ArticlePDF Available

Myofascial Tissue and Depression

Authors:

Abstract and Figures

Background The myofascial system plays a fundamental role in the mechanics of the body, in body tension regulation and the etiology of pathological states like chronic pain. Moreover, it contains contractile elements and preliminary evidence suggests that its properties are linked to psychological factors. The aim of the present research was to investigate characteristics of the myofascial tissue in patients with Major Depressive Disorder (MDD) and to examine whether the state of the myofascial tissue causally affects pathopsychological processes in MDD. Methods In Study 1, stiffness and elasticity of the myofascial tissue of 40 inpatients suffering from MDD measured with a tissue compliance meter were compared with those of 40 matched never-depressed participants. In Study 2, 69 MDD patients were randomly assigned to single-session self-myofascial release intervention (SMRI) or a placebo intervention. Effects on memory bias and affect were investigated. Results Results showed that MDD patients displayed heightened stiffness and reduced elasticity of the myofascial tissue and that patients in the SMRI group showed a reduced negative memory bias and more positive affect compared to patients in the placebo condition. Conclusions The preliminary results of our studies indicate that the myofascial tissue might be part of a dysfunctional body-mind dynamic that maintains MDD.
Content may be subject to copyright.
Vol:.(1234567890)
Cognitive Therapy and Research (2022) 46:560–572
https://doi.org/10.1007/s10608-021-10282-w
1 3
ORIGINAL ARTICLE
Myofascial Tissue andDepression
JohannesMichalak1 · LanreAranmolate1· AntoniaBonn1· KarenGrandin1· RobertSchleip2,3·
JaquelineSchmiedtke1· SvenjaQuassowsky1· TobiasTeismann4
Accepted: 25 November 2021 / Published online: 21 December 2021
© The Author(s) 2021
Abstract
Background The myofascial system plays a fundamental role in the mechanics of the body, in body tension regulation and
the etiology of pathological states like chronic pain. Moreover, it contains contractile elements and preliminary evidence
suggests that its properties are linked to psychological factors. The aim of the present research was to investigate character-
istics of the myofascial tissue in patients with Major Depressive Disorder (MDD) and to examine whether the state of the
myofascial tissue causally affects pathopsychological processes in MDD.
Methods In Study 1, stiffness and elasticity of the myofascial tissue of 40 inpatients suffering from MDD measured with a
tissue compliance meter were compared with those of 40 matched never-depressed participants. In Study 2, 69 MDD patients
were randomly assigned to single-session self-myofascial release intervention (SMRI) or a placebo intervention. Effects on
memory bias and affect were investigated.
Results Results showed that MDD patients displayed heightened stiffness and reduced elasticity of the myofascial tissue
and that patients in the SMRI group showed a reduced negative memory bias and more positive affect compared to patients
in the placebo condition.
Conclusions The preliminary results of our studies indicate that the myofascial tissue might be part of a dysfunctional body-
mind dynamic that maintains MDD.
Keywords Embodiment· Depression· Myofascial tissue· Memory bias
Introduction
Major depression disorder (MDD) is associated with signifi-
cant suffering and impairment for the depressed individu-
als and their families. Moreover, MDD leads to substantial
social costs (König etal., 2020). Given the high prevalence
and its often recurring and chronic course it is important
to develop comprehensive models of factors affecting the
vulnerability and course of MDD. Up to now, psychologi-
cal models of MDD have particularly focused on cognitive
(e.g., rumination, negative cognitive style) and interpersonal
factors (e.g., conflicts, diminished social support) (Hankin
etal., 2018).
In addition to the well documented cognitive and inter-
personal factors, some recent studies have examined the
possible role of bodily processes as an etiology factor in
MDD. These studies were inspired by accumulating evi-
dence from basic research that motor displays affect emo-
tional processes. This close interplay between motoric and
emotional processes was, for example, documented in a
recent meta-analysis including over 70 studies on experi-
mental manipulations of motor displays in non-clinical par-
ticipants (Elkjær etal., 2020). In these studies, participants
were made to adopt for example an upright or slumped pos-
ture or to walk in a depressed or non-depressed style. The
results of this meta-analysis have shown robust differences
* Johannes Michalak
johannes.michalak@uni-wh.de
1 Department ofPsychology andPsychotherapy, Witten/
Herdecke University, Alfred-Herrhausen-Straße 50,
58448Witten, Germany
2 Department forConservative andRehabilitative Orthopedics,
Technical University Munich, Georg-Brauchle-Ring 60/62,
80992München, Germany
3 Department forMedical Professions, DIPLOMA
University ofApplied Sciences, Am Hegeberg 2,
37242BadSooden-Allendorf, Germany
4 Department ofClinical Psychology andPsychotherapy,
Ruhr-Universität Bochum, Massenbergstraße 9,
44787Bochum, Germany
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
561Cognitive Therapy and Research (2022) 46:560–572
1 3
between contractive displays (e.g., slumped posture, sad gait
pattern) and expansive displays (e.g., upright posture) for
affective responses (e.g., power feeling and mood) and overt
behavioral responses (e.g., risk taking) across different con-
texts, types of manipulation, and methods of measurement.
Moreover, analyses of a subset of studies including a condi-
tion with neutral motor display indicate that the effects are
driven by the absence of contractive motor displays rather
than the presence of expansive displays.
Studies investigating the role of the motoric system
in MDD have shown that depression is associated with a
slumped posture, especially greater anterior head inclination
and thoracic kyphosis (e.g., Canales etal., 2010; Wilkes
etal., 2017) and gait pattern alternations (e.g., Michalak
etal., 2009). Moreover, first experimental studies have docu-
mented that changing motor displays have causal effects on
depression-related processes. Two studies have investigated
the effects of short motor manipulations on memory bias in
MDD. A biased memory is characterized by the tendency
of depressed individuals to recall more negative than posi-
tive information in memory task. Non-depressed individuals
show a bias in the positive direction, they tend to recall more
positive than negative information. A negative memory bias
is one of the most robust findings on cognitive processes in
MDD (Gotlib & Joormann, 2010) and empirical studies have
shown that a biased memory predicts the course of depres-
sion symptoms (Beeney & Arnett, 2008).
Michalak etal. (2014) showed that changing the sitting
posture of inpatients suffering from MDD had effects on this
biased recall of negative information. In this experiment par-
ticipants sat either in a slumped (depressed) or in an upright
(non-depressed) posture while imagining a visual scene of
themselves in connection with the presentation of positive or
depression-related words. After a distractor task an inciden-
tal recall test of these words was conducted. Patients sitting
in an upright position showed an unbiased recall of positive
and negative words while patients sitting in a slumped posi-
tion showed the biased recall of negative words typical for
depressed individuals.
Effects of motor manipulations on memory bias were also
investigated in a study by Michalak etal. (2018). Patients
suffering from MDD practiced either an upward-opening Qi
Gong movement, which runs counter to the habitual slumped
and downward depressive movement style, or a downward-
closing Qi Gong movement. Again, an incidental recall of
the cue words was conducted. Results showed that patients
in the upward-opening movement condition in contrast to
the downward-closing movement condition showed a more
positively biased recall of affective words (i.e., they recalled
more positive than negative words). Moreover, in this study
effects of movements on overgeneral autobiographical
memories were investigated. When depressed individuals
are asked to remember events that refer to a particular time
and place they often respond with overgeneral memories,
referring to a whole class of events, or with references to
semantically related content that does not include any auto-
biographical memory. An overgeneral memory is a stable
cognitive characteristic of depressed individuals (see Wil-
liams etal., 2007 for a review). In the study of Michalak
etal. (2018) patients in the upward-opening movement
condition, in addition to a more positively biased memory,
showed a reduced tendency to report overgeneral autobio-
graphical memories.
The findings of these studies show that, comparable to
the broad evidence base for the impact of manipulations of
motor displays on emotional processes in non-clinical sam-
ples (Elkjær etal., 2020), motoric manipulations can also
affect emotional processes in depressed individuals. Cor-
respondingly, they support theoretical accounts that stress
the relevance of the body in depression. Specifically, the
Interacting Cognitive Subsystems approach (Teasdale &
Barnard, 1993) proposes that proprioceptive and kinesthetic
input from the body makes a direct and important contribu-
tion to emotional information processing in MDD. Accord-
ing to this theory, a depressive interlock configuration of
bodily and cognitive feedback loops can become established
that ‘locks’ subsystems into a self-perpetuating configura-
tion that maintains depression. Self-perpetuating means that
depressive cognitions lead to negative body displays (e.g.,
slumped posture, sad gait pattern) and in turn the negative
body displays increase the tendency to think in a negative
and depressive way, which leads to a vicious circle deepen-
ing the depressive states.
However, studies in basic as well as clinical research to
date have only investigated the effects of short manipulations
of motor displays. In our present research we investigated
an important bodily system that plays a fundamental role
in the mechanics of the body, in body tension regulation
and the etiology of pathological states like chronic pain—
the myofascial system. It builds a three-dimensional con-
tinuum of soft, loose and dense fibrous connective tissue
containing collagen that permeates the body and enables
all body systems to operate in an integrated manner. Clas-
sically it was proposed that the fascia tissue has merely a
passive role in force transmission within the body. However,
more recent research has shown that fascial tissue contains
contractile elements enabling it to play a modulating role
in force generation and also mechanosensory fine-tuning
(Schleip & Klingler, 2019). Fascial stiffness and elasticity
can be regulated within different time frames ranging from
minutes to days and months. It is influenced by biochemical
as well as biomechanical processes. The contractile activity
of the fascial cells is biochemically influenced by the expres-
sion of various cytokines within the non-fibrous component
of the extracellular matrix, also referred to as ground sub-
stance. For one of the cytokines involved in the transmission,
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
562 Cognitive Therapy and Research (2022) 46:560–572
1 3
TGF-β1, a clear influence of the autonomous nervous sys-
tem on its activity has been documented (Bhowmick etal.,
2009; Liao etal., 2014). Stress-related dysregulations of the
autonomous nervous system (Alvares etal., 2016) and dys-
functions of the immune system, including elevated TGF-β1
levels (Davami etal., 2016; Lee & Kim, 2010), are features
of MDD. Therefore, we expect that by these dysfunctions of
the autonomous nervous and the immune system in individu-
als with MDD (e.g., elevated TGF-β1 levels with effects on
contractile activity of the fascial cells)‚ characteristics of
the myofascial tissue like heightened stiffness and reduced
elasticity should result in individuals with MDD.
Moreover, in addition to this biochemical pathway we
postulate a biomechanical pathway resulting in dysfunc-
tional characteristics of the myofascial tissue in MDD.
