ArticlePDF Available

Acute effect of self-myofascial release using a foam roller on the plantar fascia on hamstring and lumbar spine superficial back line flexibility

Authors:

Abstract and Figures

Objective: The purpose of this study was to investigate the immediate effect of applying self-myofascial release (SMR) to the plantar fascia using a foam roller on hamstring and lumbar spine superficial back line (SBL). Design: Randomized controlled trial. Methods: Thirty-one healthy adults agreed to the method and purpose of the study. Selection and exclusion criteria were screened, and baseline measurements for the Toe Touch test and passive straight leg raise (PSLR) test were obtained. The participants were then randomly assigned to the SMR group or the sham group. After group assignment, the SMR group rolled the surface of the foot from the heel to the metatarsal head using a foam roller for 5 minutes. The sham group received passive mobilization of the ankle joint in the supine position. Afterwards, the Toe Touch test and the passive straight leg-raise test were re-assessed. Results: In the SMR group, the Toe Touch test results showed significant improvement (p<0.05). Left and right PSLR test results showed a significant increase (p<0.05). In the sham group, there was no significant difference between pre and post-test results. The SMR group showed a significant difference in the PSLR test and Toe Touch test compared to the sham group (p<0.05). Conclusions: The results of this study showed that SMR on the plantar fascia was immediately effective for improving the flexibility of the SBL of the lumbar spine and hamstring.
Content may be subject to copyright.
http://crossmark.crossref.org/dialog/?doi=10.14474/ptrs.2018.7.1.35&domain=pdf&date_stamp=2018-03-25
Received: 17 January, 2018 Revised: 12 March, 2018 Accepted: 13 March, 2018
Corresponding a uthor: Jongeun Yim (ORCID http://orcid.org/0000-0001-7510-8233)
Department of Physical Therapy, College of Health Science and Social Welfare, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul 01795, Republic of
Korea
Tel : 82-2-3399-1635 Fax: 82-2-3399-1639 E-ma il: jeyim@syu.ac.kr
This is an Open-Access article distribut ed under the terms of the Creative Commons Attribution Non-Commercial License (htt p://creativecommons.org/licenses/
by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright © 2018 Korean Academy of Physical Therapy Rehabilitation Science
https://doi.org/10.14474/ptrs.2018.7.1.35
pISSN 2287-7576
eISSN 2287-7584
Phys Ther Rehabil Sci
2018, 7 (1), 35-40
www.jptrs.org
Acute effect of self-myofascial release using a foam roller
on the plantar fascia on hamstring and lumbar spine
superficial back line flexibility
Kwangsun Doa, Jaeeun Kimb, Jongeun Yimc
aDepartment of Physical Therapy, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Republic of Korea
bDepartment of Physical Therapy, Barosun Hospital, Seoul, Republic of Korea
cDepartment of Physical Therapy, College of Health Science and Social Welfare, Sahmyook University, Seoul, Republic of Korea
Objective:
The purpose of this study was to investigate the immediate effect of applying self-myofascial release (SMR) to the
plantar fascia using a foam roller on hamstring and lumbar spine superficial back line (SBL).
Design:
Randomized controlled trial.
Methods:
Thirty-one healthy adults agreed to the method and purpose of the study. Selection and exclusion criteria were
screened, and baseline measurements for the Toe Touch test and passive straight leg raise (PSLR) test were obtained. The partic-
ipants were then randomly assigned to the SMR group or the sham group. After group assignment, the SMR group rolled the sur-
face of the foot from the heel to the metatarsal head using a foam roller for 5 minutes. The sham group received passive mobi-
lization of the ankle joint in the supine position. Afterwards, the Toe Touch test and the passive straight leg-raise test were
re-assessed.
Results:
In the SMR group, the Toe Touch test results showed significant improvement (p<0.05). Left and right PSLR test results
showed a significant increase (p<0.05). In the sham group, there was no significant difference between pre and post-test results.
The SMR group showed a significant difference in the PSLR test and Toe Touch test compared to the sham group (p<0.05).
Conclusions:
The results of this study showed that SMR on the plantar fascia was immediately effective for improving the flexi-
bility of the SBL of the lumbar spine and hamstring.
Key W ords:
Plantar fascia, Range of motion, Self-myofascial release, Superficial back line
Introduction
Flexibility can be defined as the ability for muscle stretch
to enable movement of a joint as far as the range of motion,
which is an essential component of normal biomechanical
function [1]. A change in flexibility is necessary for all
movements because it can cause abnormal loads and result
in damage to the musculoskeletal system [2,3]. One of the
factors that cause damage to the lines of the musculoskeletal
system is insufficient flexibility [4,5].
The thin sheets of fascia and connective tissue fibers that
form a line can form a pathway, which is called the my-
ofascial meridians. Among them, the superficial back line
(SBL) is a plantar aponeurosis, achilles tendon and gastro-
cnemius, popliteus, hamstring, sacrotuberous ligament, sac-
rolumbar fascia, erector spinae, and galea aponeurotica/epi-
cranial fascia. The SBL functions as a single continuous line
with integrated muscle fascia. For example, plantar fasciitis
is associated with tachypnea tension, lumbar lordosis, and
resistance to superficial cervical spondylosis [6,7]. Because
Original Article
36
Phys Ther Rehabil Sci 7(1)
Figure 2. Position of the foam roller on the plantar fascia during
self-myofascial release.
Table 1. General characteristics (N=31)
Characteristic SMR group (n=15) Sham group (n=16)
Sex (male/female) 10/5 9/7
Height (cm) 170 (7.68) 168.4 (7.44)
Weight (kg) 65.73 (10.55) 60.18 (11.88)
Age (y) 30.53 (3.6) 23.93 (4.9)
Values are presented as number only or mean (SD).
SMR: self-myofascial release.
