Foam Roller Myofascial Release (SMFR)

Foam Roller Massage - An MSK Therapy perspective

Understanding human anatomy, physiology, and the underpinning principles of the techniques foam rollers look to replicate is crucial for safe use. A foam roller is just one form of the myofascial release tool. Tools are designed for a specific purpose, even if it is possible to use them in different ways (technique). Using the wrong tool for the job at hand or the wrong way can produce poor results. The author of this article understands these factors. He is a qualified Musculoskeletal professional and advanced clinical sports and remedial massage therapist with over 16 years of experience.

A large proportion of the active and even inactive population have no doubt either come across or used a foam roller as a form of self-massage. Results can often vary greatly between individuals, and symptoms can be made worse in some cases. Such variability in results typically relates to technique and using the wrong tool for the desired outcome. It is equally useful to know a little about anatomy, physiology, and types of injury. It is always advisable to seek professional advice before embarking on any form of treatment, self or otherwise. In addition, there are contraindications to using the massage techniques foam rollers look to replicate. For example, it may not be safe or advisable to use a roller at all or only on specific body areas. Equally, some people with Chronic Pain may find the technique beneficial. In contrast, others may find symptoms are made worse, (see the article on Chronic Pain for further details on aspects of such conditions).

Origins of Foam Rolling for Myofascial release (MFR)

An American Physical Therapist, Sean Gallagher is commonly referred to as the originator of the technique, as used for Self Myofascial release (SMFR). The use of foam rollers for self-massage appears to date back to the early to mid-1980s. The SMFR industry has grown hugely in the last 5-10 years, and there are all kinds of videos and books of people happily (smiling) while foam rolling various parts of their body. There are many health and fitness products advertised with people happily smiling while using them. For those of you that have used the products/tools, it is undoubtedly not the most comfortable experience, and at worst, a gritted teeth. There is also an ever-increasing number of product designs, shapes and sizes, and a vast industry developed relatively quickly.

A good soft tissue therapist (STT) has many advantages over a person attempting self-massage. To get the best out of self-massage foam rolling, one needs to understand these differences and try to account for them. Rollers can be a valuable maintenance tool when used correctly, though there are limits on what they can achieve. A foam roller cannot replace the knowledge and skill of a good therapist but is still useful. Foam rolling is best suited to treating larger (longer) muscles in the body, such as the legs. It is hard and frequently impossible to use the products on smaller (shorter) muscles. Such muscles tend to be inaccessible to rollers due to the muscles location within the body. Equally, the design of the rollers and how one uses them (technique) creates further limits. Shorter muscles within the body can and frequently affect longer muscles, becoming the symptom and not the reason for symptoms. This article touches on aspects of the "Kinetic Chain" and which has relevance for self-treatment. Equally, myofascial pain and Myofascial Trigger Points MTrP's, also have relevance to any type of MFR including SMFR.

The relevance of Pressure, Tissue reaction and Pain

When muscles are relaxed, one can treat them more effectively, and a good soft tissue therapist will use differing pressure and techniques according to tissue tension. Applying too much force or the wrong type of therapy tends to be painful, making tissues tense up and creating more pain. People in pain often adopt a rapid and shallow breathing pattern, leading to further tissue tension. In essence, the body's "fight or flight or (freeze)" response becomes initiated, and the sympathetic nervous fully activates. Any perceived form of "stressor" or "threat" to the body can initiate the "Stress Response", and pain is just one of many possible stressors (see the related Human Stress Response articles).

Trying to bash the tissues into submission then tends to prove hugely unpleasant for the patient and can even lead to bruising. It may then feel great afterwards, once the pain infliction has ended and the bodies natural endorphins have been released. That said, soft tissue therapists should know how to work with various tissues and get excellent results without all the pain. A soft tissue therapist has distinct advantages, including knowledge, training in multiple methods, the patient is lying down and can relax. The comfortable position means that the muscles are not under the additional load of holding the patient's body weight. Equally, physically applying techniques creates changes in tissue tension, affecting results and levels of discomfort. Such tensional changes occur in the therapist's body while using techniques, rather than the relaxed patient's.

In the case of foam rolling, one frequently has to get into positions that result in the tissues one is treating becoming tense or placed under load. As mentioned, massaging muscles under pressure can be painful, even when using SMFR techniques. Ideally, one wants to try and have a minimal load on the soft tissues under treatment. One may have to find some creative self-massage positions to relax tissues under treatment.

A Foam Rolling and Sports Massage Therapy

Massage therapy education can vary hugely, not just in duration and the types of massage techniques learned. There are also varying levels of knowledge surrounding anatomy, physiology and other medical knowledge. Base level massage training and sports massage therapists learn four primary techniques. Foam rollers aim to replicate one of these techniques, petrissage, including squeezing and stripping. However, a massage therapist knows additional techniques and can use all of these methods more precisely than is possible with foam rolling tools. That said, self-massage with such SMFR tools should produce some of the results that a massage therapist can with Petrissage techniques. Such benefits may include reduced muscle tension, stimulation of the parasympathetic nervous system (increasing venous and lymphatic return and tissue permeability), all of which can aid in the removal of waste products. Sadly, many massage therapists confuse stimulating the nervous system with releasing toxins from muscles. There is a distinct lack of evidence for massage releasing or removing toxins from within tissues, among other myths.

Relevance of Anatomy and Physiology knowledge

Why NOT to Foam Roll the ITB

The author has frequently seen people using foam rollers to treat tight Iliotibial Band - ITB. Unfortunately, in many respects, ITB's are a structural component, much like tendons and ligaments. Usually, one would not want to stretch structural elements as they provide stability to other body parts within the kinetic chain. Too much stretching can lead to laxity in the tissues, impacting how other tissues work. Also, a tight ITB is a symptom, so stretching is a pointless exercise and a highly uncomfortable process. Although using a foam roller on the ITB may produce some tension relief, it will not fix the problem. The symptoms of the ITB tension will be somewhere else in the kinetic chain and will likely impact multiple components in the chain. The ITB then usually becomes tight due to other dysfunctional tissues, which creates additional load on other soft tissues and further dysfunction.

In summary

• Avoid applying too much pressure.
• Avoid massaging muscles which are under load.
• Massage towards the heart.
• Avoid massaging the symptom (tight ITB) and address the reason for symptoms.
• Avoid overworking tissues.
• Avoid using a foam roller to treat inflamed tissues or tissues in spasm (see Trigger point therapy (TPT) article).
• Avoid using a foam roller if you meet any of the contraindications for Massage, Sports Massage or Remedial Massage.

If in doubt seek advice from a suitably qualified therapist or primary care practitioner. There is also a more recent article about treating the Quadricep muscles with self-myofascial release (SMFR) using a Massage Stick Roller here.