Individuals suffering from MDD often show greater ante-
rior head inclination and thoracic kyphosis (Canales etal.,
2010) and a slumped posture (Adolph etal, 2021; Michalak
etal., 2009). In congruence with the well described flexion-
relaxation phenomenon such postural changes tend to be
associated with an enhanced mechanical loading of passive
connective tissues on the posterior side of the trunk (Colloca
& Hinrichs, 2005). Based on this mechanism, we expect that
individuals suffering from MDD should show heightened
stiffness and reduced elasticity of the myofascial tissue in
the neck and upper back region. Moreover, since tightening
the posterior neck and upper back has been described as
a protective biological response to danger/stress (Bullock,
1984), the chronic stress associated with MDD might lead
to a heightened stiffness and reduced elasticity especially in
these regions of the body. To test the postulated dysfunc-
tional characteristics of the myofascial tissue in MDD, in
Study 1 we compared stiffness and elasticity of the myofas-
cial tissue in the neck and upper back region of patients suf-
fering from MDD with non-depressed control participants.
Moreover, we assumed that heightened stiffness and
decreased elasticity of the myofascial tissue in the neck
and upper back region might be part of depressive interlock
configuration as the Interacting Cognitive Subsystem frame-
work (Teasdale & Barnard, 1993) postulates. If heightened
stiffness and decreased elasticity of the myofascial tissue
becomes chronic it might be part of the proprioceptive input
from the body that constantly makes negative and depres-
sogenic cognitive and emotional process more accessible
and therefore contributes to the dynamics of establishing
self-perpetuating body-mind configurations that maintain
depression. Therefore, in Study 2 we were interested in
the possible causal contribution of the myofascial tissue to
depressive processes and investigated the effects of a single-
session self-myofascial release intervention on affect and
negative memory bias in patients suffering from MDD.
Negative affect and the biased recall of negative informa-
tion are both key maintaining factors in cognitive models of
MDD (e.g., Gotlib & Joormann, 2010; Rehm & Naus, 1990)
and empirical studies have shown that negative emotionality
(Wilson etal., 2014) and biased memory predict the course
of depression symptoms (Beeney & Arnett, 2008; LeMoult
etal., 2017; LeMoult etal., 2017; Rude etal., 2002).
Study 1
Methods
Participants
Participants were 40 psychiatric inpatients and 40 never-
depressed control participants matched for age, sex and
body-mass-index (BMI). The inpatients were recruited
from two adult psychiatric units. Depressed patients were
included in the study if they met the criteria of the Diagnos-
tic and Statistical Manual of Mental Disorder (4th TR edi-
tion; DSM-IV-TR; American Psychiatric Association, 2000)
for a primary diagnosis of current MDD and had a score of
14 or more on the Beck Depression Inventory. Exclusion cri-
teria were as follows: psychotic disorders, bipolar disorders,
current substance-related disorders, diseases of the muscu-
loskeletal system and back pain. Diagnoses were derived
by trained raters with the German version of the Structured
Clinical Interview for DSM-IV (Wittchen etal., 1997).
The control participants were recruited by means of pub-
lic notices. They were included in the control group if they
had no current or lifetime MDD diagnosis. Exclusion criteria
were derived with the SCID. Moreover, participants with
diseases of the musculoskeletal system or back pain were
excluded.
In both groups 25 participants were female and 15 male.
All participants lived in Germany. The groups did not dif-
fer significantly in age (depressed patients: M = 35.15,
SD = 12.43, never-depressed: M = 31.50, SD = 10.53) or BMI
(depressed patients: M = 24.31, SD = 3.07, never-depressed:
M = 23.35, SD = 3.01) (all ps > 0.15). Depressed patients had
significantly higher BDI-II scores than never-depressed con-
trol participants (depressed patients: M = 30.40, SD = 7.73,
never-depressed: M = 2.72, SD = 3.35; t[78] = 20.79,
p < 0.001).
Twenty-five out of 40 depressed patients had comorbid
diagnoses (most of them anxiety disorders). Thirty-nine
depressed patients were receiving antidepressant medication,
most of them Serotonin-Reuptake Inhibitors or Serotonin-
Noradrenalin-Reuptake Inhibitors.
Beck Depression Inventory
The Beck Depression Inventory (BDI-II; Beck etal., 1996,
German version by Hautzinger etal., 2006) is a widely used
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
563Cognitive Therapy and Research (2022) 46:560–572
1 3
21-item self-report measure covering affective, cognitive,
motivational, behavioral and biological symptoms of depres-
sion with good psychometric properties.
Measurement ofMyofascial Tissue
We measured the stiffness and elasticity of the myofascial
tissue in the neck and upper back region of our participants
with an electronic tissue compliance meter (ETCM). This
tool was custom-built (Chemnitz University of Technology,
Chemnitz, Germany) as a new and improved version of the
semi-electronic tissue compliance meter described by Wilke
etal. (2018) as a valid and reliable measurement tool to evalu-
ate muscle stiffness. The latter study reported an intraclass
correlation coefficient for test–retest reliability of 0.84 for the
ETCM, indicating an excellent reliability.
In contrast to the semi-electronic tissue compliance meter,
the ETCM incorporates an electronic registration of the meas-
ured force and strain values, permitting a resolution of 0.001
Newton and 0.01mm as the smallest differences (compared
with 0.1 Newton and 0.1mm in the semi-electronic tissue
compliance meter). Successful applications of the ECTM in
scientific invivo investigations in humans include a recent
comparative assessment of the stiffness of the plantar fascia
and heel pad (Holowka etal., 2019) and a recent evaluation of
the stiffness of three different back muscles (Kett etal., 2020).
For a more detailed technical description of the ETCM see
Kett etal. (2020).
For the ETCM measurements in this study a fixed inden-
tation depth of 8mm was chosen. Three assessments were
conducted at each location within a period of 30s in which
the center piece of the tool indented the tissue up to a depth
of 8mm and the maximum tissue resistance was measured
in N at each indentation. The maximum resistance at the first
indentation divided by the indentation depth (8mm) was used
as the stiffness value of this location, whereas the difference
in resistance between the first and last indentation was used
as an indicator of the tissue elasticity (reverse of viscolestic
relaxation) (Rätsep etal., 2011). A difference of 0% would be
interpreted as maximum elasticity (100%), whereas a differ-
ence of 100% between the first and last indentation would be
interpreted as minimum elasticity. The location of the exact
measurement point on the upper trapezius muscle was deter-
mineed according to Heizelmann etal. (2017). In addition, a
location 2cm below the inferior edge of the scapula on the
thoracic back was used as an additional measurement site. All
ETCM measurements were conducted at four locations: right
trapezius, left trapezius, right thoracic back, left thoracic back.
For the stiffness values as well as for elasticity, the mean of all
four locations was used as a final value for each patient.
Results
Descriptive statistics for elasticity and stiffness of the myo-
fascial tissue in the depressed and never-depressed group can
be found in Table1. The correlation between stiffness and
elasticity was r = 0.66 (p < 0.001) in the depressed group and
r = 0.67 (p < 0.001) in the never-depressed group.
To test for group differences we conducted a multivari-
ate analysis of variance (MANOVA) across the two groups
(depressed vs. non-depressed) with elasticity and stiffness
of the myofascial tissue as the two dependent variables.
There was a significant multivariate effect of group (Wilks’s
Lambda = 0.88), F(2, 77) = 5.13, p < 0.01, η2
p = 0.12,
90% CI (0.02—0.22) which was reflected in significant
univariate group effects for elasticity (F[1,78] = 8.47,
p < 0.01, η2
p = 0.10, 90% CI [0.02—0.21]) and stiffness
(F[1,78] = 8.73, p < 0.01, η2
p = 0.10, 90% CI [0.02—0.21]).
To test whether the small group differences in age and
BMI that we descriptively observed might have affected
our results, we conducted a multivariate analysis of covari-
ance (MANCOVA) with age and BMI as covariates. In this
MANCOVA the significant difference between the depressed
and non-depressed group remained intact (for details see
supplement).
The correlation between depression severity (BDI-II-
scores) and stiffness was r = 0.32, p < 0.01, between depres-
sion severity and elasticity was r = 0.32, p < 0.01.
Discussion
As expected patients with MDD and never-depressed con-
trol participants differed in the characteristics of the myofas-
cial tissue. Depressed patients showed higher stiffness and
reduced elasticity of the myofascial tissue. Since fascial tis-
sue is involved in the modulation of force generation and also
mechanosensory fine-tuning, long-term dysfunction in this
tissue represented by stiffness and reduced elasticity might
lead to chronically intensified body tension and reduced sup-
pleness of the motoric system. This might be one of the
reasons why depressed gait is characterized by reduced arm
swing, a reduced vertical up-and-down dynamic (Michalak
etal., 2009) and why depressed individuals show a slumped
Table 1 Descriptive statistics (Study 1)
Depressed patients
(n = 40)
Never-depressed
control participants
(n = 40)
Stiffness: M (SD) 2.55 (1.02) 1.96 (0.82)
Elasticity: M (SD) 0.56 (0.42) 0.33 (0.25)
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
564 Cognitive Therapy and Research (2022) 46:560–572
1 3
posture (Canales etal., 2010; Wilkes etal., 2017). Height-
ened body tension, depressed gait patterns and posture might
then feedback into the psychological system and make nega-
tive cognitions and emotional states more accessible.
It should be noted that we measured characteristics
of the myofascial tissue only in the upper back and neck
region. It is unclear how dysfunctions in these regions are
interconnected with the myofascial tissue of other body
regions and how stiffness and reduced elasticity in the
back and neck influence posture or more complex motor
activity like gait in depressed individuals. Therefore,
future studies should supplement the present findings by
measuring characteristics of the myofascial tissue in other
body regions and should also investigate effects of stiffness
and reduced elasticity on posture and motoric activity of
depressed individuals. Moreover, since the method used
in our study focused on measuring stiffness and elasticity
future research should use other methods like sonogra-
phy and sonoelastography that permit a more fine-grained
analysis of the characteristics of the fascia tissue (e.g.,
Langevin etal., 2009, Stecco etal., 2014). It is possible
that such additional analyses may then be able to clarify
more specifically to what degree the different tissue lay-
ers—including the dermis, subcutaneous connective tis-
sue, Fascia profunda, and muscular layer—contribute to
the increased stiffness and decreased elasticity observed in
this study. Such contributions may involve—among other
aspects—a change in the thickness, stiffness, regularity
or in the shearing mobility of one or several tissue lay-
ers (Blain etal., 2019; De Coninck etal, 2018; Langevin
etal., 2011).
