Twenty years ago you would hardly have ever seen a foam roller...now they're everywhere. A search on Amazon for "Foam Roller" produces over 36 pages of results! A recent news article claims that Tom Brady uses a "vibrating foam roller" to achieve his results. (Deflating footballs and having Gronk on your team doesn't hurt either. ) But what does the research say about "Foam Rolling" for the release of Trigger Points (TrPs)?
A RCT by Wilke, Vogt, & Banzer (2018) studied the effects of self-foam rolling on Latent TrPs. The authors took 50 subjects with Latent TrPs in their Gastrocnemius muscles. I was going to type Gastrocnemi but it just sounds weird...then again, I said "fishes" the other day so I don't know what I'm talking about. Anyway, the subjects were randomized into 3 groups:
Static compression via Foam Roller for 90 seconds
Dynamic Foam Roller for for 90 seconds
Prone lying with Placebo laser for 90 seconds
Each subject's TrP was assessed pre and post using a pressure algometer. So what were the results? Only one group showed a significant improvement: The Static compression group.
So was this what you would have expected? Probably not...but when you consider the dosage over the TrP, the outcomes seem to make sense. When you have your patient perform a traditional foam rolling with movement, the TrP is actually getting very little stimuli over the actual TrP, while a larger amount of the adjacent area is being stimulated. Perhaps this is effective in the acute stage of an Active TrP, but not for a Latent, or dormant, TrP.
How should this feel?
This study instructed subjects to increase the pressure until it feels like a 6-7 on a NPRS. Another study by Aboodarda et al (2015) also had subjects receive TrP release techniques to a 7/10 on the NPRS. So it looks like that "strong but comfortable" cue might be appropriate.
Are there any other options for foam rolling?
Well, it turns out that you might also want to consider changing the location. A study by Cheatham & Kolber (2018) examined the effects of dynamic Foam Rolling on the Quadriceps muscle group. The results showed the ipsilateral Hamstrings and the contralateral Quadriceps had significantly decreased sensitivity and decreased pain when tested with a pressure algometer. This aligns with the centralized sensitization model and the overall neurphysiological response elicited with Foam Rolling
Foam Rolling over the painful or tight area might not be the best option. An evidence-based approach might be to perform static compression (30-90 seconds) directly over the TrP or to perform Foam Rolling over the antagonist group.
You can learn more about the screening and treatment for Myofascial Trigger Points through Integrative Clinical Concepts, where the author teaches a full day course. Aside from the use of Foam Rollers, you will use how to perform emerging release techniques using Static and Dynamic Cupping and other instruments designed for focused stimulation of the restricted areas.
If you would like to host a course for your staff (either a vestibular, neuro, sports or ortho clinic), please do not hesitate to contact Dr. Siyufy at email@example.com for rates.
ICC: Advancing Clinical Excellence. Become the clinician your patients are looking for.
Aboodarda, S. J., Spence, A. J., & Button, D. C. (2015). Pain pressure threshold of a muscle tender spot increases following local and non-local rolling massage. BMC musculoskeletal disorders, 16(1), 265.
Cheatham, S. W., & Kolber, M. J. (2018). Does Roller Massage With a Foam Roll Change Pressure Pain Threshold of the Ipsilateral Lower Extremity Antagonist and Contralateral Muscle Groups? An Exploratory Study. Journal of sport rehabilitation, 27(2), 165-169.
Weiler, L. (2018). The 1 Workout Tom Brady Swears By Will Make You Rethink Everything. The Cheat Sheet. Retrieved 30 January 2019, from https://www.cheatsheet.com/health-fitness/the-alternative-workout-tom-brady-swears-by-is-insane.html/
Wilke, J., Vogt, L., & Banzer, W. (2018). Immediate effects of self-myofascial release on latent trigger point sensitivity: a randomized, placebo-controlled trial. Biology of Sport, 35(4).