der Regene-
ration nach sportlichen Belastungen sowie
zur Schmerzreduktion bei Muskelkater gibt
es erste Wirksamkeitsnachweise; verglei-
chende Studien mit tradierten Methoden
zur Regeneration fehlen jedoch. Foam-Rol-
ling €
ubt auf das darunter liegende Gewebe
(Faszien, Muskulatur, Nerven, Gef€
aße,
Knochen) hohen Druck aus, der bis zum
Zehnfachen der h€
ochsten Kompressions-
klasse 4 reicht und doppelt so hoch ist
wie bei Studien mit kompletter Okklusion.
Gegenw€
artig existiert f€
ur das Foam-Rolling
keine trainingswissenschaftlich und evi-
denzbasierte Trainingsmethodik. Zuk€
unfti-
ge Untersuchungen m€
ussen konkrete Ziel-
setzungen, Ein- und Ausschlusskriterien
sowie die physiologischen Grundlagen des
Foam-Rolling kl€
aren und festlegen. Ferner
m€
ussen Foam-Roller bez€
uglich ihrer Kon-
struktion an die individuellen Bed€
urfnisse
in Sport und Therapie angepasst werden
(z.B. Material, Durchmesser). Bevor diese
Arbeiten nicht geleistet und die offenen
Fragen nicht beantwortet sind, ist Foam-
Rolling nur mit Vorsicht und unter Be-
r€
ucksichtigung potentieller Risiken anzu-
wenden, auf die in beiden Teilen des
Reviews hingewiesen wird.
Schl€
usselw€
orter
Foam-Rolling– Training– Faszien– Therapie –
Physiotherapie
Figure 1
Different types of foam-rollers (left – www.blackroll.de; center top – www.
sport-thieme.de; center bottom – www.suprfit.de; right – www.togu.de).
Figure 2
Foam-rolling exercise on the anterior tight.
268 J. Freiwald et al. Foam-Rolling in sport and therapy – Potential benefits and risks
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 267–275 (2016)

settings [13,41,63,76] as well as an
isolated or additive warming-up pro-
cedure in competitive sports [64,65].
In the latter context, Foam-rolling
exercises are also intended to
enhance recovery after endurance
and strength efforts [57].
Due to the different types of applied
interventions and FOAM-rollers, the
results of the few existing studies are
not comparable [18,21,38,64,65].
Therefore, the resulting recommen-
dations to use Foam-rolling exercises
are ambiguous. While subjective
criteria like pain are mostly used
to evaluate therapy and training
treatments, less objective criteria
such as a controlled application
speed, pressure, or targeted region
have been applied.
Although current research for Foam-
rolling is deficient and contradic-
tory, many assumptions about its
effectiveness are postulated. In
sport, the following expectations
are suggested:
improving warming-up and blood
flow;
improving strength and jump
performance;
improving anaerobic capacity;
improving flexibility in terms of
range of motion (ROM);
improving sensomotoric function
and coordination;
improving stress-relaxation;
reduction delayed onset of muscle
soreness (DOMS) and pain;
reduction muscle and connective
tissue tone.
Improving warming up, blood
flow, and athletic performance
Using Foam-rolling exercises for
warming-up procedures are fre-
quently recommended. When Foam-
rolling exercises as warming up pro-
cedures are performed, the blood
flow in the treated area can increases
due to various causes. In addition to
fluid shifts, hormonal and/or inflam-
matory effects can be discussed, but
also a potential neuromuscular acti-
vation of the treated muscles, which
has not been studied yet [7,14].
Additionally, temperature shifts
can lead to changes in biomechan-
ical contraction and relaxation
parameters as well as stretch
responses of skeletal muscles and
fascial connective tissue [6,19,
37,40,49,58,74].Furthermore,after
warming-up, a more accurate joint
position perception at the knee joint
has been reported [5].
In one investigations of our labora-
tory, after four and eight hours
of heating with a heat wrap
(ThermaCare
®
), we have found differ-
ences in resting tone parameters
(i.e., passive mechanical muscle
tone, stiffness, elasticity, relaxation
time) at the paravertebral L3-L4 level
of the erector spinae muscle [47].The
biomechanical parameters of muscle
tone, stiffness, and elasticity were
lower after the heat application,
but the relaxation time and creeping
have increased. Interestingly, after
the heat treatment, most subjects
reported an increased subjective feel-
ing in relaxation [47], but it is ques-
tionable, whether these results allow
atransfertoactivewarming-uppro-
cedures in sport.
One explanation for the mismatch
between objective and subjective
tension parameters may be that
active and passive warming-up pro-
cedures have increased the tempera-
ture of muscle and fascial connective
tissue, and thereby, influenced the
thresholds of chemo- and mechanor-
eceptors [12,33,34].
In regards to athletic performance,
the results of the existing studies
are also rare and contradictory.