Another issue that should be addressed in future research
is the question whether the stiffness and reduced elastic-
ity we observed is attributable to the slumped posture of
depressed individuals (biomechanical explanation) or to a
biochemical process in the myofascial tissues. This research
should also utilize alternative methods to assess characteris-
tics of the myofascial tissue (Schleip & Bartsch, 2021; Zügel
etal., 2018). A future study using matched pair group of
individuals with a slumped or forward head posture (e.g.,
people working in jobs with prolonged sitting) but without
a diagnosis of MDD might also be useful for differentiating
between a biomechanical and a biochemical causation of
stiffness and reduced flexibility. Moreover, the role of medi-
cation and comorbid anxiety disorders should be addressed.
Since many patients in our study were under medication and
had comorbid anxiety disorders, future studies might include
samples without medication and comorbid anxiety disorders.
To elucidate the possibility that the myofascial tissue is
involved in a depressive interlock configuration that makes
negative and depressogenic cognitive and emotional pro-
cesses more accessible we conducted a second study involv-
ing an intervention targeting the myofascial tissue. Patients
with MDD were randomized either to this intervention or to
a placebo control condition and effects of the intervention on
psychological factors involved in the maintenance of depres-
sion were investigated.
Study 2
Methods
Participants andOverview ofProcedure
Sixty-nine psychiatric inpatients suffering from MDD
were randomized either to a single-session self-myofascial
release intervention (SMRI) (n = 38) or a placebo interven-
tion (PI) (n = 31). We had aimed to collect data from 40
patients in each group. However, as a result of an early
end to testing due to the Covid-19 pandemic the actual
sample size was smaller. Post-hoc power analysis for a
MANOVA with two groups and two response variables
revealed that the actual samples size of the present study
was large enough to detect an effect of at least medium
effect size with Type I error rates set at 0.05 (two sided)
and Type II error rates set at 0.80.
Patients were recruited from adult psychiatric units.
Inclusion and exclusion criteria were the same as for the
depressed sample in Study 1. Inclusion criteria: current
major depressive episode as defined by the DSM-IV-TR
and a score of 14 or more on the BDI-II (Beck etal., 1996;
German version: Hautzinger etal., 2006). Exclusion cri-
teria: psychotic disorders, bipolar disorders, current sub-
stance-related disorders, diseases of the musculoskeletal
system and back pain. Inclusion and exclusion diagnoses
were derived by trained raters with the German version of
the Structured Clinical Interview for DSM-IV (Wittchen
etal., 1997). Most patients (68%) had comorbid diagnoses
(most of them anxiety disorders) and the majority (80%)
were receiving treatment with antidepressant medication.
The SMRI group and the PI group did not differ in
sex (SMR group: 19 female, 18 male, 1 non-binary;
placebo group: 20 female, 11 male), age (SMR group:
M = 37.89, SD = 13.74, placebo group: M = 35.55,
SD = 11.17), BMI (SMR group: M = 26.32, SD = 5.81, pla-
cebo group: M = 24.74, SD = 2.82) or BDI scores (SMR
group: M = 28.13, SD = 12.05, placebo group: M = 26.35,
SD = 7.04) (all ps 0.15). All patients lived in Germany.
Participants completed the SMRI or PI in three phases:
(1) They began the first phase by watching a short instruc-
tion video for the SMR or PI neck and back exercises. (2)
In the second phase, while lying on a gymnastics mat,
participants practiced the neck and back exercises for 30s
each using a foam roller while listening to the same audio
instructions that had accompanied the video in the first
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
565Cognitive Therapy and Research (2022) 46:560–572
1 3
phase. (3) After the training round, participants began
the third phase in which the exercises were executed indi-
vidually without audio instructions. Neck as well as back
exercises were performed twice for 60s each (i.e. 2 × 60s
SMRI or placebo neck exercise and 2 × 60s SMRI or pla-
cebo back exercise). The order of neck and back exercises
was randomized across participants. Between rounds,
participants rested for 90s (lying on the mat). During
the resting phase, participants were directed to relax and
were given the positive and negative words of the self-
referential encoding task (see below). Finally, after the last
exercise round the Positive and Negative Affect Schedule
(PANAS) was administered. To prevent changes of posture
from interfering with the after-effects of the exercises, par-
ticipant continued to lie on the mat and PANAS instruc-
tions were given by video. The experimenter recorded
participants’ verbal PANAS response.
Self‑myofascial Release Intervention (SMRI)
Various methods to affect myofascial tissues have been
developed, most of them are applied by physiotherapists
(e.g., Ajimsha, 2011; Barnes, 1997). One method that can
by applied independently of a therapist and individually by
the patient is the use of a foam roller, which typically con-
sists of a semi-rigid foam material. The foam roller makes it
possible for the tissue to be rolled out using one’s own body
weight. Through the rolling, the stiffness in myofascial tis-
sues can be lowered (Kett etal., 2020) and in addition the
sliding ability between adjacent fascial tissue layers can be
increased (Griefahn etal., 2017; Krause etal., 2019). In
addition, a dehydration and subsequent rehydration in the
treated tissues during foam rolling has been proposed (Behm
& Wilke, 2019). Moreover, Golgi receptors in the facia are
stimulated imparting an inhibitory reflex that reduces muscle
tone (Roylance etal., 2013). A randomized controlled trial
has shown that a single SMRI session with a foam roller
has short-term impact on the mobility of the fascia tissue. It
improved the mobility of the thoracolumbar fascia (Griefahn
etal., 2017).
Because Study 1 has shown that the myofascial tissue of
the neck and upper back show reduced elasticity and higher
stiffness in depressed patients we applied the SMRI with a
foam roller to these body regions. The instruction videos
were developed in accordance with the instruction manual
for self-myofascial release intervention by Lukas (2012).
During both SMRIs, participants were asked to lie on the
mat. In the neck SMRI they were instructed to first rest their
neck on the foam roller and then to roll their head slowly
from right to left and back again continuously at an even
pace for the duration of the exercise (see Fig.1a). During
the upper back SMRI, the participants were instructed to
rest their back on the foam roller and slowly move the roller
between their shoulders and the middle of their back evenly
for the duration of the exercise (see Fig.1b).
Because the exercises might induce pain, we instructed
participants to allow discomfort, but to manage the level of
pain so that it does not exceed 8 on a scale from 1 (slight
tension, no pain) to 10 (extremely high tension, distressing
pain). A rating of 8 was defined as very high tension that is
bearable, slightly positive but tending to be uncomfortable;
the participant can still talk to other people normally and has
no physical, mental or emotional resistance to the tension.
Placebo Intervention
Because SMRI is only effective through rolling out of the
tissue but not just by pressure (MacDonald etal., 2013;
Thömmes, 2014) we used a placebo intervention (PI) for
both the neck and back without rolling movements. This
placebo intervention was parallel to the SMRI in all aspects
including the kind of instructions, exercise length, materi-
als used, and the body position during the exercise. Partici-
pants in the PI used the same foam roller and mat during
all exercises as participants of the SMRI. During both PIs,
participants were asked to lie on the mat. In the neck PI they
were instructed to first rest their neck on the foam roller and
then to lift their head slowly and lower it back onto the roll
continuously at an even pace for the duration of the exercise
(see Fig.2a). During the upper back PI, the participants were
instructed to rest their back on the foam roller and slowly
lift their torso from the mat and lower it again evenly for the
duration of the exercise (see Fig.2b). The instruction for
managing discomfort and pain were identical to that given
in the SMRI condition.
Fig. 1 Self-myofascial release intervention for neck (a) and upper
back (b)
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
566 Cognitive Therapy and Research (2022) 46:560–572
1 3
Measures
Assessment of Memory Bias
To assess effects of the interventions on memory bias we
adapted the self-referent encoding task (Ramel etal., 2007).
In an initial encoding phase, participants, while resting in on
the mat between the SMRI or PI exercise rounds, were pre-
sented a list of 10 positive and 10 negative words in random
order by audio tape (negative words: bad, sorry, ugly, hurt,
clumsy, helpless, angry, hopeless, guilty, lonely; positive
words: pretty, secure, satisfied, proud, enthusiastic, happy,
successful, relieved, interested, hopeful; words were taken
from Williams & Broadbent, 1986). Directly after hearing
each word, they were asked to respond out loud by saying
either “yes” or “no” based on whether or not each word
described them well. The participants were given 6s for this
response before the next word was presented. This phase was
used to induce a self-referent encoding of the cue words.
Following all SMRI or PI exercises and after the par-
ticipants completed the PANAS, an incidental recall of the
cue words was conducted. Participants were asked (written
instruction on the monitor) to recall out loud all words from
the list of cue words they could remember and all answers
were recorded by the experimenter. The number of positive
and negative words correctly recalled was used as an indica-
tor of biased memory in our analyses.
Positive andNegative Affect Schedule
To measure affect we used the Positive and Negative Affect
Schedule (PANAS) state version (Watson etal., 1988; Ger-
man version Krohne etal., 1996). It consists of two scales,
one for positive and one for negative affect, each consisting
of 10 adjectives with regard to which respondents rate their
current mood on a Likert-type scale. It is a reliable (Cron-
bach’s α in the present study: PANAS positive scale: 86;
PANAS negative scale: 81) and valid instrument to measure
positive and negative affect.
Rating onCredibility oftheInterventions
To assess the credibility of the SMRI and PI interventions
we asked our participants after completion of the interven-
tion: “At this point, how logical does the fascial intervention
seem to you?”. The patients scored this item on a scale from
1 (not at all logical) to 9 (very logical).
Pain Rating
In addition to the scale that patients used to constantly moni-
tor their pain level during the intervention (described above),
we asked patients after completion of the intervention to rate
retrospectively the level of pain provoked by the interven-
tion on a scale ranging from 1 = “no pain at all” to 9 “very
much pain”.
Results
Descriptive Statistics
Descriptive statistics as well as intercorrelations of affective
variables can be found in Table2. Most correlations are in
the expected direction. Positive affective variables tend to
correlate positively with other positive affective variables
and negatively with negative affective variables. With only
a few exceptions correlations tend to be in a low or medium
range.
We checked whether SMRI and PI differed in credibility
or levels of pain induced by the intervention. Credibility
ratings did not differ between conditions (SMRI condition
M = 6.18, SD = 1.78; PI condition: M = 5.71, SD = 2.22;
t[67] = −0.98, ns). However, pain levels were higher dur-
ing the SMRI than during PI (SMRI condition M = 4.29,
SD = 2.17; PI condition: M = 2.90, SD = 1.66; t[67] = 2.98,
p < 0.01, g = 0.79, 95% CI [0.22–1.20]).