Figure 1. Micro foam roller (Ristroller, USA). The micro foa
m
roller is device designed for release the forearm and plantar fasci
a
with rolling motion. Small design of Foam rollers, commonly
known as fascia relaxation.
the hamstring and calf muscles are a connected continuity,
the reduced flexibility and stiffness of the hamstring may be
the cause of plantar fasciitis [8].
There are several methods for increasing the flexibility of
the fascia including the Rolfing, instrument-assisted fascial
release, connective tissue massage, myofascial trigger point
therapy, muscle energy techniques, and strain-counter strain
[9]. One of the most common manipulative techniques, the
myofascial release (MFR), helps to reduce fibrous adhesion
or limited membrane between fascial tissue layers [10]. The
self-myofascial release (SMR) has the same theory as the
MFR, which can be applied by self under the supervision of
a therapist [11]. It has been developed from the myofascial
release as a principle that stimulates the muscles, tendons,
and mechanoreceptors of the fascia and biomechanically
loads the soft tissues [12]. The Golgi tendon organ (GTO)
reflex arc model and other mechanoreceptors are the two
mechanisms for increasing fascia mobilization using SMR.
When the muscles are stretched, GTOs provide afferent
feedback to the spinal cord. As pressure increases in the fas-
cia by MFR or SMR, it stimulates GTOs, which reduces the
motor unit firing rate and consequently reduces muscle tone
[13]. The Ruffini and Pacinian corpuscles and the interstitial
muscle receptors are the mechanoreceptors that are also in-
volved in the neurophysiological mechanism for increasing
fascia mobilization using SMR [14]. As pressure increases,
the mechanical receptors stimulate the nervous system,
thereby reducing muscle tone [15].
In previous studies, many studies have been conducted to
improve flexibility using SMR [10,11,16-20]. Studies have
focused mainly on the muscles that are to be increased.
According to Anatomy Trains [7], there is a way to observe
the association of the SBL. Myers [7] advocates that the ef-
fect of SBL can be seen through a simple test of rolling a ten-
nis ball or golf ball on the plantar fascia. Relaxing the plantar
fascia has additional effects on the hamstring and lumbar
spine, which have the same myofascial train. This means
that when one part of the body is relaxed, it affects the other
connected fascia. However, this proposal has had some clin-
ical effects, and no evidence has been provided through for-
mal studies.
Therefore, the purpose of this study was to investigate the
immediate effect of applying SMR to the plantar fascia us-
ing foam roller on hamstring and lumbar spine.
Methods
Subjects
Thirty-one healthy adults agreed to the method and pur-
pose of the study. The selection criterion was defined as hav-
ing no problems in the back and lower back, pain, sensory
Do, et al: SMR of plantar fascia using foam roller and myofascial meridian
37
Figure 4. Passive straight leg raise.Figure 3. Toe Touch test.
abnormality, and other lower extremity and lumbar prob-
lems within the past 6 months. In addition, the Toe Touch
test excluded those who could reach the floor. The character-
istics of the study subjects are shown in Table 1.
This study was approved by the Institutional Review
Board of the Sahmyook University (IRB No. 2-1040781-
AB-N-01-2018009HR).
Procedure
The selection and exclusion criteria were screened, and
Toe Touch test and passive straight leg raise (PSLR) test
baseline were measured. The participants were then ran-
domly assigned to the experimental group (SMR) or control
group (Sham) and randomly used the online tool “Graph
Pad” (GraphPad Software, San Diego, CA, USA; http://
www.graphpad.com/quickcalcs/randomize1.cfm/). After gr-
oup assignment, the SMR group rolled the surface of the foot
from the heel to the metatarsal head for 5 minutes using a
foam roller (Figures 1, 2) [21]. Participants were instructed
to apply as much pressure as possible without pain [22].
Then, the Toe Touch test and the PSLR were re-measured.
The sham group received passive mobilization of the ankle
joint while being in a supine position. Passive movements
applied in a randomized order were supination, pronation,
abduction, adduction, flexion, and extension. Subjects were
given 5 minutes of mobilization [23].
Outcome measures
Toe Touch test
Subjects were asked to stand up straight on a 20-cm high
platform with feet together and no shoes. Then, the subjects
were instructed to bend down towards the platform as much
as possible while keeping the knees, arms, and fingers in full
extension. (Figure 3). The distance from the tip of the middle
finger and the platform was measured in centimeters with a
supple measuring tape. If the tip of the middle finger could
not reach the platform, the test was considered positive. If
the subject could reach past the platform, the test was con-
sidered negative. Both evaluators were experienced in
measuring the finger-to-floor distance. The intra-class cor-
relation coefficient (ICC) of the Toe Touch test was 0.99.
The Spearman’s correlation coefficient for trunk flexion as-
sessed by the test and the radiologic measure was 0.96
[24].