One examination incorporating an
acute bout of Foam-rolling exercises
in adjunct with an active warming-
up shows an improved performance
in power, agility, strength, and
speed parameters. Therefore, the
authors recommended Foam-rolling
exercises [64]. However, most of the
studies show no performance
enhancing effects concerning maxi-
mum strength, and power as well
Figure 3
Foam-rolling exercise on the lower leg (calf).
J. Freiwald et al. Foam-rolling in sport and therapy 269
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 267–275 (2016)

as anaerobic capacity, explosive
strength, and anaerobic power
related parameters (Overviews in
[10,18,51,59,83]).
Mikesky et al. [59] and Healey et al.
[38] investigated the effects of prior
Foam-rolling exercises on vertical
jump height, hamstring flexibility,
flying-start 20-yard dash, and iso-
kinetic knee extension at 908/s. The
results showed no effects of Foam-
rolling exercises. These findings are
supported by those of Ku¨hnemann
[48], who demonstrated that an
ergometer based warming-up
increased the vertical jump height
in contrast to Foam-rolling exercises
(Fig. 4).
To summarize, most studies show no
effects of Foam-rolling exercises on
performance parameters in athletes,
when Foam-rolling exercises were
included in warming-up procedures
[21,38,59,64]. Consequently, to
improve athletic performance, no
general recommendation to perform
Foam-rolling exercises as warming-
up procedures prior to training or
competition can be given at this
time.
Improving anaerobic performance
Janot et al. [42] compared the
effects of static stretching and
Foam-rolling exercises on anaerobic
power parameters (i.e., 30-sec
Wingate test performance). The
effects of Foam-rolling exercises
on anaerobic power are inconclu-
sive. Consequently, to improve
anaerobic capacity, no recommen-
dation to perform Foam-rolling exer-
cises can be given.
Improving flexibility (ROM)
Foam-rolling exercises can tempor-
arily increase the ROM of hip, knee,
and ankle-joint without impairing
the neuromuscular activity or maxi-
mum isometric force [18,51,60].
However, in one study, there were
no differences in ROM, when a con-
ventional stretch training was com-
pared to Foam-rolling exercises [44].
While many studies have examined
the short-term effects of Foam-roll-
ing exercises on flexibility (ROM),
only few studies have investigated
middle- or long-term effects [10,11,
16,18,36,44,60,77].
Roylance et al. [72] investigated the
short-term effects of either postural
alignment or static stretching on
lumbar spinal, hip, knee, and ankle
flexibility (ROM), when Foam-rolling
exercises were additionally per-
formed. The results demonstrate
that additionally performed Foam-
rolling exercises increased flexibility
(ROM).
Similarly, Markovic [53] evaluated
the short-term effects of Foam-roll-
ing exercises on hip and knee flexi-
bility (ROM) in soccer players. In
this study, passive knee flexion
and straight leg raise tests were
measured before, immediately after,
and 24 h after the Foam-rolling
treatment. The findings show that
the knee and hip flexibility (ROM)
only improved immediately after the
treatment, whereas no effects were
evident after 24 h.
Further, Skarabot et al. [80] com-
pared the short-term effects of
Foam-rolling, static-stretching, and
a combination of both exercises on
ankle flexibility (ROM). The results
show that all interventions increased
flexibility (ROM); noteworthy, a
combination of Foam-rolling and
static stretching exercises has
superior effects compared to an iso-
lated treatment. Moreover, accord-
ing to the interventions, the
effects on flexibility (ROM) lasted
less than 10 min.
Lastly, Mohr et al. [60] compared
the middle-term effects of Foam-
rolling, static stretching, and a
combination of both exercises on
hip flexibility (ROM) over six ses-
sions. Again, the outcomes revealed
that all interventions increased
flexibility (ROM) and that a combi-
nation of Foam-rolling and static
Figure 4
Effects of commonly performed Foam-rolling (i.e., at both thighs and calves) and
traditional ergometer cycling warming-up (i.e., for 10 min at RPE 12-14) exercises
on the counter movement jump height in male recreational athletes (n= 20). Note:
* Statistical significant differences (p< 0.001) between pre and post and within post.
270 J. Freiwald et al. Foam-Rolling in sport and therapy – Potential benefits and risks
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 267–275 (2016)

stretching exercises showed the
largest effects.
Taken overall, the underlying
reasons for the improved flexibility
(ROM) remain unclear. From a struc-
tural point of view, the observed
effects can be explained by a
reduction in bonds between fascial
connective and muscle tissue [8,12,
67–70,78] or a plastic deformation
of the connective tissue (e.g., fas-
cia, tendon, capsule). From an func-
tional point of view, a temporally
reduction in the perception of pain
may also lead to a short-term
enhanced flexibility (ROM) [10,12,
23,43,68,91,90].