Effects oftheSMRI onBiased Memory
To test whether SMRI and PI affected biased memory of the
depressed patients differently, we conducted a MANOVA
across the two groups (SMRI vs. PI) with the number of
positive and the number of negative word recalled in the
self-reference encoding tasks as the two dependent variables.
There was a significant multivariate effect of group (Wilks’s
Lambda = 0.86), F(2, 66) = 5.28, p < 0.01, η2
p = 0.14, 90% CI
Fig. 2 Placebo intervention for neck (a) and upper back (b)
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
567Cognitive Therapy and Research (2022) 46:560–572
1 3
(0.02–0.25) which was reflected in a significant univariate
group effect for negative words (F[1,67] = 7.86, p < 0.01,
η2
p = 0.11, 90% CI [0.02–0.23]) and a statistical trend for
positive words (F[1,67] = 3.52, p < 0.1, η2
p = 0.05, 90%
CI [0.00–0.15]). Compared to depressed patients in the PI
condition, those in the SMRI recalled a smaller number of
negative words and showed a trend to recall more positive
words. To test whether difference in pain induced by the
intervention and credibility of interventions affected the
results, we used a MANCOVA controlling for level of pain
and for credibility. This MANCOVA revealed that control-
ling for pain and credibility did not change the pattern of
results (for details see Supplement).
Effects oftheSMRI onPositive andNegative Affect
We also observed effects of the SMRI intervention on affect.
A MANOVA across the two groups (SMRI vs. PI) with the
PANAS positive affect and PANAS negative affect as the two
dependent variables showed a significant multivariate effect
of group (Wilks’s Lambda = 0.91), F(2, 66) = 3.47, p < 0.05,
η2
p = 0.10, 90% CI (0.01–0.20) which was reflected in sig-
nificant univariate group effect for PANAS positive mood
(F[1,67] = 6.99, p < 0.01, η2
p = 0.09, 90% CI [0.01–0.21]).
No significant univariate group differences were observed
for PANAS negative affect (F[1,67] = 0.68, ns, η2
p = 0.01,
90% CI [0.00 – 0.08]). Depressed patients in the SMRI had a
more positive mood than those in the PI condition. Control-
ling for level of pain and for credibility of the intervention
in a MANCOVA did not change this pattern of results (for
details see Supplement).
Discussion
The results of Study 2 showed that an intervention targeting
the myofascial tissue had effects on memory bias and affect
of depressed individuals. Patients in the SMRI recalled a
smaller number of negative words and had more positive
affect compared to patients in the placebo condition. The
mostly low or medium correlations between the outcome
variables of Study 2 indicate that the different measures
we used (i.e., memory bias, positive and negative affect,)
tap different affective dimensions. Therefore SMRI seems
to have effects on a relatively broad spectrum of affective
dimensions.
The differences between the SMRI and PI that we
observed cannot be attributed to the credibility of the inter-
vention since credibility was comparable in both conditions
and controlling for credibility in the MANCOVAs did not
change the results. Moreover, controlling for pain levels did
not change the results. This is a remarkable result because
the SMRI induced more pain than the PI but produced more
positive affective outcomes. That this effect is attributable to
the operation of opponent processes (i.e., affective/hedonic
contrasts induced by a negative stimulation, Solomon, 1980)
is rather unlikely since our results survived when control-
ling for pain levels in the MANCOVAs. Rather, these results
indicate that the effects of the SMRI on the myofascial tis-
sue are responsible for our results. Since other research has
shown that single-session SMRIs impacts the functional
characteristics of the fascia tissue (Griefahn etal., 2017) it
seems plausible that higher elasticity/reduced stiffness of the
fascial tissue induced by the SMRI might be responsible for
the effects on affect observed in our study. The effect might
be explained by the somato-sensory input associated with the
higher elasticity/reduced stiffness of the myofascial tissue
induced by the SMRI. Stiffness and reduced elasticity might
be biologically associated with states of heightened danger
and stress. If stiffness decreases and elasticity increases by
the SMRI, this might be a somato-sensory signal of reduced
danger and stress. This in turn might lead to a more posi-
tive emotional state and a more positive memory processing
leading to a de-escalation of the depressive mind–body inter-
lock configuration postulated by the Interacting Cognitive
Subsystems approach (Teasdale & Bernard, 1993).
Table 2 Descriptive statistics and intercorrelations of variables (Study 2)
SRET positive word = number of positive words recalled in the self-reference encoding task; SRET negative word = number of negative words
recalled in the self-reference encoding task; PANAS positive = positive affect in the Positive and Negative Affect Schedule; PANAS nega-
tive = negative affect in the Positive and Negative Affect Schedule; BDI score: Beck Depression Inventory total score
Variables Self-myofascial release intervention (n = 38) Placebo intervention (n = 30)
M SD 1 2 3 4 M SD 1 2 3 4
SRET positive words 3.63 3.16 2.35 2.32
SRET negative words 1.55 1.45 −0.08 2.87 2.42 −0.07
PANAS positive 2.76 0.58 0.38* −0.32* 2.37 0.64 0.68*** 0.24
PANAS negative 1.78 0.62 −0.34* 0.30 −0.50** 1.90 0.59 −0.27 0.08 −0.27
BDI score 28.13 12.05 −0.24 0.10 −0.28 0.14 26.35 7.04 −0.43* 0.01 −0.40* 0.39*
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
568 Cognitive Therapy and Research (2022) 46:560–572
1 3
However, one limitation of our study was that the effect
of the SMRI on characteristics of the myofascial tissue (e.g.,
elasticity or stiffness) was not directly measured. We did not
include this measure to reduce time burden and stress for our
vulnerable participants. An augmenting influence of self-
myofascial release on passive as well as active joint range of
motion has been described (Skinner etal., 2020; Wilke etal.,
2020). In addition, a short term reduction in myofascial stiff-
ness has been documented as a response to a self-myofascial
treatment of human back muscles (Kett etal., 2020). The
latter study described a reduction in elastic modulus of the
upper trapezius (in addition to other paraspinal muscles)
in response to an 8-min foam roller self-massage in seden-
tary office workers. However, studies exploring foam roll-
ing applications on the upper leg reported either no change
(Pepper etal., 2021) or mixed results (Mayer etal., 2020)
in terms of stiffness changes in response to their specific
self-myofascial treatments. Our investigation followed the
application protocol as well as the assessment technology as
described by Kett etal. (2020) for the upper trapezius region
to a high degree. It could be expected that the biomechanical
tissue changes in this region reported in this study are very
similar to our study. Nevertheless, further research is neces-
sary to determine in which body regions and/or under what
circumstances self-myofascial release treatments induce a
change in the biomechanical tissue properties. Therefore,
future research on the effects of SMRI should consider
including the measures of the state of the myofascial tissue
to directly link changes in myofascial tissue to changes in
depressive processes.
Moreover, we cannot exclude that subtle difference
between the SMRI and the placebo condition might be
responsible for our results. We controlled for pain and cred-
ibility in our analyses. Furthermore, both SMRI and the
control intervention included physical activity. However, it
cannot completely be ruled out that subtle differences in
level of physical activity might have influenced our results.
Therefore futures studies should measure the physiological
activity level produced by the SMRI and control condition.
In addition, the role of the autonomous arousal stages on
the effects we observed should be investigated. A strong
mechanical stimulation of group II and III somatic affer-
ent fibers has been shown to induce a short-term sympa-
thetic activation, followed by a subsequent—and longer
lasting—augmentation of vagal nerve activation (Terui &
Koizumi, 1984). Future research with measures of auto-
nomic responses should elucidate whether this mechanisms
contributes to the effects of the SMRI on memory bias and
affect.
Moreover, it should be noted that a single-session SMRI
has only transient effects on fascial tissue. More enduring
changes of the structure of the fascial tissue that lead to
permanent heightened elasticity and reduced stiffness need
more extensive training of up to 3months (Bohm etal.,
2015; Miller etal., 2005). Therefore, future research should
investigate the effect of more extended SMRI on MMD.
A rather puzzling result was that the multivariate group
effect observed in memory bias was particularly driven by
group differences in the recall of negative words (and not
positive words), while the multivariate group effect in affect
was particularly driven by group differences in positive
affect (and not negative affect). This difference is difficult
to interpret and future research should investigate whether
more extensive SMRI might lead to effects that span both
positive and negative dimensions of memory bias and affect,
respectively.
Taken as a whole the results of Study 2 showed that a
self-administered intervention targeting the myofascial tis-
sue can lead to changes in processes relevant in the etiology
of MDD. The SMRI was relatively short and restricted to
one session. Nevertheless, even this short intervention pro-
duced effects in memory bias and affect of moderate effects
sizes.
General Discussion
The aim of our present research was to investigate whether
the myofascial tissue might contribute to the dynamics of
establishing self-perpetuating mind–body interlock configu-
rations that maintain depression. In Study 1 we observed that
patients suffering from MDD, compared to non-depressed
control participants, showed reduced elasticity and height-
ened stiffness of the myofascial tissue in the neck and upper
back. Moreover, results of Study 2 indicate that changes in
the myofascial tissue achieved by a SMRI can causally affect
important pathopsychological processes involved in the
maintenance of MDD. Therefore, the results of our present
research indicate that characteristics of the myofascial tissue
might be part of a depressive interlock configuration of bod-
ily and psychological processes (Teasdale & Barnard, 1993)
that ‘lock’ subsystems into a self-perpetuating configura-
tion that maintains depression. Stiff and inflexible myofas-
cial tissue seems to contribute to reduced positive affect and
heightened accessibility of negative memories which in turn
might increase stress that could further increase stiffness and
reduce elasticity of the tissue. While the latter part of these
body–mind vicious circles (effects of stress on character-
istics of the tissue) was not tested in the present research
our results support the notion that the myofascial tissue can
affect emotional processes. Thus, our results are consist-
ent with a large number of studies showing that bodily pro-
cesses like movement patterns and posture affect emotional
processes in non-clinical samples (Elkjær etal., 2020) and
emerging evidence that bodily processes might also be rel-
evant in the etiology of MDD (e.g., Michalak etal., 2014).