Passive straight leg raise
PSLR was conducted with the subject in supine position
on a medical bed. The examiner performed the PSLR by
keeping the knee in full extension and the ankle in neutral
position. Full ankle dorsiflexion was avoided to prevent calf
muscle stiffness or pain (gastrocnemius and soleus) from
confounding the sensation of hamstring stiffness and pain,
which would signal the limit of the PSLR test. The examiner
stabilized the talus in order to prevent any hip rotation during
hip flexion. The examiner lifted the subject's lower limb un-
til the subject began to complain of pain or stiffness in the
thigh region, perform knee flexion, or swing into a posterior
pelvic tilt position (noted as movement of the anterior supe-
rior iliac spine). Range of motion measurements for the
PSLR were taken using Clinometer (Plaincode, Stephan-
38
Phys Ther Rehabil Sci 7(1)
Table 2. Comparison of PSLR and Toe Touch test
b
etween
two groups (N=31)
Variable SMR group
(n=15)
Sham group
(n=16) t (p)
Left PSLR
Pre-test 45.6 (7.10) 51.43 (10.25) 1.83 (0.07)
Post-test 54.13 (8.12) 52.06 (10.20) 0.62 (0.53)
t (p)6.95 (<0.001) 0.59 (0.56)
Change value 8.53 (4.74) 0.62 (4.20) 4.91 (<0.001)
Right PSLR
Pre-test 45.27 (5.99) 49.93 (7.46) 1.91 (0.06)
Post-test 53.73 (8.87) 48.43 (8.64) 1.68 (0.10)
t (p)5.66 (<0.001) 1.66 (0.11)
Change value 8.46 (5.79) 1.50 (3.61) 5.78 (<0.001)
Toe Touc h te st
Pre-test 17.88 (6.98) 17.76 (9.59) 0.39 (0.96)
Post-test 13.22 (6.91) 16.28 (8.37) 1.10 (0.27)
t (p) 6.76 (<0.001) 2.11 (0.05)
Change value 4.66 (2.66) 1.47 (2.78) 3.24 (<0.001)
Values are presented as mean (SD).
PSLR: passive straight leg raise, SMR: self-myofascial release.
skirchen, Germany; http://www.plaincode.com/products/clin-
ometer/), which is a smart phone application that has pre-
viously been shown to be reliable at measuring range of mo-
tion of the shoulder. The intra-observer reliability of the
smartphone inclinometric and goniometric measurements
was ICC value >0.9 [25]. The upper part of the patella was
marked and the end of the smart phone was aligned (Figure
4).
Statistical analysis
Results were analyzed using the SPSS ver. 15.0 (SPSS
Inc., Chicago, IL, USA). For the general subject character-
istics, the descriptive statistics was conducted. To examine
the changes in PSLR and Toe Touch results before and after
intervention, the paired t-test was performed. To compare
the PSLR and Toe Touch test results between the SMR and
the Sham group, the independent t-test was performed. The
statistical significance was assumed to be α=0.05.
Results
This study selected 31 healthy adults who passed the se-
lection criteria. The general characteristics are shown (Table 1).
Before the experiment, there were no significant differ-
ences in PSLR and Toe Touch test results between the SMR
group and the Sham group (Table 2). In the SMR group, the
Toe Touch test results showed a significant improved, from
17.88 to 13.22 (p<0.05). Left PSLR significa ntly increased
from 45.6 to 54.13 (p<0.05). Right PSLR significantly in-
creased from 45.27 to 53.73 (p<0.05). In the Sham group,
there were no significant differences between pre and post
test. The SMR group showed a significant difference in
PSLR and Toe Touch test results compared to the Sham
group (p<0.05; Table 2).
Discussion
There is a hypothesis that an increase in muscle tension in
one part of the body causes excessive tension in other parts
of the body due to the continuity of the body. This continuity
of the fascia can cause stress on not only the muscles but all
the structures that are surrounded and supported by the fas-
cia [7]. Based on this hypothesis and anatomy, Myers [7]
supported the increase in the Toe Touch test when the plantar
fascia at the end of the SBL was released. However, some
clinical effects were claimed and there were no formal
studies. Therefore, the purpose of this study was to inves-
tigate the effect of performing SMR to the plantar fascia on
hamstring and lumbar spine flexibility.
The PSLR and Toe Touch results of the SMR group were
significantly increased after intervention (p<0.05) and also
showed a significant difference compared to the Sham
group. There was no significant difference in the Sham
group pre and post intervention. These results suggest that
the SMR of the plantar fascia was immediately effective for
the lumbar and hamstring flexibility. There have been many
studies on the effect of SMR on the range of motion and flex-
ibility [10,11,20,26]. However, previous research on in-
creasing flexibility has been limited to selected parts of the
body. There has been no research showing the effects of ap-
plying SMR to one part of the body may affect other parts of
the body. According to the Anatomy Trains [7], SMR ap-
plied to the plantar fascia is effective in increasing flexibility
anywhere along the SBL, but no evidence has been sug-
gested through formal studies. However, this study found
that the application of SMR using a foam roller to the plantar
fascia could support the concept of increased flexibility of
other body parts connected by myofascial meridians such as
hamstring and lumbar spine.
Although we did not use SMR, there are some studies that
have experimented with the concept of myofascial meri-
dians. An RCT investigated the effects of hamstring passive
stretching on the range of motion of the neck in healthy
Do, et al: SMR of plantar fascia using foam roller and myofascial meridian
39
adults. The range of motion of the cervical, which is the as-
cending part of SBL, increased after hamstring stretching
[27]. According to Spina [28], a patient with chronic ham-
string pain was relieved of pain and dysfunction by applying
an active release technique to the SBL, the lumbar spine, and
calf. Akhbari et al. [29] reported that a patient with chronic
plantar fasciitis was treated with dry needling on the
Achilles tendon, medial gastrocnemius, biceps femoris,
semimembranosus, and ischial tuberosity. After 4 treat-
ments over 2 weeks, the patient showed a 60% to 70% reduc-
tion in pain.
Many anatomical books have described the function of
muscles as separate from adjacent structures, excluding the
upper and lower connective muscles, nerves and blood
vessels. For example, it is simply defined that the distance
between the origin and the insertion point of a particular
muscle is close to the function of the muscle. Separate think-
ing of the muscles makes it difficult for current-generation
therapists to have different views on the function of muscles
and muscles [7]. This is similar to the view that clinicians
limit the treatment to the area of pain or discomfort. In the fu-
ture, it will be possible to get more effective treatments if
you use a mixture of extended concepts such as myofascial
meridian.
The limitation of this study is the lack of the number of ex-
perimental groups. Secondly, there is a lack of clinically rel-
evant thinking about the application to healthy adults. In the
future, it is hoped that further studies will be conducted to in-
vestigate the effects of the disease on pain and function.
