RESEARCH REVIEW: Self-massage – pain for gain?
Foam rolling has become ubiquitous on gym floors across the land – so is all that grimacing in the stretching corner really achieving results?
Title: Is self-massage an effective range of motion strategy? A pilot study
Authors: Dr’s Monteiro and colleagues. (Federal University (Brazil) and Memorial University of Newfoundland (Canada))
Source: Journal of Bodywork & Movement Therapies (2017). 21: 223-226.
Introduction: I have two personalities when I go to the gym to train. First, there’s the somewhat relaxed, social persona that trains after work. Because I’m not rushing, these workouts are generally less stressful and I can add extra sets/reps or cardio time as I like. Then there’s the stressed, antisocial neurotic who has hotfooted it to the gym between patients, so has little to no time for idle chit chat and must move like a gazelle between cardio, stretching and weights, while also ensuring there’s enough time to shower and fly back to the clinic for the next patient. Stressful from woe to go, to say the least. On a positive note, using gaps between patients to get a gym (or swim) training session in is very good time management. On the negative, anti-social behaviour is never well received. Rumour has it they think I have a split personality…
Regardless of my personality on the day, my training regime stipulates stretching and abs immediately following cardio, otherwise these exercises simply will not get done. Sounds easy enough, but over the past year or so, my back-slab training (as I like to refer to it) has become progressively more difficult. Not due to my ageing or lack or abdominal fitness, but because the stretching zone is increasingly inundated with people using foam rollers on every imaginable body part! What the h*ll is going on? Joe and I discussed this phenomenon and he agreed that they may be being over-used, and in many instances may not be reaping results in exchange for the pain and effort. Used for myofascial release, in effect self-massage is believed to break up adhesions on the fibrous connective tissue (i.e. fascia) surrounding muscles. As regards the efficacy of foam rollers, we thought this instalment of Research Review was an ideal place to address one aspect of this topic, gains in flexibility.
We are all aware that joint function and muscle flexibility is important for athletic and physical performance, and to some degree reduces the risk of injury. Therefore, any technique or method that can potentially enhance joint function and flexibility is worthy of investigation, and that is exactly what Dr Monteiro and his colleagues did as they compared the effectiveness of self-massage foam rolling versus self-roller massage on hamstring flexibility.
Methods: As this was a pilot study (a small scale preliminary research project) there were only 10 participants, all of them young (average age 27 years) healthy males, free from musculoskeletal injury or pain. The researchers used a randomised, counter-balanced cross-over design, meaning that all subjects completed all four of the self-massage interventions, which consisted of:
- foam rolling for 60 seconds
- foam rolling for 120 seconds
- roller massage for 60 seconds
- roller massage for 120 seconds.
The foam rolling was completed by the participants sitting with their dominant leg hamstrings on top of the foam roller (from Foam Roller Brazil) and their non-dominant leg relaxed (hip and knee flexed, foot flat on the floor).
Participants then rolled themselves with their full body weight back and forth over the foam roller (from ischium to popliteal tuberosity) in a smooth and continuous manner for either the 60 or 120 seconds. For roller massage (using the GRID® STK Foam Roller by TriggerPoint, pictured) subjects rolled the stick over the same area with as much pressure as possible, again for either 60 or 120 seconds). Hip extension and hip flexion were assessed via a goniometer. Three attempts for hip extension and hip flexion were allowed, with the average of the three trials used for analysis. The data was collected over a nine-day period, with participants avoiding any lower body exercises or intense exercise for the duration of the research process.
Results: The authors reported significant improvement in hip flexion and hip extension. With regard to hip flexion, improvements ranged from +109.8% (foam rolling for 60 seconds) to +130% (foam rolling for 120 seconds). In both instances, additional time (i.e. 120 seconds) resulted in improved flexibility regardless of the stretching technique used.
Hip extension showed similar results, with all four interventions resulting in improved flexibility. This ranged from +232.8% (roller massage for 120 seconds) to +315% (foam roller for 120 seconds). It is important to note that all of the interventions resulted in at least a 2 times improvement in flexibility, with the foam rolling for 120 seconds exceeding a 3 times improvement.
Conclusions: This was the first study to investigate both the mode (foam roller versus roller massage) and dose (60 seconds versus 120 seconds) of techniques to improve hip flexibility. The authors stated there are a number of mechanisms that may be responsible for the increases seen in hip flexibility, but that they are not fully understood. They discussed mechanical (facial adhesions, trigger points, and visco-elastic properties of the tissue) as well as neurophysiological factors (collagen remodeling and elastic).
Pros: It is positive to see evidence supporting the efficacy of both the foam roller and roller massage on hip flexion and extension. This research adds support/credibility to their use in improving hip flexibility. It is also satisfying to see such results being achieved through the use of equipment that is generally available at most fitness training facilities, and that is also mobile and affordable enough for home use.
For reference, according to Family Practice Notebook, normal hip flexion (with the patient supine) is 110 to 120 degrees and normal hip extension (patient on their side) is 10 to 15 degrees.
Cons: It would have been beneficial if the researchers included an additional intervention of, for example, static stretching for comparison. Although we may have been harbouring reservations about the potential overuse of foam rollers, the fact is that the majority of stretching we see is being performed without these devices. Based upon the findings of this study, perhaps they should be using them after all (as should we!)
While there is some contention about this point, care should be taken when performing foam roller type activities to apply high levels of pressure only when rolling in the direction towards the heart. This applies to other similar aggressive massage-type activities as well. The reason being that there are valves in the veins throughout the body, including for example in the legs, but also in other muscles and extremities. These valves allow blood to move back towards the heart without falling due to gravity. There is some claim that rolling with intense pressure against these valves (i.e. away from the heart such as down the arms or legs) could rupture them. While this is not life threatening, it is biomechanically non-optimal to have damaged these valves and could lead to unappealing vein formations (blood pooling, varicose veins). While there is some argument about this, particular care should be taken at areas where there is not significant musculature protecting these veins/valves, such as in the back of the knee, or the inside of the elbow. It should also be noted that the research by Dr’s Monteiro and colleagues took no such precaution. We disagree in general with their claim that use of a massage stick would provide less pressure than a foam roller and due to its small radius and ridged structure would advise even greater caution. This would particularly be the case when used by a personal trainer on a client that is smaller or less muscular than themself. Foam rolling is often conducted without awareness of this potential damage; however, we have seen enough evidence to advise taking this precaution.
A recent review of the literature by DeBruyne and colleagues in the Journal of Sport Rehabilitation (2017, 26:94-100) concluded that a roller massager should be used, although they do agree that the longer duration may provide the greatest benefits to flexibility and potentially injury reduction.
Associate Professor Mike Climstein, PhD FASMF FACSM FAAESS is one of Australia’s leading Accredited Exercise Physiologists and researchers. He is director of chronic disease rehabilitation at Vale Medical Practice.
Joe Walsh, MSc is a sport and exercise scientist. As well as working for Charles Darwin and Bond Universities, he is a director of Fitness Clinic in Five Dock, Sydney. fitnessclinic.com.au