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
569Cognitive Therapy and Research (2022) 46:560–572
1 3
Moreover, the results of the present research correspond
with phenomenological approaches to depression (Fuchs,
2013; Fuchs & Schlimme, 2009, Ratcliff, 2015). Phenom-
enological approaches stress that individuals suffering from
depression often report a sense of bodily rigidity. This rigid-
ity is manifested in bodily feelings like having a tire around
the chest, a sense of pressure in the head or a general sense
of tightness of the body. Instead of expressing the self, in
depression the body is thus turned into a barrier to impulses
directed to the environment. Through its rigidity, the body
no longer gives access to the world, but stands in the way
as an obstacle, separated from its surroundings. Phenom-
enological approaches posit that such an altered feeling of
“being-in-the-world” (separated instead of connected to
the world) is a core aspect of the phenomenon of depres-
sion. It can be speculated that the heightened stiffness and
reduced elasticity of the myofascial tissue we observed in
our research is a physiological correlate for the sense of
rigidity that is a core characteristic of the depressed feel-
ing of “being-in-the-world”. However, it should be noted
that although some authors postulate an important role of
the myofascial tissue in proprioception and body awareness
(e.g., Langevin, 2021), no study yet has directly examined
whether people can consciously detect the level of and
degree of change in tissue stiffness and elasticity.
Future research should extend the findings of the pre-
sent research by investigating a more fine-grained analysis
of the role of the myofascial tissue in MDD and other psy-
chological disorders. For example, it should be investigated
whether stiffness and reduced elasticity can be found only
in the neck and upper body region or whether the tissue
in other regions of the body also shows these characteris-
tics. Moreover, future research should investigate whether
dysfunctions of the myofascial tissue are specific to MDD
or whether they can also be observed in other psychologi-
cal disorders. In addition, the predictive utility of charac-
teristics of the myofascial tissue in longitudinal studies on
the course of depressionshould be examined. Furthermore,
investigating the association between characteristics of the
myofascial tissue and the subjective experience of the body
reported in phenomenological approaches and the analysis
of the interplay between characteristics of the myofascial
tissue and deviations in the motoric system of patients with
MDD (e.g., gait or posture, Michalak etal., 2009) might be
valuable lines of research. Moreover, future research should
elucidate the causes of the stiffness and reduced elasticity of
the myofascial tissue in MDD. Besides research on biologi-
cal factors that impact structure and function of the tissue
(e.g., generic factors, hormones) it could be promising to
examinethe role of past experiences like critical life-events
or childhood adversities in the formation of a body memory
including stiff and inflexible myofascial tissue (Koch etal.,
2012). A limitation of our studies is that data on racial/ethnic
identification and socioeconomic status of the participants
was not collected.
In addition to the contribution of our results to a deep-
ened theoretical understanding of the etiology of MDD, they
might also shed light on new perspectives on the treatment
of this debilitating condition. Future research should inves-
tigate whether intervention affecting the myofascial tissue
might help to deescalate possible dysfunctional body–mind
vicious circles in MDD. They should investigate the effects
of a series of SMRI. It would be useful to include objective
outcome measures and the assessment of retention effects by
follow-up measures in these studies. In addition to SMRI, a
relatively broad spectrum of other interventions exists tar-
geting the myofascial tissue. Fascial interventions applied
by physiotherapists (e.g., Ajimsha, 2011; Barnes, 1997) are
widely used. However, their possible role as a component in
the treatment of MDD has not yet been studied. Moreover,
Asian approaches like Yoga or some Qi Gong systems aim
to improve elasticity of the fascial tissue by stretching or
specific movement practices. There is preliminary evidence
that Yoga as well as Qi Gong have effects in the treatment
of MDD (e.g., Cramer etal., 2013; Liu etal., 2015). An
advantage of SMRI, Yoga and Qi Gong is that they can
be used regularly on a self-administered basis. It could be
worthwhile to investigate the combination of these bodily
approaches with classical treatment approaches for MDD
(i.e., cognitive behavioral) in methodologically rigorous,
randomized controlled trials.
In summary, the present study offers evidence that myo-
fascial tissue might be involved in the etiology of depres-
sion and that it might be part of a dysfunctional body-mind
dynamic that maintains MDD. However, it should be noted
that we have broken new ground with our study and the
results should therefore be considered preliminary. Repli-
cation studies using more sophisticated methodology are
needed before firm conclusions can be drawn. Especially,
a replication of Study 1 testing whether the heightened
stiffness and reduced elasticity are specific to the neck and
shoulder region or can also be also found in other regions
and a replication of Study 2 that includes a direct measure-
ment of stiffness/elasticity are needed. While keeping these
limitations in mind, our hope is that our results might have
the potential to deepening our theoretical understanding of
MDD and might also inspire innovative approaches to the
treatment of MDD which take into account the probably
important role of bodily processes in the formation of this
debilitating condition.
Supplementary Information The online version contains supplemen-
tary material available at https:// doi. org/ 10. 1007/ s10608- 021- 10282-w .
Acknowledgements We would like to thank would like to thank the
following clinics for their support in recruiting participants for the
studies: EOS Klinik Münster, Evangelisches Krankenhaus Bergisch
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
570 Cognitive Therapy and Research (2022) 46:560–572
1 3
Gladbach, St. Marien-Hospital Dortmund, and St. Marien-Hospital
Eickel. Moreover, we would like to thank Dorothee Neumärker for her
helpful comments on the instructions for the self-myofascial release
intervention.
Author contributions JM developed the study concept, conducted
the data analysis and interpretation and drafted the paper. All authors
contributed to the study design. Testing and data collection was per-
formed by LA, AB, KG, JS and SQ. RS gave advice and technical
support on the measurement of the myofascial tissue. TT provided
critical revisions. All authors approved the final version of the paper
for submission.
Funding Open Access funding enabled and organized by Projekt
DEAL.
Declarations
Conflict of interest The authors declare that they have no conflict of
interest.
Ethical Approval Ethics approval was obtained from the ethics com-
mittee of Witten/Herdecke University.
Informed Consent Informed consent was obtained from all individual
participants included in the study.
Animal Rights No animal studies were carried out by the authors for
this article.
Open Access This article is licensed under a Creative Commons Attri-
bution 4.0 International License, which permits use, sharing, adapta-
tion, distribution and reproduction in any medium or format, as long
as you give appropriate credit to the original author(s) and the source,
provide a link to the Creative Commons licence, and indicate if changes
were made. The images or other third party material in this article are
included in the article's Creative Commons licence, unless indicated
otherwise in a credit line to the material. If material is not included in
the article's Creative Commons licence and your intended use is not
permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a
copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/.
References
Adolph, D., Tschacher, W., Niemeyer, H., & Michalak, J. (2021).
Gait patterns and mood in everyday life: A comparison between
depressed patients and non-depressed controls. Cognitive Ther-
apy and Research, 45, 1128–1140. https:// doi. org/ 10. 1007/
s10608- 021- 10215-7
Ajimsha, M. S. (2011). Effectiveness of direct vs indirect technique
myofascial release in the management of tension-type headache.
Journal of Bodywork and Movement Therapies, 15(4), 431–435.
https:// doi. org/ 10. 1016/j. jbmt. 2011. 01. 021
Alvares, G. A., Quintana, D. S., Hickie, I. B., & Guastella, A. J. (2016).
Autonomic nervous system dysfunction in psychiatric disorders
and the impact of psychotropic medications: A systematic review
and meta-analysis. Journal of Psychiatry and Neuroscience,
41(2), 89–104. https:// doi. org/ 10. 1503/ jpn. 140217
American Psychiatric Association. (2000). DSM-IV-TR: Diagnostic
and statistical manual of mental disorders (4th ed.). American
Psychiatric Press.
Barnes, M. F. (1997). The basic science of myofascial release: Mor-
phologic change in connective tissue. Journal of Bodywork and
Movement Therapies, 1(4), 231–238. https:// doi. org/ 10. 1016/
S1360- 8592(97) 80051-4
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck
Depression Inventory-II. The Psychological Corporation. https://
doi. org/ 10. 1037/ t00742- 000
Beeney, J., & Arnett, P. A. (2008). Stress and memory bias interact to
predict depression in multiple sclerosis. Neuropsychology, 22(1),
118. https:// doi. org/ 10. 1037/ 0894- 4105. 22.1. 118
Behm, D. G., & Wilke, J. (2019). Do self-myofascial release devices
release myofascia? Rolling mechanisms: A narrative review.
Sports Medicine, 49(8), 1173–1181. https:// doi. org/ 10. 1007/
s40279- 019- 01149-y
Bhowmick, S., Singh, A., Flavell, R. A., Clark, R. B., O’Rourke, J., &
Cone, R. E. (2009). The sympathetic nervous system modulates
CD4(+)FoxP3(+) regulatory T cells via a TGF-beta-dependent
mechanism. Journal of Leukocyte Biolology, 86(6), 1275–1283.
https:// doi. org/ 10. 1189/ jlb. 02091 07
Blain, M., Bedretdinova, D., Bellin, M. F., Rocher, L., Gagey, O.,
Soubeyrand, M., & Creze, M. (2019). Influence of thoracolum-
bar fascia stretching on lumbar back muscle stiffness: A super-
sonic shear wave elastography approach. Clinical Anatomy, 32(1),
73–80. https:// doi. org/ 10. 1002/ ca. 23266
Bohm, S., Mersmann, F., & Arampatzis, A. (2015). Human tendon
adaptation in response to mechanical loading: A systematic review
and meta-analysis of exercise intervention studies on healthy
adults. Sports Medicine Open, 1(1), 7. https:// doi. org/ 10. 1186/
s40798- 015- 0009-9
Bullock, T. H. (1984). Comparative neuropathology of startle, rapid
escape, and giant fiber-mediated responses. In R. Eaton (Ed.),
Neural mechanisms of startle behavior. Plenum Press.
Canales, J. Z., Cordás, T. A., Fiquer, J. T., Cavalcante, A. F., & Moreno,
R. A. (2010). Posture and body image in individuals with major
depressive disorder: A controlled study. Brazilian Journal of Psy-
chiatry, 32(4), 375–380. https:// doi. org/ 10. 1590/ S1516- 44462
01000 04000 10
Colloca, C. J., & Hinrichs, R. H. (2005). The biomechanical and clini-
cal significance of the lumbar erector spinae flexion-relaxation
phenomenon: A review of literature. Journal of Manipulative and
Physiological Therapeutics, 28(8), 623–631. https:// doi. org/ 10.
