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Content uploaded by Kyle Stull
Author content
All content in this area was uploaded by Kyle Stull on Feb 03, 2019
Content may be subject to copyright.
ABSTRACT
Background: Foam rolling is a popular form of roller massage. To date, no studies have examined the therapeutic effects of
different density type rollers. Understanding the different densities may provide clinicians with the knowledge to accu-
rately prescribe a particular foam roller and safely progress the client.
Purpose: The purpose of this study was to compare the immediate effects of three different density type foam rollers on
prone passive knee flexion range of motion (ROM) and pressure pain thresholds (PPT) of the quadriceps musculature.
Study Design: Pretest, posttest randomized controlled trial.
Methods: Thirty-six recreationally active adults were randomly allocated to one of three groups: soft density, medium den-
sity, and hard density foam roller. The intervention lasted a total of two minutes. Outcome measures included prone passive
knee flexion ROM and PPT. Statistical analysis included parametric and non-parametric tests to measure changes among
groups.
Results: Between group comparisons revealed no statistically significant differences between all three rollers for knee ROM
(p=.78) and PPT (p=.37). Within group comparison for ROM revealed an 8⬚ (p< 0.001) post-intervention increase for the
medium and hard density rollers and a 7⬚ (p< 0.001) increase for the soft density roller. For PPT, there was a post-interven-
tion increase of 180 kPa (p< 0.001) for the medium density roller, 175 kPa (p< 0.001) for the soft density roller, and 151 kPa
(p< 0.001) for the hard density roller.
Conclusion: All three roller densities produced similar post-intervention effects on knee ROM and PPT. These observed
changes may be due to a local mechanical and global neurophysiological response from the pressure applied by the roller.
The client’s pain perception may have an influence on treatment and preference for a specific foam roller. Clinicians may
want to consider such factors when prescribing foam rolling as an intervention.
Level of evidence: 2C
Keywords: Massage, muscle soreness, perceived pain, recovery, roller
IJSPT
ORIGINAL RESEARCH
COMPARISON OF THREE DIFFERENT DENSITY TYPE
FOAM ROLLERS ON KNEE RANGE OF MOTION AND
PRESSURE PAIN THRESHOLD: A RANDOMIZED
CONTROLLED TRIAL
Scott W. Cheatham, PhD, DPT, PT, OCS, ATC, CSCS1
Kyle R. Stull, DHSc, MS, LMT, CSCS, NASM-CPT, CES2
1 California State University Dominguez Hills, Carson, CA, USA
2 National Academy of Sports Medicine, Chandler, AZ, USA
Confl ict of Interest: The authors have no confl ict of
interest with this study.
CORRESPONDING AUTHOR
Scott W. Cheatham, PhD, DPT, PT, OCS,
ATC, CSCS
Associate Professor
California State University Dominguez Hills
1000 E. Victoria Street, Carson, California 90747
E-mail: Scheatham@csudh.edu
The International Journal of Sports Physical Therapy | Volume 13, Number 3 | June 2018 | Page 474
DOI: 10.26603/ijspt20180474
The International Journal of Sports Physical Therapy | Volume 13, Number 3 | June 2018 | Page 475
personal preference.3 Furthermore, the client may
purchase a foam roller based upon price, personal
preference, or recommendation by a clinician.
Further investigation into the therapeutic effects
of different density foam rollers is warranted given
the gap in the knowledge about foam rolling. Under-
standing the effects of different density foam rollers
may provide clinicians with the knowledge to more
accurately prescribe a particular foam roll and to
safely progress the client through different densities.
The purpose of this study was to compare the imme-
diate effects of three different density type rollers
on passive knee range of motion (ROM) and pres-
sure pain threshold (PPT). The authors of this study
hypothesized that the higher density foam roller will
have a greater effect than the less dense roller. This
investigation was also considered exploratory and a
starting point for future research.
METHODS
This pretest, posttest randomized controlled trial
was approved by the Institutional Review Board
(IRB:18-023) at California State University Domin-
guez Hills.
