Do Foam Rollers Actually Work? Reviewing the Evidence

Foam rollers have gained substantial popularity in the last decade and are commonly prescribed by health and fitness professionals to improve myofascial mobility, as well as to enhance recovery and performance¹. That being said, the effectiveness of foam rollers has been a hot topic, and consequently, has been heavily researched in the last 5 years. So what is the consensus? Do foam rollers actually work? Before I answer that question, let’s go over the basics!

What Is A Foam Roller?

Foam rollers are a form of self-myofascial release in which the client uses their body weight to apply pressure on a specific soft tissue by rolling on it with the ultimate goal of enhancing myofascial mobility¹. Foam rollers come in a variety of shapes and sizes, varying from 6 inches by 18 inches, to 6 inches by 36 inches. Different foam densities and material allow for varying depths of self-myofascial release. Other forms of self-myofascial release include using massage rollers, which are typically applied against a soft tissue with the upper extremities, as well as tennis balls¹.

Foam roller: 6 inches by 18 inches

Why Are Foam Rollers Used?

Before I dive into why foam rollers are used, I would like to quickly gloss over a term you may or may not be familiar with: “fascia”. Fascia is a connective tissue that encases all muscles, organs, glands, neural pathways and blood vessels². It has both a mechanical and metabolic role². That being said, the main purpose of using a foam roller is to achieve a massage and/or stretch of the underlying soft tissue and fascial connective tissue. Biomechanically speaking, several purposes have been previously identified³:

• To improve fascial remodelling
• To improve elastic recoil of fascial tissues
• To improve myofascial health
• To improve fascial hydration
• To improve prioceptive refinement

Do Foam Rollers Actually Work?

I must admit to being a frequent user of foam rollers, especially for myofascial release of the lower extremities. More specifically, I use them to release my adductors, quadriceps, hamstrings, glutes, iliotibial band and calves. I typically roll each muscle group for 2 minutes with a generally slow cadence, taking at least ten seconds to complete a cycle (a cycle would be rolling from the origin to the insertion of a muscle group and back). Throughout this process, pain and discomfort make me wonder why I chose to foam roll in the first place, but afterward, I feel fantastic! This is when I began to ask myself: is this just a placebo effect or do foam rollers actually work? I’ve had this burning question on my mind for a while now and took it upon myself to explore the scientific literature to see if any recent research had been published regarding this topic. I stumbled upon two systematic reviews, both published in 2015, which reviewed the literature concerning the effective of foam rollers on a variety of different outcomes such as range of motion, delayed onset muscle soreness (DOMS) and muscle performance, among others¹ ⁴. It is important to note that one systematic review included 14 studies whose quality of evidence varied between 6 and 10 on the Pedro Scale (maximum score is 11, which would indicate excellent quality of evidence)¹. The second systematic review included 22 studies, whose quality of evidence varied between 4 and 8 on the Pedro scale (mean score of 5.91). The latter would indicate that the quality of evidence of the scientific literature on foam rolling currently available is quite variable, depending on the study. Now, below I present the results of the two systematic reviews separated by outcome:

RANGE OF MOTION ¹ ⁴

The research suggests that foam rolling may confer short-term benefits for joint range of motion at the hip, knee and ankle without affecting muscle performance. The increases of joint range of motion tend to be limited to approximately 10 minutes⁴. It is important to note that self-myofascial release has been shown to be more effective when combined with static stretching⁵ ⁶. However, there is conflicting evidence with respect to the long-term effects of foam rolling on joint range of motion⁴. Lastly, there is no consensus regarding optimal parameters for foam rolling due to the increased variability of study designs and intervention protocols across research studies. However, interventions typically consisted of 2 to 5 sessions of foam rolling for 30 seconds to 2 minutes.

MUSCLE PERFORMANCE¹ ⁴

The majority of studies included in both systematic reviews demonstrated that self-myofascial release did not impede athletic performance, measured through a wide range of different force and power production outcome measures⁴. More specifically, one systematic review found that a short bout of foam rolling (1 session of 30 seconds) to the lower extremity after a dynamic lower body warm-up did not acutely enhance nor negatively impact muscle performance¹. This could potentially make foam-rolling a viable alternative to static stretching prior to exercise, as it does not seem to acutely affect muscle performance as static stretching does⁷.

DELAYED ONSET MUSCLE SORENESS & RECOVERY¹ ⁴

According to the scientific literature, using a foam roller between 10 to 20 minutes after high intensity exercise has been shown to reduce delayed onset muscle soreness through the reduction of perceived pain levels. It has also been suggested that a patient’s perceived pain level may be further decreased with 20 minutes of continued foam rolling over a three day period¹. The latter has been demonstrated in both trained and untrained populations, as well as through the use of different outcome measures for perceived pain (i.e. pressure pain threshold, self-reported pain using a visual analogue scale and self-reported pain using the BS-11 Numerical Rating Scale)⁴. The latter may make foam rolling an interesting option for recovery enhancement post training or competition for athletes.

ARTERIAL FUNCTION, ENDOTHELIAL FUNCTION AND PARASYMPATHETIC NERVOUS SYSTEM ACTIVITY⁴

Preliminary evidence suggests that self-myofascial release may also lead to improvements in arterial and endothelial function⁸, as well as parasympathetic nervous system activity⁹, which may potentially contribute to recovery enhancement. However, the evidence is limited.