Consequently, to improve flexibility
(ROM), a recommendation to per-
form Foam-rolling exercises can be
given, when aiming to increase the
flexibility beyond the maximal
accessible effects induced through
traditional stretching procedures.
Improving sensomotoric function
and coordination
The fascia connective tissue, especi-
ally the deep layers, has a compre-
hensive innervation and is supplied
by various receptors [39,55,82,84].
The number of receptors located in
the fascial connective tissue is
about 10-fold higher than in the
muscle tissue [88]. The periosteum
is considered as fascia connective
tissue as well and is also densely
supplied with receptors [85,88].
Among others, pain, motion, pres-
sure, vibration, chemical, and ther-
mal conditions can be detected by
receptors within the fascial connec-
tive tissue. The afferent information
are integrated by the peripheral and
central nervous system, potentially
affecting sensomotoric function and
coordination [24,26–29,50].
Schleip and Muller [75] proposed
Foam-rolling exercises to improve
proprioceptive refinement, but
whether Foam-rolling exercises
affect the sensomotoric function
and coordination has not been pro-
ven yet. It is important to consider
that Foam-rolling exercises may not
only impact the sensory function,
but also the local metabolism.
Therefore, changes in the local
metabolism may influence the sen-
somotoric function [56]. In contrast
to Foam-rolling exercises, after
traditional warming-up procedures,
the improvement in joint position
perception and position sense at
the knee joint are well proven
[5,50,73].
Consequently, to improve sensomo-
toric function and coordination, a
recommendation to perform Foam-
rolling exercises cannot be given at
this time. In athletes, a sport-
specific and individual warming-up
seems to be more beneficial than
Foam-rolling exercises.
Improving reduction of stress-
relaxation
Practitioners recommend Foam-roll-
ing exercises to reduce stress.
However, in this context, there is
only one study. Kim et al. [45]
examined the influence of Foam-roll-
ing exercises on the level of serum
cortisol as an established stress
parameter after treadmill running
and showed that Foam-rolling exer-
cises had no beneficial effects [45].
Consequently, at this time, we can-
not give a recommendation to per-
form Foam-rolling exercises to
reduce stress associated cortisol
levels.
Reduction of delayed muscle
soreness (DOMS)
It has been shown that Foam-rolling
exercises can reduce the subjective
perceived delayed onset of muscle
soreness (DOMS) measured by pres-
sure pain thresholds and a visual
analog scale [52].
The underlying mechanisms of a
decrease in DOMS according to
Foam-rolling exercises remain
unclear. However, it is possible that
Foam-rolling exercises induce struc-
tural damage or metabolic and
neuronal alterations that lead to
changes in DOMS [10,12,25,31,43,
68,89,92].
Consequently, at this time, there is
only minor scientific evidence in
regards to Foam-rolling exercises
as a treatment to reduce DOMS.
Reduction of muscle and
connective tissue tone
One Foam-rolling exercises associ-
ated expectation is to reduce the
muscular and connective tissue tone
(‘Myofascial Release’). Noteworthy,
most research failed to conduct
valid measurements. For example,
previous studies failed to differen-
tiate between the mechanical tone
and neuro-muscular activation,
which is widely independent from
ROM [23,25,32,56].
Due to the lack of valid measure-
ments, future studies should apply
valid procedures to measure the
muscle and connective tissue tone
(e.g., through myotonometrie and
electromyography).
Therefore, we cannot give a recom-
mendation to perform Foam-rolling
exercises to reduce the muscle
and fascial connective tissue tone
yet.
Foam rolling – potential risks
Surprisingly, and in consideration of
many assumed positive effects of
Foam-rolling exercises, our litera-
ture review has revealed no refer-
ence concerning any harmful
effects. This is remarkable, since
Foam-rolling exercises exert a high
mechanical pressure not only on the
targeting fascial connective tissue,
but also on muscles, bones, nerves,
receptors, and vessels. In addition
to the pressure load, the shear and
tensile forces caused by Foam-roll-
ing exercises in and between the
J. Freiwald et al. Foam-rolling in sport and therapy 271
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 267–275 (2016)

different tissues cannot be neg-
lected [15,61].
Mechanical strain of the
underneath tissue
Curran et al. [20] showed that
the mechanical pressure differs
according to the applied type of
Foam-roller and also among the
subjects [20]. In their study, the
authors measured the maximum
mean pressure load at the lateral
tight that was reported to be
68.8 kPa (i.e., 516 mm/Hg). Thus,
these measured pressure values are
about 10-fold higher than the
highest medical compression
category 4 (i.e., extra strong com-
pression, at least 6.5 kPa or
49 mm/Hg) and exceeded twice
thepressureloadsthatareused
in occlusion studies [1,9,22].