Subjects
Thirty-six recreationally active adults (Males=26,
Females=10) were recruited via convenience sam-
pling (e.g. flyers) and randomly allocated into three
groups of 12 subjects: (1) soft density, (2) medium
density, and (3) hard density foam roller interven-
tion groups (Table 1). Recruited subjects reported
participated in recreational fitness activities (e.g.
walking) and prior experience using a foam roller
within the last two years but were not currently
using any devices. Exclusion criteria included the
p
resence of any musculoskeletal, systemic, or meta-
bolic disease that would affect
lower extremity joint
ROM or tolerance to PPT testing and the inability to
avoid medications that may affect testing. Descrip-
tive demographic information is provided in Table 2.
Instruments
Two instruments were used in this investigation
to measure ROM and PPT. For ROM, the baseline
digital inclinometer (Fabrication Enterprises, White
Plains, NY, USA) was used to measure passive knee
flexion ROM. The manufacturer reports an accuracy
INTRODUCTION
The popularity and use of foam rolling has increased
over the past decade and has emerged as one of the
top 20 fitness trends the past two years (2016-2017)
in the United States.1,2 The majority of research has
focused on the effects of foam rolling as a form of
roller massage.3 The research suggests that foam roll-
ing may be used as a warm-up without negatively
effecting performance and may enhance joint mobil-
ity at the shoulder,4,5 lumbopelvis,6,7 hip,8-14 knee,14-18
and ankle.19,20 Researchers have found that foam roll-
ing may reduce post exercise decrements in muscle
performance,3,21-24, increase posttreatment pressure
pain thresholds (PPT),15,16,22,24-27 and reduce the effects
of delayed onset muscle soreness in healthy individu-
als.3,21,28-30 Several recent studies have also documented
positive post-exercise effects of rolling for different
sports,29,31-33 occupations,34 and fibromyalgia.35
Many different foam rollers are available to con-
sumers which vary in density, shape, and surface
texture. These architectural differences may influ-
ence how the myofascial tissues are being massaged
during treatment. More specifically, the density
and surface texture of the foam roller may provide
a more effective massage to the tissue than a less
dense roller. Curran et al36 investigated the pressure
being applied by a higher density, multilevel tex-
tured surface foam roller and a lower density, solid
EVA roller with a uniform textured surface to the lat-
eral thigh of ten subjects (N=10). The researchers
found that the higher density, multilevel textured
roller produced more pressure and isolated con-
tact area on the target tissues than the less dense,
smooth textured roller.36 Despite the small sample
size, this study has become a reference standard
and has prompted researchers to use higher density
foam rollers in their investigations.3,15,21,28,37
Since the Curran et al36 study, no other investigators
have compared the therapeutic effects of different
density rollers. They have either used commercial
high-density rollers or developed their own custom
high-density roller.3,21,28 The unknown therapeutic
effects of various density rollers create a knowledge
gap that has potential implications for clinical prac-
tice. The clinician is challenged with the inability to
provide an evidence based recommendation for the
type of foam roller for a patient and may depend on
The International Journal of Sports Physical Therapy | Volume 13, Number 3 | June 2018 | Page 476
Table 1. Consort Flow Diagram
Table 2. Subject demographics
of ± 0.5 degrees.19 This device has been shown to
be valid and reliable for measuring lower extrem-
ity ROM (Figure 1)38-41 and has been used in prior
foam roller research.15,26,37 Second, The JTECH (Mid-
vale, UT) Tracker Freedom® wireless algometer
(Figure 2) was used with the accompanying Tracker
5® Windows® based software to measure PPT. The
manufacturer reports an accuracy error of <± 0.5%
(.05kg/cm2) for this technology.42 Algometry is a
valid and reliable tool for measuring pressure pain
thresholds.25,43-45 This instrument has also been used
in prior foam roller research.15,26,37
The International Journal of Sports Physical Therapy | Volume 13, Number 3 | June 2018 | Page 477
Instructional Video and Foam Rollers
A commercial internet-based instruction video was
used in this investigation (TriggerPoint, a division
of Implus, LLC, Austin, Texas). The short foam roll-
ing instructional video demonstrated the use of the
foam roller on the left quadriceps muscle group. This
video has been used in prior foam roll research.15,26,37
The three foam rollers used in this study were manu-
factured by TriggerPoint™ and all had the same mul-
tilevel GRID surface pattern and diameter (14cm)
which allowed for a direct comparison. The differ-
ence between the three rollers was the density. T he
soft density CORE roller (silver) was constructed of
solid EVA foam, the medium density GRID roller
(orange) had a hard, hollow core that was wrapped
in moderately firm EVA foam, and the hard density
GRID X roller (black) had a hard, hollow core that
was wrapped in very firm EVA foam (Figure 3).