1016/j. jmpt. 2005. 08. 005
Cramer, H., Lauche, R., Langhorst, J., & Dobos, G. (2013). Yoga for
depression: A systematic review and meta-analysis. Depression
and Anxiety, 30(11), 1068–1083. https:// doi. org/ 10. 1002/ da. 22166
Davami, M. H., Baharlou, R., Vasmehjani, A. A., Ghanizadeh, A., Kes-
htkar, M., Dezhkam, I., & Atashzar, M. R. (2016). Elevated IL-17
and TGF-β serum levels: A positive correlation between T-helper
17 cell-related pro-inflammatory responses with major depressive
disorder. Basic and Clinical Neurosience, 7(2), 137–142. https://
doi. org/ 10. 15412/J. BCN. 03070 207
De Coninck, K., Hambly, K., Dickinson, J. W., & Passfield, L. (2018).
Measuring the morphological characteristics of thoracolumbar
fascia in ultrasound images: An inter-rater reliability study. BMC
Musculoskeletal Disorders, 19(1), 1–6. https:// doi. org/ 10. 1186/
s12891- 018- 2088-5
Elkjær, E., Mikkelsen, M. B., Michalak, J., Mennin, D. S., & O’Toole,
M. S. (2020). Expansive and contractive postures and movement:
A systematic review and meta-analysis of the effect of motor dis-
plays on affective and behavioral responses. Perspectives on Psy-
chological Science. https:// doi. org/ 10. 1177/ 17456 91620 919358
Fuchs, T. (2013). Depression, intercorporeality and interaffectivity.
Journal of Consciusness Studies, 20(7–8), 219–238.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
571Cognitive Therapy and Research (2022) 46:560–572
1 3
Fuchs, T., & Schlimme, J. E. (2009). Embodiment and Psychopa-
thology: A phenomenological perspective. Current Opinion in
Psychiatry, 22(6), 570–575. https:// doi. org/ 10. 1097/ YCO. 0b013
e3283 318e5c
Gotlib, I. H., & Joormann, J. (2010). Cognition and depression: Current
status and future directions. Annual Review of Clinical Psychol-
ogy, 6, 285–312. https:// doi. org/ 10. 1146/ annur ev. clinp sy. 121208.
131305
Griefahn, A., Oehlmann, J., Zalpour, C., & von Piekartz, H. (2017).
Do exercises with the foam roller have a short-term impact on the
thoracolumbar fascia? A randomized controlled trial. Journal of
Bodywork and Movement Therapies, 21(1), 186–193. https:// doi.
org/ 10. 1016/j. jbmt. 2016. 05. 011
Hankin, B. L., Young, J. F., Gallop, R., & Garber, J. (2018). Cognitive
and interpersonal vulnerabilities to adolescent depression: Clas-
sification of risk profiles for a personalized prevention approach.
Journal of Abnormal Child Psychology, 46(7), 1521–1533. https://
doi. org/ 10. 1007/ s10802- 018- 0401-2
Hautzinger, M., Keller, F., & Kühner, C. (2006). Beck Depressions-
Inventar (BDI-II). Revision. Harcourt Test Services.
Heizelmann, A., Tasdemir, S., Schmidberger, J., Gräter, T., Kratzer, W.,
& Grüner, B. (2017). Measurements of the trapezius and erector
spinae muscles using virtual touch imaging quantification ultra-
sound-elastography: A cross section study. BMC Musculoskeletal
Disorder, 18, 370. https:// doi. org/ 10. 1186/ s12891- 017- 1733-8
Holowka, N. B., Wynands, B., Drechsel, T. J., Yegian, A. K., Tobol-
sky, V. A., Okutoyi, P., & Milani, T. L. (2019). Foot callus thick-
ness does not trade off protection for tactile sensitivity during
walking. Nature, 571(7764), 261–264. https:// doi. org/ 10. 1038/
s41586- 019- 1345-6
Kett, A. R., & Sichting, F. (2020). Sedentary behaviour at work
increases muscle stiffness of the back: Why roller massage has
potential as an active break intervention. Applied Ergonomics, 82,
102947. https:// doi. org/ 10. 1016/j. apergo. 2019. 102947
Koch, S. C., Fuchs, T., Summa, M., & Müller, C. (Eds.). (2012). Body
memory, metaphor and movement (Vol. 84). John Benjamins
Publishing.
König, H., König, H. H., & Konnopka, A. (2020). The excess costs
of depression: A systematic review and meta-analysis. Epidemi-
ology and Psychiatric Sciences. https:// doi. org/ 10. 1017/ S2045
79601 90001 80
Krause, F., Wilke, J., Niederer, D., Vogt, L., & Banzer, W. (2019).
Acute effects of foam rolling on passive stiffness, stretch sensa-
tion and fascial sliding: A randomized controlled trial. Human
Movement Science, 67, 102514. https:// doi. org/ 10. 1016/j. humov.
2019. 102514
Krohne, H. W., Egloff, B., Kohlmann, C. W., & Tausch, A. (1996).
Untersuchungen mit einer deutschen Version der “Positive and
Negative Affect Schedule”(PANAS). Diagnostica, 42, 139–156.
Langevin, H. M. (2021). Fascia mobility, proprioception, and myofas-
cial pain. Reduced thoracolumbar fascia shear strain in human
chronic low back pain. Life, 11, 668. https:// doi. org/ 10. 3390/ life1
10706 68
Langevin, H. M., Fox, J. R., Koptiuch, C., Badger, G. J., Greenan-Nau-
mann, A. C., Bouffard, N. A., & Henry, S. M. (2011). Reduced
thoracolumbar fascia shear strain in human chronic low back pain.
BMC Musculoskeletal Disorders, 12(1), 203. https:// doi. org/ 10.
1186/ 1471- 2474- 12- 203
Langevin, H. M., Stevens-Tuttle, D., Fox, J. R., Badger, G. J., Bouffard,
N. A., Krag, M. H., & Henry, S. M. (2009). Ultrasound evidence
of altered lumbar connective tissue structure in human subjects
with chronic low back pain. BMC Musculoskeletal Disorders,
10(1), 151. https:// doi. org/ 10. 1186/ 1471- 2474- 10- 151
Lee, H.-Y., & Kim, Y.-K. (2010). Transforming growth factor-beta1
and major depressive disorder with and without attempted suicide:
Preliminary study. Psychiatry Research, 178(1), 92–96. https://
doi. org/ 10. 1016/j. psych res. 2009. 03. 023
LeMoult, J., Kircanski, K., Prasad, G., & Gotlib, I. H. (2017). Negative
self-referential processing predicts the recurrence of major depres-
sive episodes. Clinical Psychological Science, 5(1), 174–181.
https:// doi. org/ 10. 1177/ 21677 02616 654898
Liao, M. H., Liu, S. S., Peng, I. C., Tsai, F. J., & Huang, H. H. (2014).
The stimulatory effects of alpha1-adrenergic receptors on TGF-
beta1, IGF-1 and hyaluronan production in human skin fibroblasts.
Cell and Tissue Research, 357(3), 681–693. https:// doi. org/ 10.
1007/ s00441- 014- 1893-x
Liu, X., Clark, J., Siskind, D., Williams, G. M., Byrne, G., Yang, J.
L., & Doi, S. A. (2015). A systematic review and meta-analysis
of the effects of Qigong and Tai Chi for depressive symptoms.
Complementary Therapies in Medicine, 23(4), 516–534. https://
doi. org/ 10. 1016/j. ctim. 2015. 05. 001
Lukas, C. (2012). Faszienbehandlung mit der Blackroll [Treatment of
fascia with the blackroll]. BoD, Books on Demand.
MacDonald, G. Z., Penney, M. D., Mullay, M. E., Cuconato, A. L.,
Drake, C. D., Behm, D. G., & Button, D. C. (2013). An acute
bout of self-myofascial release increases range of motion without
a subsequent decrease in muscle activation or force. Journal of
Strength and Conditioning Research, 27, 812–821. https:// doi. org/
10. 1519/ JSC. 0b013 e3182 5c2bc1
Matt, G. E., Vázquez, C., & Campbell, W. K. (1992). Mood-congruent
recall of affectively toned stimuli: A meta-analytic review. Clini-
cal Psychology Review, 12(2), 227–255. https:// doi. org/ 10. 1016/
0272- 7358(92) 90116-P
Mayer, I., Hoppe, M. W., Freiwald, J., Heiss, R., Engelhardt, M., Grim,
C., & Hotfiel, T. (2020). Different effects of foam rolling on pas-
sive tissue stiffness in experienced and nonexperienced athletes.
Journal of Sport Rehabilitation, 29(7), 926–933. https:// doi. org/
10. 1123/ jsr. 2019- 0172
Michalak, J., Chatinyan, A., Chourib, H., & Teismann, T. (2018). The
impact of upward versus downward movement patterns on mem-
ory characteristics of depressed individuals. Psychopathology,
51(5), 326–334. https:// doi. org/ 10. 1159/ 00049 2788
Michalak, J., Mischnat, J., & Teismann, T. (2014). Sitting posture
makes a difference: Embodiment effects on depressive memory
bias. Clinical Psychology & Psychotherapy, 21(6), 519–524.
https:// doi. org/ 10. 1002/ cpp. 1890
Michalak, J., Troje, N. F., Fischer, J., Vollmar, P., Heidenreich, T., &
Schulte, D. (2009). Embodiment of sadness and depression: Gait
patterns associated with dysphoric mood. Psychosomatic Medi-
cine, 71(5), 580–587.
Miller, B. F., Olesen, J. L., Hansen, M., Døssing, S., Crameri, R. M.,
Welling, R. J., & Smith, K. (2005). Coordinated collagen and
muscle protein synthesis in human patella tendon and quadriceps
muscle after exercise. The Journal of Physiology, 567(3), 1021–
1033. https:// doi. org/ 10. 1113/ jphys iol. 2005. 093690
Quirin, M., & Bode, R. C. (2014). An alternative to self-reports of trait
and state affect. European Journal of Psychological Assessment,
30, 231–237. https:// doi. org/ 10. 1027/ 1015- 5759/ a0001 90
Ratcliffe, M. (2015). Experiences in depression: A study in phenom-
enology. Oxford University Press.
Ramel, W., Goldin, P. R., Eyler, L. T., Brown, G. G., Gotlib, I. H., &
McQuaid, J. R. (2007). Amygdala reactivity and mood-congruent
memory in individuals at risk for depressive relapse. Biological
Psychiatry, 61(2), 231–239. https:// doi. org/ 10. 1016/j. biops ych.
2006. 05. 004
Rätsep, T., & Asser, T. (2011). Changes in viscoelastic properties of
skeletal muscles induced by subthalamic stimulation in patients
with Parkinson’s disease. Clinical Biomechanics, 26(2), 213–217.
https:// doi. org/ 10. 1016/j. clinb iomech. 2010. 09. 014
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
572 Cognitive Therapy and Research (2022) 46:560–572
1 3
Rehm, L. P., & Naus, M. J. (1990). A memory model of emotion. In
R. E. Ingram (Ed.), Contemporary psychological approaches to
depression (pp. 23–35). Plenum Press.