Own studies achieved comparable
results. During common Foam-roll-
ing exercises, the vertical pressure
load was 33 1% of the body
weight measured at the calf and
the front thigh. Considering relative
and absolute contraindications such
as peripheral neuropathy, diabetes
mellitus, and the risk of venous
thrombosis or osteoporosis, which
may be evident in patients, older
people, or also in athletes, the use
of Foam-rolling exercises can lead to
harmful effects.
Nerve, vessels, and bones
From the perspective of phlebology
and lymphology, the mechanical
pressure exerted by Foam-rolling
exercises has to be critically ques-
tioned. Indeed, not only the fascial
connective tissue is mechanically
stressed, but also the vessels, in
particular venous valves, and
nerves, which run near the surface
e.g. of the hamstrings in the pop-
litea fossa (i.e., among others the N.
ischiadicus, V. poplitea). During
Foam-rolling exercises at the lower
leg, own measurements using
Doppler ultrasound showed a
temporary complete interruption of
the blood flow and in some cases
even a complete compression of
the examined vessels, particularly
of veins.
Also, the effects of Foam-rolling
exercises on the lymphatic system
are still unclear. However, the
applied mechanical pressure loads
and direction of Foam-rolling
against the physiological venous
and lymphatic flow are contrary to
the commonly accepted scientific
doctrine in medicine and physio-
therapy [22,35,46,58].
Additionally, attention should be
paid to bony prominences such as
the spinous processes or the fibula
head.
Inflammation and pain
During, immediately, and on the
next day, Foam-rolling exercises
may induce pain [48]. The type of
pain and its time course may
indicate inflammatory processes
[30,66,79,92]. Due to the fact that
pain is a physiological warning sign
[92], the question arises whether
this warning must be considered in
the training advises.
Inflammatory processes can be
detected by blood tests. Okamoto,
Masuhara [62] measured increased
neutrophil concentrations after
Foam-rolling exercises. Furthermore,
in healthy volunteers,a study showed
that the arterial pulse wave velocity
decreased,while the nitric oxide con-
centration increased after Foam-roll-
ing exercises. These findings were
concluded by the authors as
beneficial and potential preventive
effects on arterial function and car-
diovascular disease, respectively.
However, it is also possible to inter-
pret, in particular, the increase in
nitric oxide concentration after
Foam-rolling exercises as a damage
of the intima (i.e., the endothelium)
[2,86].
The accumulation of fluid in tissues
occurs during inflammation, which
is detectible by the use of T2 con-
trast in MRI [87]. Due to our exten-
sive experience in top-level sports,
we have repeatedly seen athletes
showing signs of edema after
Foam-rolling exercises that were
visible in MRI (T2 weighted).
However, if the edema are induced
by shear forces and irritations or
damages of the vascular endo-
thelium during Foam-rolling exer-
cises remains unclear [8,62].
Conclusions and future
requirements
This second part of the review dis-
cussed Foam-rolling exercises in
sport and therapy. It was shown that
it is not possible to treat isolated
the fascial connective tissue by
Foam-rolling exercises and that
there are no established and proven
training methods overall [3]. There
is no scientific evidence that Foam-
rolling exercises can improve warm-
ing-up procedures, athletic perform-
ance, reduce muscle and fascial
connective tissue tone, and improve
stress-relaxation. In contrast, Foam-
rolling exercises can enhance flexi-
bility (ROM) and reduce delayed
onset of muscular soreness
(DOMS). In the scientific literature,
it is important to consider that
potential harmful effects of Foam-
rolling exercises are completely
ignored.
Future investigations to define fields
of applications concerning Foam-
rolling exercises in therapy, medi-
cine, and sport are required.
Therefore, in- and exclusion criteria
as well as implementation of indi-
vidualized Foam-rolling exercises
are needed. In a further step, train-
ing principles and methods of Foam-
rolling exercise including the use of
different types of Foam-rollers
according to different sports should
272 J. Freiwald et al. Foam-Rolling in sport and therapy – Potential benefits and risks
REVIEW / SPECIAL ISSUE
Sports Orthop. Traumatol. 32, 267–275 (2016)

be investigated and defined.
Importantly, more research to inves-
tigate the underlying mechanical
and physiological mechanisms of
Foam-rolling exercises is strongly
warranted.
Overall, in regards to the observed
minor scientific evidence with
respect to athletic performance
and underlying mechanical and
physiological mechanism as well as
the negligence of potential harmful
effects, Foam-rolling exercises
should be used cautiously at this
time.
Conflict of interest
There is no conflict of interest.
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Corresponding author:
Univ. Prof. Dr. Ju¨ rgen Freiwald M.A.,
Department of Movement
and Training Science, University of
Wuppertal, Wuppertal, Germany.
Fax: +49 0202 439 2956
E-Mail: freiwald@uni-wuppertal.de
Available online at www.sciencedirect.com
ScienceDirect
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