Outcome Measures
Two outcome measures were used for the pretest and
posttest measures for each group. For passive knee flex-
ion ROM, subjects lay prone on a carpeted floor. The
examiner grasped the left ankle and passively moved
the left knee to the end of the available flexion ROM to
the point where the knee could no longer be passively
moved without providing overpressure or point of initial
discomfort.15,26,37,46-48 The ROM measurement was then
taken by the examiner. The examiner monitored for any
compensatory movement through the lower extremity
and pelvis. This testing technique was chosen since it
replicated the same hip position and knee movements
that occurred during the foam roll interventions.15,26,37
For PPT, the left quadriceps group was tested with the
subject in the relaxed standing position (average of two
measurements).16,49,50 The 1.0-cm2 probe of the algom-
eter was placed into the midline of the left quadriceps
(rectus femoris) midway between the iliac crest and
superior border of the patella. The graded force was
applied at a constant rate of 50-60 kilopascals per second
(kPa/sec) until the subject verbaelly reported the pres-
ence of pain.16,49,50 These outcome measures have been
used in prior foam roller research.15,26,37
Pilot Study
Prior to data collection, a two-session pilot training
was conducted to establish intrarater reliability. The
Figure 1. Baseline digital inclinometer.
Figure 2. JTECH algometer.
Figure 3. Soft (silver), medium (orange), and hard (black)
foam rollers.
The International Journal of Sports Physical Therapy | Volume 13, Number 3 | June 2018 | Page 478
primary investigator took all the measurements. The
primary investigator is a licensed physical therapist
with over 13 years of experience and board certi-
fied in orthopaedics. Ten independent subjects were
recruited and tested for this portion of the study.
The intrarater reliability was calculated using the
Intraclass Correlation Coefficient (ICC model 3, 3).
There was excellent intrarater reliability for passive
knee flexion ROM (ICC= 0.95; 95% CI 0.83-0.99) and
pressure algometry (ICC= 0.94; 95% CI 0.61-0.90).51
Procedures
All eligible participants were given an IRB approved
consent form to read and sign before testing. Par-
ticipants then completed a questionnaire to provide
demographic information. All participants were
tested by one investigator and were blinded from the
results and other participants enrolled in the study.
Testing was conducted between the hours of 10 AM
and 2 PM and subjects were instructed to refrain from
any strenuous activity for three hours prior to testing
and from taking any medication that would interfere
with testing. All subjects underwent one session of
testing that included: pretest measures, followed by
the intervention, then immediate posttest measures.
Prior to testing, the primary investigator first
explained the process to each subject and answered
any questions. Then each subject was given a foam
roller (based on group allocation) and followed an
instructional video that demonstrated the use of the
foam roll on the left quadriceps muscle group.15,26,37
Subjects followed the video with no feedback from
the observing primary investigator. The instructor
in the video provided a brief introduction and then
discussed the foam rolling technique. The instruc-
tor divided the left quadriceps into zone one: top of
patella to middle of the quadriceps and zone two:
middle quadriceps to anterior superior iliac spine.
The model in the video was instructed to get in the
plank position, position the roller above the left
patella and roll back and forth longitudinally in zone
one four times at a cadence of one inch per second.
The model was then instructed to stop at the top of
zone one followed by four active knee bends to 90
degrees. This sequence was repeated for zone two.
The intervention portion lasted a total of two min-
utes. Subjects used the specific foam roll they were
assigned to based upon their group allocation (e.g.
soft, medium, or hard density). These procedures
have been used in prior foam roller research.15,26,37
S TATISTICAL ANALYSIS
Analysis
Statistical analysis was performed using SPSS ver-
sion 24.0 (IBM SPSS, Chicago, IL, USA). Subject
descriptive data was calculated and reported as the
mean and standard deviation (SD) for age, height,
body mass, and body mass index (BMI) (Table 2).