Roylance, D. S., George, J. D., Hammer, A. M., Rencher, N., Felling-
ham, G. W., Hager, R. L., & Myrer, W. J. (2013). Evaluating acute
changes in joint range-of-motion using self-myofascial release,
postural alignment exercises, and static stretches. International
Journal of Exercise Science, 6(4), 6.
Rude, S. S., Wenzlaff, R. M., Gibbs, B., Vane, J., & Whitney, T. (2002).
Negative processing biases predict subsequent depressive symp-
toms. Cognition & Emotion, 16(3), 423–440. https:// doi. org/ 10.
1080/ 02699 93014 30005 54
Schleip, R., & Klingler, W. (2019). Active contractile properties of
fascia. Clinical Anatomy, 32(7), 891–895. https:// doi. org/ 10. 1002/
ca. 23391
Schleip, R., & Bartsch, K. (2021). Mechanical assessment. In R.
Schleip & J. Wilke (Eds.), Fascia in sport and movement (pp.
235–244). Hugendubel.
Skinner, B., Moss, R., & Hammond, L. (2020). A systematic review
and meta-analysis of the effects of foam rolling on range of
motion, recovery and markers of athletic performance. Journal
of Bodywork and Movement Therapies, 24(3), 105–122. https://
doi. org/ 10. 1016/j. jbmt. 2020. 01. 007
Stecco, A., Meneghini, A., Stern, R., Stecco, C., & Imamura, M.
(2014). Ultrasonography in myofascial neck pain: Rand-
omized clinical trial for diagnosis and follow-up. Surgical and
Radiologic Anatomy, 36(3), 243–253. https:// doi. org/ 10. 1007/
s00276- 013- 1185-2
Teasdale, J. D., & Barnard, P. J. (1993). Affect, cognition and change:
Remodelling depressive thought. Lawrence Erlbaum Associates.
https:// doi. org/ 10. 1016/ 0005- 7967(94) 90171-6
Terui, N., & Koizumi, K. (1984). Responses of cardiac vagus and
sympathetic nerves to excitation of somatic and visceral nerves.
Journal of the Autonomic Nervous System, 10(2), 73–91. https://
doi. org/ 10. 1016/ 0165- 1838(84) 90047-x
Thömmes, F. (2014). Faszientraining: Physiologische Grundlagen,
Trainingsprinzipien, Anwendungen im Team- und Ausdauersport
sowie Einsatz in Prävention und Rehabilitation [Fascia training:
Physiological basics, training principles, applications in team and
endurance sports as well as use in prevention and rehabilitation].
Stiebner Verlag.
Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and
validation of brief measures of positive and negative affect: The
PANAS scales. Journal of Personality and Social Psychology,
54(6), 1063. https:// doi. org/ 10. 1037// 0022- 3514. 54.6. 1063
Wilke, J., Müller, A. L., Giesche, F., Power, G., Ahmedi, H., & Behm,
D. G. (2020). Acute effects of foam rolling on range of motion
in healthy adults: A systematic review with multilevel meta-anal-
ysis. Sports Medicine, 50(2), 387–402. https:// doi. org/ 10. 1007/
s40279- 019- 01205-7
Wilke, J., Vogt, L., Pfarr, T., & Banzer, W. (2018). Reliability and
validity of a semi-electronic tissue compliance meter to assess
muscle stiffness. Journal of Back and Musculosketal Rehabilita-
tion, 31(5), 991–997. https:// doi. org/ 10. 3233/ BMR- 170871
Wilkes, C., Kydd, R., Sagar, M., & Broadbent, E. (2017). Upright pos-
ture improves affect and fatigue in people with depressive symp-
toms. Journal of Behavior Therapy and Experimental Psychiatry,
54, 143–149. https:// doi. org/ 10. 1016/j. jbtep. 2016. 07. 015
Williams, J. M. G., Barnhofer, T., Crane, C., Hermans, D., Raes, F.,
Watkins, E. R., & Dagleish, T. (2007). Autobiographical memory
specificity and emotional disorders. Psychological Bulletin, 133,
122–148.
Williams, J. M. G., & Broadbent, K. (1986). Distraction by emotional
stimuli: Use of a stroop task with suicide attempters. British Jour-
nal of Clinical Psychology, 25(2), 101–110. https:// doi. org/ 10.
1111/j. 2044- 8260. 1986. tb006 78.x
Wilson, S., Vaidyanathan, U., Miller, M. B., McGue, M., & Iacono,
W. G. (2014). Premorbid risk factors for major depressive disor-
der: Are they associated with early onset and recurrent course?
Development and Psychopathology, 26, 1477. https:// doi. org/ 10.
1017/ S0954 57941 40011 51
Wittchen, H. U., Wunderlich, U., Gruschwitz, S., & Zaudig, M. (1997).
Strukturiertes Klinisches Interview für DSM-IV (SKID). Hogrefe.
Zügel, M., Maganaris, C. N., Wilke, J., Jurkat-Rott, K., Klingler,
W., Wearing, S. C., Findley, T., Barbe, M. F., Steinacker, J. M.,
Vleeming, A., & Bloch, W. (2018). Fascial tissue research in
sports medicine: From molecules to tissue adaptation, injury and
diagnostics: Consensus statement. British Journal of Sports Medi-
cine, 52(23), 1497. https:// doi. org/ 10. 1136/ bjspo rts- 2018- 099308
Publisher's Note Springer Nature remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
1.
2.
3.
4.
5.
6.
Terms and Conditions
Springer Nature journal content, brought to you courtesy of Springer Nature Customer Service Center GmbH (“Springer Nature”).
Springer Nature supports a reasonable amount of sharing of research papers by authors, subscribers and authorised users (“Users”), for small-
scale personal, non-commercial use provided that all copyright, trade and service marks and other proprietary notices are maintained. By
accessing, sharing, receiving or otherwise using the Springer Nature journal content you agree to these terms of use (“Terms”). For these
purposes, Springer Nature considers academic use (by researchers and students) to be non-commercial.
These Terms are supplementary and will apply in addition to any applicable website terms and conditions, a relevant site licence or a personal
subscription. These Terms will prevail over any conflict or ambiguity with regards to the relevant terms, a site licence or a personal subscription
(to the extent of the conflict or ambiguity only). For Creative Commons-licensed articles, the terms of the Creative Commons license used will
apply.
We collect and use personal data to provide access to the Springer Nature journal content. We may also use these personal data internally within
ResearchGate and Springer Nature and as agreed share it, in an anonymised way, for purposes of tracking, analysis and reporting. We will not
otherwise disclose your personal data outside the ResearchGate or the Springer Nature group of companies unless we have your permission as
detailed in the Privacy Policy.
While Users may use the Springer Nature journal content for small scale, personal non-commercial use, it is important to note that Users may
not:
use such content for the purpose of providing other users with access on a regular or large scale basis or as a means to circumvent access
control;
use such content where to do so would be considered a criminal or statutory offence in any jurisdiction, or gives rise to civil liability, or is
otherwise unlawful;
falsely or misleadingly imply or suggest endorsement, approval , sponsorship, or association unless explicitly agreed to by Springer Nature in
writing;
use bots or other automated methods to access the content or redirect messages
override any security feature or exclusionary protocol; or
share the content in order to create substitute for Springer Nature products or services or a systematic database of Springer Nature journal
content.
In line with the restriction against commercial use, Springer Nature does not permit the creation of a product or service that creates revenue,
royalties, rent or income from our content or its inclusion as part of a paid for service or for other commercial gain. Springer Nature journal
content cannot be used for inter-library loans and librarians may not upload Springer Nature journal content on a large scale into their, or any
other, institutional repository.
These terms of use are reviewed regularly and may be amended at any time. Springer Nature is not obligated to publish any information or
content on this website and may remove it or features or functionality at our sole discretion, at any time with or without notice. Springer Nature
may revoke this licence to you at any time and remove access to any copies of the Springer Nature journal content which have been saved.
To the fullest extent permitted by law, Springer Nature makes no warranties, representations or guarantees to Users, either express or implied
with respect to the Springer nature journal content and all parties disclaim and waive any implied warranties or warranties imposed by law,
including merchantability or fitness for any particular purpose.
Please note that these rights do not automatically extend to content, data or other material published by Springer Nature that may be licensed
from third parties.
If you would like to use or distribute our Springer Nature journal content to a wider audience or on a regular basis or in any other manner not
expressly permitted by these Terms, please contact Springer Nature at
onlineservice@springernature.com
ResearchGate has not been able to resolve any citations for this publication.
Article
Full-text available
The network of fasciae is an important part of the musculoskeletal system that is often overlooked. Fascia mobility, especially along shear planes separating muscles, is critical for musculoskeletal function and may play an important, but little studied, role in proprioception. Fasciae, especially the deep epimysium and aponeuroses, have recently been recognized as highly innervated with small diameter fibers that can transmit nociceptive signals, especially in the presence of inflammation. Patients with connective tissue hyper- and hypo-mobility disorders suffer in large number from musculoskeletal pain, and many have abnormal proprioception. The relationships among fascia mobility, proprioception, and myofascial pain are largely unstudied, but a better understanding of these areas could result in improved care for many patients with musculoskeletal pain.
Article
Full-text available
Background Previous laboratory findings suggest deviant gait characteristics in depressed individuals (i.e., reduced walking speed and vertical up-and-down movements, larger lateral swaying movements, slumped posture). However, since most studies to date assessed gait in the laboratory, it is largely an open question whether this association also holds in more naturalistic, everyday life settings. Thus, within the current study we (1) aimed at replicating these results in an everyday life and (2) investigated whether gait characteristics could predict change in current mood. Methods We recruited a sample of patients (n = 35) suffering from major depressive disorder and a sample of age and gender matched non-depressed controls (n = 36). During a 2-day assessment we continuously recorded gait patterns, general movement intensity and repetitively assessed the participant’s current mood. Results We replicated previous laboratory results and found that patients as compared to non-depressed controls showed reduced walking speed and reduced vertical up-and-down movements, as well as a slumped posture during everyday life episodes of walking. Moreover, independent of clinical diagnoses, higher walking speed, and more vertical up-and-down movements significantly predicted more subsequent positive mood, while changes in mood did not predict subsequent changes in gait patterns. Conclusion In sum, our results support expectations that embodiment (i.e., the relationship between bodily expression of emotion and emotion processing itself) in depression is also observable in naturalistic settings, and that depression is bodily manifested in the way people walk. The data further suggest that motor displays affect mood in everyday life.
