Quick Summary: Here is what you need to know
1: Foam rolling can increase range of motion as effectively as stretching prior to training with no performance decrements. However, the effects are short lived.
2: The density of the foam roller has a significant impact on outcomes. PVC based foam rollers will have greater benefit over foam based rollers.
3: Some evidence suggests that foam rolling coupled with dynamic stretching may positively effect performance. However literature to this effect is limited.
Self-Myofascial Release (SMR), first introduced by Barnes (1997) has gained popularity over the past few years as part of the warm up protocol and recovery strategies for athletes. Foam rolling, the most common type of manual release therapy, involves the athlete applying their body weight to a dense cylindrical tube and rolling across the fibres of individual muscles (Schleip, Niederer, Niemeyer, Wilke, & Banzer, 2018).
The aim of this article series is to critically appraise the literature in order to assess the benefits, if any, of foam rolling for athletes, and to make suggestions for the most effective methods and timings for foam rolling. Today, we will be looking at the use of foam rolling for increasing range of motion (ROM) as part of the warm up. Whilst the literature is non-conclusive, there is evidence to suggest that foam rolling has a positive impact on flexibility via ROM(Škarabot, Beardsley, & Štirn, 2015), however there is no universally accepted protocol for the time, sets, reps or equipment required for the greatest effect.
Foam rolling and range of motion
The mechanisms of foam rolling are not fully understood, however two potential theories for improved flexibility are offered in the literature. The first is that the proprioceptors, Golgi tendon organs sense a build-up in tension and inhibit the muscle in response (Schleip, 2003). The other is that adhesions and scar tissue are broken down, improving the quality and elasticity of muscle by way of fluid movement across the facia during rolling (Schleip & Müller, 2013).
10 studies were found which have reviewed the effects of foam rolling on range of motion. Acute ROM of the hamstrings was considered in 5 studies, 4 finding a significant positive effect (Junker & Stöggl, 2015; Mohr, Long, & Goad, 2014; Škarabot et al., 2015; Smith, Pridgeon, & Hall, 2018; Su, Chang, Wu, Guo, & Chu, 2011) with no effect in 1 study (Couture, Karlik, Glass, & Hatzel, 2015). The sit and reach test was used to measure ROM in 3 study designs finding a positive result (Junker & Stöggl, 2015; Smith et al., 2018; Su et al., 2011). The sit and reach test is not considered to be a hamstring specific test, accounting for lumbar flexibility and the effective movement of multiple joints (Couture et al., 2015). The test also has limited validity in participants with poor hamstrings flexibility (Mayorga-Vega, Merino-Marban, & Viciana, 2014). Madoni et al., (2018) & Mohr et al., (2014), both made use of passive hip flexion measuring with a goniometer to capture positive increases of 6.8% and 2.5% respectively following foam rolling. A notable difference between these study designs are the length of time foam rolling took place. 3 sets of 30 seconds yielding 2.5% improvement whilst 3 x 1 minute allowed a 6.8% increase. Couture et al., (2015) also measured passive hip flexion and found no change following 4 x 30 seconds of rolling. Of note, the equipment used for SMR (EPE/EVA type foam roller) is of low firmness (See figure 1). The effect of this on results is considered in more detail later.
ROM of the quadriceps has been improved following acute foam rolling in 2 studies (MacDonald et al., 2013; Su et al., 2011) by 12.7% and 9.37% respectively. Both studies used PVC rollers within the study with the variance possibly being accounted for by the time variations of rolling. 2 x 1 minute producing the best results vs 3 x 30 seconds. Test results were recorded using a modified Thompson test and kneeling lunge test which relied on the subject’s expression of ‘discomfort’ which may be considered subjective.