Group differences were calculated using the ANOVA
statistic for continuous level data and the Kruskal
Wallis statistic for ordinal level data. Between group
difference were calculated using the ANCOVA sta-
tistic.52 For the ANCOVA, the independent variable
was the group, dependent variable was post-test
scores, and pretest scores was the covariate. Within
group comparisons were calculated using the paired
t-test. Effect size (ES) was calculated (d = M1 - M2 /
σpooled) for each group. Effect size of >.70 was consid-
ered strong, .41 to .70 was moderate, and < .40 was
weak.53 All statistical assumptions were met for the
ANOVA, ANCOVA and paired t-test statistics. Statisti-
cal significance was considered p< .05 using a con-
servative two-tailed test.
RESULTS
Thirty-six subjects completed the study (Table 1).
There was no statistically significant difference
between groups for age (p=.81), height (p=.66), body
mass (p=.38), or BMI (p=.27). There were no adverse
events or subject attrition during data collection.
Patient demographic data is presented in Table 2.
Between Group Analysis
B etween group comparisons were calculated. For
passive knee flexion ROM, the between group analy-
sis revealed no significant difference between the
three types of foam rollers [F (2,32) =.247, p=.78,
partial η2=.015]. For PPT, no significant differences
were found between the three types of rollers [F (2,
32) =1.02, p=.37, partial η2=.196].
Within Group Comparison
Within group comparison results are presented in
Table 3. For passive knee flexion ROM, within group
analysis revealed a posttest increase of 7° (p<.001,
ES: .92) for the soft density roller, 8° degrees
The International Journal of Sports Physical Therapy | Volume 13, Number 3 | June 2018 | Page 479
(p<.001, ES: 0.76) for the medium density roller,
and an 8° (p<.001, ES: 1.26) increase for the hard
density roller. For PPT, a posttest increase of 175 kPa
(p<.001, ES: 0.76) for the soft density roller, 180 kPa
(p<.001, ES: 0.85) increase for the medium density
roller, and a 151 kPa (p<.001, ES: 0.60) increase for
the hard density roller. All densities of rollers dem-
onstrated comparable changes in ROM and PPT.
DISCUSSION
This investigation compared the effects of three dif-
ferent density type rollers with the same multilevel
surface pattern. This allowed for a direct compari-
son of different foam roll densities which may have
clinical implications. The between group analysis
revealed that all three density type rollers produced
statistically similar post-test increases in passive
knee flexion ROM (p=0.78) and PPT (p=0.37). Cur-
ran et al36 is the only known investigation to docu-
ment the effects of two foam rollers with different
densities and surface architecture on myofascial tis-
sues. The researchers did not measure the therapeu-
tic effects of the rollers. This current investigation
built upon the prior study by measuring the effects
of three density type rollers on knee joint ROM and
PPT of the quadriceps.
Clinical Implications
The r esults of this investigation should be considered
exploratory and a starting point for future research.
The results suggest that the myofascial system may
respond to different density foam rollers in a statisti-
cally comparable manner as observed by the post-
intervention changes in joint ROM and PPT. These
observed changes may be due to a mechanical and
neurophysiological response.19,37,54 The d irect pres-
sure of the roller may produce a local mechanical
and global neurophysiological effect that influences
tissue relaxation and pain reduction in the target
and surrounding tissues.25,55,56 For tissue relaxation,
the local pressure from the roller may affect the
viscoelastic properties of myofascia which may be
responsible for the changes. Other mechanisms that
may be involved include thixotropy (reduced viscos-
ity), myofascial restriction, fluid changes, and cel-
lular responses.19,54 Researchers have also found that
rolling reduces arterial stiffness57, increases arterial
tissue perfusion,58 and improves vascular endothe-
lial function57 which are related to tissue relaxation.