Potential Risks of Foam Rolling

As with any form of exercise prescription, potential risks must be taken into consideration. Foam rolling can exert a high mechanical pressure to the fascial connective tissue, bones, nerve receptors and blood vessels¹⁰. For instance, one study published in 2008 demonstrated that the maximum mean pressure load generated at the lateral thigh with a foam roller was found to be 10 times higher than the highest medical compression category¹¹. Consequently, relative and absolute contraindications for foam rolling should include patients with peripheral neuropathy, diabetes mellitus, osteoporosis, as well as patients with an increased risk of developing a deep vein thrombosis¹⁰.

Conclusion

I would like to take a minute to emphasize several key points when considering the summarized results of both systematic reviews. Firstly, current research concerning foam rolling on flexibility, delayed onset muscle soreness and muscle performance is far from sufficient to generate any form of consensus regarding the effectiveness of foam rolling. The majority of research studies had relatively small sample sizes and there was high variability between study designs (i.e. study protocols, intervention parameters, type of foam roller used, outcome measures etc.). The heterogeneity between studies makes it difficult to establish a firm conclusion regarding the effectiveness of foam rolling, and complicates the development of an optimal training program. Moreover, all research studies only found short-term benefits. The long-term benefits of foam rolling, if any, are unknown¹. Therefore, further research should focus on generating more high-quality randomized controlled trials with more consistent foam rolling intervention protocols and study designs, as well as increased sample sizes. Lastly, further research should examine both the short-term and long-term efficacy of foam rolling.

That being said, the current scientific literature appears to suggest that foam rolling may provide a range of potentially valuable benefits for both athletes and the general population, including increasing flexibility, reducing delayed onset muscle soreness and enhancing recovery without detriment to acute muscle performance. There is very limited evidence to support the effect of foam rolling on arterial and endothelial function, as well as parasympathetic nervous system activity. Moreover, there is conflicting evidence regarding whether or not foam rolling can confer long-term flexibility benefits. Lastly, the physiological effects of foam rollers on soft tissue are still under investigation and no consensus currently exists regarding the optimal program parameters (foam rolling duration, repetitions, frequency, cadence, etc.) for range of motion, recovery, and performance¹ ⁴.

How To Use A Foam Roller?

This is the next logical question for those of you who are new to foam rolling. In this article, I provide 6 easy exercises for the lower extremities, targeting the quadriceps, hamstring, gluteals, iliotibial band, calves and hip adductors.

If you have any questions or concerns regarding how you to use a foam roller, please consult your physiotherapist or any other qualified health professional. If you have any questions or concerns regarding the content of this blog post, you may contact me directly infophysiotherapy10@gmail.com.

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DISCLAIMER: This blog is not meant for diagnostic or treatment purposes. It should not substitute for professional diagnosis and treatment. This blog was not created to provide physiotherapy consultations, nor was it created to obtain new clients. I am adamant on patient education and it is an absolute privilege to share my knowledge. The content of this blog is a resource for information only. This blog was created to inform the general population about different musculoskeletal, neurological and cardiorespiratory conditions in a variety of patient populations. For any further questions or concerns regarding how you to use a foam roller, please consult your physiotherapist or any other qualified health professional.

References

1. Cheatham, S. W., Kolber, M. J., Cain, M., Lee, M. (2015), The Effects of Self-Myofascial Release Using A Foam Or Roller Massager On Joint Range Of Motion, Muscle Recovery, And Performance: A Systematic Review. International Journal of Sports Physical Therapy, 10(6): 827–838.

2. Freiwald, J., Baumgart, C., Kuhnemann, M., & Hoppe, M. W. (2016). Foam Rolling in sport and therapy — Potential benefits and risks Part 1. Sports Orthopaedics and Traumatology, 32(3): 258–266.

3. Schleip, R., & Muller, D. G. (2013). Training principles for fascial connective tissues: scientific foundation and suggested practical applications. J. Bodyw. Mov. Ther, 17(1):103–115.

4. Beardsley, C. & Skarabot, J. (2015). Effects of self-myofascial release: A systematic review. Journal of Bodywork & Movement Therapies, 19(4): 747–758.

5. Mohr, A. R., Long, B. C., Goad, C. L. (2014). Effect of foam rolling and static stretching on passive hip-flexion range of motion. J Sport Rehabil, 23(4): 296–299.

6. Škarabot J., Beardsley, C., Štirn, I. (2015). Comparing the effects of self-myofascial release with static stretching on ankle range-of-motion in adolescent athletes. Int J Sports Phys Ther, 10(2): 203–212.

7. Kay, A. D., & Blazevich, A. J. (2012). Effect of acute static stretch on maximal muscle performance: a systematic review. Med. Sci. Sports Exerc, 44(1):154–164.

8. Okamoto, T., Masuhara, M., & Ikuta, K. (2014). Acute effects of self-myofascial release using a foam roller on arterial function. J. Strength Cond. Res, 28(1) 69–73.

9. Kim, K., Park, S., Goo, B.O., Choi, S.C., 2014. Effect of self-myofascial release on reduction of physical stress: a pilot study. J. Phys. Ther. Sci. 26(11): 1779–1781.

10. Freiwald, J., Baumgart, C., Kuhnemann, M., & Hoppe, M. W. (2016). Foam Rolling in sport and therapy — Potential benefits and risks Part 2. Sports Orthopaedics and Traumatology, 32(3): 267–275.

11. Curran, P. F., Fiore, R. D., Crisco, J. J. (2008). A comparison of the pressure exerted on soft tissue by 2 myofascial rollers. J. Sport Rehabil, 17(4): 432–442.