The results of this study showed that SMR on the plantar
fascia was immediately effective for improving the flexi-
bility of the SBL of the lumbar spine and hamstring. These
results suggest that in order to increase flexibility, inter-
ventions should be made not only to the body part but also to
other parts of the body, taking into account the continuity of
the myofascial meridian.
Conflict of Interest
The authors declared no potential conflicts of interest
with respect to the authorship and/or publication of this
article.
References
1. Hopper D, Deacon S, Das S, Jain A, Riddell D, Hall T, et al.
Dynamic soft tissue mobilisation increases hamstring flexibility
in healthy male subjects. Br J Sports Med 2005;39:594-8; dis-
cussion 598.
2. Wilson A. Effective management of musculoskeletal injury: a
clinical ergonomics approach to prevention, treatment and
rehabilitation. Edinburgh: Elsevier Health Sciences; 2002.
3. Ylinen J. Stretching therapy for sport and manual therapies.
Edinburgh: Elsevier Health Sciences; 2008.
4. Davis DS, Ashby PE, McCale KL, McQuain JA, Wine JM. The
effectiveness of 3 stretching techniques on hamstring flexibility
using consistent stretching parameters. J Strength Cond Res
2005;19:27-32.
5. Decoster LC, Scanlon RL, Horn KD, Cleland J. Standing and su-
pine hamstring stretching are equally effective. J Athl Train
2004;39:330-4.
6. Schleip R, Findley TW, Chaitow L, Huijing P. Fascia: the ten-
sional network of the human body-e-book: the science and clin-
ical applications in manual and movement therapy. Churchill
Livingstone: Elsevier; 2013. p. 131.
7. Myers TW. Anatomy trains: myofascial meridians for manual
and movement therapists [E-book]. Churchill Livingstone:
Elsevier Health Sciences; 2013.
8. Bolívar YA, Munuera PV, Padillo JP. Relationship between tight-
ness of the posterior muscles of the lower limb and plantar
fasciitis. Foot Ankle Int 2013;34:42-8.
9. Simmonds N, Miller P, Gemmell H. A theoretical framework for
the role of fascia in manual therapy. J Bodyw Mov Ther 2012;16:
83-93.
10. MacDonald GZ, Penney MD, Mullaley ME, Cuconato AL,
Drake CD, Behm DG, et al. An acute bout of self-myofascial re-
lease increases range of motion without a subsequent decrease in
muscle activation or force. J Strength Cond Res 2013;27:812-21.
11. Sullivan KM, Silvey DB, Button DC, Behm DG. Roller-massag-
er application to the hamstrings increases sit-and-reach range of
motion within five to ten seconds without performance impair-
ments. Int J Sports Phys Ther 2013;8:228-36.
12. Remvig L, Ellis RM, Patijn J. Myofascial release: an evidence-
based treatment approach? Int Musculoskelet Med 2008;30:29-
35.
13. Tozzi P. Selected fascial aspects of osteopathic practice. J Bodyw
Mov Ther 2012;16:503-19.
14. Stecco C, Gagey O, Belloni A, Pozzuoli A, Porzionato A,
Macchi V, et al. Anatomy of the deep fascia of the upper limb.
Second part: study of innervation. Morphologie 2007;91:38-43.
15. Schleip R. Fascial plasticity-a new neurobiological explanation:
part 1. J Bodyw Mov Ther 2003;7:11-9.
16. Grieve R, Goodwin F, Alfaki M, Bourton AJ, Jeffries C, Scott H.
The immediate effect of bilateral self myofascial release on the
plantar surface of the feet on hamstring and lumbar spine flexi-
bility: a pilot randomised controlled trial. J Bodyw Mov Ther
2015;19:544-52.
17. Halperin I, Aboodarda SJ, Button DC, Andersen LL, Behm DG.
Roller massager improves range of motion of plantar flexor mus-
cles without subsequent decreases in force parameters. Int J
Sports Phys Ther 2014;9:92-102.
18. Mikesky AE, Bahamonde RE, Stanton K, Alvey T, Fitton T.
Acute effects of The Stick on strength, power, and flexibility. J
Strength Cond Res 2002;16:446-50.
19. Roylance DS, George JD, Hammer AM, Rencher N, Gellingham
40
Phys Ther Rehabil Sci 7(1)
GW, Hager RL, et al. Evaluating acute changes in joint
range-of-motion using self-myofascial release, postural align-
ment exercises, and static stretches. Int J Exerc Sci 2013;6:310-9.
20. Škarabot J, Beardsley C, Štirn 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:
203-12.
21. Yadav AO, Lakshmiprabha R. Comparison of the effects of ther-
apeutic ultrasound v/s myofascial release technique in treatment
of plantar fasciitis. Indian J Physiother Occup Ther Int J 2012;6:
13-6.
22. Curran PF, Fiore RD, Crisco JJ. A comparison of the pressure ex-
erted on soft tissue by 2 myofascial rollers. J Sport Rehabil
2008;17:432-42.
23. Castellote-Caballero Y, Valenza MC, Puentedura EJ, Fernández-
de-Las-Peñas C, Alburquerque-Sendín F. Immediate effects of
neurodynamic sliding versus muscle stretching on hamstring
flexibility in subjects with short hamstring syndrome. J Sports
Med (Hindawi Publ Corp) 2014;2014:127471.
24. Perret C, Poiraudeau S, Fermanian J, Colau MM, Benhamou
MA, Revel M. Validity, reliability, and responsiveness of the fin-
gertip-to-floor test. Arch Phys Med Rehabil 2001;82:1566-70.
25. Shin SH, Ro du H, Lee OS, Oh JH, Kim SH. Within-day reli-
ability of shoulder range of motion measurement with a
smartphone. Man Ther 2012;17:298-304.