For pain reduction, researchers have postulated
that the pressure from the roller may modulate
pain through stimulation of cutaneous receptors,25
mechanoreceptors,55 afferent central nociceptive
pathways (gate theory of pain),25,59 and descending
anti-nociceptive pathways (diffuse noxious inhibi-
tory control).7,25 Researchers have found that rolling
decreases evoked pain59 and reduces spinal excitabil-
ity55 which provides evidence for these theories.
Because the post-intervention changes among all
three density rollers were similar, clinicians may
want to consider the client’s pain perception when
prescribing a particular roller. The Curran et al36
study supports the effectiveness of a harder density
roller but did not consider the influence of a client’s
pain perception. Pain is a very complex multidimen-
sional process involving the central nervous system
and other systems of the body.60,61 Clients may choose
a foam roller based upon their pain perception and
Table 3. Pretest, posttest descriptive results
The International Journal of Sports Physical Therapy | Volume 13, Number 3 | June 2018 | Page 480
roller pressure. The density of the roller and client’s
pain perception may have an influence on treatment
and preference for a specific foam roller. Clinicians
may want to consider such factors when prescribing
foam rolling as a myofascial intervention.
REFERENCES
1. Thompson WR. Worldwide survey of fi tness trends
for 2016: 10th Anniversary Edition. ACSM’s Health
Fitness J. 2015;19(6):9-18.
2. Thompson WR. Worldwide survey of fi tness trends
for 2017. ACSM’s Health Fitness J. 2016;20(6):8-17.
3. Cheatham SW, Kolber MJ, Cain M, et al. The effects
of self-myofascial release using a foam roll or roller
massager on joint range of motion, muscle recovery,
and performance: a systematic review. Int J Sports
Phys Ther. 2015;10(6):827-838.
4. Le Gal J, Begon M, Gillet B, et al. Effects of Self-
Myofascial Release on Shoulder Function and
Perception in Adolescent Tennis Players. J Sport
Rehabil. 2017:1-19.
5. Fairall RR, Cabell L, Boergers RJ, et al. Acute effects
of self-myofascial release and stretching in overhead
athletes with GIRD. J Bodyw Mov Ther.
2017;21(3):648-652.
6. Grieve R, Goodwin F, Alfaki M, et al. The immediate
effect of bilateral self myofascial release on the
plantar surface of the feet on hamstring and lumbar
spine fl exibility: A pilot randomised controlled trial.
J Bodyw Mov Ther. 2015;19(3):544-552.
7. Sullivan KM, Silvey DB, Button DC, et al. Roller-
massager application to the hamstrings increases
sit-and-reach range of motion within fi ve to ten
seconds without performance impairments. Int J
Sports Phys Ther. 2013;8(3):228-236.
8. DeBruyne DM, Dewhurst MM, Fischer KM, et al.
Self-Mobilization Using a Foam Roller Versus a Roller
Massager: Which Is More Effective for Increasing
Hamstrings Flexibility? J Sport Rehabil. 2017;26(1):94-
100.
9. Behara B, Jacobson BH. Acute Effects of Deep Tissue
Foam Rolling and Dynamic Stretching on Muscular
Strength, Power, and Flexibility in Division I
Linemen. J Strength Cond Res. 2017;31(4):888-892.
10. Monteiro ER, Cavanaugh MT, Frost DM, et al. Is
self-massage an effective joint range-of-motion
strategy? A pilot study. J Bodyw Mov Ther.
2017;21(1):223-226.
11. Bushell JE, Dawson SM, Webster MM. Clinical
Relevance of Foam Rolling on Hip Extension Angle
in a Functional Lunge Position. J Strength Cond Res.
2015;29(9):2397-2403.
threshold during rolling. For example, a hard den-
sity roller may produce more discomfort during the
intervention eliciting a protective muscle guarding
response.62,63 Understanding this may help guide the
clinician in prescribing a specific foam roll and pro-
gressing them through the different densities.