Finally, a difference in significant results were seen foam rolling the gastrocnemius in 2 studies, with a positive increase of 3.5% following 3 x 60 seconds, taken 30 minutes post rolling (Aune et al., 2019) and a positive but non-significant increase of 2.8% following 3 x 30 second rolling (Škarabot et al., 2015). Both studies used the weight bearing lunge test for ankle ROM measurements (image 1). Whilst tight gastrocnemius muscles can lead to reduced range at the ankle, foot structure plays a significant role in ankle ROM which would not be fixed by flexibility improvement(Kaufman, Brodine, Shaffer, Johnson, & Cullison, 1999).
Overall, there is clear evidence that foam rolling does improve ROM, however, owing to the variations in results and methods, the next section will make considerations for best methods for the greatest outcomes.
The effect of foam roller firmness and pressure exerted. Curran, Fiore, & Crisco (2016) studied the effect of a foam-based roller and a hard, PVC roller on pressure exerted. They discovered a significant difference in the two types with the firmer roller exerting more pressure which was theorised to facilitate greater myofascial release. Of the current studies, this pattern does seem to be replicated. The largest improvements were noted when using PVC based rollers such as the GRID (MacDonald et al., 2013; Su et al., 2011) whilst negative or limited results did seem to correlate with low roller firmness (Aune et al., 2019; Couture et al., 2015; Madoni et al., 2018). Low density rollers are likely to increase the surface area of roller contact and reduce the applied force. A further example of this is a study on NCAA football players using the foam roller hybrid, rumble roller. This type of roller was designed for deeper muscle penetration over smooth rollers. A study on NCAA football players reported a 15.6% increase in hip flexion following rumble rolling for 1 minute (Behara & Jacobson, 2017). Whilst one study found improved but not significant ROM whilst using a GRID roller (Image 2), the author noted that the participants had been using solid PVC pipes for 6 months prior. The use of a lower pressure roller could possibly account for these effects.
The effect of the warm up
The warm up is considered as any exercise which increases heart rate and body temperature prior to the main session (Bishop, 2003). A typical warm up used in the studies reviewed was 5 minutes of cycling. 3 studies tested the use of foam rolling without a noted warmup (Madoni et al., 2018; Mohr et al., 2014; Škarabot et al., 2015). Whilst positive outcomes were revealed, these studies demonstrated either non-significant or lower than typical percentage improvements in ROM (2.5, 2.6 and 6.8%). Morales-Artacho, Lacourpaille, & Guilhem (2017) assessed the effect of a cycling warm up vs foam rolling on hamstring stiffness, and indicated the warm up plays an important role in increasing muscle ROM. Whilst studies using the standard warm up have failed to show ROM improvement (Couture et al., 2015), there is evidence to suggest it forms an important part of an effective foam rolling strategy.
Effect of sets/reps on ROM improvement
As seen in figure 2, ROM outcomes were varied based on the time spent rolling. However, 2 x 1 minute did have the greatest effective outcome in 2 studies. Time has been suggested to play a key role in ROM outcomes in studies using fixed roller massagers (Bradbury-Squires et al., 2015; Sullivan, Silvey, Button, & Behm, 2013), with greater time of application related to ROM. Specifically, Bradbury-Squires et al. (2015) investigated the effect of time on quadriceps ROM improvement after fixed rolling and discovered a linear relationship between time applied (20 vs 60 seconds) and percentage improvement (10 vs 16%). Whilst more study is needed, possibly ensuring the correct use of warm up and rolling equipment, sets of 1 minute may have the most benefit to ROM.
Foam rolling vs traditional flexibility
Dynamic and static stretches are often utilised in the warm up to improve mobility and ROM (Riebe et al., 2015). ROM improvements via foam rolling outperformed static stretching in one case (Su et al., 2011), whilst was not significantly worse on ankle ROM (Škarabot et al., 2015) and significantly worse on hip flexion (Mohr et al., 2014). However, all three studies found a large effect when combining the two methods over all other conditions. Foam rolling significantly improved ROM over dynamic stretching also, in the study by Su et al. (2011), whilst no significant differences have been found in others (Behara & Jacobson, 2017; Smith et al., 2018; Somers, Aune, Horten, & Kim, 2019).