Article
Full-text available
Background: Foam rolling (FR) has been demonstrated to acutely enhance joint range of motion (ROM). However, data syntheses pooling the effect sizes across studies are scarce. It is, furthermore, unknown which moderators affect the treatment outcome. Objective: To quantify the immediate effects of FR on ROM in healthy adults. Methods: A multilevel meta-analysis with a robust random effects meta-regession model was used to pool the standardized mean differences (SMD) between FR and no-exercise (NEX) as well as FR and stretching. The influence of the possible effect modifiers treatment duration, speed, targeted muscle, testing mode (active/passive ROM), sex, BMI, and study design was examined in a moderator analysis. Results: Twenty-six trials with high methodological quality (PEDro scale) were identified. Compared to NEX, FR had a large positive effect on ROM (SMD: 0.74, 95% CI: 0.42 to 1.01, p=0.0002), but was not superior to stretching (SMD: -0.02, 95% CI: -0.73 to 0.69, p=0.95). Although the few individual study findings suggest that FR with vibration may be more effective than NEX or FR without vibration, the pooled results did not reveal significant differences (SMD: 6.75, 95% CI: -76.4 to 89.9, p=0.49 and SMD: 0.66, 95% CI: -1.5 to 2.8, p=0.32). According to the moderator analysis, most potential effect modifiers (e.g. BMI, speed or duration) do not have a significant impact (p>0.05) but FR may be less effective in men (p<0.05). Conclusion: FR represents an effective method to induce acute improvements in joint ROM. The impact of moderators should be further elucidated in future research.
Article
Full-text available
The term “self-myofascial release” is ubiquitous in the rehabilitation and training literature and purports that the use of foam rollers and other similar devices release myofascial constrictions accumulated from scar tissue, ischaemia-induced muscle spasms and other pathologies. Myofascial tone can be modulated with rollers by changes in thixotropic properties, blood flow, and fascial hydration affecting tissue stiffness. While rollers are commonly used as a treatment for myofascial trigger points, the identification of trigger points is reported to not be highly reliable. Rolling mechanisms underlying their effect on pain suppression are not well elucidated. Other rolling-induced mechanisms to increase range of motion or reduce pain include the activation of cutaneous and fascial mechanoreceptors and interstitial type III and IV afferents that modulate sympathetic/parasympathetic activation as well as the activation of global pain modulatory systems and reflex-induced reductions in muscle and myofascial tone. This review submits that there is insufficient evidence to support that the primary mechanisms underlying rolling and other similar devices are the release of myofascial restrictions and thus the term “self-myofascial release” devices is misleading.
Article
Full-text available
Until relatively recently, humans, similar to other animals, were habitually barefoot. Therefore, the soles of our feet were the only direct contact between the body and the ground when walking. There is indirect evidence that footwear such as sandals and moccasins were first invented within the past 40 thousand years¹, the oldest recovered footwear dates to eight thousand years ago² and inexpensive shoes with cushioned heels were not developed until the Industrial Revolution³. Because calluses—thickened and hardened areas of the epidermal layer of the skin—are the evolutionary solution to protecting the foot, we wondered whether they differ from shoes in maintaining tactile sensitivity during walking, especially at initial foot contact, to improve safety on surfaces that can be slippery, abrasive or otherwise injurious or uncomfortable. Here we show that, as expected, people from Kenya and the United States who frequently walk barefoot have thicker and harder calluses than those who typically use footwear. However, in contrast to shoes, callus thickness does not trade-off protection, measured as hardness and stiffness, for the ability to perceive tactile stimuli at frequencies experienced during walking. Additionally, unlike cushioned footwear, callus thickness does not affect how hard the feet strike the ground during walking, as indicated by impact forces. Along with providing protection and comfort at the cost of tactile sensitivity, cushioned footwear also lowers rates of loading at impact but increases force impulses, with unknown effects on the skeleton that merit future study.
Article
This review and meta-analysis explores the experimental effects of expansive and contractive motor displays on affective, hormonal, and behavioral responses. Experimental studies were located through systematic literature searches. Studies had to manipulate motor displays to either expansive or contractive displays and investigate the effect of the displays on affect, hormones, or overt behavior. Meta-analyses were conducted to determine the pooled, standardized mean differences between the effects of motor displays on affective, hormonal, and behavioral responses. From 5,819 unique records, 73 relevant studies were identified. Robust differences between expansive and contractive displays emerged for affective responses and overt behavioral responses across contexts, type of manipulation, and methods of measurement. The results suggest that the effects are driven by the absence of contractive motor displays (contractive vs. neutral displays: Hedges’s g = 0.45) rather than the presence of expansive displays (expansive vs. neutral displays: g = 0.06). The findings stand as a corrective to previous research, as they indicate that it is the absence of contractive displays rather than the presence of expansive displays that alters affective and behavioral responding. Future research should include neutral control groups, use different methods to assess hormonal change, and investigate these effects in the context of ideographic goals.
Article
Objective To conduct a systematic review with meta-analysis assessing the effects of foam rolling on range of motion, laboratory- and field-based athletic measures, and on recovery. Data sources MEDLINE, PubMed, EMBASE, SPORTDiscus and Science Direct were searched (2005-June 2018). Study selection Experimental and observational studies were included if they examined the effects of foam rolling on measures of athletic performance in field or laboratory settings. Data extraction Two investigators independently assessed methodologic quality using the Physiotherapy Evidence Database (PEDro) Scale. Study characteristics including participant age, sex and physical activity status, foam rolling protocol and pre- and post-intervention mean outcome measures were extracted. Data synthesis A total of 32 studies (mean PEDro = 5.56) were included in the qualitative analysis, which was themed by range of motion, laboratory-based measures, field-based measures and recovery. Thirteen range of motion studies providing 18 datasets were included in the meta-analysis. A large effect (d=0.76, 95% CI 0.55-0.98) was observed, with foam rolling increasing range of motion in all studies in the analysis. Conclusions Foam rolling increases range of motion, appears to be useful for recovery from exercise induced muscle damage, and there appear to be no detrimental effect of foam rolling on other athletic performance measures. However, except range of motion, it cannot be concluded that foam rolling is directly beneficial to athletic performance. Foam rolling does not appear to cause harm and seems to elicit equivalent effects in males and females
Article
Context: Foam rolling (FR) has been developed into a popular intervention and has been established in various sports disciplines. However, its effects on target tissue, including changes in stiffness properties, are still poorly understood. Objective: To investigate muscle-specific and connective tissue-specific responses after FR in recreational athletes with different FR experience. Design: Case series. Setting: Laboratory environment. Participants: The study was conducted with 40 participants, consisting of 20 experienced (EA) and 20 nonexperienced athletes (NEA). Intervention: The FR intervention included 5 trials per 45 seconds of FR of the lateral thigh in the sagittal plane with 20 seconds of rest between each trial. Main outcome measures: Acoustic radiation force impulse elastosonography values, represented as shear wave velocity, were obtained under resting conditions (t0) and several times after FR exercise (0 min [t1], 30 min [t2], 6 h [t3], and 24 h [t4]). Data were assessed in superficial and deep muscle (vastus lateralis muscle; vastus intermedius muscle) and in connective tissue (iliotibial band). Results: In EA, tissue stiffness of the iliotibial band revealed a significant decrease of 13.2% at t1 (P ≤ .01) and 12.1% at t3 (P = .02). In NEA, a 6.2% increase of stiffness was found at t1, which was not significantly different to baseline (P = .16). For both groups, no significant iliotibial band stiffness changes were found at further time points. Also, regarding muscle stiffness, no significant changes were detected at any time for EA and NEA (P > .05). Conclusions: This study demonstrates a significant short-term decrease of connective tissue stiffness in EA, which may have an impact on the biomechanical output of the connective tissue. Thus, FR effects on tissue stiffness depend on the athletes' experience in FR, and existing studies have to be interpreted cautiously in the context of the enrolled participants.
Article
Free access until Oct 29, 2019: https://authors.elsevier.com/a/1ZiJD_5NOMFgt There is increasing evidence that subjects who are exposed to long sitting periods suffer from musculoskeletal discomfort and back pain. The underlying mechanism and effective prevention strategies are still largely unknown. In this study, muscle stiffness of the back was measured in 59 office workers who followed their usual desk work regime for 4.5 h in a sitting posture. The sitting period was either followed by an 8-min roller massage intervention or a controlled standing task. Results showed that muscle stiffness increased significantly after the 4.5 h sitting period. When the sitting period was followed by roller massage, the stiffness values dropped slightly below baseline stiffness. In contrast, the stiffness values remained increased when the sitting period was followed by controlled standing. This study indicates that short-duration tissue manipulation can be an effective active break between prolonged sitting periods to prevent musculoskeletal issues, such as musculoskeletal discomfort and back pain.
Article
Purpose: Foam Rolling (FR), aims to mimic the effects of manual therapy and tackle dysfunctions of the skeletal muscle and connective tissue. It has been shown to induce improvements in flexibility, but the underlying mechanisms are poorly understood. The aim of the present study was to further elucidate the acute, systemic and tissue-specific responses evoked by FR. Methods: In a crossover study, 16 (34±6y, 6f) participants received all of the following interventions in a random order: a) 2x60 seconds of FR at the anterior thigh, b) 2x60 seconds of passive static stretching of the anterior thigh (SS), and c) no intervention (CON). Maximal active and passive knee flexion range of motion (ROM), passive stiffness, sliding of fascial layers, as well as knee flexion angle of first subjectively perceived stretch sensation (FSS) were evaluated before and directly after each intervention. Results: Flexibility increased only after, FR (active (+1.8±1.9%) and passive ROM (+3.4±2.7%), p=.006, respectively) and SS (passive ROM (+3.2±3.5%), p=.002). Angle of FSS was altered following FR (+4.3° (95% CI: 1.4°-7.2°)) and SS (+6.7° (3.7°-9.6°)), while tissue stiffness remained unchanged after any intervention compared to baseline. Movement of the deepest layer (-5.7mm (-11.3mm – -0.1mm)) as well as intrafascial sliding between deep and superficial layer (-4.9mm (-9.mm1 – -0.7mm)) decreased only after FR. Conclusion: FR improved knee flexion ROM without altering passive stiffness, but modified the perception of stretch as well as the mobility of the deep layer of the fascia lata. The mechanisms leading to altered fascial sliding merit further investigation.