Limitations
There are specific limitations to the investigation
that need to be discussed. First, this investigation
tested healthy subjects which limits the generaliz-
ability of the results to this population. Second, the
three foam rollers used had the same multilevel
GRID pattern surface and diameter which allowed
for a direct comparison. Other foam rollers with
different surface patterns, diameters, and densi-
ties may have produced different results. Third, the
short-term effects of each foam roll intervention
was studied with the left leg only. Fourth, the test-
ing examiner was not blinded to the results of the
study which could have led to testing biases. Last,
the instructional video used in the intervention only
demonstrated one foam rolling technique on the
left quadriceps group. Other rolling techniques may
have produced different results as well as testing
other muscle groups.
Future research
Future studies are needed to validate the results of
this study and to develop a consensus on the optimal
type of foam roller for specific clients. Furthermore,
research should attempt to determine the longer-
term effects of different types of foam rollers based
upon surface patterns, density, and foam roll mate-
rial using the similar research methods. The current
foam roller research is variable with different meth-
odology which prevents a direct comparison among
studies.3,28
CONCLUSION
This was the first investigation to measure the short-
term effects of different density foam rollers on pas-
sive knee flexion ROM and PPT of the quadriceps
musculature. All three foam roll densities produced
statistically similar post-intervention effects on both
ROM and PPT. These observed changes may be due to
a mechanical and neurophysiological response that
can be triggered by low, moderate, or high-density
The International Journal of Sports Physical Therapy | Volume 13, Number 3 | June 2018 | Page 481
25. Aboodarda SJ, Spence AJ, Button DC. Pain pressure
threshold of a muscle tender spot increases
following local and non-local rolling massage. BMC
Musculoskelet Disord. 2015;16:265.
26. Cheatham SW, Baker R. Differences in pressure pain
threshold among men and women after foam rolling.
Journal of Bodywork and Movement Therapies.
2017;21(4):978-982
27. Cheatham SW, Baker R. Differences in pressure pain
threshold among men and women after foam rolling.
J Bodyw Mov Ther. 2017;21(4):978-982.
28. Beardsley C, Skarabot J. Effects of self-myofascial
release: A systematic review. J Bodyw Mov Ther.
2015;19(4):747-758.
29. Rey E, Padron-Cabo A, Costa PB, et al. The Effects of
Foam Rolling as a Recovery Tool in Professional
Soccer Players. J Strength Cond Res. 2017; [Epub
ahead of print]
30. Romero-Moraleda B, La Touche R, Lerma-Lara S, et
al. Neurodynamic mobilization and foam rolling
improved delayed-onset muscle soreness in a
healthy adult population: a randomized controlled
clinical trial. PeerJ. 2017;5:e3908.
31. D’Amico A, Paolone V. The effect of foam rolling on
recovery between two eight hundred metre runs. J
Hum Kinet. 2017;57:97-105.
32. D’Amico AP, Gillis J. The infl uence of foam rolling
on recovery from exercise-induced muscle damage. J
Strength Cond Res. 2017; [Epub ahead of print]
33. Grgic J, Mikulic P. Tapering practices of croatian
open-class powerlifting champions. J Strength Cond
Res. 2017;31(9):2371-2378.
34. Kalen A, Perez-Ferreiros A, Barcala-Furelos R, et al.
How can lifeguards recover better? A cross-over
study comparing resting, running, and foam rolling.
Am J Emerg Med. 2017;35(12):1887-1891
35. Ceca D, Elvira L, Guzman JF, et al. Benefi ts of a
self-myofascial release program on health-related
quality of life in people with fi bromyalgia: a
randomized controlled trial. J Sports Med Phys
Fitness. 2017;57(7-8):993-1002.
36. Curran PF, Fiore RD, Crisco JJ. A comparison of the
pressure exerted on soft tissue by 2 myofascial
rollers. J Sport Rehabil. 2008;17(4):432-442.
37. Cheatham SW, Kolber MJ. Does Self-myofascial
release with a foam roll change pressure pain
threshold of the ipsilateral lower extremity
antagonist and contralateral muscle groups? an
exploratory study. J Sport Rehabil. 2017 1;27(2):165-
169
38. Roach S, San Juan JG, Suprak DN, et al. Concurrent
validity of digital inclinometer and universal
goniometer in assessing passive hip mobility in
12. Mohr AR, Long BC, Goad CL. Effect of foam rolling
and static stretching on passive hip-fl exion range of
motion. J Sport Rehabil. 2014;23(4):296-299.