Use of foam rolling within the warm up
A criticism of static stretching in previous literature (Franco, Signorelli, Trajano, Costa, & de Oliveira, 2012) has been a potential reduction in performance capabilities and strength. Much of the literature on foam rolling and ROM, has also assessed the effect on performance outcomes. Both discovered no change in maximal voluntary contraction or EMG following foam rolling, whilst Su et al. (2011) also found no reduction in knee flexion peak torque (PT) but did record an increase in knee extension PT. Aune et al. (2019) noted an insignificant reduction in reactive strength index in 2 of 20 participants. Behara & Jacobson (2017) found no negative effect of foam rolling on vertical jump power or velocity, whilst Smith et al. (2018) also found no negative effect of foam rolling alone on vertical jump height with a performance increase when combining foam rolling with dynamic stretching vs either variable alone.
Foam rolling does seem to have a positive effect on flexibility performance without any detrimental effects on performance. There is also indication that performance may be improved as a result of foam rolling or in combination with dynamic based movements. More research is required to discover the full potential of this relationship. The positive effects of foam rolling do seem sensitive to sets and reps, equipment and the use of a warm up. Foam rolling may be a useful tool to be used as part of the warm up, ideally following pulse raising exercise, using PVC or firm foam rolling equipment, allowing at least 2 sets of 1 minute per muscle and ensuring as much body weight on the equipment as possible. Using foam rolling before dynamic stretching or activation may be of further benefit.
Aune, A. A. G., Bishop, C., Turner, A. N., Papadopoulos, K., Budd, S., Richardson, M., & Maloney, S. J. (2019). Acute and chronic effects of foam rolling vs eccentric exercise on ROM and force output of the plantar flexors. Journal of Sports Sciences. https://doi.org/10.1080/02640414.2018.1486000Barnes, M. F. (1997). The basic science of myofascial release: morphologic change in connective tissue. Journal of Bodywork and Movement Therapies. https://doi.org/10.1016/S1360-8592(97)80051-4Behara, B., & Jacobson, B. H. (2017). Acute Effects of Deep Tissue Foam Rolling and Dynamic Stretching on Muscular Strength, Power, and Flexibility in Division i Linemen. Journal of Strength and Conditioning Research. https://doi.org/10.1519/JSC.0000000000001051Bishop, D. (2003). Warm up II: Performance changes following active warm up and how to structure the warm up. Sports Medicine. https://doi.org/10.2165/00007256-200333070-00002Bradbury-Squires, D. J., Noftall, J. C., Sullivan, K. M., Behm, D. G., Power, K. E., & Button, D. C. (2015). Roller-massager application to the quadriceps and knee-joint range of motion and neuromuscular efficiency during a lunge. Journal of Athletic Training. https://doi.org/10.4085/1062-6050-49.5.03Couture, G., Karlik, D., Glass, S. C., & Hatzel, B. M. (2015). The Effect of Foam Rolling Duration on Hamstring Range of Motion. The Open Orthopaedics Journal. https://doi.org/10.2174/1874325001509010450Curran, P. F., Fiore, R. D., & Crisco, J. J. (2016). A Comparison of the Pressure Exerted on Soft Tissue by 2 Myofascial Rollers. Journal of Sport Rehabilitation. https://doi.org/10.1123/jsr.17.4.432Franco, B. L., Signorelli, G. R., Trajano, G. S., Costa, P. B., & de Oliveira, C. G. (2012). Acute effects of three different stretching protocols on the Wingate test performance. Journal of Sports Science and Medicine.Junker, D. H., & Stöggl, T. L. (2015). The Foam Roll as a Tool to Improve Hamstring