26. Fairall RR, Cabell L, Boergers RJ, Battaglia F. Acute effects of
self-myofascial release and stretching in overhead athletes with
GIRD. J Bodyw Mov Ther 2017;21:648-52.
27. Hyong IH, Kang JH. The immediate effects of passive hamstring
stretching exercises on the cervical spine range of motion and
balance. J Phys Ther Sci 2013;25:113-6.
28. Spina A. Treatment of proximal hamstring pain using active re-
lease technique applied to the myofascial meridian: a case report
[Internet]. San Francisco (CA): SCRIBD, 2011 [cited 2018 Jan
17]. Available from: https://www.scribd.com/document/82089618/
Treatment-of-Proximal-Hamstring-Pain-Using-Active-Release-Te
chnique.
29. Akhbari B, Salavati M, Ezzati K, Mohammadi Rad S. The use of
dry needling and myofascial meridians in a case of plantar
fasciitis. J Chiropr Med 2014;13:43-8.
... PEDro score ranged from 4 to 8. None of the study had score less than 4. Good quality studies were 9 (Grieve et al., 2015;Joshi et al., 2018;Skarabot et al., 2015;Hanten and Chandler 1994;Stanek et al., 2018;Shetty et al., 2018;Cathcart 2019;Kimberly et al., 2018;Roylance et al., 2013) and fair quality were 7 (Do et al., 2018;Behara and Jacobson 2017;Junker et al., 2015;Colin et al., 2019;Kuruma et al., 2013;Hsuan et al., 2017;Smith 2018). Each study has mentioned proper eligibility criteria and they all did between group comparison analyses. ...
... Grieve et al. (2015) and Do et al. (2018) examined the effect of bilateral Self Myofascial Release Technique (SMR) on the plantar aspect of the feet, on hamstring and lumbar spine flexibility in 24 and 31 healthy subjects respectively. Both studies reported significant (p ¼ 0.03, p < 0.05) increase in flexibility of both regions in MFRT group compared to the control group. ...
... In the meta-analysis of five included studies (Grieve et al., 2015;Do et al., 2018;Joshi et al., 2018;Junker et al., 2015, Hsuan et al., 2017, the pooled mean before the experiment was found to be 25.02 (95% CI: 16.54, 33.50)]. Heterogeneity was found to be low among the included studies (p ¼ 0.65, I 2 ¼ 0%). ...
... The latter has been already investigated along the SBL. For example, studies showed that a single foam rolling application on the plantar surface led to an acute increase in range of motion of the dorsal thigh and lower back (Grieve et al., 2015;Kwangsun et al., 2018). This implies that fascial chains might be able to modify their properties or functional capacities in non-adjacent areas along their course . ...
... The ten minute intervention was performed on the dominant leg only and consisted of self-and therapeutic SMM techniques. All techniques were supervised or conducted by a physical therapist following protocols described in prior studies (Ajimsha et al., 2014;Alotaibi et al., 2020;Grieve et al., 2015;Kwangsun et al., 2018;Stecco et al., 2016;Thong-On et al., 2019). The non-dominant leg received no intervention. ...
... They were allowed to hold on to a wall and were instructed to adapt the intensity of pressure to their subjective tolerance level. Further, they were encouraged to continue foam rolling for the total of four minutes, but were additionally allowed to take short breaks if needed (Grieve et al., 2015;Kwangsun et al., 2018). This was followed by a plantar fascia specific stretch where subjects crossed the dominant leg over the other in a sitting position and stabilized the heel with their hand. ...
Article
Full-text available
Prior studies have shown that self- and manual massage (SMM) increases flexibility in non-adjacent body areas. It is unclear whether this also influences performance in terms of force generation. Therefore, this study investigated the effect of SMM on the plantar surface on performance in the dorsal kinetic chain. Seventeen young participants took part in this within-subject non-randomized controlled study. SMM was applied on the plantar surface of the dominant leg, but not on the non-dominant leg. A functional performance test of the dorsal kinetic chain, the Bunkie Test, was conducted before and after the intervention. We measured the performance in seconds for the so-called posterior power line (PPL) and the posterior stabilizing line (PSL). The performance of the dominant leg in the Bunkie Test decreased significantly by 17.2% from (mean ± SD) 33.1 ± 9.9 s to 27.4 ± 11.1 s for the PPL and by 16.3% from 27.6 ± 9.8 s to 23.1 ± 11.7 s for the PSL. This is in contrast to the non-dominant leg where performance increased significantly by 5.1% from 29.7 ± 9.6 s to 31.1 ± 8.9 s for the PPL and by 3.1% from 25.7 ± 1.5 s to 26.5 ± 1.7 s for the PSL. SMM interventions on the plantar surface might influence the performance in the dorsal kinetic chain.
... Biotensegrity concept has been studied on the myofascial continuity of the plantar fascia, calf, hamstring and paraspinals, known as the superficial back line [43] , with therapeutic based evidence regarding the practical application of Biotensegrity was established, when myofascial release (MFR) was performed on the plantar fascia, an immediate increase of lumbar and hip range of motion was achieved [45] , while shortening of calf and hamstring was proven to be associated with plantar fasciitis [46][47][48] . Treatments based on the SBL myofascial continuities was advocated by Myers, and proven effective by research, as stretching of elements of the SBL; the calf and hamstring is determined as an effective treatment for plantar fasciitis [49][50][51] , surgical release of Proximal Medial Gastrocnemius was effective too [52,53] . ...