13. Vigotsky AD, Lehman GJ, Contreras B, et al. Acute
effects of anterior thigh foam rolling on hip angle,
knee angle, and rectus femoris length in the
modifi ed Thomas test. PeerJ. 2015;3:e1281.
14. Murray AM, Jones TW, Horobeanu C, et al. Sixty
seconds of foam rolling does not affect functional
fl exibility or change muscle temperature in adolescent
athletes. Int J Sports Phys Ther. 2016;11(5):765-776.
15. Cheatham SW, Kolber MJ, Cain M. Comparison of
video-guided, live instructed, and self-guided foam
roll interventions on knee joint range of motion and
pressure pain threshold: a randomized controlled
trial. Int J Sports Phys Ther. 2017;12(2):242-249.
16. Cheatham SW, Stull KR, Kolber MJ. Comparison of a
vibrating foam roller and a non-vibrating foam roller
intervention on knee range of motion and pressure
pain threshold: a randomized controlled trial. J Sport
Rehabil. 2017; [Epub ahead of print]
17. Su H, Chang NJ, Wu WL, et al. Acute Effects of Foam
Rolling, Static Stretching, and Dynamic Stretching
During Warm-Ups on Muscular Flexibility and
Strength in Young Adults. J Sport Rehabil.
2017;26(6):469-477
18. Couture G, Karlik D, Glass SC, et al. The Effect of
Foam Rolling Duration on Hamstring Range of
Motion. Open Orthop J. 2015;9:450-455.
19. Kelly S, Beardsley C. Specifi c and cross-over effects
of foam rolling on ankle dorsifl exion range of
motion. Int J Sports Phys Ther. 2016;11(4):544-551.
20. Skarabot J, Beardsley C, Stirn I. Comparing the
effects of self-myofascial release with static
stretching on ankle range-of-motion in adolescent
athletes. Int J Sports Phys Ther. 2015;10(2):203-212.
21. Schroeder AN, Best TM. Is self myofascial release an
effective preexercise and recovery strategy? A
literature review. Curr Sports Med Rep.
2015;14(3):200-208.
22. Macdonald GZ, Button DC, Drinkwater EJ, et al.
Foam rolling as a recovery tool after an intense bout
of physical activity. Med Sci Sports Exerc.
2014;46(1):131-142.
23. MacDonald GZ, Penney MD, Mullaley ME, et al. An
acute bout of self-myofascial release increases range
of motion without a subsequent decrease in muscle
activation or force. J Strength Cond Res.
2013;27(3):812-821.
24. Cavanaugh MT, Aboodarda SJ, Hodgson D, et al.
Foam Rolling of Quadriceps Decreases Biceps
Femoris Activation. J Strength Cond Res.
2017;31(8):2238-2245
The International Journal of Sports Physical Therapy | Volume 13, Number 3 | June 2018 | Page 482
51. Portney LG, Watkins MP. Foundations of Clinical
Research: Applications to Practice. Pearson/Prentice
Hall; 2009.
52. Dugard P, Todman J. Analysis of PretestPosttest
Control Group Designs in Educational Research.
Educational Psychology. 1995;15(2):181-198.
53. Cohen J. A power primer. Psychol Bull.
1992;112(1):155-159.
54. Jay K, Sundstrup E, Sondergaard SD, et al. Specifi c
and cross over effects of massage for muscle
soreness: randomized controlled trial. Int J Sports
Phys Ther. 2014;9(1):82-91.
55. Young JD, Spence AJ, Behm DG. Roller massage
decreases spinal excitability to the soleus. J Appl
Physiol (1985). 2018; [Epub ahead of print]
56. Grabow L, Young JD, Alcock LR, et al. Higher
quadriceps roller massage forces do not amplify
range of-motion increases or impair strength and
jump performance. J Strength Cond Res. 2018; [Epub
ahead of print].
57. Okamoto T, Masuhara M, Ikuta K. Acute effects of
self-myofascial release using a foam roller on arterial
function. J Strength Cond Res. 2014;28(1):69-73.