Flexibility. Journal of Strength and Conditioning Research. https://doi.org/10.1519/JSC.0000000000001007Kaufman, K. R., Brodine, S. K., Shaffer, R. A., Johnson, C. W., & Cullison, T. R. (1999). The effect of foot structure and range of motion on musculoskeletal overuse injuries. American Journal of Sports Medicine. https://doi.org/10.1177/03635465990270050701MacDonald, G. Z., Penney, M. D. H., Mullaley, M. E., Cuconato, A. L., Drake, C. D. J., 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. https://doi.org/10.1519/JSC.0b013e31825c2bc1Madoni, S. N., Costa, P. B., Coburn, J. W., & Galpin, A. J. (2018). Effects of Foam Rolling on Range of Motion, Peak Torque, Muscle Activation, and the Hamstrings-to-Quadriceps Strength Ratios. Journal of Strength and Conditioning Research. https://doi.org/10.1519/JSC.0000000000002468Mayorga-Vega, D., Merino-Marban, R., & Viciana, J. (2014). Criterion-related validity of sit-and-reach tests for estimating hamstring and lumbar extensibility: A meta-analysis. Journal of Sports Science and Medicine.Mohr, A. R., Long, B. C., & Goad, C. L. (2014). Effect of Foam Rolling and Static Stretching on Passive Hip-Flexion Range of Motion. Journal of Sport Rehabilitation. https://doi.org/10.1123/jsr.2013-0025Morales-Artacho, A. J., Lacourpaille, L., & Guilhem, G. (2017). Effects of warm-up on hamstring muscles stiffness: Cycling vs foam rolling. Scandinavian Journal of Medicine and Science in Sports. https://doi.org/10.1111/sms.12832Riebe, D., Franklin, B. A., Thompson, P. D., Garber, C. E., Whitfield, G. P., Magal, M., & Pescatello, L. S. (2015). Updating ACSM’s recommendations for exercise preparticipation health screening. Medicine and Science in Sports and Exercise. https://doi.org/10.1249/MSS.0000000000000664Schleip, R. (2003). Fascial plasticity – a new neurobiological explanation: Part 1. Journal of Bodywork and Movement Therapies. https://doi.org/10.1016/s1360-8592(02)00067-0Schleip, R., & Müller, D. G. (2013). Training principles for fascial connective tissues: Scientific foundation and suggested practical applications. Journal of Bodywork and Movement Therapies. https://doi.org/10.1016/j.jbmt.2012.06.007Schleip, R., Niederer, D., Niemeyer, P., Wilke, J., & Banzer, W. (2018). Influence of Foam Rolling Velocity on Knee Range of Motion and Tissue Stiffness: A Randomized, Controlled Crossover Trial. Journal of Sport Rehabilitation. https://doi.org/10.1123/jsr.2018-0041Škarabot, J., Beardsley, C., & Štirn, I. (2015). Comparing the effects of self-myofascial release with static stretching on ankle range-of-motion in adolescent athletes.International Journal of Sports Physical Therapy. https://doi.org/10.1146/annurev-matsci-070616-124109Smith, J. C., Pridgeon, B., & Hall, M. C. (2018). Acute Effect of Foam Rolling and Dynamic Stretching on Flexibility and Jump Height. Journal of Strength and Conditioning Research. https://doi.org/10.1519/JSC.0000000000002321Somers, K., Aune, D., Horten, A., & Kim, J. (2019). Acute effects of Gastrocnemius / Soleus Self-Myofacial Release vs Dynamic Stretching on Closed Chain Dorsiflexion. Journal of Sport Rehabilitation, 0(0), 1–28.Su, H., Chang, N.-J., Wu, W.-L., Guo, L.-Y., & Chu, I.-H. (2011). Acute Effects of Foam Rolling, Static Stretching, and Dynamic Stretching During Warm-Ups on Muscular Flexibility and Strength in Young Adults. International Journal of Sport Nutrition and Exercise Metabolism. https://doi.org/10.1123/ijspp.2015-0012Sullivan, K., Silvey, D., Button, D., & Behm, D. (2013). Roller‐Massager Application To the Hamstrings Increases Sit‐and‐Reach Range of Motion Within Five To Ten Seconds without Performance Impairments. International Journal of Sports Physical Therapy.