Article
Full-text available
Background: Knee osteoarthritis is a common orthopedic condition. Imaging based pathoanatomical findings are utilized as a cornerstone for diagnosis of the condition, 97% of asymptomatic knees demonstrate pathoanatomical findings, causing doubt of diagnosis and efficiency of intervention based on asymptomatically present pathoanatomical features. Purpose: This study explores myofascial dysfunctions as an alternative explanation to knee pain. Identifying new syndromes termed as knee myofascial pain and knee-abdomen syndromes. Therapeutic intervention: Describing 3 cases of knee osteoarthritis and one case of rheumatoid arthritis treated to full recovery as myofascial dysfunction. All of these cases were investigated and treated to complete recovery from specific myofascial continuity known as deep front line dysfunction, as a cause of knee pain. Results: Both syndromes demonstrated 50% to 100% pain reduction after one session of myofascial release, with no recurrence over long-term follow-up after discharge. Conclusion: Knee myofascial pain and knee-abdomen syndromes are clinically present commonly misdiagnosed as arthritic changes. Myofascial release produced an immediate major pain reduction ranging from 50 to 100%. High quality research is required to identify more accurate diagnostic criteria and consequently best treatment strategies.
... The effects were greater especially when the foam roller was applied for relatively short times. This implication is not new and the results are similar to those observed by Grieve et al., when self-massage of the plantar fascia with a ball was performed for 5 min [43], or to the results described by Do et al. with self-massage for 5 min [44]. Joshi et al. obtained comparable results to ours when treatment was applied by a therapist over various sessions; they also found better results when the SMR was self-applied [42]. ...
Article
Full-text available
Background: The hamstring muscles are described as forming part of myofascial chains or meridians, and the superficial back line (SBL) is one such chain. Good hamstring flexibility is fundamental to sporting performance and is associated with prevention of injuries of these muscles. The aim of this study was to measure the effect of self-myofascial release (SMR) on hamstring flexibility and determine which segment of the SBL resulted in the greatest increase in flexibility. Methods: 94 volunteers were randomly assigned to a control group or to one of the five intervention groups. In the intervention groups, SMR was applied to one of the five segments of the SBL (plantar fascia, posterior part of the sural fascia, posterior part of the crural fascia, lumbar fascia or epicranial aponeurosis) for 10 min. The analyzed variables were hamstring flexibility at 30 s, 2, 5, and 10 min, and dorsiflexion range of motion before and after the intervention. Results: Hamstring flexibility and ankle dorsiflexion improved when SMR was performed on any of the SBL segments. The segments with the greatest effect were the posterior part of the sural fascia when the intervention was brief (30 s to 2 min) or the posterior part of the crural fascia when the intervention was longer (5 or 10 min). In general, 50% of the flexibility gain was obtained during the first 2 min of SMR. Conclusions: The SBL may be considered a functional structure, and SMR to any of the segments can improve hamstring flexibility and ankle dorsiflexion.
... The results of this study showed that self-myofascial release on the plantar fascia was immediately effective for improving the flexibility of the superficial backline of the lumbar spine and hamstring, thus the whole body is connected. 6 Study conducted by Pawar et al concluded that the lumbar lordosis angle and the pelvic inclination angle in bharatnatyam dancers is more than the nondancers which could affect the flexibility of backline. 7 Another study by Schleip et al concluded that active cellular contractility of fascial tissues may be able to impact musculoskeletal dynamics. ...
Article
Full-text available
Background: Bharatnatyam is an Indian classical dance form which have been practiced for a long period of time and is equivalent to any sporting activity. The postures attained during this dance form require good amount of muscle strength and flexibility among the dancers. There is lack of research on flexibility of backline and lower limb strength in bharatnatyam dancers. The overall function of the superficial backline is to support the body in full upright extension and impacts musculoskeletal dynamics. The lumbar lordosis angle and the pelvic inclination angle in bharatnatyam dancers is more than the non-dancers which can affect the backline flexibility. This study analysed if there is any difference, in the lower limb strength and flexibility of backline as compared to participants of same age group.Methods: 10 bharatnatyam dancers and 10 non-dancers between 15 to 30 years participated in this study. Triple hop distance test for both sides and toe touch test was used to check the strength of lower limb and flexibility of backline respectively.Results: There was significant difference in the triple hop distance of right lower limb between bharatnataym dancers and non-dancers. There was no significant difference in the triple hop distance of left lower limb between the two groups. There was not quite significant difference in the toe touch test of between the two groups.Conclusions: There was significant difference in the strength and power of right lower limb of dancers as compared to right lower limb of non-dancers. There was no statistical difference in the left lower limb of both the groups. There was no statistical difference between the flexibility of backline of bharatnatyam dancers and non-dancers.
... It produces a feeling of tissue release within 2 minutes. It involves applying gentle sustained pressure into the restrictive layers 8,9 of connective tissue. It stimulates the Golgi tendon organs and reduces the motor unit ring rate. ...
Article
Aim of study: The aim of the study was to compare the immediate effect on application of remote self- myofascial release on posterior chain exibility in asymptomatic young individuals. Material and Method: 44 subjects were assigned into two groups, Group (A) Plantar fascia release and Group (B) Suboccipital release. Outcomes measures used were Sit and reach test (SRT), Active knee extension test (AKE) and Weight bearing lunge test. Result: There was a signicant difference in SRT and AKE on left side between group A and B. Within the same group there was a signicant improvement in outcome measures post intervention. Conclusion: There was an immediate increase in exibility of the hamstrings, gastrocnemius-soleus muscles and lumbar spine ROM through remote self- myofascial release.