58. Hotfi el T, Swoboda B, Krinner S, et al. Acute Effects
of Lateral Thigh Foam Rolling on Arterial Tissue
Perfusion Determined by Spectral Doppler and
Power Doppler Ultrasound. J Strength Cond Res.
2017;31(4):893-900.
59. Cavanaugh MT, Doweling A, Young JD, et al. An
acute session of roller massage prolongs voluntary
torque development and diminishes evoked pain.
Eur J Appl Physiol. 2017;117(1):109-117.
60. Cheatham SW, Kolber MJ, Mokha GM, et al.
Concurrent validation of a pressure pain threshold
scale for individuals with myofascial pain syndrome
and fi bromyalgia. J Man ManipulatTher.
2018;26(1):25-35
61. Cheatham SW, Kolber MJ, Mokha M, et al.
Concurrent validity of pain scales in individuals with
myofascial pain and fi bromyalgia. J Bodyw Mov
Ther.2017 [Epub ahead of print]
62. van der Hulst M, Vollenbroek-Hutten MM, Rietman
JS, et al. Back muscle activation patterns in chronic
low back pain during walking: a “guarding”
hypothesis. Clin J Pain. 2010;26(1):30-37.
63. Bank PJ, Peper CE, Marinus J, et al. Motor
consequences of experimentally induced limb pain:
a systematic review. Eur J Pain. 2013;17(2):145-157.
healthy subjects. Int J Sports Phys Ther. 2013;8(5):680-
688.
39. Romero-Franco N, Montano-Munuera JA, Jimenez-
Reyes P. Validity and Reliability of a Digital
Inclinometer to Assess Knee Joint Position Sense in
a Closed Kinetic Chain. J Sport Rehabil. 2017
;26(1):1-5
40. Konor MM, Morton S, Eckerson JM, et al. Reliability
of three measures of ankle dorsifl exion range of
motion. Int J Sports Phys Ther. 2012;7(3):279-287.
41. Gnat R, Kuszewski M, Koczar R, et al. Reliability of
the passive knee fl exion and extension tests in
healthy subjects. J Manipulative Physiol Ther.
2010;33(9):659-665.
42. Monteiro ER, Neto VG. Effect of different foam
rolling volumes on knee extension fatigue. Int J
Sports Phys Ther. 2016;11(7):1076-1081.
43. Chesterton LS, Sim J, Wright CC, et al. Interrater
reliability of algometry in measuring pressure pain
thresholds in healthy humans, using multiple raters.
Clin J Pain. 2007;23(9):760-766.
44. Nussbaum EL, Downes L. Reliability of clinical
pressure-pain algometric measurements obtained on
consecutive days. Phys Ther. 1998;78(2):160-169.
45. Walton DM, Macdermid JC, Nielson W, et al.
Reliability, standard error, and minimum detectable
change of clinical pressure pain threshold testing in
people with and without acute neck pain. J Orthop
Sports Phys Ther. 2011;41(9):644-650.
46. Lee SY, Sung KH, Chung CY, et al. Reliability and
validity of the Duncan-Ely test for assessing rectus
femoris spasticity in patients with cerebral palsy.
Dev Med Child Neurol. 2015;57(10):963-968.
47. Marks MC, Alexander J, Sutherland DH, et al.
Clinical utility of the Duncan-Ely test for rectus
femoris dysfunction during the swing phase of gait.
Dev Med Child Neurol. 2003;45(11):763-768.
48. Peeler J, Anderson JE. Reliability of the Ely’s test for
assessing rectus femoris muscle fl exibility and joint
range of motion. J Orthop Res. 2008;26(6):793-799.
49. Pearcey GE, Bradbury-Squires DJ, Kawamoto JE, et
al. Foam rolling for delayed-onset muscle soreness
and recovery of dynamic performance measures. J
Athl Train. 2015;50(1):5-13.
50. Cheatham SW, Kolber MJ, Cain M. Comparison of a
video-guided, live instructed, and self-guided foam
roll interventions on knee joint range of motion and
pressure pain threshold: a randomized controlled
trial. Int J Sports Phys Ther. 2017;12(2):1-8.