Article
Objective Our review is aimed to find out the efficacy of Myofascial Release Technique (MFRT) based on the Randomised Controlled Trials, on flexibility when given along Superficial back line (SBL) structures and to compare it with other soft tissue release techniques. Data Sources A systematic literature search on MEDLINE (Pubmed), Google Scholar, Science direct, Cochrane Library, Physiotherapy Evidence Database (PEDro) and Clinical Trial Database in English; up to April 2020 was undertaken. Study selection PRISMA (The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) was used for screening the relevant citations and reviewing the relevant studies. The literature searched total of 6,938 articles, however, only 68 were screened for eligibility. In the further screening, 16 studies fulfilled the inclusion criteria for our systematic review. Data Extraction Data was extracted into a table containing sample size, mean age of subjects, types of intervention, area to be treated, outcome measures used and results of the accepted studies. Data Synthesis 16 Randomized controlled trials and cross-over trials were found to be eligible for our review. Quality assessment of the RCTs was done with the PEDro scoring method. Randomised clinical trials that studied the comparative effect of Myofascial Release (MFRT) technique with different MFRT techniques, control/sham, and other soft tissue release techniques like stretching, were included. Results of this study showed little evidence proving the effectiveness of MFRT treatment compared to other soft tissue release techniques for improving flexibility so as to consider it as the preferred treatment. Methodological aspects of selected studies for further research are suggested. Study was registered in the PROSPERO database (CRD42020179118). Conclusion MFRT is a good technique for improving flexibility but when we talk about comparison with other soft tissue release techniques, then this therapy becomes little weak. More research are supposed to be done to give strong evidence regarding its effectiveness.
Article
Background: Plantar fasciitis (PF) can disturb individual’s weight-bearing activities. Hence, conservative treatments with immediate effect in reducing pain and improving foot function is required. Objective: This study compared the effect of kinesiotaping and stretching exercise in individuals with PF. Methods: Thirty patients with PF were randomly divided into three groups, and received kinesiotaping, stretching exercise, and a combination of the two aforementioned interventions. Pain intensity and foot disability were measured at baseline, immediately after the first treatment, and at one week. Results: Immediately after the first treatment, all groups showed significant changes in heel pain intensity (p ≤ .012) with the standardized response mean (SRM) of 2.85, 1.96, and 1.43 for the taping, stretching, and the combination groups, respectively. Nevertheless, no significant change in foot disability was found (p > .05). At the one week, all groups continued to demonstrate significant reduction in heel pain (p ≤ .012) with the SRM of 1.78, 2.84, and 2.09 for the taping, stretching, and the combination groups, respectively. While the combination group showed significant reduction in foot disability (p = .024). However, there was no significant difference of the change score in all parameters among the three groups (p > .05). Conclusion: Improvement in heel pain was observed in all groups after the first treatment. However, improvement in foot function over one week was observed only among those who received the combined treatment. Further studies on larger samples are required to establish the superiority of the combined treatment over kinesiotaping or stretching alone.
Book
Full-text available
This textbook contains valuable information for physiotherapists, masseurs, physical education instructors and teachers, trainers, coaches, medical doctors, osteopaths, sportsmen and all those who use stretching in their work. Stretching has an important part to play in the care of soft tissues after strain at work or in sport. It is used to promote recovery of the tendo-muscular system after exercise, post acute trauma, to treat overstrained muscles and for relaxation. This practical resource examines the research, theory, and practice associated with stretching therapy. Anatomical illustrations and clear descriptions make it easy to learn which muscles are affected by specific treatment techniques. Full-color photographs show correct positioning of the patient and the therapist, with explanations of each movement on the same page or two-page spread. Comprehensive information on stretching provides essential knowledge for sports therapy or other manual therapy practice. Easy-to-access format presents each topic on a single page or page spread. Full-color photographs illustrate the correct position of the patient. Two-color anatomical illustrations show the position of the muscle involved in each technique. Within physiotherapy, manual stretching is used to remove muscle tension or spasticity and to restore normal stretchability of soft tissues and stretching techniques are commonly used within all manual therapies to treat the tendo-musular system. This book contains a review of research into the effects of stretching and comparisons of different stretching techniques. The theoretical background and physiologic mechanisms are also explained. Colour photographs show clearly how stretching is applied while anatomical drawings illustrate the location and direction of the muscles treated so that correct hand positions can be readily adopted and the direction of the stretch is clear. Both static and tension-relaxation stretching techniques are described and special attention is given to possible complications and contraindications. 286 pages. Over 160 colour photographs and over 200 drawings. Churchill Livingstone, Elsevier, 1st ed. 2007 Medirehabook Inc. 2nd revised ed. 2013
Article
Full-text available
Compiled by experts of international renown, Fascia: The Tensional Network of the Human Body brings together very different contributors who share the desire to bridge the gap between theory and practice as much as possible in our current knowledge of the human fascia. With contributions from over 100 specialists and researchers from throughout the world, this new volume will be ideal for all professionals who have an interest in fascia and human movement - physiotherapists, osteopathic physicians and osteopaths, chiropractors, structural integration practitioners, manual therapists, massage therapists, acupuncturists, yoga or Pilates instructors, exercise scientists and personal trainers - as well as physicians involved with musculoskeletal medicine, pain management and rehabilitation, and basic scientists working in the field.
Article
Full-text available
Increased flexibility is often desirable immediately prior to sports performance. Static stretching (SS) has historically been the main method for increasing joint range-of-motion (ROM) acutely. However, SS is associated with acute reductions in performance. Foam rolling (FR) is a form of self-myofascial release (SMR) that also increases joint ROM acutely but does not seem to reduce force production. However, FR has never previously been studied in resistance-trained athletes, in adolescents, or in individuals accustomed to SMR. To compare the effects of SS and FR and a combination of both (FR+SS) of the plantarflexors on passive ankle dorsiflexion ROM in resistance-trained, adolescent athletes with at least six months of FR experience. Eleven resistance-trained, adolescent athletes with at least six months of both resistance-training and FR experience were tested on three separate occasions in a randomized cross-over design. The subjects were assessed for passive ankle dorsiflexion ROM after a period of passive rest pre-intervention, immediately post-intervention and after 10, 15, and 20 minutes of passive rest. Following the pre-intervention test, the subjects randomly performed either SS, FR or FR+SS. SS and FR each comprised 3 sets of 30 seconds of the intervention with 10 seconds of inter-set rest. FR+SS comprised the protocol from the FR condition followed by the protocol from the SS condition in sequence. A significant effect of time was found for SS, FR and FR+SS. Post hoc testing revealed increases in ROM between baseline and post-intervention by 6.2% for SS (p < 0.05) and 9.1% for FR+SS (p < 0.05) but not for FR alone. Post hoc testing did not reveal any other significant differences between baseline and any other time point for any condition. A significant effect of condition was observed immediately post-intervention. Post hoc testing revealed that FR+SS was superior to FR (p < 0.05) for increasing ROM. FR, SS and FR+SS all lead to acute increases in flexibility and FR+SS appears to have an additive effect in comparison with FR alone. All three interventions (FR, SS and FR+SS) have time courses that lasted less than 10 minutes. 2c.
Article
Full-text available
Limited dorsiflexion range of motion (ROM) has been linked to lower limb injuries. Improving limited ankle ROM may decrease injury rates. Static stretching (SS) is ubiquitously used to improve ROM but can lead to decreases in force and power if performed prior to the activity. Thus, alternatives to improve ROM without performance decrements are needed. To compare the effects of SS and self massage (SM) with a roller massage of the calf muscles on ankle ROM, maximal voluntary contraction (MVC) force F100 (force produced in the first 100 ms of the MVC), electromyography (EMG of soleus and tibialis anterior) characteristics of the plantar flexors, and a single limb balance test. Fourteen recreationally trained subjects were tested on two separate occasions in a randomized cross-over design. After a warm up, subjects were assessed for passive dorsiflexion ROM, MVC, and a single-limb balance test with eyes closed. The same three measurements were repeated after 10 minutes (min) of rest and prior to the interventions. Following the pre-test, participants randomly performed either SS or SM for 3 sets of 30 seconds (s) with 10s of rest between each set. At one and 10 min post-interventions the participants repeated the three measurements, for a third and fourth cycle of testing. Roller massage increased and SS decreased maximal force output during the post-test measurements, with a significant difference occurring between the two interventions at 10 min post-test (p < 0.05, ES = 1.23, 8.2% difference). Both roller massage (p < 0.05, ES = 0.26, ~4%) and SS (p < 0.05, ES = 0.27, ~5.2%) increased ROM immediately and 10 min after the interventions. No significant effects were found for balance or EMG measures. Both interventions improved ankle ROM, but only the self-massage with a roller massager led to small improvements in MVC force relative to SS at 10 min post-intervention. These results highlight the effectiveness of a roller massager relative to SS. These results could affect the type of warm-up prior to activities that depend on high force and sufficient ankle ROM. 2c.
Article
Full-text available
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
Objective: To examine the acute effects of self-myofascial release (SMR), static stretching (SS), and the combination of self-myofascial release and static stretching (SMR + SS) on glenohumeral internal rotation range of motion (GH IR ROM) in overhead athletes with glenohumeral internal rotation deficit (GIRD). Participants: Twelve asymptomatic adult male amateur softball position players exhibiting GIRD. Results: All three methods significantly improved GH IR ROM. Post hoc testing revealed that SS alone and SMR + SS improved GH IR ROM significantly more than SMR alone. However, there were no significant differences in GH IR ROM between SS alone and SMR + SS. Conclusions: If an athlete has a limited time to perform a warm-up (e.g., 3-4 min), SS alone is recommended to improve GH IR ROM. However, if the athlete has more time available to warm up (e.g., 7-8 min), combining SMR + SS may result in a greater increase in GH IR ROM.
Article
[Purpose] The purpose of the present study was to examine the immediate effects of passive hamstring stretching exercises on cervical spine range of motion and balance. [Subjects] The present study was conducted with 60 healthy university students without any musculoskeletal dysfunction as subjects. They were divided into an experimental group consisting of 30 subjects and a control group consisting of 30 subjects. [Methods] Cervical spine range of motion was measured using a cervical range of motion goniometer, and the stability test was conducted to assess balance. The experimental group were administered hamstring stretching with ankle dorsiflexion for 30 seconds three times, whereas the control group received the same treatment without ankle dorsiflexion. [Results] Cervical spine range of motion and balance immediately increased in the experimental group while there was no change in the control group. [Conclusion] The results show that hamstring muscle stretching exercises the fascia of the skeletal muscles of the human body and that the fascia are connected to each other by interactions of force. The human skeletal muscles interacted with each other to increase the flexion and extension range of motion of the cervical spine. In addition, the transfer of these forces to the stabilizer muscles of the pelvis and spine were the most important factor in the improvement of the subjects' balance.
Article
The purpose of this case report is to describe the use of dry needling based on myofascial meridians for management of plantar fasciitis. A 53-year-old man presented with bilateral chronic foot pain for more than 2 years. After 2 months of conventional treatment (ultrasound, plantar fascia and Achilles tendon stretching, and intrinsic foot strengthening), symptoms eventually improved; however, symptoms returned after prolonged standing or walking. Almost all previous treatment methods were localized in the site of pain that targeted only the plantar fascia. Initial examination of this individual revealed that multiple tender points were found along the insertion of Achilles tendon, medial gastrocnemius, biceps femoris, semimembranosus, and ischial tuberosity. Dry needling of the trigger points was applied. After 4 treatments over 2 weeks, the patient felt a 60% to 70% reduction in pain. His pressure pain threshold was increased, and pain was alleviated. The patient returned to full daily activities. The rapid relief of this patient's pain after 2 weeks of dry needling to additional locations along the superficial back line suggests that a more global view on management was beneficial to this patient. Dry needling based on myofascial meridians improved the symptoms for a patient with recurrent plantar fasciitis.
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.